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Pusnik A, Hartzler B, Vjorn O, Rutkowski BA, Chaple M, Becker S, Freese T, Nichols M, Molfenter T. Comparison of Use Rates of Telehealth Services for Substance Use Disorder During and Following COVID-19 Safety Distancing Recommendations: Two Cross-Sectional Surveys. JMIR Ment Health 2024; 11:e52363. [PMID: 39136186 PMCID: PMC11331268 DOI: 10.2196/52363] [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: 09/15/2023] [Revised: 05/29/2024] [Accepted: 06/07/2024] [Indexed: 08/21/2024] Open
Abstract
Background The COVID-19 social distancing guidelines resulted in a dramatic transition to telephone and video technologies to deliver substance use disorder (SUD) treatment. Before COVID-19, the question was "Will telehealth ever take hold for SUD services?" Now that social distancing guidelines have been lifted, the question is "Will telehealth remain a commonly used care modality?" Objective The principal purpose of this investigation was to examine the extent to which telehealth use in SUD service settings persisted following the lifting of COVID-19 safety distancing recommendations. Additionally, the study aimed to explore practitioners' perceptions of telehealth convenience and value after its regular implementation during the pandemic. Specifically, the goal of this study was to compare telehealth activity between time intervals: May-August 2020 (during peak COVID-19 safety distancing recommendations) and October-December 2022 (following discontinuation of distancing recommendations). Specifically, we compared (1) telehealth technologies and services, (2) perceived usefulness of telehealth, (3) ease of use of telephone- and video-based telehealth services, and (4) organizational readiness to use telehealth. Methods An online cross-sectional survey consisting of 108 items was conducted to measure the use of telehealth technologies for delivering a specific set of SUD services in the United States and to explore the perceived readiness for use and satisfaction with telephonic and video services. The survey took approximately 25-35 minutes to complete and used the same 3 sets of questions and 2 theory-driven scales as in a previous cross-sectional survey conducted in 2020. Six of 10 Regional Addiction Technology Transfer Centers funded by the Substance Abuse and Mental Health Services Administration distributed the survey in their respective regions, collectively spanning 37 states. Responses of administrators and clinicians (hereafter referred to as staff) from this 2022 survey were compared to those obtained in the 2020 survey. Responses in 2020 and 2022 were anonymous and comprised two separate samples; therefore, an accurate longitudinal model could not be analyzed. Results A total of 375 staff responded to the 2022 survey (vs 457 in 2020). Baseline organizational characteristics of the 2022 sample were similar to those of the 2020 sample. Phone and video telehealth utilization rates remained greater than 50% in 2022 for screening and assessment, case management, peer recovery support services, and regular outpatient services. The perceived usefulness of phone-based telehealth was higher in 2022 than in 2020 (mean difference [MD] -0.23; P=.002), but not for video-based telehealth (MD -0.12; P=.13). Ease of use of video-based telehealth was perceived as higher in 2022 than in 2020 (MD-0.35; P<.001), but no difference was found for phone-based telehealth (MD -0.12; P=.11). From the staff's perspective, patients had greater readiness for using telehealth via phone than video, but the staff perceived their personal and organizational readiness for using telehealth as greater for video-based than for phone-based telehealth. Conclusions Despite lower telephone and video use in 2022 for telehealth services than in 2020, both modalities continue to be perceived positively. Future research may further determine the relative cost and clinical effectiveness of video-based services and thereby help to address some sources of the noted challenges to implementation by SUD organizations.
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Affiliation(s)
- Adrijana Pusnik
- Center for Health Enhancement Systems Studies (CHESS), Department of Industrial and Systems Engineering, University of Wisconsin-Madison, Madison, WI, United States
| | - Bryan Hartzler
- Addictions, Drug & Alcohol Institute, Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, United States
| | - Olivia Vjorn
- Center for Health Enhancement Systems Studies (CHESS), Department of Industrial and Systems Engineering, University of Wisconsin-Madison, Madison, WI, United States
| | - Beth A Rutkowski
- Integrated Substance Use and Addiction Programs, Division of Addiction Psychiatry, University of California, Los Angeles, Los Angeles, CA, United States
| | - Michael Chaple
- New York State Psychiatric Institute, Division of Substance Use Disorders, Columbia University Irving Medical Center, New York City, NY, United States
| | - Sara Becker
- Center for Dissemination and Implementation Science, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Thomas Freese
- Integrated Substance Use and Addiction Programs, Division of Addiction Psychiatry, University of California, Los Angeles, Los Angeles, CA, United States
| | - Maureen Nichols
- Addiction Research Institute, Steve Hicks School of Social Work, University of Texas at Austin, Austin, TX, United States
| | - Todd Molfenter
- Center for Health Enhancement Systems Studies (CHESS), Department of Industrial and Systems Engineering, University of Wisconsin-Madison, Madison, WI, United States
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Aafjes-van Doorn K, Spina DS, Horne SJ, Békés V. The association between quality of therapeutic alliance and treatment outcomes in teletherapy: A systematic review and meta-analysis. Clin Psychol Rev 2024; 110:102430. [PMID: 38636207 DOI: 10.1016/j.cpr.2024.102430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 11/28/2023] [Accepted: 04/08/2024] [Indexed: 04/20/2024]
Abstract
OBJECTIVE The strength of the therapeutic alliance is widely understood to impact treatment outcomes, however, the alliance-outcome relationship in teletherapy has remained relatively unexamined. The aim of this meta-analysis is to systematically summarize the relationship between therapeutic alliance and treatment outcomes in teletherapy with adult patients conducted via videoconferencing or telephone. METHODS We conducted a systematic search of the databases PsycINFO, PsycARTICLES, ProQuest Dissertation Databases, EMBASE, The Cochrane Library, MEDLINE, Google Scholar, and PubMed for studies published before June 26, 2023. We identified 31 studies with 34 independent samples (4862 participants). RESULTS The average weighted effect size was 0.15, p = .001, 95% CI [0.07, 0.24], k = 34. reflecting a small effect of therapeutic alliance on mental health outcomes. There was significant heterogeneity in the effect sizes, which was driven by between-study differences in the alliance-outcome correlation. The alliance-outcome effect was larger when the alliance was measured late in treatment and when the outcome was measured from the patient's perspective. CONCLUSION Very few teletherapy treatment studies were identified that initially reported on alliance-outcome associations, underlining that this is an under-researched area. The association between alliance-teletherapy outcomes in this meta-analysis was small but significant, and somewhat weaker than the alliance-outcome associations reported for in-person treatments and other online interventions. This might indicate that there are other processes at play in teletherapy that explain variance of treatment outcomes, or that the therapist (and the relationship) has less influence on the treatment outcomes than in in-person therapy.
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Affiliation(s)
| | - Daniel S Spina
- Pennsylvania State University, Psychology Department, PA, USA
| | - Sarah J Horne
- Yeshiva University, Ferkauf Graduate School of Psychology, New York, USA
| | - Vera Békés
- Yeshiva University, Ferkauf Graduate School of Psychology, New York, USA
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Davis KA, Zhao F, Janis RA, Castonguay LG, Hayes JA, Scofield BE. Therapeutic alliance and clinical outcomes in teletherapy and in-person psychotherapy: A noninferiority study during the COVID-19 pandemic. Psychother Res 2024; 34:589-600. [PMID: 37399573 DOI: 10.1080/10503307.2023.2229505] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 06/16/2023] [Accepted: 06/20/2023] [Indexed: 07/05/2023] Open
Abstract
Objective The current study aimed to inform the varied and limited research on clinical variables in the context of teletherapy. Questions remain about the comparative quality of therapeutic alliance and clinical outcome in the context of teletherapy compared to in-person treatment.Methods We utilized a cohort design and a noninferiority statistical approach to study a large, matched sample of clients who reported therapeutic alliance as well as psychological distress before every session as part of routine clinical practice at a university counseling center. A cohort of 479 clients undergoing teletherapy after the emergence of the COVID-19 pandemic was compared to a cohort of 479 clients receiving in-person treatment before the onset of the pandemic. Tests of noninferiority were conducted to investigate the absence of meaningful differences between the two modalities of service delivery. Client characteristics were also examined as moderators of the association between modality and alliance or outcome.Results Clients receiving teletherapy showed noninferior alliance and clinical outcome when compared to clients receiving in-person psychotherapy. A significant main effect on alliance was found with regard to race and ethnicity. A significant main effect on outcome was found with regard to international student status. Significant interactions on alliance were found between cohort and current financial stress.Conclusions Study findings support the continued use of teletherapy by demonstrating commensurate clinical process and outcome. Yet, it will be important for providers to be aware of existing mental health disparities that continue to accompany psychotherapy - in person and via teletherapy. Results and findings are discussed in terms of research and clinical implications. Future directions for researching teletherapy as a viable treatment delivery method are also discussed.
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Affiliation(s)
- Katherine A Davis
- Department of Psychology, The Pennsylvania State University, University Park, PA, USA
| | - Fanghui Zhao
- Department of Educational Psychology, Counseling, and Special Education, The Pennsylvania State University, University Park, PA, USA
| | - Rebecca A Janis
- Counseling and Psychological Services, The Pennsylvania State University, University Park, PA, USA
| | - Louis G Castonguay
- Department of Psychology, The Pennsylvania State University, University Park, PA, USA
| | - Jeffrey A Hayes
- Department of Educational Psychology, Counseling, and Special Education, The Pennsylvania State University, University Park, PA, USA
| | - Brett E Scofield
- Counseling and Psychological Services, The Pennsylvania State University, University Park, PA, USA
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Blair M, Tweedlie L, Minnis H, Cronin I, Turner F. Online therapy with families - what can families tell us about how to do this well? A qualitative study assessing families' experience of remote Dyadic Developmental Psychotherapy compared to face-to-face therapy. PLoS One 2024; 19:e0301640. [PMID: 38626223 PMCID: PMC11020366 DOI: 10.1371/journal.pone.0301640] [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: 08/10/2023] [Accepted: 03/19/2024] [Indexed: 04/18/2024] Open
Abstract
Dyadic Developmental Psychotherapy (DDP) is a family-based therapy for adopted children aiming to achieve secure attachment between the child and parent. Due to restrictions under the COVID-19 pandemic, delivery of DDP transitioned from face-to-face to online methods. This study aimed to explore families experience of online DDP compared to face-to-face DDP, looking at the advantages and disadvantages of remote delivery methods and the implications this has on future service delivery for clinicians. Semi-structured interviews with 6 families were conducted online. Analysis of transcripts using Interpretative Phenomenological Analysis (IPA) revealed four superordinate themes: environment and child engagement, non-verbal communication, travel and familiarity with remote interactions. Parents recognised the influence the physical and online environment had on their child's engagement levels, however, varied in their experience and hence preference of delivery method. All families emphasised the importance of non-verbal communication within DDP sessions and majority highlighted this may be lost online. For families who travelled to face-to-face DDP, car journeys provided a unique opportunity to decompress and reflect after sessions. For families where travel is unfeasible, online DDP was a lifeline, demonstrating the ability of remote therapy to widen access to specialist healthcare. Familiarity with online work emerged as a strong indicator of positive attitudes towards remote DDP, especially if the previous experience is positive and the child is confident using technology. Overall, families differed greatly in their experience of remote and face-to-face DDP indicating a new approach must be undertaken with each family beginning therapy, ensuring it is unique and individual to their needs.
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Affiliation(s)
- Monica Blair
- College of Medical Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Leigh Tweedlie
- College of Medical Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Helen Minnis
- Institute of Health & Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Irene Cronin
- Academic Child and Mental Health Services, University of Glasgow, Glasgow, United Kingdom
| | - Fiona Turner
- Institute of Health & Wellbeing, University of Glasgow, Glasgow, United Kingdom
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Muehlensiepen F, Petit P, Knitza J, Welcker M, Vuillerme N. Prediction of the acceptance of telemedicine among rheumatic patients: a machine learning-powered secondary analysis of German survey data. Rheumatol Int 2024; 44:523-534. [PMID: 38206379 PMCID: PMC10866795 DOI: 10.1007/s00296-023-05518-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 12/06/2023] [Indexed: 01/12/2024]
Abstract
Telemedicine (TM) has augmented healthcare by enabling remote consultations, diagnosis, treatment, and monitoring of patients, thereby improving healthcare access and patient outcomes. However, successful adoption of TM depends on user acceptance, which is influenced by technical, socioeconomic, and health-related factors. Leveraging machine learning (ML) to accurately predict these adoption factors can greatly contribute to the effective utilization of TM in healthcare. The objective of the study was to compare 12 ML algorithms for predicting willingness to use TM (TM try) among patients with rheumatic and musculoskeletal diseases (RMDs) and identify key contributing features. We conducted a secondary analysis of RMD patient data from a German nationwide cross-sectional survey. Twelve ML algorithms, including logistic regression, random forest, extreme gradient boosting (XGBoost), and neural network (deep learning) were tested on a subset of the dataset, with the inclusion of only RMD patients who answered "yes" or "no" to TM try. Nested cross-validation was used for each model. The best-performing model was selected based on area under the receiver operator characteristic (AUROC). For the best-performing model, a multinomial/multiclass ML approach was undertaken with the consideration of the three following classes: "yes", "no", "do not know/not answered". Both one-vs-one and one-vs-rest strategies were considered. The feature importance was investigated using Shapley additive explanation (SHAP). A total of 438 RMD patients were included, with 26.5% of them willing to try TM, 40.6% not willing, and 32.9% undecided (missing answer or "do not know answer"). This dataset was used to train and test ML models. The mean accuracy of the 12 ML models ranged from 0.69 to 0.83, while the mean AUROC ranged from 0.79 to 0.90. The XGBoost model produced better results compared with the other models, with a sensitivity of 70%, specificity of 91% and positive predictive value of 84%. The most important predictors of TM try were the possibility that TM services were offered by a rheumatologist, prior TM knowledge, age, self-reported health status, Internet access at home and type of RMD diseases. For instance, for the yes vs. no classification, not wishing that TM services were offered by a rheumatologist, self-reporting a bad health status and being aged 60-69 years directed the model toward not wanting to try TM. By contrast, having Internet access at home and wishing that TM services were offered by a rheumatologist directed toward TM try. Our findings have significant implications for primary care, in particular for healthcare professionals aiming to implement TM effectively in their clinical routine. By understanding the key factors influencing patients' acceptance of TM, such as their expressed desire for TM services provided by a rheumatologist, self-reported health status, availability of home Internet access, and age, healthcare professionals can tailor their strategies to maximize the adoption and utilization of TM, ultimately improving healthcare outcomes for RMD patients. Our findings are of high interest for both clinical and medical teaching practice to fit changing health needs caused by the growing number of complex and chronically ill patients.
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Affiliation(s)
- Felix Muehlensiepen
- Univ. Grenoble Alpes, AGEIS, 38000, Grenoble, France.
- Faculty of Health Sciences Brandenburg, Center for Health Services Research, Brandenburg Medical School Theodor Fontane, Seebad 82/83, 15562, Rüdersdorf bei Berlin, Germany.
| | - Pascal Petit
- Univ. Grenoble Alpes, AGEIS, 38000, Grenoble, France
| | - Johannes Knitza
- Univ. Grenoble Alpes, AGEIS, 38000, Grenoble, France
- Institute for Digital Medicine, University Hospital of Giessen and Marburg, Philipps-University Marburg, Marburg, Germany
| | - Martin Welcker
- Medizinisches Versorgungszentrum für Rheumatologie Dr M Welcker GmbH, Planegg, Germany
| | - Nicolas Vuillerme
- Univ. Grenoble Alpes, AGEIS, 38000, Grenoble, France
- Institut Universitaire de France, Paris, France
- LabCom Telecom4Health, Orange Labs & Univ. Grenoble Alpes, CNRS, Inria, Grenoble INP-UGA, Grenoble, France
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Moudatsou M, Stavropoulou A, Rovithis M, Koukouli S. Evaluation of Online Counseling through the Working Experiences of Mental Health Therapists Amidst the COVID-19 Pandemic. Healthcare (Basel) 2024; 12:495. [PMID: 38391870 PMCID: PMC10888081 DOI: 10.3390/healthcare12040495] [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: 12/31/2023] [Revised: 02/02/2024] [Accepted: 02/15/2024] [Indexed: 02/24/2024] Open
Abstract
This study aimed to reflect on mental health professionals' experiences with online counseling during the COVID-19 pandemic, as well as their perceptions and recommendations for the future. The method of qualitative research with semi-structured interviews was used. The sample consisted of 17 mental health professionals working in the public or private sectors. A framework analysis revealed four main themes, namely (a) the evaluation of online counseling; (b) comparing in-person and online counseling; (c) factors influencing the effectiveness of online counseling; and (d) suggestions for the future use of online counseling. Most therapists reported that their overall experience with online counseling was positive. The main advantages cited were the accessibility for everyone and the reductions in time, money, and distance. Its primary drawbacks included less nonverbal communication, the inability to employ certain therapeutic tools, problems with confidentiality, lack of experience, and technical difficulties during online sessions. Its effectiveness depends on contextual factors and factors related to the therapeutic process itself. Organizational planning, training, and a solid implementation strategy may help ensure that this communication medium is used to its fullest potential. In addition, the possible utilization of remote counseling combined with in-person psychotherapeutic intervention methods will provide solutions for the future, especially in crisis situations.
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Affiliation(s)
- Maria Moudatsou
- Department of Social Work, Faculty of Health Sciences, Hellenic Mediterranean University, 71410 Heraklion, Greece
- Laboratory of Interdisciplinary Approaches for the Enhancement of Quality of Life (QoLab), 71410 Heraklion, Greece
| | - Areti Stavropoulou
- Laboratory of Interdisciplinary Approaches for the Enhancement of Quality of Life (QoLab), 71410 Heraklion, Greece
- Department of Nursing, Faculty of Health and Care Sciences, University of West Attica, 12243 Athens, Greece
- Faculty of Health, Science, Social Care and Education, Kingston University, London KT2 7LB, UK
| | - Michael Rovithis
- Laboratory of Interdisciplinary Approaches for the Enhancement of Quality of Life (QoLab), 71410 Heraklion, Greece
- Department of Business Administration and Tourism, School of Management and Economics Sciences, Hellenic Mediterranean University, 71410 Heraklion, Greece
| | - Sofia Koukouli
- Department of Social Work, Faculty of Health Sciences, Hellenic Mediterranean University, 71410 Heraklion, Greece
- Laboratory of Interdisciplinary Approaches for the Enhancement of Quality of Life (QoLab), 71410 Heraklion, Greece
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Fisher H, Stone SJ, Zilcha-Mano S, Goldstein P, Anderson T. Integrating exploration and prediction in computational psychotherapy science: proof of concept. Front Psychiatry 2024; 14:1274764. [PMID: 38283895 PMCID: PMC10811256 DOI: 10.3389/fpsyt.2023.1274764] [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: 08/08/2023] [Accepted: 12/15/2023] [Indexed: 01/30/2024] Open
Abstract
Introduction Psychotherapy research has long preferred explanatory over predictive models. As a result, psychotherapy research is currently limited in the variability that can be accounted for in the process and outcome of treatment. The present study is a proof-of-concept approach to psychotherapy science that uses a datadriven approach to achieve robust predictions of the process and outcome of treatment. Methods A trial including 65 therapeutic dyads was designed to enable an adequate level of variability in therapist characteristics, overcoming the common problem of restricted range. A mixed-model, data-driven approach with cross-validation machine learning algorithms was used to predict treatment outcome and alliance (within- and between-clients; client- and therapist-rated alliance). Results and discussion Based on baseline predictors only, the models explained 52.8% of the variance for out-of-sample prediction in treatment outcome, and 24.1-52.8% in therapeutic alliance. The identified predictors were consistent with previous findings and point to directions for future investigation. Although limited by its sample size, this study serves as proof of the great potential of the presented approach to produce robust predictions regarding the process and outcome of treatment, offering a potential solution to problems such as p-hacking and lack of replicability. Findings should be replicated using larger samples and distinct populations and settings.
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Affiliation(s)
- Hadar Fisher
- Department of Psychology, University of Haifa, Haifa, Israel
| | - Suzannah J. Stone
- Department of Psychology, Ohio University, Athens, OH, United States
| | | | - Pavel Goldstein
- Integrative Pain Laboratory (iPainLab), School of Public Health, University of Haifa, Haifa, Israel
| | - Timothy Anderson
- Department of Psychology, Ohio University, Athens, OH, United States
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de Beurs E, Rademacher C, Blankers M, Peen J, Dekker J, Goudriaan A. Alcohol use disorder treatment via video conferencing compared with in-person therapy during COVID-19 social distancing : A non-inferiority comparison of three cohorts. ALCOHOL, CLINICAL & EXPERIMENTAL RESEARCH 2023; 47:2208-2217. [PMID: 38226749 DOI: 10.1111/acer.15184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 08/28/2023] [Accepted: 08/28/2023] [Indexed: 01/17/2024]
Abstract
BACKGROUND Social distancing measures during the COVID-19 pandemic forced an abrupt transformation of treatment delivery for mental health care. In mid-March 2020, nearly all in-person contact was replaced with video conferencing. The pandemic thus offered a natural experiment and a unique opportunity to conduct an observational study of whether alcohol use disorder treatment through video conferencing is non-inferior to in-person treatment. METHODS In a large urban substance use disorder treatment center in the Netherlands, treatment evaluation is routine practice. Outcome data are regularly collected to support shared decision making and monitor patient progress. For this study, pre-test and post-test data on alcohol use (Measurements in the Addictions for Triage and Evaluation), psychopathology (Depression Anxiety Stress Scales), and quality of life (Manchester Short Assessment of Quality of Life) were used to compare outcomes of cognitive behavioral therapy treatment for three cohorts: patients who received treatment for a primary alcohol use disorder performed prior to (n = 628), partially during (n = 557), and entirely during (n = 653) the COVID-19 lockdown. RESULTS Outcome was similar across the three cohorts: No inferior outcomes were found for treatments that were conducted predominantly through video conferencing during lockdown or treatments that started in-person, but were continued through video conferencing, compared to in-person treatments that were conducted prior to COVID-19. The number of drop-outs were also similar between cohorts. However, there was a difference in average treatment intensity between cohorts, with treatment partially or fully conducted during the COVID-19 pandemic lasting longer. CONCLUSIONS Treatment for a primary alcohol use disorder, provided partially or predominantly through video conferencing during the COVID-19 pandemic resulted in abstinence rates and secondary outcomes similar to traditional in-person care, in spite of the potentially negative effects of the COVID-related lockdown measures themselves. These results from everyday clinical practice corroborate findings of randomized controlled studies and meta-analyses in which video conferencing appeared non-inferior to in-person care in clinical effectiveness.
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Affiliation(s)
- Edwin de Beurs
- Department of Clinical Psychology, University of Leiden, Leiden, The Netherlands
- Arkin GGZ, Amsterdam, The Netherlands
| | - Clara Rademacher
- Department of Clinical Psychology, University of Leiden, Leiden, The Netherlands
| | - Matthijs Blankers
- Arkin GGZ, Amsterdam, The Netherlands
- Department of Psychiatry, University of Amsterdam, Amsterdam, The Netherlands
- Trimbos Institute, Utrecht, The Netherlands
| | - Jaap Peen
- Arkin GGZ, Amsterdam, The Netherlands
| | - Jack Dekker
- Arkin GGZ, Amsterdam, The Netherlands
- Department of Clinical Psychology, Vrije Universiteit, Amsterdam, The Netherlands
| | - Anneke Goudriaan
- Arkin GGZ, Amsterdam, The Netherlands
- Amsterdam Institute for Addiction Research, Amsterdam, The Netherlands
- Department of Psychiatry, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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Griffith B, Archbold H, Sáez Berruga I, Smith S, Deakin K, Cogan N, Tanner G, Flowers P. Frontline experiences of delivering remote mental health supports during the COVID-19 pandemic in Scotland: innovations, insights and lessons learned from mental health workers. PSYCHOL HEALTH MED 2023; 28:964-979. [PMID: 36408950 DOI: 10.1080/13548506.2022.2148698] [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: 11/23/2022]
Abstract
COVID-19 restrictions drove rapid adaptations to service delivery and new ways of working within Scotland's mental health sector. This study explores mental health workers' (MHWs') experiences of delivering their services remotely. Twenty participants, who had worked in mental health professions in the National Health Service (NHS) in Scotland throughout the COVID-19 pandemic, took part in online semi-structured interviews. Data was transcribed then analysed using an inductive thematic analysis. Two major themes are reported: (1) 'Improved Flexibility for both MHWs and Service Users' and (2) 'Teletherapies Challenge Therapeutic Boundaries'. In relation to (1) virtual platforms were seen as vital in maintaining patient care throughout the COVID-19 pandemic and a valuable resource for service users (SUs) who had previously struggled with mobility or social anxieties when accessing face-to-face services. Some MHWs' also noted benefits for their productivity and comfort. Regarding (2) MHWs highlighted that whilst conducting teletherapies from home, work-life boundaries became blurred and, in some instances, typically comforting spaces became associated with the traumatic content discussed by SUs. These stressors seemed to be compounded by MHWs' isolation, as they were less able to draw upon their colleagues for support. Further, confidentiality could not be assured, as MHWs and SUs alike had to accommodate their family members. These findings highlight important insights from MHWs in adapting to rapid changes in mental health working practices, particularly in relation to the challenges of delivering quality, safe and equitable services and the increased use of teletherapies. Such insights are vital in informing service developments and supporting future pandemic preparedness across a range of healthcare contexts and countries seeking to adopt hybrid models of mental health service delivery.
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Affiliation(s)
- Bethany Griffith
- School of Psychological Sciences and Health, University of Strathclyde, Glasgow, UK
| | - Heather Archbold
- School of Psychological Sciences and Health, University of Strathclyde, Glasgow, UK
| | - Isabel Sáez Berruga
- School of Psychological Sciences and Health, University of Strathclyde, Glasgow, UK
| | - Samantha Smith
- School of Psychological Sciences and Health, University of Strathclyde, Glasgow, UK
| | - Karen Deakin
- School of Psychological Sciences and Health, University of Strathclyde, Glasgow, UK
| | - Nicola Cogan
- School of Psychological Sciences and Health, University of Strathclyde, Glasgow, UK
| | - Gary Tanner
- School of Psychological Sciences and Health, University of Strathclyde, Glasgow, UK
| | - Paul Flowers
- School of Psychological Sciences and Health, University of Strathclyde, Glasgow, UK
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10
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Békés V, Aafjes-van Doorn K, Roberts KE, Stukenberg K, Prout T, Hoffman L. Adjusting to a new reality: Consensual qualitative research on therapists' experiences with teletherapy. J Clin Psychol 2023; 79:1293-1313. [PMID: 36704974 DOI: 10.1002/jclp.23477] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 11/26/2022] [Accepted: 12/27/2022] [Indexed: 01/28/2023]
Abstract
OBJECTIVE In the wake of the COVID-19 pandemic, the use of teletherapy has become more pervasive than ever. Many therapists faced this move to a remote setting with little experience or training. We aimed to qualitatively examine therapists' subjective experience of providing teletherapy, including changes in technique, the therapeutic relationship, and the therapeutic process. METHODS Thirty-one psychotherapists participated in semistructured interviews. Interviews were recorded, then transcribed and analyzed using the Consensual Qualitative Research method. RESULTS Therapists typically reported a change in the therapeutic relationship in terms of an increased sense of disconnection as well as shifts in various aspects of the relational dynamics, and they also typically experienced differences in the therapy process due to changes in patient and therapist engagement in the therapeutic work. Additionally, some therapists also reported that they became more active and directive in sessions, took a more informal, personal, or relaxed approach to interacting with patients, and while the emotional connection changed and they missed the energy and intimacy of in-person sessions, the relationship in telesessions felt more authentic and human for some, and teletherapy also provided a way to discuss new dimensions in the process. CONCLUSION Overall, these results suggest great variability in therapists' subjective experiences with teletherapy, and present teletherapy as a distinct therapy format in many aspects. Further process-level research and subsequent training is needed to better equip therapists to navigate teletherapy's challenges and harness its unique opportunities.
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Affiliation(s)
- Vera Békés
- Ferkauf Graduate School of Psychology, Yeshiva University, New York, New York, USA
| | | | - Kailey E Roberts
- Ferkauf Graduate School of Psychology, Yeshiva University, New York, New York, USA
| | - Karl Stukenberg
- School of Psychology, Xavier University, Cincinnati, Ohio, USA
| | - Tracy Prout
- Ferkauf Graduate School of Psychology, Yeshiva University, New York, New York, USA
| | - Leon Hoffman
- New York Psychoanalytic Institute, New York, New York, USA
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11
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Psychotherapy under lockdown: The use and experience of teleconsultation by psychotherapists during the first wave of the COVID-19 pandemic. CLINICAL PSYCHOLOGY IN EUROPE 2022; 4:e6821. [PMID: 36398003 PMCID: PMC9667335 DOI: 10.32872/cpe.6821] [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: 05/27/2021] [Accepted: 05/31/2022] [Indexed: 11/25/2022] Open
Abstract
Background Facing the COVID-19 pandemic, some psychotherapists had to propose remote consultations, i.e., teleconsultation. While some evidence suggests positive outcomes from teleconsultation, professionals still hold negative beliefs towards it. Additionally, no rigorous and integrative practice framework for teleconsultation has yet been developed. This article aims to explore the use and experience of teleconsultation by 1) investigating differences between psychotherapists proposing and not proposing it; 2) evaluating the impact of negative attitudes towards teleconsultation on various variables; 3) determining the perceived detrimental effect of teleconsultation, as opposed to in-person, on the therapeutic relationship and personal experience; and 4) providing insights for the development of a teleconsultation practice framework. Method An online survey was distributed via different professional organisations across several countries to 246 (195 women) French-speaking psychotherapists. Results Psychotherapists who did not propose teleconsultation believed it to be more technically challenging than psychotherapists who proposed it, but felt less constrained to propose it, and had less colleagues offering it. Attitudes towards teleconsultation showed no significant associations with therapeutic relationship, personal experience, and percentage of teleconsultation. As compared to in-person, empathy, congruence, and therapeutic alliance were perceived to significantly deteriorate online, whereas work organisation was perceived to be significantly better. While most psychotherapists proposed remote consultations, they did not provide adaptations to such setting (e.g., ascertaining a neutral video background); nor used videoconferencing platforms meeting privacy and confidentiality criteria. Conclusion Training and evidenced-based information should be urgently provided to practitioners to develop rigorous guidelines and an ethically and legally safe practice framework. Psychotherapists differ in their perceptions of teleconsultation as whether they propose it or not. Attitudes towards teleconsultation are not related to its use nor to the therapeutic relationship. Teleconsultation worsens perceived therapeutic relationship, but improves work organisation. Training is needed to improve an ethically and legally safe practice of teleconsultation.
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12
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Békés V, Belleville G, Lebel J, Ouellet MC, Chen Z, Morin CM, Bergeron N, Campbell TS, Ghosh S, Bouchard S, Guay S, MacMaster FP. Trainee Therapists’ Perceptions of a Blended Intervention to Promote Resilience after a Natural Disaster: A Qualitative Case Study. J Clin Med 2022; 11:jcm11154361. [PMID: 35955982 PMCID: PMC9369013 DOI: 10.3390/jcm11154361] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 06/22/2022] [Accepted: 07/18/2022] [Indexed: 12/04/2022] Open
Abstract
Background: Natural disasters happen in an increased frequency, and telemental health interventions could offer easily accessible help to reduce mental health symptoms experienced by survivors. However, there are very few programs offered to natural disaster survivors, and no research exists on therapists’ experiences with providing blended interventions for natural disaster survivors. Aims: Our qualitative case study aims to describe psychologists’ experiences with an online, therapist-assisted blended intervention for survivors of the Fort McMurray wildfires in Alberta, Canada. Method: The RESILIENT intervention was developed in the frames of a randomized controlled trial to promote resilience after the Fort McMurray wildfires by providing survivors free access to a 12-module, therapist-assisted intervention, aiming to improve post-traumatic stress, insomnia, and depression symptoms. A focus group design was used to collect data from the therapists, and emerging common themes were identified by thematic analysis. Results: Therapists felt they could build strong alliances and communicate emotions and empathy effectively, although the lack of nonverbal cues posed some challenges. The intervention, according to participating therapists, was less suitable for participants in high-stress situations and in case of discrepancy between client expectations and the intervention content. Moreover, the therapists perceived specific interventions as easy-to-use or as more challenging based on their complexity and on the therapist support needed for executing them. Client engagement in the program emerged as an underlying theme that had fundamental impact on alliance, communication, and ultimately, treatment efficiency. Therapist training and supervision was perceived as crucial for the success of the program delivery. Conclusions: Our findings provided several implications for the optimalization of blended interventions for natural disaster survivors from our therapists’ perspective.
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Affiliation(s)
- Vera Békés
- Ferkauf Graduate School, Yeshiva University, 1165 Morris Park Ave, The Bronx, NY 10461, USA;
- Correspondence:
| | - Geneviève Belleville
- School of Psychology, Laval University, 2325 Rue de l’Université, Québec, QC G1V 0A6, Canada; (G.B.); (J.L.); (M.-C.O.); (C.M.M.)
| | - Jessica Lebel
- School of Psychology, Laval University, 2325 Rue de l’Université, Québec, QC G1V 0A6, Canada; (G.B.); (J.L.); (M.-C.O.); (C.M.M.)
| | - Marie-Christine Ouellet
- School of Psychology, Laval University, 2325 Rue de l’Université, Québec, QC G1V 0A6, Canada; (G.B.); (J.L.); (M.-C.O.); (C.M.M.)
| | - Zhaoyi Chen
- Ferkauf Graduate School, Yeshiva University, 1165 Morris Park Ave, The Bronx, NY 10461, USA;
| | - Charles M. Morin
- School of Psychology, Laval University, 2325 Rue de l’Université, Québec, QC G1V 0A6, Canada; (G.B.); (J.L.); (M.-C.O.); (C.M.M.)
| | - Nicolas Bergeron
- Département de Psychiatrie, Centre Hospitalier de l’Université de Montréal, 1000 Rue St-Denis, Montréal, QC H2X 0C1, Canada;
- Department of Psychiatry and Addiction, University of Montreal, 2900 Edouard Montpetit Blvd., Montreal, QC H3T 1J4, Canada;
| | - Tavis S. Campbell
- Department of Psychology, University of Calgary, 2500 University Dr. NW, Calgary, AB T2N 1N4, Canada;
| | - Sunita Ghosh
- Faculty of Medicine and Dentistry, University of Alberta, 116 St & 85 Ave, Edmonton, AB T6G 2R3, Canada;
| | - Stephane Bouchard
- Département de Psychoéducation et de Psychologie, Université du Québec en Outaouais, CISSS de l’Outaouais, 283 Alexandre-Taché Blvd., Gatineau, QC J8X 3X7, Canada;
| | - Stéphane Guay
- Department of Psychiatry and Addiction, University of Montreal, 2900 Edouard Montpetit Blvd., Montreal, QC H3T 1J4, Canada;
- School of Criminology, University of Montreal, 2900 Edouard Montpetit Blvd., Montreal, QC H3T 1J4, Canada
| | - Frank P. MacMaster
- Addictions and Mental Health Strategic Clinical Network, Alberta Children’s Hospital, 28 Oki Drive NW, Calgary, AB T3B 6A8, Canada;
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13
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Békés V, Aafjes-Van Doorn K. Patients’ attachment avoidance and their perceived quality of the real relationship predict patients’ attitudes towards telepsychotherapy. COUNSELLING PSYCHOLOGY QUARTERLY 2022. [DOI: 10.1080/09515070.2022.2075324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Vera Békés
- Ferkauf Graduate School of Psychology, Yeshiva University, New York, USA
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14
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Emran A, Smith JA, Iqbal N. Psychotherapists’ experience of the transition to telepsychotherapy amidst COVID-19 in India. COUNSELLING PSYCHOLOGY QUARTERLY 2022. [DOI: 10.1080/09515070.2022.2093164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Ashti Emran
- Department of Psychology, Jamia Millia Islamia, New Delhi, India
| | - Jonathan A. Smith
- Department of Psychological Sciences, Birkbeck, University of London, London, UK
| | - Naved Iqbal
- Department of Psychology, Jamia Millia Islamia, New Delhi, India
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15
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Zentner K, Gaine G, Ethridge P, Surood S, Abba-Aji A. Clinicians' Attitudes Toward Telepsychology in Addiction and Mental Health Services, and Prediction of Postpandemic Telepsychology Uptake: Cross-sectional Study. JMIR Form Res 2022; 6:e35535. [PMID: 35559793 PMCID: PMC9143772 DOI: 10.2196/35535] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 03/22/2022] [Accepted: 04/12/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic has resulted in unprecedented uptake of telepsychology services; however, clinicians have mixed attitudes toward virtual technologies. OBJECTIVE This study (1) explored clinicians' experiences of and intentions to use video, telephone, and in-person services, and (2) tested the utility of the unified theory of acceptance and use of technology (UTAUT) to predict clinicians' intentions to offer telepsychology after the COVID-19 pandemic. METHODS Clinician satisfaction and therapeutic alliance were compared across in-person, video, and telephone services, while technology attitudes and intention to use after the pandemic were compared across video and telephone services among 118 addiction and mental health clinicians during the COVID-19 pandemic. RESULTS Clinicians reported more positive experiences with in-person services than both virtual technologies; further, clinicians reported greater positive experiences, attitudes, and intentions to use video services than telephone services across measures. Based on the UTAUT, performance expectancy positively predicted concurrent intentions to use video services (β=0.46; P<.001) and telephone services (β=0.35; P<.001) after the pandemic. Social influence (β=0.24; P=.004) and facilitating conditions (β=0.19; P=.03) additionally predicted the intention to use telephone services. CONCLUSIONS Clinicians rated in-person services more positively than virtual technologies, with video services perceived more positively than telephone services. Performance expectancy was the primary facilitator of the uptake of both virtual modalities.
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Affiliation(s)
- Kristen Zentner
- Clinical Supports and Services, Addiction & Mental Health, Alberta Health Services, Edmonton, AB, Canada
| | - Graham Gaine
- Clinical Supports and Services, Addiction & Mental Health, Alberta Health Services, Edmonton, AB, Canada
- Department of Educational Psychology, University of Alberta, Edmonton, AB, Canada
- Department of Psychiatry, University of Alberta, Edmonton, AB, Canada
| | - Paige Ethridge
- Department of Psychology, Glenrose Rehabilitation Hospital, Alberta Health Services, Edmonton, AB, Canada
| | - Shireen Surood
- Clinical Supports and Services, Addiction & Mental Health, Alberta Health Services, Edmonton, AB, Canada
| | - Adam Abba-Aji
- Department of Psychiatry, University of Alberta, Edmonton, AB, Canada
- Young Adult Assessment, Evaluation & Reintegration, Addiction and Mental Health, Alberta Health Services, Edmonton, AB, Canada
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16
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Beurs E, Blankers M, Peen J, Rademacher C, Podgorski A, Dekker J. Impact of COVID‐19 social distancing measures on routine mental health care provision and treatment outcome for common mental disorders in the Netherlands. Clin Psychol Psychother 2022; 29:1342-1354. [PMID: 35068003 PMCID: PMC9015637 DOI: 10.1002/cpp.2713] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 01/13/2022] [Accepted: 01/17/2022] [Indexed: 11/24/2022]
Abstract
Objective The uptake of digital interventions in mental health care (MHC) has been slow, as many therapists and patients believe that in‐person contact is essential for establishing a good working relationship and good outcomes in treatment. The public health policies regarding social distancing during the coronavirus disease‐2019 (COVID‐19) pandemic forced an abrupt transformation of MHC provisions for outpatients: Since mid‐March 2020, nearly all in‐person contact was replaced with videoconferencing. The COVID‐19 crisis offered a unique opportunity to investigate whether MHC with videoconferencing yields inferior results as compared to in‐person interventions. Method In a large urban MHC facility in the Netherlands, measurement‐based care is routine practice. Outcome data are regularly collected to support shared decision making and monitor patient progress. For this study, pretest and post‐test data were used to compare outcomes for three cohorts: treatments performed prior to, partially during and entirely during the COVID‐19 lockdown. Outcomes were compared in two large data sets: Basic MHC (N = 1392) and Specialized MHC (N = 1040). Results Therapeutic outcomes appeared robust for COVID‐19 conditions across the three cohorts: No differences in outcomes were found between treatments that were conducted during lockdown compared to in‐person treatments prior to COVID‐19, or treatments which started in‐person, but needed to be continued by means of videoconferencing. Discussion Videoconferencing care during the COVID‐19 pandemic had similar outcomes compared to traditional in‐person care. These real‐world results corroborate findings of previous randomized controlled studies and meta‐analyses in which videoconferencing and in‐person care has been directly compared in terms of clinical effectiveness.
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Affiliation(s)
- Edwin Beurs
- Arkin Mental Health Care NN Amsterdam Netherlands
- Leiden Universiteit, Department of Clinical Psychology AK Leiden Netherlands
| | - Matthijs Blankers
- Arkin Mental Health Care NN Amsterdam Netherlands
- Amsterdam University Medical Center, Location AMC, Department of Psychiatry AZ Amsterdam The Netherlands
- Trimbos Institute VS Utrecht Netherlands
| | - Jaap Peen
- Arkin Mental Health Care NN Amsterdam Netherlands
| | - Clara Rademacher
- Leiden Universiteit, Department of Clinical Psychology AK Leiden Netherlands
| | - Alicja Podgorski
- Leiden Universiteit, Department of Clinical Psychology AK Leiden Netherlands
| | - Jack Dekker
- Arkin Mental Health Care NN Amsterdam Netherlands
- Vrije Universiteit, Department of Clinical Psychology BT Amsterdam Netherlands
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Butz B, Kloep L, Kriegesmann B. User experience reevaluation and diffusion of technology in the context of compulsory usage illustrated by the example of telepsychotherapy—a literature review. Digit Health 2022; 8:20552076221134448. [PMID: 36386248 PMCID: PMC9663607 DOI: 10.1177/20552076221134448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Accepted: 10/04/2022] [Indexed: 11/15/2022] Open
Abstract
Objective Models explaining technology acceptance fail to recognize the influence temporary, compulsory usage, meaning forced usage due to external factors, may have on user evaluation and continued diffusion. However, in context of the Covid-19 pandemic, a highly infectious respiratory disease, the significance of this factor is evident. Triggered by legal contact restrictions and extended reimbursement capacities, usage of telepsychotherapy increased drastically, thereby influencing therapists' attitude and increasing the technology's maturity. In this comprehensive literature review, we aim to outline the current state of research toward telepsychotherapy adoption and identify potential influences of the compulsory usage on the reevaluation of technology as well as barriers inhibiting and factors promoting future use. Methods The review was conducted on the five databases ScienceDirect, Web of Science, PubMed, PubPsych, and IEEE up to April 2022. Results Out of 685 identified references, a final selection was made of 22 papers, discussing experiences with telepsychotherapy in the context of the Covid-19 pandemic. Satisfaction and intention to use are universally high, further increasing with time and use experience, while perceived challenges decrease. Barriers include mostly contextual factors, such as technical issues, reimbursement issues, strict regulations, insufficient infrastructure, and lack of organizational support, but also concerns regarding efficacy. Promoting factors are training, guidelines, and organizational support. Conclusions Telepsychohtherapy has become an integral part of psychotherapeutic care. A hybrid system in close coordination between provider and patient may prevail, addressing individual needs of both parties to achieve optimal care and provider well-being. This requires transparent regulations, guidelines, and standards.
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Affiliation(s)
- Benjamin Butz
- Institute for Innovation Research and Management, Westphalian University of Applied Sciences, Bochum, Germany
| | - Leonie Kloep
- Institute for Innovation Research and Management, Westphalian University of Applied Sciences, Bochum, Germany
| | - Bernd Kriegesmann
- Institute for Innovation Research and Management, Westphalian University of Applied Sciences, Bochum, Germany
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18
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Affiliation(s)
- Paul M G Emmelkamp
- Paris Institute for Advanced Study.,Department of Clinical Psychology, University of Amsterdam
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19
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Békés V, Aafjes-van Doorn K, McCollum J, Prout TR, Hoffman L. The development of a self-report scale to assess therapists' acceptance of telepsychotherapy. J Clin Psychol 2021; 78:1240-1260. [PMID: 34897674 DOI: 10.1002/jclp.23289] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 11/17/2021] [Accepted: 11/24/2021] [Indexed: 12/11/2022]
Abstract
OBJECTIVE We aimed to develop a self-report measure of therapist acceptance of telepsychotherapy based on the Unified Theory of Acceptance and Use of Technology (UTAUT) framework. METHODS Using a cross-sectional survey design, 1265 therapists completed the UTAUT-T, as well as additional questions. RESULTS Confirmatory analysis indicated that the original UTAUT model did not fit the therapist context well. Exploratory factor analysis specified a better-fitting five-factor model, which showed good internal validity fit (χ2 = 17,753.36, RMSEA = 0.063, TLI = 0.886, SRMSR = 0.04). The five UTAUT-T subscales showed high internal consistency (Cronbach's α = 0.86) and together predicted the intention to use online therapy in the future (R2 = 0.42, F(5, 1259) = 181.9, p < 0.001). CONCLUSION The 21-item UTAUT-T offers a promising self-report measure of therapist acceptance of telepsychotherapy and intention towards using it in the future. Future studies on the convergent and predictive validity of the UTAUT-T are warranted.
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Affiliation(s)
- Vera Békés
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, United States, USA
| | | | - James McCollum
- San Francisco Psychotherapy Research Group, San Francisco, California, USA
| | - Tracy R Prout
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, United States, USA
| | - Leon Hoffman
- New York Psychoanalytic Society and Institute, New York, New York, USA
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