Remote CBT for Psychosis During the COVID-19 Pandemic: Challenges and Opportunities

Left Behind: Experiences of Community Mental Health Center Clients with Serious Mental Illness During the COVID-19 Pandemic

While some international qualitative research has interviewed people with serious mental illnesses (SMI) about their experiences in the initial months of the COVID-19 pandemic, few US studies have explored their experiences and perspectives as the pandemic has continued. Drawing from disability studies perspectives, this qualitative study conducted in 2022 explored the experiences of people with SMI seeking services at community mental health centers during the COVID-19 pandemic. Fifteen clients who identified as living with an SMI and were clients during March 2020 were interviewed. Using narrative analysis, we identified an overarching tenor of client experiences: feeling left behind by institutions and society. This feeling of being left behind was conceptualized as three themes. As the literature around the COVID-19 pandemic grows and we attempt to integrate it into community mental health policy and practice, it is essential to include the experiences and perspectives of clients with lived experience of SMI.

Randomised controlled trial on the effect of video-conference cognitive behavioural therapy for patients with schizophrenia: a study protocol

INTRODUCTION

Cognitive behavioural therapy for psychosis (CBTp) has demonstrated effectiveness in reducing positive symptoms, improving depression, enhancing coping skills and increasing awareness of illness. However, compared with cognitive behavioural therapy for depression and anxiety, the spread of CBTp in clinical practice is minimal. The present study designed a randomised controlled trial (RCT) research protocol to evaluate whether real-time remote video-conference CBTp (vCBTp) could facilitate access to psychosocial interventions and effectively improve symptoms compared with usual care (UC) for patients with schizophrenia.

METHODS AND ANALYSIS

This exploratory RCT will consist of two parallel groups (vCBTp+UC and UC alone) of 12 participants (n=24) diagnosed with schizophrenia, schizoaffective disorder or paranoid disorder, who remain symptomatic following pharmacotherapy. Seven 50-min weekly vCBTp interventions will be administered to test efficacy. The primary outcome will be the positive and negative syndrome scale score at week 8. The secondary outcome will be the Beck Cognitive Insight Scale to assess insight, the Patient Health Questionnaire-9 to assess depression, the Generalised Anxiety Disorder-7 to assess anxiety, the 5-level EuroQol 5-dimensional questionnaire to assess quality of life and the Impact of Event Scale-Revised to assess subjective distress about a specific stressful life event. We will take all measurements at 0 weeks (baseline) and at 8 weeks (post-intervention), and apply intention-to-treat analysis.

ETHICS AND DISSEMINATION

We will conduct this study in the outpatient department of Cognitive Behavioral Therapy Center at Chiba University Hospital. Further, all participants will be informed of the study and will be asked to sign consent forms. We will report according to the Consolidated Standards of Reporting Trials.

TRIAL REGISTRATION NUMBER

UMIN000043396.

Adapting to the COVID-19 Pandemic: A Psychological Crisis Support Call Service Within a Community Mental Health Team

To mitigate potential mental health crises within a Community Mental Health Team (CMHT) the psychology department implemented a short-term, rapid access, crisis telephone support service for clients during the COVID-19 pandemic. We aimed to evaluate the feasibility and acceptability. Data was collected on who the service was offered to and whom engaged. Demographic information, referral and crisis support call information was collected from the service's electronic database. Forty-four participants were referred to the service. Seventy seven percent of participants engaged in one or more telephone sessions. Participants rated the service as highly useful, with simply 'talking to someone' seen as the most important aspect of the calls. A number of age differences were noted regarding the content that was discussed in sessions. The psychological crisis telephone support service was feasible and acceptable to service users during the COVID-19 pandemic.

Trans-diagnostic determinants of psychotherapeutic treatment response: The pressing need and new opportunities for a more systematic way of selecting psychotherapeutic treatment in the age of virtual service delivery

Numerous forms of psychotherapy have demonstrated effectiveness for individuals with specific mental disorders. It is, therefore, the task of the clinician to choose the most appropriate therapeutic approach for any given client to maximize effectiveness. This can prove to be a difficult task due to at least three considerations: (1) there is no treatment approach, method or model that works well on all patients, even within a particular diagnostic class; (2) several treatments are equally efficacious (i.e., more likely to be effective than no treatment at all) when considered only in terms of the patient's diagnosis; and (3) effectiveness in the real-world therapeutic setting is determined by a host of non-diagnostic factors. Typically, consideration of these latter, trans-diagnostic factors is unmethodical or altogether excluded from treatment planning - often resulting in suboptimal patient care, inappropriate clinic resource utilization, patient dissatisfaction with care, patient demoralization/hopelessness, and treatment failure. In this perspective article, we argue that a more systematic research on and clinical consideration of trans-diagnostic factors determining psychotherapeutic treatment outcome (i.e., treatment moderators) would be beneficial and - with the seismic shift toward online service delivery - is more feasible than it used to be. Such a transition toward more client-centered care - systematically considering variables such as sociodemographic characteristics, patient motivation for change, self-efficacy, illness acuity, character pathology, trauma history when making treatment choices - would result in not only decreased symptom burden and improved quality of life but also better resource utilization in mental health care and improved staff morale reducing staff burnout and turnover.

Cognitive Behavioral Psychotherapy after COVID-19: Opportunities and Prospects

This article reviews domestic and foreign studies on cognitive behavioral therapy techniques in treating cognitive disorders in former COVID-19 patients. Coronavirus-induced cognitive disorders include damage to the nervous system as a result of respiratory distress syndrome, cytokine storm, cerebral vascular thrombosis, direct exposure to SARS-Cov2, and inadequate immune response. Concomitant mental illnesses include autistic disorders, dementia, cognitive decline, eating disorders, suicidal behavior, anxiety, depression, post-traumatic stress, insomnia, etc. Diagnostic methods usually take into account a complex violation of mental activities, e.g., short memory span, attention deficiency, slow thinking, and various affective disorders. As a result, diagnostic methods can be divided into several areas: neuropsychological diagnostics of cognitive functions (MMSE, MOCA, FAB), identification of inadequate attitudes and behavior (WCQ, SPB, DAS), identification of violations of daily activity (The Barthel Scale), identification of psychological and psychiatric issues (Hospital Anxiety and Depression Scale, State-Trait Anxiety Inventory, Hamilton Rating Scale for Depression). Psychological care for former COVID-19 patients relies on some basic principles. Cognitive behavioral psychotherapy techniques aim at correcting cognitive distortions, teaching relaxation and self-regulation, improving problem-solving skills, and restoring cognitive functions. 

Predicting the role of coping factors on pandemic-related anxiety

The year 2020 saw the emergence of a worldwide pandemic caused by the novel coronavirus COVID-19. Measures against further spread of the virus were taken nearly everywhere in the world. Many countries also imposed social distancing rules and lockdowns on their population. This situation has caused a lot of fear and insecurity, along with reactance and even unrest in some countries. In this study, we measured the psychological concepts of resilience, reactance, positive schemas, social solidarity, and anxiety among psychiatric patients and in how far these factors influence their psychopathological anxiety during the pandemic. The aim was to better understand in what ways these factors influence pandemic anxiety to be able to reduce its negative psychological effects. Findings show a significant effect of positive schemas and social solidarity on the level of pandemic anxiety in a sample of psychiatric patients, but no correlation between resilience or reactance and pandemic anxiety. Based on these insights, the inclusion of positive schemas and social solidarity for therapy should be considered. Looking deeper into the relation between positive schemas and pandemic anxiety could provide insight into the different ways that schemas influence people's anxiety and determine whether some of them are particularly important.

Experience of the Absence of the Journey to Sessions in Clients' Narratives About Online Psychotherapy

Background

Remotely provided psychotherapy due to the COVID-19 pandemic became common. One of the most significant changes related to providing online psychotherapy services is that clients no longer travel to their sessions.

Aims

In the article we are interested in the narrated experience of the absence of journey to psychotherapy sessions. We study clients' stories of past journeys and how their absence, resulting from the change of the mode of therapy provision, is coped with and replaced by other activities in their narratives.

Methods

The study takes a constructionist approach to discourse and focuses on the lexico-grammatical form of the notes. The data come from 12 semi-structured interviews with people who declared attending remote psychotherapy sessions after the national lockdown had been introduced.

Results

In the collected data, the physical journey is constructed not only as travel time, solitude which can be used for reflection, but, importantly, as an active process which ends with a resolution. In contrast, in narratives of the time before an online session, constructions of unfettered agents are replaced with those of people whose actions are hedged and qualified.

Conclusion

We argue that in the informants' narratives the journey to psychotherapy is meaningful and is part of the therapeutic process. We propose that it is a time of passing between two states—one before therapy and one in session. The journey therefore is experienced as a process of change, and not only a process of traveling.

Impacts of COVID-19 on Refugee Service Provision and Community Support: A Rapid Assessment during the Pandemic

The coronavirus (COVID-19) pandemic has significant impacts on refugee populations and created social, economic as well as public health crises that led to multipronged challenges and barriers to resettlement services and community support. This study aims to explore the impacts of the pandemic on refugee service provision from the standpoint of refugee-serving professionals, refugee community leaders, and volunteers. Using rapid evaluation and appraisal methods, we conducted individual and focus group interviews with 42 key stakeholders in refugee services, followed by a brief online survey with 69 service providers. A thematic analysis revealed how preexisting are conflated with emergent barriers during the pandemic and how such cumulative adversities experienced by the refugee community have widened the gaps in social services and healthcare as well as social support within the refugee community. This study proposes several implications for future research and policy in social work with refugee populations during the post-COVID time.

Cognitive Behavioural Therapy: A Strategy to Address Pandemic-Induced Anxiety

Mental health morbidity has increased amid the COVID-19 pandemic due to social isolation, impairment of basic needs, financial instability, and fears of the virus. New cases of anxiety and depression have been on the rise, while preexisting mental and chronic illnesses have been exacerbated. Cognitive behavioral therapy (CBT) is a highly flexible technique used to manage an array of mental illnesses. CBT may be of particular benefit under conditions of social isolation and virtual health care delivery. This report addresses the critical role of nurse practitioners in navigating effective CBT for mental wellness.

Mental Health Staff Perceptions of Improvement Opportunities around COVID-19: A Mixed-Methods Analysis

While COVID-19 has had widespread impact on the way behavioral health services are delivered, very little research exists characterizing how providers have perceived these changes. This study used mixed-methods to understand the complex and varied experiences of staff of a psychiatric service line at a large tertiary medical center with high community spread of COVID-19. A brief convenience survey was sent to all staff of the service line and thematic analysis generated brief themes and their frequency. Qualitative focus groups were then held to elucidate greater detail on survey responses. In total, 99 individuals responded to the survey and 17 individuals attended two focus groups in which theoretical saturation was achieved. While brief survey responses generated three broad themes, including operations, telehealth and technology, and communication, focus group data provided nuanced information about these themes, including reasons underlying heightened stress and fatigue felt by staff, inadequacy of technology while finding innovative approaches for its use, and appreciation for the benefits of telehealth while expressing concern for patients not served well by it. These mixed-methods findings highlight the complexities of implementing widespread changes during COVID-19 and demonstrate how survey and focus group data can be used to evaluate rapid care transformations driven by COVID-19.

Overview of sleep management during COVID-19

The sleep of millions has suffered during the global COVID-19 pandemic. Prevalence rates of 20-45% are reported globally for insomnia symptoms during the pandemic. Affected populations include the public and health care workers. A sleep deprived society faces the increased burden of COVID-related economic disruption, psychosocial problems, substance abuse, and suicide. Disordered sleep is not expected to disappear with control of infection, making interventions acutely necessary. The question becomes how to manage the sleep dysfunction during and after the pandemic. Depression and anxiety are prominent complaints during pandemic restrictions. Insomnia symptoms and fatigue continue even as mood improves in those who are in recovery from COVID-19 infection. Management of disturbed sleep and mental health is particularly needed in frontline health care workers. This overview describes 53 publications, as of February 2021, on disturbed sleep during the pandemic, treatment studies on COVID-related sleep disturbance, and need to rely on current treatment guidelines for common sleep disorders. The available research during the first year of COVID-19 has generally described symptoms of poor sleep rather than addressing treatment strategies. It covers digital cognitive behavioral therapy for insomnia (CBT-i) for the public and frontline workers, recognizing the need of greater acceptance and efficacy of controlled trials of CBT for affected groups. Recommendations based on a tiered public health model are discussed.