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Wille L, Caporale-Berkowitz N, Woznicki N, Carmona Y, Parent MC. Cisgender Sexual Minority Women's Interest in Telemental Health Services: A Latent Class Analysis. Telemed J E Health 2024. [PMID: 39185555 DOI: 10.1089/tmj.2024.0230] [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: 08/27/2024] Open
Abstract
Introduction: Telemental health is increasingly recognized for its potential to overcome barriers like cost and stigma, particularly for marginalized groups. Sexual minority women in particular may benefit from increased access to telemental health services, due to the unique health disparities faced by this population. However, very little research thus far has assessed the telemental health preferences of this group. Methods: The present study surveyed 1,092 cisgender sexual minority women regarding their demographic information, mental health, and telemental health preferences, using the Prolific.co research platform. Latent class analysis was conducted to identify subgroups within the sample based on their responses to the survey. Results: Results revealed diverse attitudes toward telemental health, with some that prefer in-person sessions, whereas others show a strong interest in virtual options. Latent class analysis identified five groups, termed the Neutral, Ambivalent, Inclined, Inclined Related to Travel, and Averse groups. There were statistically significant differences between groups on measures of rurality, socioeconomic status, previous therapy experience, and symptoms of depression and anxiety. Overall, sexual minority women demonstrated interest in telemental health, especially individuals with mobility challenges and those living in rural areas. Conclusion: This study underscores the importance of tailoring mental health services to diverse needs and suggests that telemental health could be a valuable tool in addressing health disparities among sexual minority women. Importantly, these data were conducted prior to the COVID-19 pandemic. Further research could examine how sexual minority women's attitudes toward telemental health have shifted since the COVID-19 pandemic and how telemental health services could be tailored for marginalized subgroups.
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Affiliation(s)
- Lexie Wille
- Counseling Psychology Program, Department of Educational Psychology, The University of Texas at Austin, Austin, Texas, USA
| | | | - Nate Woznicki
- Human Development, Culture, & Learning Sciences, Department of Educational Psychology, The University of Texas at Austin, Austin, Texas, USA
| | - Yaritza Carmona
- Counseling Psychology Program, Department of Educational Psychology, The University of Texas at Austin, Austin, Texas, USA
| | - Mike C Parent
- Counseling Psychology Program, Department of Educational Psychology, The University of Texas at Austin, Austin, Texas, USA
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Döpfner M, von Wirth E, Adam J, Goldbeck C, Schulze-Husmann K, Herpertz-Dahlmann B, Simons M, Heuer F, Schwendowius J, Poustka L, Wegner C, Bender S. Feasibility, satisfaction, and goal attainment in routine telemedicine consultation in child and adolescent psychiatry and psychotherapy. Eur Child Adolesc Psychiatry 2024:10.1007/s00787-024-02477-9. [PMID: 38836920 DOI: 10.1007/s00787-024-02477-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 05/18/2024] [Indexed: 06/06/2024]
Abstract
Telehealth services were rapidly adopted during the COVID-19 pandemic, but evidence regarding the effectiveness and feasibility of telehealth services in child and adolescent mental healthcare is sparse. This study aims to investigate feasibility, satisfaction, and goal attainment in video-delivered consultations in routine care child and adolescent psychiatry and psychotherapy. A total of 1046 patients from four university child and adolescent outpatient psychiatric clinics and one university outpatient unit for child and adolescent psychotherapy were screened for study participation. We examined a) the percentage of patients considered eligible for video-delivered consultation, b) clinicians', parents' and patients' satisfaction with video consultation, c) clinicians' ratings of goal attainment in video consultation, and d) factors associated with satisfaction and goal attainment. 59% of the screening sample (n = 621) fulfilled eligibility criteria and were considered eligible for video consultation. A total of 267 patients consented to participate in the study and received a video consultation. Clinicians reported high levels of satisfaction with video consultation and high levels of goal attainment in video consultations, especially for patients scheduled for initial patient assessments. Parents and patients were also highly satisfied with the video consultations, especially if patients had less severe emotional and behavioral problems. The present findings suggest that video consultations are a feasible and well-accepted alternative to in-person consultations in child and adolescent mental health care, especially for children with less severe symptoms and for children in early phases of assessment and treatment. Limitations include the lack of a control group. The study was registered at the German Clinical Trials Registry (DRKS00023525).
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Affiliation(s)
- 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.
| | - Elena von Wirth
- Department of Clinical Child and Adolescent Psychology and Psychotherapy, University of Trier, Trier, Germany
| | - Julia Adam
- School of Child and Adolescent Cognitive Behavior Therapy (AKiP), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Carolina Goldbeck
- School of Child and Adolescent Cognitive Behavior Therapy (AKiP), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Karen Schulze-Husmann
- School of Child and Adolescent Cognitive Behavior Therapy (AKiP), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Beate Herpertz-Dahlmann
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, RWTH Aachen University, Aachen, Germany
| | - Michael Simons
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, RWTH Aachen University, Aachen, Germany
| | - Fabiola Heuer
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Jan Schwendowius
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Luise Poustka
- Department of Child and Adolescent Psychiatry, Center for Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Christiane Wegner
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Medical Centre Göttingen, Göttingen, Germany
| | - Stephan Bender
- 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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3
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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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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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Engelhardt CL, Meier M, Keller S, Laireiter AR. Positive psychotherapy and cognitive behavioral therapy in anxiety patients - A study protocol for a randomized control trial in an online group setting. PLoS One 2024; 19:e0299803. [PMID: 38625877 PMCID: PMC11020599 DOI: 10.1371/journal.pone.0299803] [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] [Received: 06/21/2023] [Accepted: 01/16/2024] [Indexed: 04/18/2024] Open
Abstract
BACKGROUND Anxiety disorders are common and debilitating which is why treatment is so important. According to the guidelines, Cognitive Behavioral Therapy (CBT) has the highest level of effectiveness among psychotherapeutic treatments and is the recommended procedure. However, not everyone responds well or at all to CBT which makes a wider range of therapy options valuable. Positive Psychotherapy (PPT) comes to mind as an alternative with its strength-based approach focusing on enhancing well-being and life satisfaction. Additionally, it has not yet been extensively studied how the processes that occur during treatment sessions and between treatment sessions effect treatment outcome. Thus, to lessen the lack of evidence regarding the efficacy of PPT as an anxiety treatment the planned study examines and compares the effectiveness of CBT and PPT as well as the effect of intrasession and intersession processes of the two therapy approaches. METHOD The study is in the planning stage and consists of an efficacy and a process study. The efficacy study is a randomized controlled comparative study of patients with anxiety disorders (generalized anxiety disorder and/or panic disorder with or without agoraphobia) with two active treatment conditions (PPT and CBT) and a control group (CG; positive psychotherapy with minimal therapeutic supervision) in an online group setting. There are three measurement time points: before treatment begins (T0), at the end of the ten-week treatment (T1), and a follow-up after three months (T2). The aim of the study is to evaluate the efficacy of PPT and CBT in the treatment of anxiety disorders, and to compare the efficacy of online-based PPT with minimal therapeutic supervision and online-based PPT with intensive therapeutic supervision in the treatment of anxiety disorders. The process study will be used to evaluate both the intrasession processes and the intersession processes of the therapy in the two intervention groups. In addition, the process variables that predict the success of the therapy and the extent to which PPT and CBT differ in the therapy processes will be tested. The study is registered at the German Clinical Trial Register (№ DRKS00027521). DISCUSSION To our knowledge, this is the first randomized controlled comparative study to examine the effectiveness of CBT and PPT for anxiety disorders in an online group setting.
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Affiliation(s)
| | - Marina Meier
- Department of Psychology, Paris Lodron University of Salzburg, Salzburg, Austria
| | - Sabrina Keller
- Department of Psychology, Paris Lodron University of Salzburg, Salzburg, Austria
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Mulungu C, Mindu T, Mulungu K. Effectiveness of online counselling during COVID-19 in Zambia. A client and therapists perspective. BMC Psychol 2024; 12:132. [PMID: 38454526 PMCID: PMC10921579 DOI: 10.1186/s40359-024-01614-y] [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: 08/28/2023] [Accepted: 02/20/2024] [Indexed: 03/09/2024] Open
Abstract
Population-based studies have shown that a growing number of counsellors have been providing counselling via the Internet. There are mixed findings regarding the effectiveness of online counselling compared to traditional face-to-face counselling and other modalities. During the COVID-19 outbreak, online counselling services were advanced as the only safe means of attending to mental health conditions, especially during the lockdowns. However, the effectiveness of online counselling remains unclear, especially in developing countries with low digital literacy and poor Internet connectivity. This study's main purpose was to investigate and determine the clients' and therapists' perspectives on the effectiveness of online counselling during the pandemic based on the level of preparedness, mode of delivery, and challenges faced. The study used mixed methods employing a parallel convergent design and collected data from 284 participants (44 therapists and 240 counselling clients). The study found that therapists were not prepared to offer online counselling services, but were compelled by high demands for counselling services from clients during the pandemic. Both clients and therapists cited the cost of data bundles to connect to the Internet as a major barrier. Furthermore, both clients and therapists indicated that the most effective platform was video conferencing. The findings also show that therapists observed slowed progress in the client's recovery due to clients missing sessions. Logistic regression results on factors associated with preparedness and positive perception of online counselling showed that older therapists and lay counsellors were less likely to be prepared and evaluate sessions as less effective, respectively. Living in Lusaka (the capital) was associated with higher odds of perceiving online counselling as effective. Client results showed that older clients had lower odds of being prepared, and the counsellor being prepared increased the odds of the online counselling being perceived as effective. The researchers conclude that online counselling, in the context of a developing country, is ineffective because of the cost of Internet connection, the multiplicity of information communication technology (ICT) channels, low digital literacy, and lack of knowledge or experience using these platforms.
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Affiliation(s)
- Choongo Mulungu
- University of Lusaka/ Ministry of Health - Lusaka District Health Office, Lusaka, Zambia.
| | - Tafadzwa Mindu
- School of Nursing and Public Health, Univeristy of KwaZulu-Natal, Durban, South Africa
| | - Kelvin Mulungu
- International Maize and Wheat Improvement Center (CIMMYT), Lusaka, Zambia
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O’Neill JC, O’Callaghan ET, Sullivan S, Winsberg M. Novel Telehealth Adaptations for Evidence-Based Outpatient Suicide Treatment: Feasibility and Effectiveness of the Crisis Care Program. Healthcare (Basel) 2023; 11:3158. [PMID: 38132048 PMCID: PMC10743225 DOI: 10.3390/healthcare11243158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Revised: 12/07/2023] [Accepted: 12/09/2023] [Indexed: 12/23/2023] Open
Abstract
Background: Suicide rates in the United States have escalated dramatically over the past 20 years and remain a leading cause of death. Access to evidenced-based care is limited, and telehealth is well-positioned to offer novel care solutions. The Crisis Care program is a suicide-specific treatment program delivered within a national outpatient telehealth setting using a digitally adapted version of the Collaborative Assessment and Management of Suicidality (CAMS) as the framework of care. This study investigates the feasibility and preliminary effectiveness of Crisis Care as scalable suicide-specific treatment model. Methods: Patient engagement, symptom reduction, and care outcomes were examined among a cohort of patients (n = 130) over 16 weeks. The feasibility of implementation was assessed through patient engagement. Clinical outcomes were measured with PHQ-9, GAD-7, and the CAMS SSF-4 rating scales. Results: Over 85% of enrolled patients were approved for Crisis Care at intake, and 83% went on to complete at least four sessions (the minimum required to graduate). All patient subgroups experienced declines in depressive symptoms, anxiety symptoms, suicidal ideation frequency, and suicide-specific risk factors. Conclusions: Results support the feasibility and preliminary effectiveness of Crisis Care as a suicide-specific care solution that can be delivered within a stepped-care model in an outpatient telehealth setting.
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Affiliation(s)
- J. Conor O’Neill
- Brightside Health, 2471a Peralta Street, Oakland, CA 94607, USA (M.W.)
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Dol A, van Strien T, Velthuijsen H, van Gemert-Pijnen L, Bode C. Preferences for coaching strategies in a personalized virtual coach for emotional eaters: an explorative study. Front Psychol 2023; 14:1260229. [PMID: 38034311 PMCID: PMC10687361 DOI: 10.3389/fpsyg.2023.1260229] [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: 07/17/2023] [Accepted: 11/01/2023] [Indexed: 12/02/2023] Open
Abstract
Objectives Emotional eating is recognized as a potential contributor to weight gain. Emotional eaters often hide their problems because of feelings of shame about their behavior, making it challenging to provide them with the necessary support. The introduction of a virtual coach might offer a potential solution in assisting them. To find out whether emotional eaters are receptive to online personalized coaching, we presented emotional eaters with two essential proto-typical problem situations for emotional eaters: "experiencing cravings" and "after giving in to cravings," and asked them whether they preferred one of the three coaching strategies presented: Validating, Focus-on-Change and Dialectical. Methods An experimental vignette study (2 × 3 design) was carried out. The vignettes featured two distinct personas, each representing one of the two common problem scenarios experienced by emotional eaters, along with three distinct coaching strategies for each scenario. To identify potential predictors for recognition of problem situations, questionnaires on emotional eating (DEBQ), personality traits (Big-5), well-being (PANAS), and BMI were administrated. Results A total of 62% of the respondents identified themselves with "after giving in to cravings" and 47% with "experiencing cravings." BMI, emotional eating and emotional stability appeared to be predictors in recognizing both the problem situations. In "experiencing cravings," the participating women preferred Dialectical and the Validation coaching strategies. In the "after giving in to cravings" condition, they revealed a preference for the Dialectical and the Focus-on-Change coaching strategies. Conclusion Using vignettes allowed a less threatening way of bringing up sensitive topics for emotional eaters. The personas representing the problem situations were reasonably well recognized. To further enhance this recognition, it is important for the design and content of the personas to be even more closely related to the typical problem scenarios of emotional eaters, rather than focusing on physical characteristics or social backgrounds. This way, users may be less distracted by these factors. With the knowledge gained about the predictors that may influence recognition of the problem situations, design for coaching can be more customized. The participants represented individuals with high emotional eating levels, enhancing external validity.
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Affiliation(s)
- Aranka Dol
- Department of Psychology, Health and Technology, University of Twente, Enschede, Netherlands
- Institute for Communication, Media & IT, Hanze University, Groningen, Netherlands
| | - Tatjana van Strien
- Behavioural Science Institute, Radboud University, Nijmegen, Netherlands
| | - Hugo Velthuijsen
- Institute for Communication, Media & IT, Hanze University, Groningen, Netherlands
| | | | - Christina Bode
- Department of Psychology, Health and Technology, University of Twente, Enschede, Netherlands
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Gauhe G, Cisneros REK, Ward J, Hohenschurz-Schmidt DJ. Creatively Adapting Touch-Based Practices to the Web Format During the COVID-19 Pandemic: Systematic Review. J Med Internet Res 2023; 25:e46355. [PMID: 37883151 PMCID: PMC10636621 DOI: 10.2196/46355] [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: 02/21/2023] [Revised: 08/11/2023] [Accepted: 09/20/2023] [Indexed: 10/27/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic forced numerous touch-based fields, including manual therapy, body psychotherapy, arts therapy, creative arts practices, and the fitness industry, to swiftly transition to web-based service delivery. These disciplines faced substantial challenges in adapting their traditionally in-person practices, which rely heavily on physical touch and close proximity, to a web format. OBJECTIVE This review intends to provide a systematically sourced overview of the literature concerning innovative approaches for adapting touch-based practices to the web format in response to the COVID-19 pandemic. METHODS A systematic search across 7 databases and gray literature sources identified studies presenting innovative web delivery methods, particularly those addressing the challenges arising from the absence of physical proximity and touch. The inclusion criteria were designed to encompass studies exploring the creative adaptation of touch-based practices to web formats in response to the COVID-19 pandemic irrespective of study methodology. The exclusion criteria applied to studies focusing solely on technical aspects of web delivery or nontouch or noninteractive practices. There were no geographical restrictions, but the selection was limited to publications from 2020 onward. As only qualitative studies were found, data synthesis was conducted thematically. RESULTS The review encompassed 17 studies revealing that touch-based fields successfully devised innovative and creative methods for web service delivery. These methods were categorized into five main themes: (1) adapted working methods (cross-field methods), (2) adapted working methods for sensorial experiences and nonphysical connections, (3) creative methods using materials or additional tools, (4) creative use of web-based platform tools or additional technologies, and (5) creative methods requiring previous preparation of practitioners or participants. These creative approaches allowed practitioners to address the challenges of web touch-based practices, fostering connections and offering unique sensory experiences, albeit with some concerns related to technology and preparation. CONCLUSIONS These innovative methods demonstrate promise in circumventing the limitations imposed by the lack of physical touch and proximity in web settings during the COVID-19 pandemic. Furthermore, these insights hold potential for application in other fields in the future. This systematic search and thematic synthesis provide valuable guidance for practitioners and educators seeking to navigate the evolving landscape of web service delivery in touch-based disciplines, ensuring continuity of care even in challenging circumstances. TRIAL REGISTRATION PROSPERO CRD42022379731; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=379731.
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Affiliation(s)
- Greta Gauhe
- Centre for Dance Research, Coventry University, Coventry, United Kingdom
| | | | - Jade Ward
- Centre for Dance Research, Coventry University, Coventry, United Kingdom
| | - David J Hohenschurz-Schmidt
- Pain Group, Department of Surgery & Cancer, Imperial College London, London, United Kingdom
- Research Department, University College of Osteopathy, London, United Kingdom
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Daros AR, Wardell JD, Quilty LC. Multilevel associations of emotion regulation strategy use during psychotherapy for depression: A longitudinal study. J Affect Disord 2023; 338:107-118. [PMID: 37290525 DOI: 10.1016/j.jad.2023.06.014] [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: 08/02/2022] [Revised: 03/24/2023] [Accepted: 06/04/2023] [Indexed: 06/10/2023]
Abstract
BACKGROUND People with depression select avoidant emotion regulation (ER) strategies more often than engagement strategies. While psychotherapy improves ER strategies, examining the week-to-week changes in ER and their relationship to clinical outcomes is warranted to understand how these interventions work. This study examined the changes in six ER strategies and depressive symptoms during virtual psychotherapy. METHODS Treatment-seeking adults (N = 56) with moderate depression severity completed a baseline diagnostic interview and questionnaires and were followed for up to 3 months as they completed virtual psychotherapy in an unrestricted format (e.g., individual) and orientation (e.g., cognitive-behavioral therapy; CBT). Participants completed weekly assessments of depression and six ER strategies along with assessments of CBT skills and participant-rated CBT components for each psychotherapy session. Multilevel modeling was used to examine associations between within-person changes in ER strategy use and weekly depression scores, controlling for between-person effects and time. RESULTS Depressive symptoms, rumination, and experiential avoidance decreased non-linearly over time while cognitive reappraisal and acceptance increased non-linearly. Controlling for CBT skills, within-person increases in acceptance and cognitive reappraisal, as well as within-person decreases in experiential avoidance, were associated with fewer depressive symptoms over time. People who reported greater CBT components in their sessions also reported fewer depressive symptoms over time. LIMITATIONS The study was unable to make more causal inferences or standardize the type, baseline, or length of psychotherapy received. CONCLUSIONS Improvements in ER strategies were associated with depression symptom reduction during psychotherapy. Future research to elucidate ER strategies as mediators of treatment response is warranted.
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Affiliation(s)
- Alexander R Daros
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Canada; Department of Psychology, York University, Canada.
| | - Jeffrey D Wardell
- Department of Psychology, York University, Canada; Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Canada; Department of Psychiatry, University of Toronto, Canada
| | - Lena C Quilty
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Canada; Department of Psychiatry, University of Toronto, Canada
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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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12
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Fernandez E, Perez B, Sun R, Kolaparthi K, Pham T, Iwuala E, Garza R, Shattuck EC, Wu W. Anger treatment via CBAT delivered remotely: Outcomes on psychometric and self-monitored measures of anger. Clin Psychol Psychother 2023. [PMID: 37699599 DOI: 10.1002/cpp.2907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 07/04/2023] [Accepted: 08/28/2023] [Indexed: 09/14/2023]
Abstract
Studies of anger treatment have often reported on reappraisal and relaxation techniques delivered in person to forensic and psychiatric samples. The present study evaluated an integrative programme of cognitive-behavioural affective therapy (CBAT) delivered remotely to chronic pain sufferers with comorbid anger. Volunteers (N = 54) were randomly assigned to either CBAT or an Emotional Education (EE) group, both receiving hour-long videorecorded sessions twice a week for 4 weeks plus weekly calls by telephone. At 1-month post-treatment, follow-up was conducted. Outcomes were measured using the Anger Parameters Scale (APS) and its five subscales (frequency, duration, intensity, latency and threshold) as well as daily self-monitored anger logs. As hypothesized, pre- to post-treatment decline in APS total scores was significant for CBAT, Hedges' g = 0.65, 95% CI [0.14, 1.16] but nonsignificant and small for EE, g = 0.17, CI [-0.41, 0.75]. At the primary endpoint (post-treatment), APS total scores were significantly lower for CBAT than for EE. Treatment gains were maintained till follow-up. On all five APS subscales, pre-post effect sizes were medium-sized for CBAT and generally small for EE. This picture was mirrored in the self-monitored frequency, duration and intensity of anger. Findings support the efficacy of CBAT over time, its comparative efficacy over EE and its ecological generalizability. Future research could expand sample size, reduce sample imbalance, extend follow-up and strengthen treatment potency with more sessions. The present study renews enthusiasm for teletherapy and is the first to demonstrate CBAT efficacy in treating maladaptive anger in the chronic pain population.
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Affiliation(s)
- Ephrem Fernandez
- Psychology Department, University of Texas San Antonio, San Antonio, Texas, USA
| | - Brandon Perez
- University of Texas San Antonio, San Antonio, Texas, USA
| | - Renhao Sun
- Dept. of Management Science and Statistics, University of Texas San Antonio, San Antonio, Texas, USA
| | - Krishna Kolaparthi
- Institute for Health Disparities Research, University of Texas San Antonio, San Antonio, Texas, USA
| | - Tuan Pham
- University of Texas Medical Branch, San Antonio, Texas, USA
| | | | - Rudy Garza
- University of Texas San Antonio, San Antonio, Texas, USA
| | - Eric C Shattuck
- Institute for Health Disparities Research and Department of Public Health, University of Texas San Antonio, San Antonio, Texas, USA
| | - Wenbo Wu
- Dept. of Management Science and Statistics, University of Texas San Antonio, San Antonio, Texas, USA
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13
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Lisi DM, Hawley LL, McCabe RE, Rowa K, Cameron DH, Richter MA, Rector NA. Online versus in-person delivery of cognitive behaviour therapy for obsessive compulsive disorder: An examination of effectiveness. Clin Psychol Psychother 2023. [PMID: 37699581 DOI: 10.1002/cpp.2908] [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: 04/11/2023] [Revised: 06/13/2023] [Accepted: 08/28/2023] [Indexed: 09/14/2023]
Abstract
Cognitive behavioural therapy (CBT) including exposure and response prevention is the first-line psychological treatment for obsessive compulsive disorder (OCD). Given changes in the clinical landscape, there are increasing efforts to evaluate its effectiveness in online contexts. Mirroring the traditional in-person delivery, few studies have assessed the role of therapist-guided, manual-based CBT for OCD delivered in real-time via videoconferencing methods. The present study sought to fill this gap by comparing in-person and online delivery of group-based CBT for the treatment of OCD. A convenience sample of participants with moderate to severe OCD (n = 144) were recruited from a naturalistic database from two large OCD specialty assessment and treatment centres. Patients received group-based CBT that was provided in-person (pre-COVID-19 pandemic; March 2018 to March 2020) or online via videoconferencing (during the COVID-19 pandemic; March 2020 to April 2021). In both delivery methods, treatment consisted of 2-h weekly sessions led by trained clinicians. Analyses revealed that, regardless of treatment modality, both in-person and online groups demonstrated significant, reliable, and statistically equivalent improvements in OCD symptoms post-treatment. Videoconferenced, clinician-led CBT may be a promising alternative to in-person delivery for those with moderate to severe OCD symptoms.
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Affiliation(s)
- Diana M Lisi
- Frederick W. Thompson Anxiety Disorders Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Lance L Hawley
- Frederick W. Thompson Anxiety Disorders Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Randi E McCabe
- Anxiety Treatment and Research Clinic, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Karen Rowa
- Anxiety Treatment and Research Clinic, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Duncan H Cameron
- Anxiety Treatment and Research Clinic, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Margaret A Richter
- Frederick W. Thompson Anxiety Disorders Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Neil A Rector
- Frederick W. Thompson Anxiety Disorders Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
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14
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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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15
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Biagianti B, Lisi I, Di Liberto A, Turtulici N, Foti G, Zito S, Ginex V, Fornoni C, Gallo F, Cantù F, Tombola V, Di Fede V, Rossetti MG, Colombo E, Stocchetti N, Zanier ER, Bellani M, Bressi C, Brambilla P. Feasibility and preliminary efficacy of brief tele-psychotherapy for COVID-19 patients and their first-degree relatives. J Affect Disord 2023; 330:300-308. [PMID: 36934855 PMCID: PMC10022466 DOI: 10.1016/j.jad.2023.03.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 03/01/2023] [Accepted: 03/11/2023] [Indexed: 03/19/2023]
Abstract
BACKGROUND The SARS-CoV-2 pandemic compromised the mental health of COVID-19 patients and their family members. Due to social distancing and lockdown measures, a remote, tele-psychotherapy program for former or current COVID-19 patients and their relatives was implemented. OBJECTIVE The primary goal of this project was to evaluate intervention feasibility. The secondary aim was to assess the impact of the intervention by means of pre-post psychological changes. METHODS After a phone-based eligibility screening and remote neuropsychological testing, participants completed online self-reports assessing baseline COVID-related psychopathology. Next, participants attended eight tele-psychotherapy sessions. After treatment, the online self-reports were completed again. RESULTS Of 104 enrolled participants, 88 completed the intervention (84.6 % completion rate). Significant pre-post improvements were observed for generalized anxiety (d = 0.38), depression (d = 0.37), insomnia (d = 0.43), post-traumatic psychopathology (d = 0.54), and general malaise (d = 0.31). Baseline cluster analysis revealed a subgroup of 41 subjects (47.6 %) with no psychopathology, and a second subgroup of 45 subject (52.3 %) with moderate severity. Thirty-three percent of the second group reached full symptom remission, while 66 % remained symptomatic after treatment. CONCLUSIONS Remote brief tele-psychotherapy for COVID-19 patients and their first-degree relatives is feasible and preliminary efficacious at reducing COVID-related psychopathology in a subgroup of patients. Further research is needed to investigate distinct profiles of treatment response.
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Affiliation(s)
- Bruno Biagianti
- Department of Psychology, University of Milan Bicocca, 20126, Milano, Italy
| | - Ilaria Lisi
- Laboratory of Acute Brain Injury and Therapeutic Strategies, Department of Neuroscience, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, 20156 Milano, Italy
| | - Asia Di Liberto
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Nunzio Turtulici
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Giuseppe Foti
- Department of Psychology, University of Milan Bicocca, 20126, Milano, Italy
| | - Silvana Zito
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Valeria Ginex
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Chiara Fornoni
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Francesca Gallo
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Filippo Cantù
- Department of Psychology, University of Milan Bicocca, 20126, Milano, Italy
| | - Valentina Tombola
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Viviana Di Fede
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Maria Gloria Rossetti
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Elisa Colombo
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Nino Stocchetti
- Department of Anaesthesia and Critical Care, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Elisa R Zanier
- Laboratory of Acute Brain Injury and Therapeutic Strategies, Department of Neuroscience, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, 20156 Milano, Italy
| | - Marcella Bellani
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, 37134 Verona, Italy
| | - Cinzia Bressi
- Department of Psychology, University of Milan Bicocca, 20126, Milano, Italy; Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Paolo Brambilla
- Department of Psychology, University of Milan Bicocca, 20126, Milano, Italy; Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy.
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von Below C, Bergsten J, Midbris T, Philips B, Werbart A. It turned into something else: patients' long-term experiences of transitions to or from telepsychotherapy during the COVID-19 pandemic. Front Psychol 2023; 14:1142233. [PMID: 37251023 PMCID: PMC10213395 DOI: 10.3389/fpsyg.2023.1142233] [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: 01/11/2023] [Accepted: 04/21/2023] [Indexed: 05/31/2023] Open
Abstract
Introduction The shift from in-person therapy to telepsychotherapy during the COVID-19 pandemic was unprepared for, sudden, and inevitable. This study explored patients' long-term experiences of transitions to telepsychotherapy and back to the office. Methods Data were collected approximately two years after the declaration of COVID-19 as a pandemic. Eleven patients were interviewed (nine women and two men, aged 28 to 56, six in psychodynamic psychotherapy, five in CBT). Treatments switched between in-person and video/telephone sessions. Interview transcripts were analyzed applying the qualitative methodology of inductive thematic analysis. Results (1) The patients experienced the process in telepsychotherapy as impeded. Interventions were difficult to understand and lost impact. Routines surrounding the therapy sessions were lost. Conversations were less serious and lost direction. (2) Understanding was made more difficult when the nuances of non-verbal communication were lost. (3) The emotional relationship was altered. Remote therapy was perceived as something different from regular therapy, and once back in the therapy room, the patients felt that therapy started anew. The emotional presence was experienced as weakened, but some of the patients found expressing their feelings easier in the absence of bodily co-presence. According to the patients, in-person presence contributed to their security and trust, whereas they felt that the therapists were different when working remotely, behaving in a more easygoing and familiar way, as well as more solution-focused, supportive and unprofessional, less understanding and less therapeutic. Despite this, (4) telepsychotherapy also gave the patients an opportunity to take therapy with them into their everyday lives. Discussion The results suggest that in the long run, remote psychotherapy was seen as a good enough alternative when needed. The present study indicates that format alternations have an impact on which interventions can be implemented, which can have important implications for psychotherapy training and supervision in an era when telepsychotherapy is becoming increasingly common.
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Crowe M, Inder M, Manuel J, Carlyle D. Characteristics of effective teletherapy for major depression: A systematic review. J Affect Disord 2023; 327:175-182. [PMID: 36758869 DOI: 10.1016/j.jad.2023.02.019] [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: 06/01/2022] [Revised: 01/19/2023] [Accepted: 02/03/2023] [Indexed: 02/11/2023]
Abstract
BACKGROUND People would prefer to have psychotherapy as treatment over medication for major depression. There is evidence that psychotherapy does not require in-person delivery to be effective. Other modes of delivery, such as videoconferencing teletherapy, may make it a more accessible treatment. METHOD The aim of this review was to identify the characteristics of effective psychotherapy delivered by videoconference for adults in primary care with a primary diagnosis of depression. A quantitative systematic review was conducted and reported according to PRISMA guidelines. RESULTS There were 8 studies included in the review. The therapies studied were tele problem-solving therapy, behavioural activation and cognitive behavioural therapy. All studies had a medium to high risk of bias. Six were randomized controlled trials, one was a pragmatic retrospective cohort study and one was an open-label design. Four studies found similar outcomes to the in-person comparators, one study found tele problem-solving therapy was more effective than behavioural activation, and one study found cognitive behavioural therapy to be similar to usual care. LIMITATIONS The search identified only 8 studies. Due to the heterogeneity of outcome measures and comparators, a meta-analysis could not be conducted. CONCLUSIONS No definitive conclusions can be drawn about the effectiveness of teletherapy in primary care based on this review, however, there is emerging evidence to suggest it has similar outcomes to in-person therapy for people with a primary diagnosis of depression. There is no evidence regarding the superiority of one model of therapy over the others.
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Affiliation(s)
- Marie Crowe
- University of Otago, Christchurch, New Zealand.
| | - Maree Inder
- University of Otago, Christchurch, New Zealand
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Weinberg H. Online Training Process Groups for Therapists: A Proposed Model. Int J Group Psychother 2023; 73:141-165. [PMID: 38446564 DOI: 10.1080/00207284.2023.2170236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
Abstract
The article proposes a new model for online experiential training groups for therapists. Experiential groups are an essential part of training for group therapists. The article summarizes the requirements for becoming a group therapist, reviews the literature about training-process groups for therapists, and discusses the dilemmas that are part of these groups. Ethical questions and the difference between training-process groups and therapy groups are presented. This training model uses weekly online process group sessions that include a 10-minute didactic discussion at the end of each session, combined with an annual in-person intensive meeting. Group vignettes are included to illustrate group processes. The advantages and disadvantages of the model are discussed, as well as important areas for future research.
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von der Groeben S, Czaplicki A, Hegerl U, Reich H. Telemedicine during the COVID-19 pandemic in Germany: Results from three nationally representative surveys on use, attitudes and barriers among adults affected by depression. Internet Interv 2023; 32:100622. [PMID: 37091132 PMCID: PMC10114311 DOI: 10.1016/j.invent.2023.100622] [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: 08/18/2022] [Revised: 03/14/2023] [Accepted: 04/17/2023] [Indexed: 04/25/2023] Open
Abstract
Introduction The COVID-19 pandemic has necessitated a reduction in face-to-face consultations, resulting in significant limitations in healthcare for individuals with depression. To ensure safe and adequate care, e-health services, such as telemedicine, gained a more prominent role. Governments have eased restrictions on the use of telemedicine, enabling healthcare professionals to increasingly offer video and telephone consultations. Objective This study examines, 1) possible changes over the course of the pandemic in reported use of video and telephone consultations and intended future use of video consultations with healthcare professionals among adults with diagnosed depression; 2) their attitudes towards video and telephone consultations and perceived barriers towards using e-health after prolonged time of the pandemic; and 3) differences in results between subgroups based on sociodemographic and clinical characteristics. Methods Three population-representative online surveys were conducted in Germany at different timepoints (t) during the COVID-19 pandemic. Respondents aged 18-69 years with a professionally diagnosed depression were included in the present analyses (t1: June/July 2020 with n = 1094; t2: February 2021 with n = 1038; t3: September 2021 with n = 1255). Results The overall proportion of adults with depression who used video or telephone consultations did not change significantly in the time surveyed (t1: 16.51 %, n = 179; t2: 20.23 %, n = 210; t3: 18.47 %, n = 230). However, among users, reported use of video consultations with a psychotherapist increased significantly from t1 (34.83 %, n = 62) to t3 (44.98 %, n = 102, p = .023). Intended future use of VC for healthcare varied depending on the purpose of the consultation. Significant differences over time were only found for the purpose of using VC to discuss clinical findings, laboratory results and diagnostic analyses with a doctor, with higher intentions reported at t2 during lockdown in Germany. At t3, the majority of adults with depression felt that video and telephone consultations were too impersonal and considered them more as a helpful support rather than an alternative to face-to-face psychotherapy. Key barriers to using e-health were found within the societal context and the lacking support from significant others for using e-health, while knowledge and skills represented facilitators for using e-health. Conclusion Despite ambivalent attitudes towards video and telephone consultations among adults with depression, reported use of video consultations with a psychotherapist increased during the COVID-19 pandemic.
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Affiliation(s)
- S von der Groeben
- Goethe University Frankfurt, University Hospital, Depression Research Centre of the German Depression Foundation, Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, Germany
| | - A Czaplicki
- Goethe University Frankfurt, University Hospital, Depression Research Centre of the German Depression Foundation, Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, Germany
- German Depression Foundation, Leipzig, Germany
| | - U Hegerl
- Goethe University Frankfurt, University Hospital, Depression Research Centre of the German Depression Foundation, Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, Germany
- German Depression Foundation, Leipzig, Germany
- Johann Christian Senckenberg Distinguished Professorship, Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital, Goethe University, Frankfurt am Main, Germany
| | - H Reich
- Goethe University Frankfurt, University Hospital, Depression Research Centre of the German Depression Foundation, Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, Germany
- German Depression Foundation, Leipzig, Germany
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Biagianti B, Foti G, Di Liberto A, Bressi C, Brambilla P. CBT-informed psychological interventions for adult patients with anxiety and depression symptoms: A narrative review of digital treatment options. J Affect Disord 2023; 325:682-694. [PMID: 36690081 DOI: 10.1016/j.jad.2023.01.057] [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] [Received: 06/28/2022] [Revised: 01/03/2023] [Accepted: 01/13/2023] [Indexed: 01/21/2023]
Abstract
BACKGROUND Across a range of age, educational and clinical characteristics, adults experiencing depression and anxiety already use digital technology to manage their symptoms. Although several reviews and meta-analyses indicated feasibility and efficacy for adults with depression and anxiety, digital treatments are poorly accessed and disseminated. This review illustrates potentials and limitations of interventions that specifically leveraged unique features of digital technology and were grounded in the principles of Cognitive Behavioral Therapy (CBT). METHODS This systematic review followed the PRISMA guidelines. An electronic database search was conducted in October 2021. Peer-reviewed, English-language studies were included if i) they reported data from RCTs for adults aged 18+ who engaged with CBT-informed digital interventions targeting primarily depression and anxiety; ii) they used at least PHQ-9 or GAD-7 as standardized and validated assessment self-report measures for depression and anxiety. RESULTS Findings from 35 RCTs examining 33 interventions (25 internet-based, 6 mobile-based, a2 mobile/web) are discussed. The quality of the evidence differed widely as many small-scale RCTs reported only short-term feasibility and preliminary efficacy. Effects of CBT-informed digital interventions were substantially larger when compared to waitlist than active control conditions. Greater therapeutic benefits were observed for interventions that offered clinical assistance or were used in combination with other treatments. CONCLUSIONS CBT-informed digital interventions have accumulated enough scientific evidence to be positioned today as: i) a low-intensity tool for those with subclinical levels of symptoms; ii) a first step in a stepped-care approach to service delivery iii) a low-cost, easily accessible option for targeted preventive programs.
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Affiliation(s)
- Bruno Biagianti
- Department of Psychology, University of Milano-Bicocca, Milan, Italy.
| | | | | | - Cinzia Bressi
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy.
| | - Paolo Brambilla
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy.
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21
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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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22
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Shariatpanahi M, Faramarzi M, Barat S, Farghadani A, Shirafkan H. Acceptability, feasibility, and effectiveness of internet-based emotion-focused cognitive behavior therapy with husband participation for Iranian pregnant women with anxiety disorder. INTERNATIONAL JOURNAL OF SYSTEMIC THERAPY 2023. [DOI: 10.1080/2692398x.2023.2174773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/08/2023]
Affiliation(s)
- Mojgan Shariatpanahi
- Psychology, Department of Psychology, Saveh Branch, Islamic Azad University, Saveh, Iran
| | - Mahbobeh Faramarzi
- Psychology, Social Determinants of Health Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Shahnaz Barat
- Obstetrics and Gynecology, Infertility and Health Reproductive Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Azadeh Farghadani
- Department of Psychology, Saveh Branch, Islamic Azad University, Saveh, Iran
| | - Hoda Shirafkan
- Biostatistics, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
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23
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Lee HJ, Stein MB. Update on treatments for anxiety-related disorders. Curr Opin Psychiatry 2023; 36:140-145. [PMID: 36480651 DOI: 10.1097/yco.0000000000000841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE OF REVIEW This review examines recent evidence that informs the treatment of anxiety-related disorders. RECENT FINDINGS In addition to selective serotonin reuptake inhibitors (SSRIs), serotonin and norepinephrine reuptake inhibitors (SNRIs), and benzodiazepines, agomelatine has demonstrated efficacy in treating generalized anxiety disorder (GAD). Other novel products, such as ketamine, psilocybin and cannabidiol, are in the process of gathering evidence in support of the treatment of anxiety disorders. In psychological therapy, various psychological treatments for anxiety disorders, such as mindfulness-based intervention, acceptance and commitment therapy, psychodynamic therapy, emotion-focused therapy and dialectical behavioural therapy, have been tried. Still, most therapies have not proven superior to cognitive behavioural therapy (CBT). In very preliminary findings: Repetitive transcranial magnetic stimulation (rTMS) was effective in GAD; transcranial direct current stimulation (tDCS) was effective for social anxiety disorder (SAD) and GAD and augmented exposure therapy for specific fears. Internet and mobile-based interventions have comparable efficacy to face-to-face therapy. SUMMARY Pharmacotherapy of anxiety disorders is expanding to novel products. Despite trying other psychological therapies for anxiety disorders, most therapies were comparable to but not superior to CBT. rTMS and tDCS were also used and show early promise for GAD, but further studies are needed. Most internet or mobile app based psychological therapies were based on CBT, and some can be considered as alternatives to in-person face-to-face therapy.
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Affiliation(s)
- Hyun Jeong Lee
- Department of Psychiatry and Behavioral Science, National Cancer Center, Goyang, South Korea
- Department of Psychiatry, University of California San Diego, La Jolla, California, USA
| | - Murray B Stein
- Department of Psychiatry, University of California San Diego, La Jolla, California, USA
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24
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Schittenhelm JM, von Borell C, Clément C, Schüller J, Stangier U, Hoyer J. Evaluation of a smartphone application for self-help for patients with social anxiety disorder: a randomized controlled study-SMASH. Trials 2023; 24:154. [PMID: 36855058 PMCID: PMC9974392 DOI: 10.1186/s13063-023-07168-5] [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: 10/08/2022] [Accepted: 02/14/2023] [Indexed: 03/02/2023] Open
Abstract
BACKGROUND There is growing evidence that Internet-based cognitive behavioral therapy (ICBT) is as effective as a stand-alone treatment and helps facilitating access to treatment. Given the complexity of the treatment, we argue that the effect of ICBT could be even greater if guided by a therapist, as this could increase treatment adherence. We modified an established and well-evaluated treatment approach and developed a mobile application for treating social anxiety disorder (SAD). In the present study, we compare the efficacy of app use alone (APP) with video-based, therapist-guided app use (TG-APP) and with a wait-list control group (WLC) in terms of symptom reduction, and various secondary outcomes such as increase in quality of life or decrease of general psychological distress. METHODS/DESIGN A within-between interaction design with randomization to one of three conditions will be used. In the APP condition, patients receive only the app without any additional contact with therapists, while in the TG-APP condition, therapists provide 8 sessions of video-based treatment in addition to using the app. The study will be conducted in two university outpatient treatment centers with reliably diagnosed SAD patients. The primary outcome will be defined as change in SAD symptoms, as measured by the Liebowitz Social Anxiety Scale (expert rating). Furthermore, a wide range of self-reports and clinician ratings for other symptoms (depression, general psychopathology) or quality of life will be used. A simulation-based power analysis for a 3 × 2 interaction effect (group × time) on the primary outcome in a linear mixed model resulted in a total sample size of N = 165. DISCUSSION The present study will be one of the first to examine the additional benefit of therapist-guided video sessions regarding the use of an app treating SAD. Study results are pivotal to future treatment application in SAD.
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Affiliation(s)
- Jan Marius Schittenhelm
- Institute of Psychology, Goethe-Universitaet Frankfurt, Varrentrappstr. 40-42, 60486, Frankfurt, Germany.
| | - Christoph von Borell
- grid.4488.00000 0001 2111 7257Institute for Clinical Psychology and Psychotherapy, Technische Universitaet Dresden, Dresden, Germany
| | - Celina Clément
- grid.7839.50000 0004 1936 9721Institute of Psychology, Goethe-Universitaet Frankfurt, Varrentrappstr. 40-42, 60486 Frankfurt, Germany
| | - Johanna Schüller
- grid.7839.50000 0004 1936 9721Institute of Psychology, Goethe-Universitaet Frankfurt, Varrentrappstr. 40-42, 60486 Frankfurt, Germany
| | - Ulrich Stangier
- grid.7839.50000 0004 1936 9721Institute of Psychology, Goethe-Universitaet Frankfurt, Varrentrappstr. 40-42, 60486 Frankfurt, Germany
| | - Juergen Hoyer
- grid.4488.00000 0001 2111 7257Institute for Clinical Psychology and Psychotherapy, Technische Universitaet Dresden, Dresden, Germany
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25
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Kathiravan S, Chakrabarti S. Development of a protocol for videoconferencing-based exposure and response prevention treatment of obsessive-compulsive disorder during the COVID-19 pandemic. World J Psychiatry 2023; 13:60-74. [PMID: 36925949 PMCID: PMC10011942 DOI: 10.5498/wjp.v13.i2.60] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Revised: 11/01/2022] [Accepted: 12/06/2022] [Indexed: 02/17/2023] Open
Abstract
BACKGROUND The existing literature indicates that psychotherapeutic treatment, especially exposure and response prevention (ERP) is efficacious in treating obsessive-compulsive disorder (OCD). The coronavirus disease 2019 pandemic adversely impacted many patients with OCD and disrupted their usual treatment. Moreover, the pandemic forced a global switch to telemental health (TMH) services to maintain the standards and continuity of care. Consequently, clinicians are increasingly using TMH-based psychotherapeutic treatments to treat OCD. However, several challenges have made it difficult for them to implement these treatments in the changed circumstances imposed by the pandemic.
AIM To describe the formulation, implementation, feasibility, and usefulness of videoconferencing-based ERP (VC-ERP) treatment for OCD during the coronavirus disease 2019 pandemic.
METHODS This prospective, observational study was conducted in the psychiatric unit of a multi-specialty hospital in north India over 12 mo (July 2020-June 2021). All patients with OCD were assessed using the home-based TMH services of the department. The VC-ERP protocol for OCD was the outcome of weekly Zoom meetings with a group of clinicians involved in administering the treatment. After a systematic evaluation of the available treatment options, an initial protocol for delivering VC-ERP was developed. Guidelines for clinicians and educational materials for patients and their families were prepared. The protocol was implemented among patients with OCD attending the TMH services, and their progress was monitored. The weekly meetings were used to upgrade the protocol to meet the needs of all stakeholders. Feasibility and efficacy outcomes were examined.
RESULTS All patients were diagnosed with OCD as a primary or a comorbid condition according to the International Classification of Diseases, 10th version criteria. Out of 115 patients who attended the services during the study period, 37 were excluded from the final analysis. Of the remaining 78 patients, VC-ERP was initiated in 43 patients. Six patients dropped out, and three were hospitalized for inpatient ERP. Eleven patients have completed the full VC-ERP treatment. One patient completed the psychoeducation part of the protocol. VC-ERP is ongoing in 22 patients. The protocol for VC-ERP treatment was developed and upgraded online. A large proportion of the eligible patients (n = 34/43; 79%) actively engaged in the VC-ERP treatment. Drop-out rates were low (n = 6/43; 14%). Satisfaction with the treatment was adequate among patients, caregivers, and clinicians. Apart from hospitalization in 3 patients, there were no other adverse events. Hybrid care and stepped care approaches could be incorporated into the VC-ERP protocol. Therefore, the feasibility of VC-ERP treatment in terms of operational viability, service utilization, service engagement, need for additional in-person services, frequency of adverse events, and user satisfaction was adequate. The VC-ERP treatment was found to be efficacious in the 11 patients who had completed the full treatment. Significant reductions in symptoms and maintenance of treatment gains on follow-up were observed.
CONCLUSION This study provided preliminary evidence for the feasibility and usefulness of VC-ERP in the treatment of OCD. The results suggest that VC-ERP can be a useful option in resource-constrained settings.
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Affiliation(s)
- Sanjana Kathiravan
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh 160012, India
| | - Subho Chakrabarti
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh 160012, India
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26
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Hudson CC, Klein KP, Ong CW, Handy AB, Swee MB, Lambert HK, Mei S, Hom MA, Weiss RB, Beard C, Björgvinsson T. Treatment outcomes and patient satisfaction of a virtual partial hospital program: A mixed-method study. Psychother Res 2023; 33:235-250. [PMID: 35748859 DOI: 10.1080/10503307.2022.2088314] [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] [Indexed: 10/17/2022] Open
Abstract
OBJECTIVE Despite a proliferation of virtual partial hospital programs (PHP) during the COVID-19 pandemic, there is a dearth of research on such programs. In the current study, we compared treatment outcomes and patient satisfaction between an in-person and a virtual PHP. Further, we examined patients' qualitative feedback about the virtual PHP. METHOD Participants included 282 patients attending a virtual PHP during the COVID-19 pandemic and 470 patients attending an in-person PHP one year prior. Patients completed daily measures of symptom severity, and post-treatment measures of patient satisfaction and treatment outcomes. Patients in the virtual PHP provided feedback about virtual care. Quantitative data were analyzed using multilevel modeling, and qualitative data were analyzed using the principles of inductive analysis. RESULTS Patients experienced a reduction in depression (b = -.28, p < .001) and anxiety symptoms (b = -.25, p < .001) over time and reported high satisfaction in both the in-person and virtual PHPs. There were no significant differences across programs. Virtual PHP patients identified unique advantages and disadvantages of virtual care. CONCLUSION Our results suggest that virtual PHPs should be explored as an ongoing model of care that may help to systematically reduce barriers to accessing mental health services.
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Affiliation(s)
- Chloe C Hudson
- Behavioral Health Partial Hospital Program, McLean Hospital, Belmont MA, USA
- Department of Psychiatry, Harvard Medical School, Cambridge MA, USA
| | - Keith P Klein
- Behavioral Health Partial Hospital Program, McLean Hospital, Belmont MA, USA
- Department of Psychiatry, Harvard Medical School, Cambridge MA, USA
| | - Clarissa W Ong
- Behavioral Health Partial Hospital Program, McLean Hospital, Belmont MA, USA
- Department of Psychiatry, Harvard Medical School, Cambridge MA, USA
| | - Ariel B Handy
- Behavioral Health Partial Hospital Program, McLean Hospital, Belmont MA, USA
- Department of Psychiatry, Harvard Medical School, Cambridge MA, USA
| | - Michaela B Swee
- Behavioral Health Partial Hospital Program, McLean Hospital, Belmont MA, USA
- Department of Psychiatry, Harvard Medical School, Cambridge MA, USA
| | - Hilary K Lambert
- Behavioral Health Partial Hospital Program, McLean Hospital, Belmont MA, USA
- Department of Psychiatry, Harvard Medical School, Cambridge MA, USA
| | - Sara Mei
- Behavioral Health Partial Hospital Program, McLean Hospital, Belmont MA, USA
| | - Melanie A Hom
- Behavioral Health Partial Hospital Program, McLean Hospital, Belmont MA, USA
- Department of Psychiatry, Harvard Medical School, Cambridge MA, USA
| | - Rachel B Weiss
- Behavioral Health Partial Hospital Program, McLean Hospital, Belmont MA, USA
- Department of Psychiatry, Harvard Medical School, Cambridge MA, USA
| | - Courtney Beard
- Behavioral Health Partial Hospital Program, McLean Hospital, Belmont MA, USA
- Department of Psychiatry, Harvard Medical School, Cambridge MA, USA
| | - Thröstur Björgvinsson
- Behavioral Health Partial Hospital Program, McLean Hospital, Belmont MA, USA
- Department of Psychiatry, Harvard Medical School, Cambridge MA, USA
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27
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Leung T, Gutierrez G, Moghimi E, Stephenson C, Khalafi P, Nikjoo N, Jagayat J, Gizzarelli T, Reshetukha T, Omrani M, Yang M, Alavi N. Developing and Implementing a Web-Based Relapse Prevention Psychotherapy Program for Patients With Alcohol Use Disorder: Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2023; 12:e44694. [PMID: 36567076 PMCID: PMC9909521 DOI: 10.2196/44694] [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: 11/30/2022] [Revised: 12/23/2022] [Accepted: 12/25/2022] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Alcohol use disorder (AUD) is characterized by problematic alcohol use accompanied by clinically substantial distress. Patients with AUD frequently experience high relapse rates, and only 1 in 5 remain abstinent 12 months post treatment. Traditional face-to-face relapse prevention therapy (RPT) is a form of cognitive behavioral therapy (CBT) that examines one's situational triggers, maladaptive thought processes, self-efficacy, and motivation. However, access to this treatment is frequently limited due to its high cost, long waitlists, and inaccessibility. A web-based adaptation of RPT (e-RPT) could address these limitations by providing a more cost-effective and accessible delivery method for mental health care in this population. OBJECTIVE This study protocol aims to establish the first academic e-RPT program to address AUD in the general population. The primary objective of this study is to compare the efficacy of e-RPT to face-to-face RPT in decreasing relapse rates. The secondary objective is to assess the effects of e-RPT on quality of life, self-efficacy, resilience, and depressive symptomatology. The tertiary objective is to evaluate the cost-effectiveness of e-RPT compared to face-to-face RPT. METHODS Adult participants (n=60) with a confirmed diagnosis of AUD will be randomly assigned to receive 10 sessions of e-RPT or face-to-face RPT. e-RPT will consist of 10 predesigned modules and homework with asynchronous, personalized feedback from a therapist. Face-to-face RPT will comprise 10 one-hour face-to-face sessions with a therapist. The predesigned modules and the face-to-face sessions will present the same content and structure. Self-efficacy, resilience, depressive symptomatology, and alcohol consumption will be measured through various questionnaires at baseline, amid treatment, and at the end of treatment. RESULTS Participant recruitment is expected to begin in October 2022 through targeted advertisements and physician referrals. Completed data collection and analysis are expected to conclude by October 2023. Outcome data will be assessed using linear and binomial regression (for continuous and categorical outcomes, respectively). Qualitative data will be analyzed using thematic analysis methods. CONCLUSIONS This study will be the first to examine the effectiveness of e-RPT compared to face-to-face RPT. It is posited that web-based care can present benefits in terms of accessibility and affordability compared to traditional face-to-face psychotherapy. TRIAL REGISTRATION ClinicalTrials.gov NCT05579210; https://clinicaltrials.gov/ct2/show/NCT05579210. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/44694.
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Affiliation(s)
| | - Gilmar Gutierrez
- Department of Psychiatry, Queen's University, Kingston, ON, Canada
| | - Elnaz Moghimi
- Department of Psychiatry, Queen's University, Kingston, ON, Canada
| | - Callum Stephenson
- Department of Psychiatry, Queen's University, Kingston, ON, Canada.,Centre for Neuroscience Studies, Queen's University, Kingston, ON, Canada
| | - Payam Khalafi
- Department of Psychiatry, Queen's University, Kingston, ON, Canada
| | - Niloofar Nikjoo
- Department of Psychiatry, Queen's University, Kingston, ON, Canada.,Centre for Neuroscience Studies, Queen's University, Kingston, ON, Canada
| | - Jasleen Jagayat
- Department of Psychiatry, Queen's University, Kingston, ON, Canada.,Centre for Neuroscience Studies, Queen's University, Kingston, ON, Canada
| | - Tessa Gizzarelli
- Department of Psychiatry, Queen's University, Kingston, ON, Canada
| | - Taras Reshetukha
- Department of Psychiatry, Queen's University, Kingston, ON, Canada.,Centre for Neuroscience Studies, Queen's University, Kingston, ON, Canada
| | - Mohsen Omrani
- Department of Psychiatry, Queen's University, Kingston, ON, Canada.,OPTT Inc, Toronto, ON, Canada
| | - Megan Yang
- Department of Psychiatry, Queen's University, Kingston, ON, Canada
| | - Nazanin Alavi
- Department of Psychiatry, Queen's University, Kingston, ON, Canada.,Centre for Neuroscience Studies, Queen's University, Kingston, ON, Canada.,OPTT Inc, Toronto, ON, Canada
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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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29
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Gerson J, Tawde P, Ghiasian G, Salwen-Deremer JK. Patients' experiences with virtual group gut-directed hypnotherapy: A qualitative study. Front Med (Lausanne) 2023; 10:1066452. [PMID: 36910502 PMCID: PMC9992176 DOI: 10.3389/fmed.2023.1066452] [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: 10/10/2022] [Accepted: 01/27/2023] [Indexed: 02/24/2023] Open
Abstract
Background Hypnotherapy is a useful treatment for a variety of gastrointestinal conditions. While there is strong evidence for delivering other treatments virtually and in groups, there is no research thus far on delivering hypnotherapy in this format. Given the growth of both psychogastroenterology and telehealth, these methods should be explored as they have great potential for increasing access and cost-effectiveness of intervention. Aims This qualitative study was developed to help understand patients experiences in virtual, group-based, gut-directed hypnotherapy (GDH) in two different institutions. Methods Authors developed a qualitative interview with the assistance of two patient partners and then recruited patients from New York University and Dartmouth Health to participate. Interviews were completed one-on-one with patients who started and then completed GDH (≥5 visits) and who did not complete GDH (≤3 visits). Data were coded and then analyzed using thematic analysis. Results Twenty-one patients from NYU and Dartmouth participated in qualitative interviews. Broadly, patients reported coming to GDH because they believed in the importance of the mind-body connection or were desperate for treatment. Regardless of why patients came to GDH, they generally reported positive outcomes for GI symptoms and for other physical and mental health conditions. Most patients appreciated the group and virtual formats, though some concerns about inflexible schedules and lack of anonymity were voiced. Despite these concerns, there was broad support for virtual, group-based GDH and general excitement for behavioral health programming. Conclusion Virtual, group-based GDH is an acceptable treatment for patients from rural and urban settings. Given the possible improvements in access and cost-effectiveness that this treatment modality can provide, GI practices may want to consider it in lieu of or in addition to the traditional one-on-one treatment format. Barriers and facilitators and recommendations for practice are discussed.
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Affiliation(s)
- Jessica Gerson
- Division of Gastroenterology, Inflammatory Bowel Disease Center, New York University (NYU) Langone Health, New York, NY, United States
| | - Prianca Tawde
- The Geisel School of Medicine at Dartmouth, Lebanon, NH, United States
| | - Ghoncheh Ghiasian
- Division of Gastroenterology, Inflammatory Bowel Disease Center, New York University (NYU) Langone Health, New York, NY, United States
| | - Jessica K Salwen-Deremer
- Departments of Psychiatry and Medicine, Dartmouth Hitchcock Medical Center, Lebanon, NH, United States
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30
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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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van Kessel K, de Pont S, Gasteiger C, Goedeke S. Clients' experiences of online therapy in the early stages of a COVID‐19 world: A scoping review. COUNSELLING & PSYCHOTHERAPY RESEARCH 2022. [DOI: 10.1002/capr.12610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- Kirsten van Kessel
- Department of Psychology and Neuroscience Auckland University of Technology Auckland New Zealand
| | - Sarita de Pont
- Department of Psychology and Neuroscience Auckland University of Technology Auckland New Zealand
| | - Chiara Gasteiger
- Department of Psychology and Neuroscience Auckland University of Technology Auckland New Zealand
- Department of Psychological Medicine, Faculty of Medical and Health Sciences University of Auckland Auckland New Zealand
| | - Sonja Goedeke
- Department of Psychology and Neuroscience Auckland University of Technology Auckland New Zealand
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Rains LS, Dalton-Locke C, Landau S, Needle JJ, Johnson S. Variations in the uptake of telemental health technologies in community and crisis mental health services during the early pandemic: a survey of mental health professionals in the UK. BMC Psychiatry 2022; 22:776. [PMID: 36494646 PMCID: PMC9733196 DOI: 10.1186/s12888-022-04385-1] [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: 06/06/2022] [Accepted: 11/11/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND One of the many challenges faced by mental health services during the COVID-19 pandemic was how to deliver care during lockdown. In community and crisis services, this often meant rapidly adopting or expanding the use of telemental health technologies, including phone and video calls. The aim of this study is to explore variations in use and report staff views of such technologies during the early stages of the pandemic. The primary analysis compared rates of use between professions, demographic groups, genders, regions, and crisis and community services. METHODS We used data from an online survey conducted by the Mental Health Policy Research Unit in Spring 2020 regarding the impact of the pandemic on mental healthcare in the United Kingdom. We included quantitative data from all professional groups working in community or crisis services providing care to working age adults, including general and specialist services. Our outcome of interest was the percentage of clients whom clinicians primarily interacted with via videocall. We also collected demographics and professional characteristics such as the type of mental health service respondents worked in. In addition, we explored respondents' views and experiences of telemental health as a medium for providing care. RESULTS 978 participants were included in the primary analysis (834 provided outcome data for community services, 193 for crisis services). In community services, virtually all staff reported stopping some or all face-to-face appointments following the onset of the pandemic, with a large majority using video or phone call appointments where possible instead. Telemental health use was higher in community than in crisis services, and amongst professionals who mainly provided psychotherapy or peer support than in other groups. There was also evidence of use being lower in regions in Northern England, Scotland, and Wales than elsewhere. There was no evidence of an association with staff gender, age, or ethnicity. Staff were generally positive about telemental health and intended to make more use of technologies following the pandemic. However, significant barriers to its use were also reported, often involving skills and available infrastructure. CONCLUSIONS Despite its rapid implementation, telemental health was viewed positively by clinicians who saw it as an effective alternative to face-to-face appointments in some contexts, including during the pandemic. However, adoption of the technology also has the potential to exacerbate existing or create new inequalities without effective management of training and infrastructure needs.
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Affiliation(s)
- Luke Sheridan Rains
- Division of Psychiatry, NIHR Mental Health Policy Research Unit, University College London, London, UK.
| | - Christian Dalton-Locke
- grid.83440.3b0000000121901201Division of Psychiatry, NIHR Mental Health Policy Research Unit, University College London, London, UK
| | - Sabine Landau
- grid.13097.3c0000 0001 2322 6764Department of Biostatistics and Health Informatics, NIHR Mental Health Policy Research Unit, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Justin J. Needle
- grid.4464.20000 0001 2161 2573Centre for Health Services Research, School of Health Sciences, City, University of London, London, UK
| | - Sonia Johnson
- grid.83440.3b0000000121901201Division of Psychiatry, NIHR Mental Health Policy Research Unit, University College London, London, UK ,grid.450564.60000 0000 8609 9937Camden and Islington NHS Foundation Trust, London, UK
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Church D, Stapleton P, Vasudevan A, O'Keefe T. Clinical EFT as an evidence-based practice for the treatment of psychological and physiological conditions: A systematic review. Front Psychol 2022; 13:951451. [PMID: 36438382 PMCID: PMC9692186 DOI: 10.3389/fpsyg.2022.951451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 09/15/2022] [Indexed: 11/13/2022] Open
Abstract
Background Since the turn of the century, Emotional Freedom Techniques (EFT) has come into widespread use in medical and psychological treatment settings. It is also used as self-help by tens of millions of people each year. Clinical EFT, the manualized form of the method, has been validated as an "evidence-based" practice using criteria published by the American Psychological Association (APA) Division 12 Task Force on Empirically Validated Therapies. Its three essential ingredients are exposure, cognitive framing, and acupressure. Objectives In 2013 we published a paper defining Clinical EFT and reviewing published research. It has been viewed or downloaded over 36,000 times, indicating widespread interest in this treatment modality. Here we update our findings based on subsequently published literature and propose directions for future research. Method We performed a systematic review of the literature to identify randomized controlled trials (RCTs) and meta-analyses. Retrieval of 4,167 results resulted in the identification of 56 RCTs (n = 2,013), 41 of which were published subsequent to our earlier review, as well as eight meta-analyses. Results RCTs have found EFT treatment to be effective for (a) psychological conditions such as anxiety, depression, phobias, and posttraumatic stress disorder (PTSD); (b) physiological issues such as pain, insomnia, and autoimmune conditions; (c) professional and sports performance; and (d) biological markers of stress. Meta-analyses evaluating the effect of EFT treatment have found it to be "moderate" to "large." Successful independent replication studies have been carried out for anxiety, depression, PTSD, phobias, sports performance, and cortisol levels. We outline the next steps in EFT research. These include determining its impact on cancer, heart disease, diabetes, and cognitive impairment; analysis of the large-scale datasets made possible by mobile apps; and delivery through channels such as virtual practitioner sessions, artificial intelligence agents, online courses, apps, virtual reality platforms, and standardized group therapy. Conclusions Subsequent research has confirmed the conclusions of earlier studies. These find Clinical EFT to be efficacious for a range of psychological and physiological conditions. Comparatively few treatment sessions are required, treatment is effective whether delivered in person or virtually, and symptom improvements persist over time. Treatment is associated with measurable biological effects in the dimensions of gene expression, brain synchrony, hormonal synthesis, and a wide range of biomarkers. Clinical EFT is a stable and mature method with an extensive evidence base. Its use in primary care settings as a safe, rapid, reliable, and effective treatment for both psychological and medical diagnoses continues to grow.
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Affiliation(s)
- Dawson Church
- National Institute for Integrative Healthcare, Petaluma, CA, United States
| | - Peta Stapleton
- Department of Society and Design, Bond University, Gold Coast, QLD, Australia
| | - Anitha Vasudevan
- National Institute for Integrative Healthcare, Petaluma, CA, United States
| | - Tom O'Keefe
- Department of Society and Design, Bond University, Gold Coast, QLD, Australia
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Wu MS, Chen SY, Wickham RE, Leykin Y, Varra A, Chen C, Lungu A. Predicting non-initiation of care and dropout in a blended care CBT intervention: Impact of early digital engagement, sociodemographic, and clinical factors. Digit Health 2022; 8:20552076221133760. [PMID: 36312847 PMCID: PMC9608016 DOI: 10.1177/20552076221133760] [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: 03/02/2022] [Accepted: 09/13/2022] [Indexed: 11/05/2022] Open
Abstract
Objective This study examines predictors of non-initiation of care and dropout in a blended care CBT intervention, with a focus on early digital engagement and sociodemographic and clinical factors. Methods This retrospective cohort analysis included 3566 US-based individuals who presented with clinical levels of anxiety and depression and enrolled in a blended-care CBT (BC-CBT) program. The treatment program consisted of face-to-face therapy sessions via videoconference and provider-assigned digital activities that were personalized to the client's presentation. Multinomial logistic regression and Cox proportional hazard survival analysis were used to identify predictors of an increased likelihood of non-initiation of therapy and dropout. Results Individuals were more likely to cancel and/or no-show to their first therapy session if they were female, did not disclose their ethnicity, reported poor financial status, did not have a college degree, endorsed more presenting issues during the onboarding triage assessment, reported taking antidepressants, and had a longer wait time to their first appointment. Of those who started care, clients were significantly more likely to drop out if they did not complete the digital activities assigned by their provider early in treatment, were female, reported more severe depressive symptoms at baseline, reported taking antidepressants, and did not disclose their ethnicity. Conclusions Various sociodemographic and clinical predictors emerged for both non-initiation of care and for dropout, suggesting that clients with these characteristics may benefit from additional attention and support (especially those with poor early digital engagement). Future research areas include targeted mitigation efforts to improve initiation rates and curb dropout.
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Affiliation(s)
- Monica S. Wu
- Lyra Health, Burlingame, USA
- Monica S. Wu, Lyra Health, 287 Lorton Ave, Burlingame, CA, 94010, USA.
| | | | - Robert E. Wickham
- Department of Psychological Sciences, Northern Arizona University, Flagstaff, USA
- Department of Psychology, Palo Alto University, Palo Alto, USA
| | - Yan Leykin
- Department of Psychology, Palo Alto University, Palo Alto, USA
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Palmer CS, Brown Levey SM, Kostiuk M, Zisner AR, Tolle LW, Richey RM, Callan S. Virtual Care for Behavioral Health Conditions. Prim Care 2022; 49:641-657. [PMID: 36357068 PMCID: PMC9581698 DOI: 10.1016/j.pop.2022.04.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Christina S. Palmer
- Department of Family Medicine, University of Colorado School of Medicine,Corresponding author
| | | | | | - Aimee R. Zisner
- Department of Family Medicine, University of Colorado School of Medicine
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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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Patients' experiences of home-based psychotherapy via videoconference: A qualitative study. Arch Psychiatr Nurs 2022; 39:91-96. [PMID: 35688550 DOI: 10.1016/j.apnu.2022.03.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 01/09/2022] [Accepted: 03/08/2022] [Indexed: 11/21/2022]
Abstract
The aim of this study is to explore adult outpatients' experiences with home-based psychotherapy via videoconferencing in a Danish mental health service. Participants found videoconferencing-based psychotherapy for preventive relapse sessions very useful, and they believed that it was possible to maintain a good therapeutic relationship via videoconferencing when they knew their therapist in advance. However, experiences with more in-depth psychotherapy are more unclear as some felt alienated and preferred other ways to communicate. In general, participants found videoconferencing-based psychotherapy to be less personal but worth considering when travel hassles outweigh the need for meeting in person.
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Feasibility and Benefit of Cognitive Behavioural Therapy for Psychosis via Teleconsultation in Indonesia: A Case Study of a 40-Year-Old Schizoaffective Disorder Patient. BEHAVIOUR CHANGE 2022. [DOI: 10.1017/bec.2022.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Abstract
Whilst Cognitive Behavioural Therapy for Psychosis (CBTp) has been found to reduce psychotic symptoms, most evidence supporting its implementation originates from studies in Western and high-income countries. Furthermore, questions remain regarding the efficacy of CBTp conducted via teleconsultation. Herein we report an ongoing case in Indonesia involving an individual with schizoaffective disorder, who received 60 sessions of CBTp over seven months. Sessions were delivered via a combination of voice and video calls. The patient, a 40-year-old male, was diagnosed with schizoaffective disorder at the age of 26. He exhibited symptoms of paranoid and religious delusions, hallucinations (auditory, visual, and somatic) and disorganised speech during our intake interview. Negative symptoms were not apparent. In the 14 years prior to our initial consultation, the patient was prescribed antipsychotics and demonstrated good adherence. He had no history of psychotherapy independent of our clinic. Treatment involved CBTp techniques, including psychoeducation, a symptom diary, relaxation, and behavioural experiments. Study outcome was assessed with Psychotic Symptom Rating Scales. Both hallucination and delusion subscale scores improved 53% from 53 at intake to 25 during an assessment administered 6 months later. Results from this study demonstrate that the CBTp is both feasible, and beneficial, when conducted via teleconsultation in Indonesia.
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Schmeckenbecher J, Rattner K, Cramer RJ, Plener PL, Baran A, Kapusta ND. Effectiveness of distance-based suicide interventions: multi-level meta-analysis and systematic review. BJPsych Open 2022; 8:e140. [PMID: 35861112 PMCID: PMC9345623 DOI: 10.1192/bjo.2022.526] [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] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The use of distance-based interventions (DBIs) to reduce suicidal ideation and behaviours are an increasingly relevant form of intervention. DBIs are more affordable, scalable and available than traditional face-to-face interventions, helping to narrow the gap between needed and provided care. AIMS To evaluate the overall effectiveness of DBIs against suicidal ideation and behaviours. METHOD We systematically searched Web of Science, Scopus and PubMed for all DBIs primarily aimed at reducing suicidal ideation and behaviours. Data were analysed with a robust variance estimation corrected, multi-level meta-analysis. RESULTS We found 38 studies, reporting 110 outcomes. Effectiveness in reducing suicidal ideation was low (standardised mean difference -0.174, 95% CI -0.238 to -0.110). DBIs were significantly less effective against suicidal behaviours than against suicidal ideation, although still effective (standardised mean difference -0.059, 95% CI -0.087 to -0.032). Human involvement had no significant effect on effectiveness. CONCLUSIONS Despite low effectiveness, DBIs might play a role in large-scale prevention efforts against suicidal ideation within a stepped care approach. Further, DBIs may be helpful in expanding mental health services in low- and middle-income countries with otherwise limited access to mental healthcare. Although the evidence for DBIs efficacy is well grounded, the technical and scientific evaluation of DBIs regarding their set up, functionality and components needs to be addressed in future studies.
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Affiliation(s)
- Jim Schmeckenbecher
- Department of Psychoanalysis and Psychotherapy, Medical University Vienna, Austria
| | - Katrin Rattner
- Clinic for Psychiatry and Psychotherapy, kbo-Inn-Salzach-Klinikum, Freilassing, Germany
| | - Robert J Cramer
- Department of Public Health Sciences, University of North Carolina at Charlotte, North Carolina, USA
| | - Paul L Plener
- Department of Child and Adolescent Psychiatry, Medical University Vienna, Austria; and Department of Child and Adolescent Psychiatry and Psychotherapy, University of Ulm, Germany
| | - Anna Baran
- Department of Medicine and Optometry, Faculty of Health and Life Sciences, Linnaeus University, Sweden; and Department of Psychiatry, Blekinge Hospital, Sweden
| | - Nestor D Kapusta
- Department of Psychoanalysis and Psychotherapy, Medical University Vienna, Austria
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Provider perceptions of telehealth and in-person exposure and response prevention for obsessive-compulsive disorder. Psychiatry Res 2022; 313:114610. [PMID: 35567851 PMCID: PMC9910090 DOI: 10.1016/j.psychres.2022.114610] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 05/04/2022] [Accepted: 05/06/2022] [Indexed: 01/27/2023]
Abstract
Until recently, psychotherapies, including exposure and response prevention (ERP) for obsessive-compulsive disorder (OCD), have primarily been delivered in-person. The COVID-19 pandemic required OCD providers delivering ERP to quickly transition to telehealth services. While evidence supports telehealth ERP delivery, limited research has examined OCD provider perceptions about patient characteristics that are most appropriate for this modality, as well as provider abilities to identify and address factors interfering with effective telehealth ERP. In the present study, OCD therapists (N = 113) rated the feasibility of delivering telehealth ERP relative to in-person for different (1) patient age-groups, (2) levels of OCD severity, and (3) provider ability to identify and address factors interfering with ERP during in-person and telehealth ERP (e.g., cognitive avoidance, reassurance seeking, etc.). Providers reported significantly greater feasibility of delivering telehealth ERP to individuals ages 13-to-65-years relative to other age groups assessed. Greater perceived feasibility for telehealth relative to in-person ERP was reported for lower versus higher symptom severity levels. Lastly, providers felt better able to identify and address problematic factors in-person. These findings suggest that providers should practice appropriate caution when offering telehealth ERP for certain patients with OCD. Future research may examine how to address these potential limitations of telehealth ERP delivery.
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Grondin F, Lomanowska AM, Poiré V, Jackson PL. Clients in Simulated Teletherapy via Videoconference Compensate for Altered Eye Contact When Evaluating Therapist Empathy. J Clin Med 2022; 11:3461. [PMID: 35743531 PMCID: PMC9224913 DOI: 10.3390/jcm11123461] [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: 03/10/2022] [Revised: 06/08/2022] [Accepted: 06/14/2022] [Indexed: 12/04/2022] Open
Abstract
Eye contact is frequently associated with an increased perception of empathy and telepresence, but the currently used videoconferencing (VC) technologies diminish the possibility of naturally conveying eye contact. This study compared the empathy, telepresence, and eye gaze patterns of clients in simulated VC teletherapy sessions where eye contact was altered or facilitated. Forty-two would-be clients met with one of four therapists in training for one 20-min simulated teletherapy session taking place via VC. The session either altered or facilitated eye contact perception by manipulating the positioning of the webcams and of the clients in their chair. Eye-tracking data focusing on the eyes, face, and general body regions of interest were obtained for 25 clients. The results show that facilitating eye contact in VC did not increase the clients' perceptions of empathy or telepresence. However, empathy was associated with greater time spent looking at the eyes and faces of the therapists, but only in the sessions facilitating eye contact. We suggest that clients successfully rely on other verbal and nonverbal cues to detect therapist empathy when eye contact is altered in teletherapy sessions.
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Affiliation(s)
- Frédéric Grondin
- École de Psychologie, Université Laval, 2325 All. des Bibliothèques, Québec City, QC G1V 0A6, Canada; (F.G.); (V.P.)
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (Cirris), 525 Wilfrid-Hamel Blvd, Québec City, QC G1M 2S8, Canada
- CERVO Brain Research Center, 2601 Chem. de la Canardière, Québec City, QC G1J 2G3, Canada
| | - Anna M. Lomanowska
- Transitional Pain Service, Toronto General Hospital, University Health Network, 200 Elizabeth St., Toronto, ON M5G 2C4, Canada;
| | - Vincent Poiré
- École de Psychologie, Université Laval, 2325 All. des Bibliothèques, Québec City, QC G1V 0A6, Canada; (F.G.); (V.P.)
| | - Philip L. Jackson
- École de Psychologie, Université Laval, 2325 All. des Bibliothèques, Québec City, QC G1V 0A6, Canada; (F.G.); (V.P.)
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (Cirris), 525 Wilfrid-Hamel Blvd, Québec City, QC G1M 2S8, Canada
- CERVO Brain Research Center, 2601 Chem. de la Canardière, Québec City, QC G1J 2G3, Canada
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Leuchtenberg S, Gromer D, Käthner I. Videoconferencing versus
face‐to‐face
psychotherapy: Insights from patients and psychotherapists about comparability of therapeutic alliance, empathy and treatment characteristics. COUNSELLING & PSYCHOTHERAPY RESEARCH 2022. [DOI: 10.1002/capr.12538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Sophie Leuchtenberg
- Department of Psychology I, Biological Psychology, Clinical Psychology and Psychotherapy University of Würzburg Würzburg Germany
| | - Daniel Gromer
- Department of Psychology I, Biological Psychology, Clinical Psychology and Psychotherapy University of Würzburg Würzburg Germany
| | - Ivo Käthner
- Department of Psychology I, Biological Psychology, Clinical Psychology and Psychotherapy University of Würzburg Würzburg Germany
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Cuthbert K, Parsons EM, Smith L, Otto MW. Acceptability of telehealth CBT during the time of COVID-19: Evidence from patient treatment initiation and attendance records. JOURNAL OF BEHAVIORAL AND COGNITIVE THERAPY 2022; 32:67-72. [PMID: 35018352 PMCID: PMC8739019 DOI: 10.1016/j.jbct.2022.01.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 12/31/2021] [Accepted: 01/03/2022] [Indexed: 05/22/2023]
Abstract
The COVID-19 pandemic provided unique conditions for examining outpatient psychotherapy clinics' rapid transition to telehealth. The current study utilized data from a large, specialty CBT clinic to investigate attendance and treatment engagement changes when services were provided via telehealth versus in-person. Results indicate that, following a complete transition to telehealth services, clinic referrals were maintained. Further, telehealth treatment appeared to be entirely acceptable as assessed by a decreased missed visit rate of telehealth appointments compared to in-person appointments. Given the elimination of commuting times, telehealth has the potential to address disparities in care linked to physical distance from the clinic and/or differential ability to take time off work for appointments.
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Affiliation(s)
- Kristy Cuthbert
- Department of Psychological and Brain Sciences, Boston University, 900 Commonwealth Avenue, Floor 2, Boston, MA 02215, USA
| | - E Marie Parsons
- Department of Psychological and Brain Sciences, Boston University, 900 Commonwealth Avenue, Floor 2, Boston, MA 02215, USA
| | - Lisa Smith
- Department of Psychological and Brain Sciences, Boston University, 900 Commonwealth Avenue, Floor 2, Boston, MA 02215, USA
| | - Michael W Otto
- Department of Psychological and Brain Sciences, Boston University, 900 Commonwealth Avenue, Floor 2, Boston, MA 02215, USA
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van Kessel R, Wong BLH, Clemens T, Brand H. Digital health literacy as a super determinant of health: More than simply the sum of its parts. Internet Interv 2022; 27:100500. [PMID: 35242586 PMCID: PMC8861384 DOI: 10.1016/j.invent.2022.100500] [Citation(s) in RCA: 59] [Impact Index Per Article: 29.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 01/25/2022] [Accepted: 02/02/2022] [Indexed: 11/23/2022] Open
Abstract
•Civic literacy refers to the ability to engage meaningfully with one's community.•Digital, health, and civic literacy are key predictors for digital health literacy.•The extent to which these three affect digital health literacy remains unclear.•Building digital health literacy is vital to limit inequalities from expanding.
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Affiliation(s)
- Robin van Kessel
- Department of International Health, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, the Netherlands
- Studio Europa, Maastricht University, the Netherlands
- Research Committee, Global Health Workforce Network (GHWN) Youth Hub, World Health Organization, Switzerland
| | - Brian Li Han Wong
- Research Committee, Global Health Workforce Network (GHWN) Youth Hub, World Health Organization, Switzerland
- The Lancet and Financial Times Commission on Governing Health Futures 2030: Growing up in a digital world, Global Health Centre, The Graduate Institute, Geneva, Switzerland
- Digital Health Section, European Public Health Association (EUPHA), Utrecht, the Netherlands
| | - Timo Clemens
- Department of International Health, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, the Netherlands
| | - Helmut Brand
- Department of International Health, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, the Netherlands
- Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, Karna-taka, India
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Abstract
This article draws on research and clinical experience to discuss how and when to use video consultations in mental health settings. The appropriateness and impact of virtual consultations are influenced by the patient's clinical needs and social context, as well as by service-level socio-technical and logistical factors.
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Affiliation(s)
- Trisha Greenhalgh
- Nuffield Department of Primary Care Health Sciences, University of Oxford, UK
| | - Joseph Wherton
- Nuffield Department of Primary Care Health Sciences, University of Oxford, UK
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Kornfield SL, Johnson RL, Hantsoo LV, Kaminsky RB, Waller R, Sammel M, Epperson CN. Engagement in and Benefits of a Short-Term, Brief Psychotherapy Intervention for PTSD During Pregnancy. Front Psychiatry 2022; 13:882429. [PMID: 35782453 PMCID: PMC9240269 DOI: 10.3389/fpsyt.2022.882429] [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: 02/23/2022] [Accepted: 05/09/2022] [Indexed: 11/26/2022] Open
Abstract
Trauma-related symptoms and post-traumatic stress disorder (PTSD) are common during pregnancy and have adverse effects on pregnancy and birth outcomes, post-partum maternal mental health, and child development. The arousal symptoms associated with PTSD, including heightened or dysregulated physiology, may contribute to these adverse outcomes. Low-income minoritized women may be at highest risk given more lifetime exposure to trauma and limited access to mental health care. While evidence-based psychotherapies for PTSD exist, none are targeted to non-treatment seeking individuals nor specifically integrated with prenatal care. Thus, we developed and tested the efficacy of a short-term (four sessions) brief (30-45 min) psychotherapeutic intervention designed to address PTSD symptoms in pregnant women receiving prenatal care at two urban medical centers. Participants were 32 pregnant women with an average gestational age of 18.5 weeks at the time of enrollment. The sample was overwhelmingly non-Caucasian, single, and reported very low income. Participants completed measures of trauma-related symptoms (Post-traumatic Stress Disorder Checklist, PCL), and depression (Edinburgh post-natal Depression Scale, EPDS) at baseline, twice during treatment, post-treatment, and at 10-14 weeks post-partum. The intervention was successful at significantly decreasing symptoms of PTSD (PCL score = -20.27, 95% CI: -25.62, -14.92, P < 0.001, W = -7.43) and depression (EPDS score = -4.81, 95% CI: -7.55, -2.06, P = 0.001, W = -3.23) by the final session. These benefits were sustained at post-treatment and post-partum follow ups. Future research should further explore the effectiveness of this treatment in a randomized controlled trial.
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Affiliation(s)
- Sara L Kornfield
- Penn Center for Women's Behavioral Wellness, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Rachel L Johnson
- Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado, Denver, CO, United States
| | - Liisa V Hantsoo
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Johns Hopkins Medicine, Baltimore, MD, United States
| | - Rachel B Kaminsky
- Penn Center for Women's Behavioral Wellness, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Rebecca Waller
- Psychology Department, University of Pennsylvania, Philadelphia, PA, United States
| | - Mary Sammel
- Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado, Denver, CO, United States.,Department of Psychiatry, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - C Neill Epperson
- Department of Psychiatry, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States.,Department of Family Medicine, School of Medicine, University of Colorado, Aurora, CO, United States
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Wu MS, Wickham RE, Chen SY, Chen C, Lungu A. Examining the Impact of Digital Components Across Different Phases of Treatment in a Blended Care Cognitive Behavioral Therapy Intervention for Depression and Anxiety: Pragmatic Retrospective Study. JMIR Form Res 2021; 5:e33452. [PMID: 34927591 PMCID: PMC8726023 DOI: 10.2196/33452] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 11/21/2021] [Indexed: 01/29/2023] Open
Abstract
Background Depression and anxiety incur significant personal and societal costs. Effective psychotherapies exist, such as cognitive behavioral therapy (CBT); however, timely access to quality care is limited by myriad barriers. Blended care therapy models incorporate traditional face-to-face therapy with scalable, digital components of care, expanding the reach of evidence-based care. Objective The aim of this study is to determine the effectiveness of a blended care CBT program (BC-CBT) in real-world settings and examine the unique impacts of the (1) digital components of care (video lessons and digital exercises) and (2) phase of treatment (early versus late) in decreasing symptoms of anxiety and depression. Methods This retrospective cohort analysis included 3401 US-based individuals enrolled in a BC-CBT program, who presented with clinical levels of depression and/or anxiety. The treatment program consisted of regular therapy sessions augmented by clinician-assigned digital video lessons and exercises. A growth curve model incorporating time-varying covariates examined the relationship between engagement with BCT components (ie, therapy sessions, digital video lessons, and digital exercises) during the early (weeks 0-7) and late (weeks 8-15) phases of treatment, and weekly symptom reports on depression and anxiety measures. Results On average, a significant decline in depression and anxiety symptoms was observed during the initial weeks of treatment (P<.001), with a continued, though slower, decline over subsequent weeks (P<.001). Each session completed was associated with significant decreases in anxiety (b=–0.72) and depression (b=–0.83) in the early phase, as well as in the late phase (anxiety, b=–0.47; depression, b=–0.27). Significant decreases in anxiety (b=–0.15) and depression (b=–0.12) were observed for time spent on video lessons (measured in 10-minute intervals) in the early phase of treatment. Engaging with exercises was associated with statistically significant increases in anxiety symptoms (b=0.03) during the early phase of treatment. However, sensitivity analyses examining the effects of exercises in isolation revealed significant decreases in anxiety (b=–0.05) in the early phase, suggesting a potential suppression effect in the larger model. Conclusions Using a retrospective cohort design, therapy sessions and digital video lessons were uniquely predictive of improvements in depression and anxiety symptoms, and their effects were modulated based on the phase of treatment (early vs late). Future research should investigate whether other treatment variables, such as therapeutic alliance or familiarity with technology, are related to differential effects on various components of care.
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Affiliation(s)
| | - Robert E Wickham
- Department of Psychological Sciences, Northern Arizona University, Flagstaff, AZ, United States.,Department of Psychology, Palo Alto University, Palo Alto, CA, United States
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Rebooting Mental Health Care Delivery for the COVID-19 Pandemic (and Beyond): Guiding Cautions as Telehealth Enters the Clinical Mainstream. COGNITIVE AND BEHAVIORAL PRACTICE 2021; 28:743-748. [PMID: 34566394 PMCID: PMC8452354 DOI: 10.1016/j.cbpra.2021.09.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 09/15/2021] [Indexed: 12/12/2022]
Abstract
Across the COVID-19 pandemic, we have witnessed perhaps the field’s largest and most abrupt transformation in scope of practice. In the context of surging mental health needs and historically limited feasibility of traditional office-based services during the pandemic, telehealth has launched into the clinical mainstream and has become a dominant mode of outpatient mental health care delivery. The articles in this terrific Special Issue outline some of the field’s most exciting innovations from the past 18 months. The present commentary discusses how these unprecedented times have prompted unprecedented resourcefulness and innovation in the field. Issues related to evolving and uncertain telehealth regulation and reimbursement policies are discussed, and cautions for the road ahead are offered as we prepare for post-pandemic practices. The commentary concludes with a call to redouble efforts to move beyond the use of telehealth to largely treat only those populations who already enjoyed access to traditional office-based services. Understanding and overcoming barriers to telehealth care and ensuring equitable access to telehealth options are critical steps for actualizing the great potential of telehealth strategies for increasing the reach of supported care to underserved populations.
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Gega L, Aboujaoude E. How Digital Technology Mediated the Effects of the COVID-19 Pandemic on Mental Health: The Good, the Bad, and the Indifferent. Front Digit Health 2021; 3:733151. [PMID: 34713202 PMCID: PMC8521901 DOI: 10.3389/fdgth.2021.733151] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 08/23/2021] [Indexed: 11/23/2022] Open
Affiliation(s)
- Lina Gega
- Department of Health Sciences & Hull York Medical School, University of York, York, United Kingdom
| | - Elias Aboujaoude
- Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, United States
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Kozlov E, McDarby M, Prescott M, Altman M. Assessing the Care Modality Preferences and Predictors for Digital Mental Health Treatment Seekers in a Technology-enabled Stepped Care Delivery System: Cross-sectional Study. JMIR Form Res 2021; 5:e30162. [PMID: 34343965 PMCID: PMC8482163 DOI: 10.2196/30162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 06/21/2021] [Accepted: 08/01/2021] [Indexed: 11/26/2022] Open
Abstract
Background Access to mental health services continues to be a systemic problem in the United States and around the world owing to a variety of barriers including the limited availability of skilled providers and lack of mental health literacy among patients. Individuals seeking mental health treatment may not be aware of the multiple modalities of digital mental health care available to address their problems (eg, self-guided and group modalities, or one-to-one care with a provider). In fact, one-to-one, in-person treatment is the dominant care model with a masters- or doctoral-level trained mental health provider, and it may or may not be the appropriate or preferred level of care for an individual. Technology-enabled mental health platforms may be one way to improve access to mental health care by offering stepped care, but more research is needed to understand the care modality preferences of digital mental health care seekers because additional modalities become increasingly validated as effective treatment options. Objective The purpose of this study was to describe and evaluate the predictors of care modality preferences among individuals enrolled in a technology-enabled stepped mental health care platform. Methods This exploratory, cross-sectional study used employee data from the 2021 Modern Health database, an employer-sponsored mental health benefit that uses a technology-enabled platform to optimize digital mental health care delivery. Chi-square tests and one-way analysis of variance (ANOVA) were conducted to evaluate associations among the categorical and continuous factors of interest and the preferred care modality. Bivariate logistic regression models were constructed to estimate the odds ratios (ORs) of preferring a one-on-one versus self-guided group, or no preference for digital mental health care modalities. Results Data were analyzed for 3661 employees. The most common modality preference was one-on-one care (1613/3661, 44.06%). Approximately one-fourth of the digital mental health care seekers (881/3661, 24.06%) expressed a preference for pursuing self-guided care, and others (294/3661, 8.03%) expressed a preference for group care. The ORs indicated that individuals aged 45 years and above were significantly more likely to express a preference for self-guided care compared to individuals aged between 18 and 24 years (OR 2.47, 95% CI 1.70-3.59; P<.001). Individuals screening positive for anxiety (OR 0.73, 95% CI 0.62-0.86; P<.001) or depression (OR 0.79, 95% CI 0.66-0.95; P=.02) were more likely to prefer one-on-one care. Conclusions Our findings elucidated that care modality preferences vary and are related to clinical severity factors and demographic variables among individuals seeking digital mental health care.
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Affiliation(s)
- Elissa Kozlov
- Institute for Health, Health Policy and Aging Research, School of Public Health, Rutgers University, New Brunswick, US
| | - Meghan McDarby
- Department of Psychological and Brain Sciences, Washington University in St. Louis, St. Louis, US
| | - Maximo Prescott
- Modern Life, Inc., 450 Sansome St, 12th Floor, San Francisco, US
| | - Myra Altman
- Modern Life, Inc., 450 Sansome St, 12th Floor, San Francisco, US.,Clinical Excellence Research Center, Stanford University, Stanford, US
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