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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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Wellspring I, Ganesh K, Kreklewetz K. Walk-in mental health: Bridging barriers in a pandemic. PLoS One 2024; 19:e0302543. [PMID: 38820293 PMCID: PMC11142450 DOI: 10.1371/journal.pone.0302543] [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: 01/11/2023] [Accepted: 04/08/2024] [Indexed: 06/02/2024] Open
Abstract
'Single Session Therapy' (SST) is a service delivery model that seeks to provide an evidence-based, solution-focused, brief intervention within a single therapy session. The stand-alone session affords the opportunity to provide brief psychological interventions while clients await access to longer-term services. The COVID-19 pandemic has adversely impacted individuals' mental health. However, the majority of research has investigated patient mental health within hospital settings and community organizations that offer long-term services, whereas minimal research has focused on mental health concerns during COVID-19 within an SST model. The primary aim of the study was to measure client experiences of a brief mental health service. The nature of client mental health concerns who access such services at various points during a pandemic was also investigated. The current study utilized client feedback forms and the Computerized Adaptive Testing-Mental Health (CAT-MH) to measure client experiences and mental health concerns. Qualitative analysis of client feedback forms revealed themes of emotional (e.g., safe space) and informational support (e.g., referrals). Clients also reported reduced barriers to accessing services (e.g., no appointment necessary, no cost), as well as limitations (e.g., not enough sessions) of the Walk-in clinic. Profile analysis of the CAT-MH data indicated that clients had higher rates of depression before COVID-19 (M = 64.2, SD = 13.07) as compared to during the pandemic (M = 59.78, SD = 16.87). In contrast, higher rates of positive suicidality flags were reported during the pandemic (n = 54) as compared to before (n = 29). The lower reported rates of depression but higher rate of suicidality during the pandemic was an unanticipated finding that contradicted prior research, to which possible explanations are explored. Taken together, the results demonstrate the positive experiences of clients who access a single session therapy.
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Affiliation(s)
- Ian Wellspring
- University of British Columbia (Okanagan), Kelowna, Canada
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Chaharshughi BT, Izadi R, Naghavi A. Tele-psychotherapy for individuals with obsessive-compulsive disorder during the COVID-19 outbreak: A qualitative study. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2024; 13:112. [PMID: 38726087 PMCID: PMC11081456 DOI: 10.4103/jehp.jehp_372_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 05/22/2023] [Indexed: 05/12/2024]
Abstract
BACKGROUND One way of delivering psychological services is tele-psychotherapy, which has attracted significant attention as a viable approach. This study aimed to identify important variables in the application of tele-counseling and psychotherapy for the treatment of patients with obsessive-compulsive disorder (OCD) in Isfahan, Iran. MATERIALS AND METHODS This research employed an exploratory qualitative methodology. The participants of this study consisted of all the clients with OCD and all the psychotherapists in the city of Isfahan. Purposive sampling was employed, and following a series of semi-structured interviews with 35 individuals with OCD and 11 counselors in this area, the sample size reached a saturation point. The data was analyzed by Braun and Clark's thematic analysis method. RESULTS Based on the findings of Braun and Clark's analysis, three primary themes emerged concerning tele-counseling: opportunities, requirements, and challenges. CONCLUSION According to the feedback received from therapists and clients, remote services could offer promising prospects to both groups by providing accessible locations and flexible time management. However, to get the full benefits of teletherapy, therapists should consider certain factors to enhance the therapeutic alliance. Moreover, there are challenges that need to be addressed.
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Affiliation(s)
- Batul Tadayon Chaharshughi
- PhD Student in Counseling, Faculty of Humanities, Khomeinishar Branch, Islamic Azad University, Khomeinishar, Isfahan, Iran
| | - Razieh Izadi
- Assistant Professor, Department of Psychology, Safahan Institute of Higher Education, Isfahan, Iran
| | - Azam Naghavi
- Associate Professor, Department of Counseling, Faculty of Education and Psychology, University of Isfahan, Isfahan, Iran
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Isaacs A, Mitchell EKL, Sutton K, Naughton M, Hine R, Bullock S, Azar D, Maybery D. Clinicians' and Users' Views and Experiences of a Tele-Mental Health Service Implemented Alongside the Public Mental Health System during the COVID-19 Pandemic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:ijerph20105870. [PMID: 37239597 DOI: 10.3390/ijerph20105870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 05/11/2023] [Accepted: 05/15/2023] [Indexed: 05/28/2023]
Abstract
A tele-mental health model called Head to Health was implemented in the state of Victoria, Australia to address the crisis caused by the COVID-19 pandemic. It was a free centralized intake service that adopted a targeted approach with several novel elements, such as stepped care and telehealth. This study examines the views and experiences of clinicians and service users of the tele-mental health service in the Gippsland region of Victoria during the COVID-19 pandemic. Data from clinicians were obtained via an online 10-item open-ended survey instrument and from service users through semi-structured interviews. Data were obtained from 66 participants, including 47 clinician surveys and 19 service user interviews. Six categories emerged from the data. They were: 'Conditions where use of tele-mental health is appropriate', 'Conditions where tele-mental health may not be useful', 'Advantages of tele-mental health', 'Challenges in using tele-mental health', 'Client outcomes with tele-mental health', and 'Recommendations for future use'. This is one of a few studies where clinicians' and service users' views and experiences have been explored together to provide a nuanced understanding of perspectives on the efficacy of tele-mental health when it was implemented alongside public mental health services.
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Affiliation(s)
- Anton Isaacs
- School of Rural Health, Monash University, Warragul, VIC 3820, Australia
| | | | - Keith Sutton
- School of Rural Health, Monash University, Warragul, VIC 3820, Australia
| | - Michael Naughton
- School of Rural Health, Monash University, Warragul, VIC 3820, Australia
| | - Rochelle Hine
- School of Rural Health, Monash University, Warragul, VIC 3820, Australia
| | - Shane Bullock
- School of Rural Health, Monash University, Warragul, VIC 3820, Australia
| | - Denise Azar
- School of Rural Health, Monash University, Warragul, VIC 3820, Australia
- Gippsland Primary Health Network, Traralgon, VIC 3844, Australia
| | - Darryl Maybery
- School of Rural Health, Monash University, Warragul, VIC 3820, Australia
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Wathen CC, Andrade Vargas E. Applying the 10 Principles of Anti-Oppression to Online Psychoeducational Groups: Steps to Intentional Changes in Emerging Technologies. JOURNAL FOR SPECIALISTS IN GROUP WORK 2023. [DOI: 10.1080/01933922.2023.2190783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/30/2023]
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Shetty KV, Sharma U, Kalyanasundaram M, Kumar S, Bamney U. Protocol for developing telephone-based brief psychosocial intervention for COVID-19 patients in India. J Family Med Prim Care 2022; 11:5479-5484. [PMID: 36505530 PMCID: PMC9730994 DOI: 10.4103/jfmpc.jfmpc_1522_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 12/14/2021] [Accepted: 04/27/2022] [Indexed: 11/06/2022] Open
Abstract
Introduction The ongoing Coronavirus disease 2019 (COVID-19) pandemic has had a huge mental health impact on people, especially the infected population. They are at greater risk of developing psychological symptoms due to the fear of death and developing severe disability, lack of proper treatment and social restrictions, stigma, and discrimination. The early psychological symptoms, if ignored, may have long-term consequences on the health and well-being of COVID patients. Due to the COVID-19 pandemic, the mental health services have been impacted negatively, and the need for technology-based psychological interventions has been identified as an alternative treatment method. Hence, the Telephone-Based Brief Psycho-Social interventions (TBPSI) will be developed for COVID-19 patients. Materials and Method A five-session tele psychosocial intervention including rapport establishment and assessment, supportive counselling, activity scheduling, relaxation technique, and post-assessment will be developed based on the extensive review of the literature. Face and content validation of the intervention package will be done by the mental health experts. Further, the feasibility of the intervention program will be tested on COVID-19 patients in the Dharwad district, and later, the same will be implemented across the COVID hospitals of Karnataka state. Discussion and Conclusion The study results may bring new insights into the culturally sensitive technology-oriented interventions during this pandemic in the country. The paradigm may be shifted from routine treatment to cost-effective and time-based intervention in the public health system in India. The telephonic brief psychosocial interventions can be utilised as a mainstream treatment during non-emergency situations as well.
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Affiliation(s)
- Kannappa V. Shetty
- Department of Psychiatric Social Work, Dharwad Institute of Mental Health and Neuro Sciences (DIMHANS), Dharwad, Karnataka, India,Address for correspondence: Dr. Kannappa V. Shetty, Assistant Professor, Department of Psychiatric Social Work, Dharwad Institute of Mental Health and Neuro Sciences (DIMHANS), Dharwad - 580 008, Karnataka, India. E-mail:
| | - Upasana Sharma
- MD, Ph.D, Independent Public Health Researcher, Chennai, Tamil Nadu, India
| | - Madhanraj Kalyanasundaram
- MD Scientist- D, Division of Environmental Health and Epidemiology, ICMR-NIREH, Bhopal, Madhya Pradesh, India
| | - Sanjeev Kumar
- Ph.D. Assistant Professor of PSW, Centre for PSS in Disaster Management, NIMHANS, Bangalore, Karnataka, India
| | - Urmila Bamney
- M. Phil. Scholar, Department of Social Work, Central University of Karnataka, Kalaburagi, Karnataka, India
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The Good, The Bad, The Uncertain: Diverse Provider Experiences with Telemental Health During COVID-19. Psychiatr Q 2022; 93:753-774. [PMID: 35689752 PMCID: PMC9187881 DOI: 10.1007/s11126-022-09990-7] [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] [Accepted: 05/17/2022] [Indexed: 11/29/2022]
Abstract
This study assessed mental health provider attitudes and perceptions of telemental health (TMH) prior to and during the COVID-19 Pandemic. The study expands on earlier work by providing a more detailed qualitative analysis of provider perceptions of TMH, including its efficacy, advantages, and limitations. The current study is part of a larger mixed methods project utilizing a repeated cross-sectional design. An online survey was administered to a sample of 1,448 mental health providers. Of the survey participants, 934 offered narrative responses to open-ended questions and were included in the present study. Qualitative data was analyzed using a coding team and the Consensual Qualitative Research paradigm. Providers described both positive and negative feelings about using TMH during the COVID-19 Pandemic. Several advantages were identified, with providers clearly appreciating the role of TMH in allowing them to work continuously and safely during the public health emergency. An array of negative views and concerns were also expressed, including that TMH may not be optimal or effective in certain settings or situations. A portion of respondents also indicated a preference for face-to-face care and illuminated ways they found TMH lacking or limited.
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Hogan JN. Conducting Couple Therapy via Telehealth: Special Considerations for Virtual Success. JOURNAL OF HEALTH SERVICE PSYCHOLOGY 2022; 48:89-96. [PMID: 35496919 PMCID: PMC9036502 DOI: 10.1007/s42843-022-00060-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Couples may experience any number of barriers to in-person couple therapy, including scheduling difficulties, childcare needs, and stigma. Providing couple treatment via telehealth can address these obstacles and improve accessibility. However, couple therapists considering the transition to telehealth may be unsure of how to alter their current treatment approach for remote delivery. Further, there are often specific concerns of how to handle safety concerns or high-conflict couples via telehealth. The goal of this paper is to provide concrete suggestions, from pre-treatment screening through treatment, for how to conduct successful couple therapy via telehealth.
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Ong T, Wilczewski H, Soni H, Nisbet Q, Paige SR, Barrera JF, Welch BM, Bunnell BE. The Symbiosis of Virtual Reality Exposure Therapy and Telemental Health: A Review. FRONTIERS IN VIRTUAL REALITY 2022; 3:848066. [PMID: 37483657 PMCID: PMC10361704 DOI: 10.3389/frvir.2022.848066] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/25/2023]
Abstract
Phobias and related anxiety are common and costly mental health disorders. Experts anticipate the prevalence of phobias will increase due to the COVID-19 pandemic. Exposure therapies have been established as effective and reliable treatments for anxiety, including recent innovations in virtual reality-based exposure therapy (VRET). With the recent advent of telemental health (TMH), VRET is poised to become mainstream. The combination of VRET and TMH has the potential to extend provider treatment options and improve patient care experiences. In this narrative review, we describe how recent events have accelerated VRET + TMH, identify barriers to VRET + TMH implementation, and discuss strategies to navigate those barriers.
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Affiliation(s)
- Triton Ong
- Doxy.me Research, Doxy.me Inc., Rochester, NY, United States
| | | | - Hiral Soni
- Doxy.me Research, Doxy.me Inc., Rochester, NY, United States
| | - Quinn Nisbet
- Doxy.me Research, Doxy.me Inc., Rochester, NY, United States
| | | | - Janelle F. Barrera
- Doxy.me Research, Doxy.me Inc., Rochester, NY, United States
- Biomedical Informatics Center, Public Health and Sciences, Medical University of South Carolina, Charleston, SC, United States
| | - Brandon M. Welch
- Doxy.me Research, Doxy.me Inc., Rochester, NY, United States
- Innovation in Mental Health Lab, Department of Psychiatry and Behavioral Neurosciences, University of South Florida, Tampa, FL, United States
| | - Brian E. Bunnell
- Doxy.me Research, Doxy.me Inc., Rochester, NY, United States
- Biomedical Informatics Center, Public Health and Sciences, Medical University of South Carolina, Charleston, SC, United States
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Wilczewski H, Paige SR, Ong T, Barrera JF, Soni H, Welch BM, Bunnell BE. Perceptions of Telemental Health Care Delivery During COVID-19: A Cross-Sectional Study With Providers, February-March 2021. Front Psychiatry 2022; 13:855138. [PMID: 35444579 PMCID: PMC9013879 DOI: 10.3389/fpsyt.2022.855138] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 03/09/2022] [Indexed: 01/02/2023] Open
Abstract
The COVID-19 pandemic accelerated adoption of telemental health (TMH). Providers with limited TMH experience faced challenges during the rapid switch to remote patient care. We investigated TMH providers' perceptions about remote care one year into the pandemic according to when providers adopted telemedicine (i.e., before vs. after March 2020) and how much of their caseloads were served remotely (i.e., < 50% vs. ≥ 50%). Between February-March 2021, 472 TMH providers completed a cross-sectional, web-based survey that measured perceived benefits and satisfaction with telemedicine, therapeutic alliance, patient-centered communication, eHealth literacy, multicultural counseling self-efficacy, and facilitating factors of using telemedicine. Providers who began using telemedicine before the pandemic reported having better training, task-related therapeutic alliance with patients, and ability to conduct multicultural interventions, assessments, and session management. Providers who served ≥ 50% of their caseload remotely reported greater satisfaction with their practice, stronger beliefs about the benefits of telemedicine, and greater perceived effects of telemedicine on alleviating the impact of COVID-19. There were no differences in reports of patient-centered communication nor eHealth literacy. In conclusion, providers who adopted TMH more recently may require additional training and support to successfully establish a working alliance with their patients, especially with multicultural aspects of care.
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Affiliation(s)
| | | | - Triton Ong
- Doxy.me Research, Doxy.me Inc., Rochester, NY, United States
| | - Janelle F Barrera
- Doxy.me Research, Doxy.me Inc., Rochester, NY, United States.,Department of Psychiatry and Behavioral Neurosciences, University of South Florida, Tampa, FL, United States
| | - Hiral Soni
- Doxy.me Research, Doxy.me Inc., Rochester, NY, United States
| | - Brandon M Welch
- Doxy.me Research, Doxy.me Inc., Rochester, NY, United States.,Biomedical Informatics Center, Medical University of South Carolina, Charleston, SC, United States
| | - Brian E Bunnell
- Doxy.me Research, Doxy.me Inc., Rochester, NY, United States.,Department of Psychiatry and Behavioral Neurosciences, University of South Florida, Tampa, FL, United States
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