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Rolvien L, Buddeberg L, Gehlenborg J, Borsutzky S, Moritz S. A Self-Guided Internet-Based Intervention for the Reduction of Gambling Symptoms: A Randomized Clinical Trial. JAMA Netw Open 2024; 7:e2417282. [PMID: 38904962 PMCID: PMC11193125 DOI: 10.1001/jamanetworkopen.2024.17282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2024] [Accepted: 04/15/2024] [Indexed: 06/22/2024] Open
Abstract
Importance Most individuals with problem gambling or gambling disorder remain untreated due to barriers to treatment. Limited research exists on alternative treatments. Objective To investigate the efficacy of a self-guided internet-based intervention for individuals with gambling problems and to identify potential outcome moderators. Design, Setting, and Participants This single-center randomized clinical trial was conducted from July 13, 2021, to December 31, 2022, at the University Medical Center Hamburg-Eppendorf. Participants were recruited across Germany for 2 assessments (before intervention [t0] and 6 weeks after intervention [t1]). Eligible participants were individuals aged 18 to 75 years with gambling problems, internet access, German proficiency, and willingness to participate in 2 online assessments. Intervention The self-guided internet-based intervention was based on cognitive behavioral therapy, metacognitive training, acceptance and commitment therapy, and motivational interviewing. Main Outcome and Measures The primary outcome was change in gambling-related thoughts and behavior as measured with the pathological gambling adaption of the Yale-Brown Obsessive-Compulsive Scale. Secondary outcomes were change in depressive symptoms, gambling severity, gambling-specific dysfunctional thoughts, attitudes toward online interventions, treatment expectations, and patient satisfaction. Results A total of 243 participants (154 [63.4%] male; mean [SD] age, 34.73 [10.33] years) were randomized to an intervention group (n = 119) that gained access to a self-guided internet-based intervention during 6 weeks or a wait-listed control group (n = 124). Completion at t1 was high (191 [78.6%]). Results showed a significantly greater reduction in gambling-related thoughts and behavior (mean difference, -3.35; 95% CI, -4.79 to -1.91; P < .001; Cohen d = 0.59), depressive symptoms (mean difference, -1.05; 95% CI, -1.87 to -0.22; P = .01; Cohen d = 0.33), and gambling severity (mean difference, -1.46; 95% CI, -2.37 to -0.54; P = .002; Cohen d = 0.40) but not in gambling-specific dysfunctional thoughts (mean difference, -1.62; 95% CI, -3.40 to 0.15; P = .07; Cohen d = 0.23) favoring the intervention group. Individuals in the intervention group who had a positive treatment expectation and more severe gambling-specific dysfunctional thoughts and gambling symptoms benefited more on the primary outcome relative to the control group. Conclusions and Relevance In this randomized clinical trial, the effectiveness of a self-guided internet-based intervention for individuals with self-reported problematic gambling behavior was demonstrated when measured 6 weeks after start of the intervention. The study's findings are particularly relevant given the increasing need for accessible and scalable solutions to address problematic gambling. Trial Registration bfarm.de Identifier: DRKS00024840.
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Affiliation(s)
- Lara Rolvien
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Lisa Buddeberg
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Josefine Gehlenborg
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Swantje Borsutzky
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Steffen Moritz
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Özer Ö, Köksal B, Altinok A. Understanding university students' attitudes and preferences for internet-based mental health interventions. Internet Interv 2024; 35:100722. [PMID: 38356613 PMCID: PMC10864831 DOI: 10.1016/j.invent.2024.100722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 01/04/2024] [Accepted: 01/31/2024] [Indexed: 02/16/2024] Open
Abstract
Internet-based interventions are recognised as a practical approach to address mental health issues. The acceptance and utilisation of such interventions are closely linked to user attitudes and preferences. This study aims to examine the predictors of university students' attitudes towards internet-based interventions. Additionally, it seeks to elucidate students' preferences regarding crucial features of these interventions, such as the format, delivery mode, content type, and structural components, to understand better what makes these interventions appealing and practical for university students. A total of 273 university students (comprising 68 % females and 32 % males) participated in the study. The data collection instruments employed were the Personal Information Form, Internet-Based Intervention Preference Survey, E-therapy Attitude Measure (ETAM), Digital Literacy Scale, Patient Health Questionnaire-9, and the Generalized Anxiety Disorder-7 (GAD-7). The data were analysed utilising descriptive statistics, Pearson correlation analysis, and multiple linear regression analysis. The multiple regression analysis revealed digital literacy as a predictive factor for attitudes towards internet-based interventions. Demographic variables, such as age and gender, and psychological variables, such as depression and anxiety levels, were found not to be associated with attitudes towards these interventions. While students are actively seeking mental health information online, a significant majority remain unaware of internet-based interventions. They show a preference for interventions offering greater human interaction, including face-to-face guidance and video content featuring people. Participants favour completing one or two sessions of the intervention weekly. Desired features of internet-based interventions include self-assessment scales, relatable characters, voice relaxation exercises, practical daily life activity tasks, and weekly reminders throughout the process. In conclusion, initiatives aimed at enhancing digital literacy levels could foster more positive attitudes towards internet-based interventions among students. Developers creating Internet-Based Interventions (IBI) for university students should consider these preferences.
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Affiliation(s)
- Ömer Özer
- Department of Social Work and Consultancy, Open Education Faculty, Anadolu University, Eskisehir, Turkiye
| | - Burak Köksal
- Counseling and Guidance Center, Gaziosmanpaşa University, Tokat, Turkiye
| | - Ahmet Altinok
- Department of Psychology, Experimental Psychology, University of Groningen, Groningen, the Netherlands
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Fenski F, Böttcher J, Hörz-Sagstetter S. [Online Therapy as an Add-on to Psychoanalysis? What Needs for Online Therapy Modules do Psychodynamic Psychotherapists in Private Practice Express for Their Outpatient Work?]. Psychother Psychosom Med Psychol 2023; 73:346-352. [PMID: 37054741 DOI: 10.1055/a-2050-3413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/15/2023]
Abstract
OBJECTIVE In recent years, psychotherapists have been increasingly confronted with the challenge of meeting treatment needs efficiently with limited time resources and at the same time achieving stable treatment success in the long term. One way to address this is to integrate Internet-based interventions (IBI) into outpatient psychotherapy. While there is a lot of research on IBI based on cognitive-behavioral therapy, little is known about the same for psychodynamic treatment models. Therefore, the question will be answered as to what specific online modules would need to look like that psychodynamic psychotherapists would use in their outpatient practice to support their regular face-to-face therapies. METHODS In this study, 20 psychodynamic psychotherapists were asked about their requirements on the content of online modules that could be integrated into outpatient psychotherapy, using semi-structured interviews. The transcribed interviews were analyzed using Mayring's qualitative content analysis. RESULTS Results showed that some psychodynamic psychotherapists already use exercises or materials which could be transferred into the online format. In addition, general requirements about online modules emerged, such as an easy handling or a playful character. At the same time, it became clear when and with what kind of patient groups online modules would be integrated into psychodynamic psychotherapy. DISCUSSION The interviewed psychodynamic psychotherapists considered it an attractive approach to offer online modules as a supplement to psychotherapy and in a broad spectrum of content. They gave practical advice for the design of possible modules, both on the level of general handling and regarding concrete contents, words, and ideas. CONCLUSION The results contributed to the development of online modules for use in routine care, the effectiveness of which will be investigated in a randomized controlled trial in Germany.
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Affiliation(s)
- Friederike Fenski
- Klinische Psychologie und Psychotherapie, Psychologische Hochschule Berlin
| | - Johanna Böttcher
- Klinische Psychologie und Psychotherapie, Psychologische Hochschule Berlin
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Lukka L, Karhulahti VM, Palva JM. Factors Affecting Digital Tool Use in Client Interaction According to Mental Health Professionals: Interview Study. JMIR Hum Factors 2023; 10:e44681. [PMID: 37428520 PMCID: PMC10366964 DOI: 10.2196/44681] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 03/16/2023] [Accepted: 04/30/2023] [Indexed: 07/11/2023] Open
Abstract
BACKGROUND Digital tools and interventions are being increasingly developed in response to the growing mental health crisis, and mental health professionals (MHPs) considerably influence their adoption in client practice. However, how MHPs use digital tools in client interaction is yet to be sufficiently understood, which poses challenges to their design, development, and implementation. OBJECTIVE This study aimed to create a contextual understanding of how MHPs use different digital tools in clinical client practice and what characterizes the use across tools. METHODS A total of 19 Finnish MHPs participated in semistructured interviews, and the data were transcribed, coded, and inductively analyzed. RESULTS We found that MHP digital tool use was characterized by 3 distinct functions: communication, diagnosis and evaluation, and facilitating therapeutic change. The functions were addressed using analog tools, digitized tools that mimic their analog counterparts, and digital tools that use the possibilities native to digital. The MHP-client communication included various media alongside face-to-face meetings, the MHPs increasingly used digitized tools in client evaluation, and the MHPs actively used digitized materials to facilitate therapeutic change. MHP tool use was generally characterized by adaptability-it was negotiated in client interactions. However, there was considerable variance in the breadth of MHPs' digital toolbox. The existing clinical practices emphasized MHP-client interaction and invited incremental rather than radical developments, which challenged the achievement of the scalability benefits expected from digital tools. CONCLUSIONS MHPs use digitized and digital tools in client practice. Our results contribute to the user-centered research, development, and implementation of new digital solutions in mental health care by classifying them according to their function and medium and describing how MHPs use and do not use them.
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Affiliation(s)
- Lauri Lukka
- Department of Neuroscience and Biomedical Engineering, Aalto University, Espoo, Finland
| | - Veli-Matti Karhulahti
- Faculty of Humanities and Social Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - J Matias Palva
- Department of Neuroscience and Biomedical Engineering, Aalto University, Espoo, Finland
- Neuroscience Center, Helsinki Institute of Life Science, University of Helsinki, Helsinki, Finland
- Centre for Cognitive Neuroimaging, Institute of Neuroscience and Psychology, University of Glasgow, Glasgow, United Kingdom
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Mendes-Santos C, Campos T, Ferreira D, Weiderpass E, Santana R, Andersson G. Breast Cancer Survivors' Attitudes toward eMental Health: A Cross-Sectional Study. Healthcare (Basel) 2023; 11:1920. [PMID: 37444755 PMCID: PMC10341406 DOI: 10.3390/healthcare11131920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 06/26/2023] [Accepted: 06/28/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND Breast cancer survivors' (BCS) attitudes toward eMental Health (eMH) are largely unknown, and adoption predictors and their interrelationships remain unclear. This study aimed to explore BCS' attitudes toward eMH and investigate associated variables. METHODS A cross-sectional study involving 336 Portuguese BCS was conducted. Attitudes toward eMH, depression and anxiety symptoms, health-related quality of life, and sociodemographic, clinical, and internet-related variables were assessed using validated questionnaires. Spearman-ranked correlations, χ2, and multiple regression analyses were computed to explore associations between attitudes and collected variables. RESULTS BCS held a neutral stance toward eMH. In models adjusted for age and education, positive attitudes were statistically significantly associated with increased depressive symptoms and worse emotional, cognitive, and body image functioning. Social network use, online health information and mental healthcare seeking, higher self-reported knowledge of eMH, and previous use of remote healthcare were positively associated with better attitudes toward eMH. CONCLUSIONS eMH programs targeting BCS seem to be a promising strategy for providing supportive psychosocial care to BCS. However, increasing awareness about eMH efficacy and security may be necessary to improve its acceptance and use among BCS. Additional research is necessary to understand how BCS' unmet care needs, and specifically their psychological distress severity, may impact BCS' acceptance and use of eMH.
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Affiliation(s)
- Cristina Mendes-Santos
- Fraunhofer Portugal AICOS, 4200-135 Porto, Portugal
- Department of Culture and Society (IKOS), Linköping University, 58183 Linköping, Sweden
- NOVA National School of Public Health, Public Health Research Centre, Universidade Nova de Lisboa, 1099-085 Lisbon, Portugal;
| | - Teresa Campos
- Faculty of Sports, University of Porto (FADEUP), 4099-002 Porto, Portugal;
| | - Diana Ferreira
- Center for Psychology, University of Porto, 4200-135 Porto, Portugal;
| | | | - Rui Santana
- NOVA National School of Public Health, Public Health Research Centre, Universidade Nova de Lisboa, 1099-085 Lisbon, Portugal;
| | - Gerhard Andersson
- Department of Behavioural Sciences and Learning (IBL), Department of Biomedical and Clinical Sciences, Linköping University, 58183 Linköping, Sweden;
- Department of Clinical Neuroscience, Psychiatry Section, Karolinska Institutet, 17177 Stockholm, Sweden
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Rutkowska E, Furmańska J, Lane H, Marques CC, Martins MJ, Sahar NU, Meixner J, Tullio V, Argo A, Bermeo Barros DM. Determinants of psychotherapists' attitudes to online psychotherapy. Front Psychiatry 2023; 14:1196907. [PMID: 37426099 PMCID: PMC10324565 DOI: 10.3389/fpsyt.2023.1196907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 06/05/2023] [Indexed: 07/11/2023] Open
Abstract
Introduction Online psychotherapy is a form of work that is becoming more and more popular. Public health problems, such as COVID-19, forced mental health professionals and patients to incorporate new methodologies such as the use of electronic media and internet to provide follow-up, treatment and also supervision. The aim of this study was to investigate which factors shape the therapists' attitudes toward online psychotherapy during a pandemic taking into account: (1) attitudes toward the COVID-19 pandemic (fear of contagion, pandemic fatigue, etc.), (2) personal characteristics of the psychotherapists (age, gender, feeling of efficacy, anxiety, depression, etc.), and (3) characteristics of the psychotherapeutic practice (guideline procedure, client age group, professional experience, etc). Materials and methods Study participants were 177 psychotherapists from four European countries: Poland (n = 48), Germany (n = 44), Sweden (n = 49), and Portugal (n = 36). Data were collected by means of an individual online survey through the original questionnaire and the standardized scales: a modified version of the Attitudes toward Psychological Online Interventions Scale (APOI), Fear of Contagion by COVID-19 Scale (FCS COVID-19), Pandemic Fatigue Scale (PFS), Hospital Anxiety and Depression Scale (HADS), Social Support Questionnaire (F-SozU K-14), and the Sense of Efficiency Test (SET). Results Determinants that impacted psychotherapists' attitudes toward online therapy were: COVID-19 belief in prevention-keeping distance and hand disinfection, pandemic behavioral fatigue, previous online therapy experience (including voice call), working with youth and adults. Our study showed that belief in the sense of prevention in the form of taking care of hand disinfection before the session, pandemic behavioral fatigue and experience in working with adults were significant predictors of negative attitudes of therapists toward online psychological interventions. On the other hand, belief in the sense of prevention in the form of keeping distance during the session had a positive effect on general attitudes toward therapy conducted via the internet. Discussion The online therapy boom during the COVID-19 pandemic has spawned a powerful tool for psychotherapists. More research in this area and training of psychotherapists are needed for online psychological interventions to become an effective therapy format that is accepted by patients and therapists alike.
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Affiliation(s)
- Emilia Rutkowska
- Institute of Psychology, University of Szczecin, Szczecin, Poland
| | - Joanna Furmańska
- Institute of Psychology, University of Szczecin, Szczecin, Poland
| | - Hakan Lane
- Brandenburg Medical School Theodor Fontane, Brandenburg an der Havel, Brandenburg, Germany
| | - Cristiana C. Marques
- Center for Research in Neuropsychology and Cognitive and Behavioral Intervention (CINEICC), Faculty of Psychology and Educational Sciences, University of Coimbra, Coimbra, Portugal
| | - Maria João Martins
- Center for Research in Neuropsychology and Cognitive and Behavioral Intervention (CINEICC), Faculty of Psychology and Educational Sciences, University of Coimbra, Coimbra, Portugal
- University of Coimbra Health Services, University of Coimbra, Coimbra, Portugal
| | - Najam us Sahar
- Fatima Jinnah Women University, Rawalpindi, Punjab, Pakistan
| | - Johannes Meixner
- Brandenburg Medical School Theodor Fontane, Brandenburg an der Havel, Brandenburg, Germany
| | - Valeria Tullio
- Department of Health Promotion, Maternal and Child Care, “G. D’Alessandro”, University of Palermo, Palermo, Sicily, Italy
| | - Antonina Argo
- Department of Health Promotion, Maternal and Child Care, “G. D’Alessandro”, University of Palermo, Palermo, Italy, University of Palermo, Palermo, Sicily, Italy
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Barceló-Soler A, García-Campayo J, Araya R, Doukani A, Gili M, García-Palacios A, Mayoral F, Montero-Marin J. Working alliance in low-intensity internet-based cognitive behavioral therapy for depression in primary care in Spain: A qualitative study. Front Psychol 2023; 14:1024966. [PMID: 37063543 PMCID: PMC10090318 DOI: 10.3389/fpsyg.2023.1024966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 03/07/2023] [Indexed: 03/31/2023] Open
Abstract
IntroductionPsychotherapies delivered via the Internet have been promoted as an alternative for improving access to psychological treatments. A conceptual working alliance model of blended (i.e., traditional face-to-face consultation combined with Internet-delivered psychotherapy) cognitive-behavioral therapy (b-CBT) for depression has been developed in the UK. However, little is known about how this important therapeutic process, namely the working alliance (WA), is developed and maintained in Internet-delivered cognitive-behavioral therapy without face-to-face consultation (i-CBT). The aim of this study was to evaluate the validity of the WA model of b-CBT in Spanish patients with depression receiving i-CBT.MethodsForty-one patients suffering from mild-moderate depression were interviewed to assess their experiences of an i-CBT program. Interviews were conducted with participants who received a self-guided application (n = 9), and low-intensity support (n = 10). Three group interviews were also conducted with patients who either did not start the program (n = 8) or did not complete it (n = 6), and with patients who did complete it (n = 8).ResultsQualitative thematic content analysis was performed using the constant comparative method, which revealed four main themes: “bond,” “goals,” “task,” and “usability heuristics,” all consistent with the existing literature. However, a new subcategory emerged, called “anonymity,” which may highlight the social stigma that mental illness still has in the Spanish context.ConclusionResults suggest that the development and maintenance of the WA through i-CBT could offer a better experience of the therapeutic process and improve the clinical impact.Clinical Trial RegistrationClinicaltrials.gov, identifier: NCT01611818.
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Affiliation(s)
- Alberto Barceló-Soler
- Navarra Medical Research Institute (IdiSNA), Pamplona, Spain
- Institute of Health Research of Aragon (IIS Aragon), Zaragoza, Spain
| | - Javier García-Campayo
- Institute of Health Research of Aragon (IIS Aragon), Zaragoza, Spain
- Department of Psychiatry, University of Zaragoza, Zaragoza, Spain
- *Correspondence: Javier García-Campayo,
| | | | - Asmae Doukani
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Margalida Gili
- Department of Psychology, University of the Balearic Islands, Palma, Spain
| | - Azucena García-Palacios
- Department of Basic and Clinical Psychology and Psychobiology, Universitat Jaume I, Castelló de la Plana, Spain
- CIBER Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto Salud Carlos III, Madrid, Spain
| | | | - Jesus Montero-Marin
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, United Kingdom
- Teaching, Research and Innovation Unit, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBER Epidemiology and Public Health—CIBERESP), Madrid, Spain
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Wilson H, Hayward P, Donkin L. Will they or won't they? Understanding New Zealand adults' attitudes towards using digital interventions. Front Digit Health 2023; 5:1008564. [PMID: 36969957 PMCID: PMC10030707 DOI: 10.3389/fdgth.2023.1008564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 01/30/2023] [Indexed: 03/11/2023] Open
Abstract
BackgroundDigital interventions deliver healthcare via the internet or smartphone application to support people's well-being and health. Yet uptake is relatively poor. Furthermore, several studies exploring attitudes towards digital interventions have found inconsistent attitudes. In addition to this, regional and cultural nuances may further influence attitudes to digital interventions.ObjectiveThis study aimed to understand New Zealand adults' attitudes towards digital interventions and their influences.ResultsA mixed-method design consisting of a cross-sectional survey and semi-structured interviews found that New Zealand adults hold varied and complex attitudes towards digital interventions. Attitudes were found to be influenced by group membership and the scenarios in which digital interventions are made available. In addition, beliefs about the benefits and concerns surrounding digital interventions, knowledge, perceived views of others, and previous experience and confidence influenced these attitudes.ConclusionsFindings indicated that digital interventions would be acceptable if offered as part of the healthcare service rather than a standalone intervention. Key modifiable factors that could positively influence attitudes were identified and could be leveraged to increase the perceived acceptability of digital interventions.
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Affiliation(s)
- Holly Wilson
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Penelope Hayward
- Department of Psychology, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Liesje Donkin
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
- Department of Psychology, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
- Correspondence: Liesje Donkin
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Tomaino SCM, Manzoni GM, Brotto G, Cipolletta S. Breaking Down the Screen: Italian Psychologists' and Psychotherapists' Experiences of the Therapeutic Relationship in Online Interventions during the COVID-19 Pandemic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1037. [PMID: 36673792 PMCID: PMC9859036 DOI: 10.3390/ijerph20021037] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 12/29/2022] [Accepted: 01/04/2023] [Indexed: 06/17/2023]
Abstract
(1) Background: The COVID-19 pandemic posed new challenges to clinical practice and delineated future directions for online interventions in psychological care. The present study aimed to explore Italian psychologists' and psychotherapists' experiences of online interventions during the pandemic, focusing on the strategies they used to develop and maintain therapeutic relationships with their patients. (2) Methods: Between February and July 2021, 368 Italian psychologists and/or psychotherapists completed an online survey. A mixed-methods analysis was conducted, using Jamovi to analyze quantitative data and ATLAS.ti 9 to analyze qualitative data. (3) Results: Of the participants, 62% had never delivered online interventions before the pandemic; though 95.4% were delivering online interventions at the time of the survey, many reported facing technical disruptions (77.1%) and having little confidence in the online setting (45.3%). Feeling present in online sessions-facilitated by emotional attunement, active listening, and conversational spontaneity-was reported as "very important" by 93.6%. (4) Conclusions: Overall, the COVID-19 pandemic allowed a great leap forward in the use of online interventions by Italian psychologists and psychotherapists. This period of upheaval generated not only a positive change in their attitudes toward and intention to use online interventions but also revealed associated technical and relational issues that must be properly addressed.
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Affiliation(s)
| | | | - Giada Brotto
- Department of General Psychology, University of Padua, 35131 Padova, Italy
| | - Sabrina Cipolletta
- Department of General Psychology, University of Padua, 35131 Padova, Italy
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Becker J, Kreis A, Schorch T, Mayer A, Tsiouris A, Beutel ME, Zwerenz R. Adherence and effectiveness of an emotion-based psychodynamic online self-help during and after inpatient and day-care psychotherapy: Results of a naturalistic study. Front Psychiatry 2023; 14:1027118. [PMID: 36741111 PMCID: PMC9894873 DOI: 10.3389/fpsyt.2023.1027118] [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: 08/24/2022] [Accepted: 01/02/2023] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Internet-based mental health interventions are considered effective in providing low-threshold support for people with mental health disorders. However, there is a lack of research investigating the transferability of such online programs into routine care settings. Low treatment adherence and problems with technical implementation often limit a successful transfer into clinical routines. This naturalistic study aims to identify influencing factors on program adherence in patients who participated in an online intervention during inpatient or day-clinic psychotherapeutic treatment. METHODS AND FINDINGS In a naturalistic study, we investigated the transferability of the transdiagnostic psychodynamic online self-help program KEN-Online, which includes eight consecutive units. Between May 2017 and October 2018, patients who received inpatient or day-clinic psychotherapeutic treatment at the Department of Psychosomatic Medicine and Psychotherapy in the University Medical Center Mainz have been offered to use KEN-Online. Of the n = 749 patients who were admitted to the clinic, n = 239 patients (32%) registered for participation in KEN-Online. While 46.9% of the participants did not complete any unit (inactive participants), 53.1% completed at least the first unit (active participants). Age, number of diagnoses, and symptom severity were associated with (in)active participation. Adherence decreased over time resulting in only 17 participants (7.6%) who completed all units. None of the sociodemographic and medical characteristics proved to be significant predictors of adherence. Analyses of effectiveness showed a significant reduction of anxiety and depression in active participants in the course of participation, with higher improvements in participants that completed more than half of the units. CONCLUSION Adherence to the online self-help program KEN-Online was lower in the naturalistic setting than in a previous clinical trial, but was still associated with greater program effectiveness. Adherence-promoting measures are crucial to increase the effectiveness of such interventions in clinical settings.
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Affiliation(s)
- Jan Becker
- Institute of Teachers' Health, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Adina Kreis
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Theresa Schorch
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Anna Mayer
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Angeliki Tsiouris
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Manfred E Beutel
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Rüdiger Zwerenz
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
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Atik E, Schückes M, Apolinário-Hagen J. Patient and Therapist Expectations for a Blended Cognitive Behavioral Therapy Program for Depression: Qualitative Exploratory Study. JMIR Ment Health 2022; 9:e36806. [PMID: 36583934 PMCID: PMC9840101 DOI: 10.2196/36806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 10/24/2022] [Accepted: 11/16/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Blended cognitive behavioral therapy (bCBT)-the combination of digital elements and face-to-face psychotherapy-has been proposed to alleviate challenges that patients and therapists face in conventional cognitive behavioral therapy. There is growing evidence that adding digital elements to face-to-face psychotherapy can contribute to better treatment outcomes. However, bCBT programs still show considerable shortcomings, and knowledge on how to improve digital apps using a bCBT protocol is limited. OBJECTIVE This study aimed to inductively identify functions and qualities that are expected from a bCBT treatment for depression in the eyes of patients and psychotherapists who were not currently receiving or practicing bCBT treatment. METHODS We used a qualitative exploratory study design and conducted 3 focus group interviews (n=6 in each) and 5 semistructured in-depth interviews with therapists as well as 11 individual interviews with patients with a primary diagnosis of depression and currently undergoing cognitive behavioral therapy treatment in Germany. Themes and categories were established inductively from transcribed interview records based on a rigorous coding method. RESULTS Both therapists and patients expected a digital app to provide patients with the opportunity to track their mood, work on therapeutic homework activities, easily access an intervention set for harder moments, and efficiently facilitate administrative tasks. The desire to be able to customize bCBT protocols to individual patient circumstances was evident in both patient and therapist interviews. Patients differed with respect to what content and the amount of material the app should focus on as well as the method of recording experiences. Therapists viewed digital apps as potentially aiding in their documentation work outside of sessions. Different attitudes surfaced on the topic of data security, with patients not as concerned as therapists. CONCLUSIONS Both patients and therapists had substantially positive attitudes toward the option of an integrated bCBT treatment. Our study presents novel findings on the expectations and attitudes of patients and therapists.
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Affiliation(s)
- Ece Atik
- Ruhr University Bochum, Bochum, Germany
| | - Magnus Schückes
- Institute for SME Research and Entrepreneurship, University of Mannheim, Mannheim, Germany
| | - Jennifer Apolinário-Hagen
- Institute of Occupational, Social and Environmental Medicine, Faculty of Medicine, Centre for Health and Society, Heinrich Heine University Dusseldorf, Dusseldorf, Germany
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Götzl C, Hiller S, Rauschenberg C, Schick A, Fechtelpeter J, Fischer Abaigar U, Koppe G, Durstewitz D, Reininghaus U, Krumm S. Artificial intelligence-informed mobile mental health apps for young people: a mixed-methods approach on users' and stakeholders' perspectives. Child Adolesc Psychiatry Ment Health 2022; 16:86. [PMID: 36397097 PMCID: PMC9672578 DOI: 10.1186/s13034-022-00522-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 11/05/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Novel approaches in mobile mental health (mHealth) apps that make use of Artificial Intelligence (AI), Ecological Momentary Assessments, and Ecological Momentary Interventions have the potential to support young people in the achievement of mental health and wellbeing goals. However, little is known on the perspectives of young people and mental health experts on this rapidly advancing technology. This study aims to investigate the subjective needs, attitudes, and preferences of key stakeholders towards an AI-informed mHealth app, including young people and experts on mHealth promotion and prevention in youth. METHODS We used a convergent parallel mixed-method study design. Two semi-structured online focus groups (n = 8) and expert interviews (n = 5) to explore users and stakeholders perspectives were conducted. Furthermore a representative online survey was completed by young people (n = 666) to investigate attitudes, current use and preferences towards apps for mental health promotion and prevention. RESULTS Survey results show that more than two-thirds of young people have experience with mHealth apps, and 60% make regular use of 1-2 apps. A minority (17%) reported to feel negative about the application of AI in general, and 19% were negative about the embedding of AI in mHealth apps. This is in line with qualitative findings, where young people displayed rather positive attitudes towards AI and its integration into mHealth apps. Participants reported pragmatic attitudes towards data sharing and safety practices, implying openness to share data if it adds value for users and if the data request is not too intimate, however demanded transparency of data usage and control over personalization. Experts perceived AI-informed mHealth apps as a complementary solution to on-site delivered interventions in future health promotion among young people. Experts emphasized opportunities in regard with low-threshold access through the use of smartphones, and the chance to reach young people in risk situations. CONCLUSIONS The findings of this exploratory study highlight the importance of further participatory development of training components prior to implementation of a digital mHealth training in routine practice of mental health promotion and prevention. Our results may help to guide developments based on stakeholders' first recommendations for an AI-informed mHealth app.
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Affiliation(s)
- Christian Götzl
- Department of Psychiatry II, University of Ulm and BKH Guenzburg, Lindenallee 2, Guenzburg, 89312, Ulm, Germany. .,Department of Forensic Psychiatry and Psychotherapy, University of Ulm and BKH Guenzburg, Ulm, Germany.
| | - Selina Hiller
- grid.6582.90000 0004 1936 9748Department of Psychiatry II, University of Ulm and BKH Guenzburg, Lindenallee 2, Guenzburg, 89312 Ulm, Germany
| | - Christian Rauschenberg
- grid.7700.00000 0001 2190 4373Department of Public Mental Health, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Anita Schick
- grid.7700.00000 0001 2190 4373Department of Public Mental Health, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Janik Fechtelpeter
- grid.7700.00000 0001 2190 4373Department of Theoretical Neuroscience, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Unai Fischer Abaigar
- grid.7700.00000 0001 2190 4373Department of Theoretical Neuroscience, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Georgia Koppe
- grid.7700.00000 0001 2190 4373Department of Theoretical Neuroscience, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany ,grid.7700.00000 0001 2190 4373Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Daniel Durstewitz
- grid.7700.00000 0001 2190 4373Department of Theoretical Neuroscience, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Ulrich Reininghaus
- grid.7700.00000 0001 2190 4373Department of Public Mental Health, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany ,grid.13097.3c0000 0001 2322 6764Centre for Epidemiology and Public Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK ,grid.13097.3c0000 0001 2322 6764ESRC Centre for Society and Mental Health, King’s College London, London, UK
| | - Silvia Krumm
- grid.6582.90000 0004 1936 9748Department of Psychiatry II, University of Ulm and BKH Guenzburg, Lindenallee 2, Guenzburg, 89312 Ulm, Germany
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Zhang X, Lewis S, Chen X, Berry N, Bucci S. Mental health professionals views and the impact of COVID-19 pandemic on implementing digital mental health in China: A nationwide survey study. Internet Interv 2022; 30:100576. [PMID: 36185346 PMCID: PMC9509019 DOI: 10.1016/j.invent.2022.100576] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 09/15/2022] [Accepted: 09/23/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Using digital health technologies (DHTs) to deliver and augment healthcare is an innovative way to solve common challenges that the mental healthcare setting faces. Despite China's rapid development of DHT, a comprehensive understanding of staff views of DHTs is lacking, which limited the evidence to support implementation strategies. In the current study, we aim to: (i) investigate staff attitudes towards digital technology for mental health problems in China; (ii) explore staff's views on the facilitators and barriers regarding uptake and adoption of digital technology in mental health services in China; and (iii) understand how the COVID-19 pandemic has changed staff views on digital mental health. METHODS An online survey was conducted to explore staff attitudes towards implementing DHTs in China. Descriptive statistics were conducted to summarise quantitative data. Free-text data were analysed using qualitative content analysis. RESULTS 1270 mental health professionals completed the survey. Respondents reported low levels of knowledge of DHTs and moderate levels of accessibility of DHTs in their hospitals. Respondents expressed positive attitudes towards DHTs and demonstrated moderate levels of perceived feasibility and acceptability of implementing DHTs in clinical services. As expected, respondents reported that the COVID-19 pandemic caused significant impacts on their clinical services, and almost all respondents deemed DHTs useful for services provision during the pandemic and were willing to apply such technologies in clinical services after the pandemic. CONCLUSIONS Despite the Chinese mental health staff expressed positive attitudes towards implementing DHTs in clinical practice, most of the staff lacked sufficient knowledge to provide such services. These findings highlight the need to develop implementation strategies such as training programmes and dissemination of research evidence to support the translation of research.
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Affiliation(s)
- Xiaolong Zhang
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, United Kingdom,The National Clinical Research Center for Mental Disorders, Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
| | - Shôn Lewis
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, United Kingdom,Greater Manchester Mental Health NHS Foundation Trust, United Kingdom
| | - Xu Chen
- The National Clinical Research Center for Mental Disorders, Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China,Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Natalie Berry
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, United Kingdom
| | - Sandra Bucci
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, United Kingdom,Greater Manchester Mental Health NHS Foundation Trust, United Kingdom,Corresponding author at: 2nd Floor Zochonis Building, Brunswick Street, Manchester M13 9PL, United Kingdom.
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Richter LE, Machleit-Ebner A, Scherbaum N, Bonnet U. How Effective is a Web-Based Mental Health Intervention (Deprexis) in the Treatment of Moderate and Major Depressive Disorders when started during Routine Psychiatric Inpatient Treatment as an Adjunct Therapy? A Pragmatic Parallel-Group Randomized Controlled Trial. FORTSCHRITTE DER NEUROLOGIE-PSYCHIATRIE 2022. [PMID: 35882364 DOI: 10.1055/a-1826-2888] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
BACKGROUND Internet-based self-help-programs like deprexis have been increasingly shown to reduce depressive symptoms if added to distinct, primarily outpatient-treatment-settings. There is limited information about the effectiveness of deprexis if started at routine psychiatric hospital inpatient treatment of moderate-to-severe major depressive disorder (MDD). SUBJECTS AND METHODS To examine, sixty-nine adult MDD-inpatients were randomly assigned to a 12-week-period of treatment-as-usual (TAU, N=33) or TAU plus guided deprexis (TAU-PLUS, N=36). The study was planned as a pragmatic approach considering psychiatric routine conditions, particularly, offering an instant and flexible discharge management when the patients felt stabilized enough for primary/secondary care. Therefore, there was no fixed time frame for the inpatient treatment duration. Post-discharge, patients were followed by structured telephone interviews up to study-endpoint, i. e., 12 weeks after deprexis-initiation. Primary (Beck-Depression-Inventory-II, BDI-II) and secondary outcome-measures (Hamilton-Depression-Scale, Clinical-Global-Impression-Severity, WHO-Well-Being-Index, Helping-Alliance-Questionnaire) were carried out at study entry and every 2 weeks. Furthermore, the working alliance with deprexis as well as the inpatient treatment duration, the daily activity and the utilization of post-hospital care after discharge were determined. RESULTS At week 12, modified ITT-analyses showed significant between-group differences of BDI-II scores in favor of the TAU-PLUS-patients (p=.03) corresponding to a medium effect size (d=-.73, 95% CI -1.4 to .06). TAU-PLUS-patients showed greater daily activity (p=.04, d=.70, 95% CI -.03 to 1.38) and had been discharged significantly earlier from inpatient treatment (p=.003). Post-discharge, the TAU-PLUS-group reported a lower rate of post-hospital care (p=.01) and re-admissions (p=.04). Secondary outcome-measures including the alliance with the therapists were not significantly different between the groups at study-endpoint. The patients´ working-alliance with deprexis significantly predicted MDD-improvement and wellbeing. Both groups (TAU and TAU plus deprexis) were comparable with regard to the prescribed antidepressant medication. Unfortunately, detailed data on the amount and actual duration of the psychotherapeutic and special therapeutic individual and group settings of the TAU were not collected CONCLUSION: TAU plus deprexis was superior to TAU in improving subjective depression-severity (BDI-II) and daily activity in patients having sought psychiatric inpatient MDD-treatment before. This beneficial effect appeared 12 weeks after inpatient deprexis-initiation, i. e. when the vast majority of patients were back in primary/secondary care. Adjunctive deprexis was associated with earlier discharges and a significant advantage for post-hospital stabilization. In this regard, it could be promising to include deprexis into inpatient treatment conditions, thereby also preparing its continuing outpatient use. We found no evidence that deprexis interfered negatively with the alliance between the patients and their therapists.
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Affiliation(s)
- Lisa Emily Richter
- Department of Psychiatry, Psychotherapy, and Psychosomatic Medicine, Evangelisches Krankenhaus Castrop-Rauxel, Castrop-Rauxel, Academic Teaching Hospital of the University of Duisburg-Essen, Germany
| | - Annika Machleit-Ebner
- Medical Study Center of the Evangelische. Krankenhausgemeinschaft Herne
- Castrop-Rauxel gGmbH, Herne, Germany
| | - Norbert Scherbaum
- LVR-Hospital Essen, Department of Psychiatry and Psychotherapy, Faculty of Medicine, University of Duisburg-Essen, Essen, Germany
| | - Udo Bonnet
- Department of Psychiatry, Psychotherapy, and Psychosomatic Medicine, Evangelisches Krankenhaus Castrop-Rauxel, Castrop-Rauxel, Academic Teaching Hospital of the University of Duisburg-Essen, Germany.,LVR-Hospital Essen, Department of Psychiatry and Psychotherapy, Faculty of Medicine, University of Duisburg-Essen, Essen, Germany
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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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Khatib A, Abo-Rass F, Gelkopf M. Theory of Planned Behavior: Exploring the Use of Digital Mental Health Interventions in Israel. J Nerv Ment Dis 2022; 210:504-509. [PMID: 34966111 DOI: 10.1097/nmd.0000000000001459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Based on the theory of planned behavior (TPB), this study aimed to examine factors influencing therapist uptake of digital mental health interventions in Israel. Two hundred twenty-nine mental health professionals recruited through a convenience sample completed a background and demographic questionnaire, as well as the TPB-based electronic-therapy attitudes and process questionnaire. Regressions were used to examine the contribution of attitudes, perceived behavioral control, subjective norms, and behavioral intentions. Intention to use and use of digital interventions were significantly predicted by attitudes, subjective norms, and perceived behavioral control, as suggested by the TPB. The use of cognitive behavioral therapy (CBT) and higher perceived behavioral control increased the likelihood of using digital interventions. Having a positive attitude, having expectations/social pressure from one's professional environment, and having a sense of control over the process were found to predict the intent to use, as well as the actual use of, digital interventions.
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Affiliation(s)
| | - Fareeda Abo-Rass
- Conflict Management and Resolution Program, Ben-Gurion University of the Negev, Beer-Sheva
| | - Marc Gelkopf
- Department of Community Mental Health, University of Haifa, Mt Carmel, Haifa, Israel
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Staeck R, Drüge M, Albisser S, Watzke B. Acceptance of E-mental health interventions and its determinants among psychotherapists-in-training during the first phase of COVID-19. Internet Interv 2022; 29:100555. [PMID: 35789691 PMCID: PMC9242936 DOI: 10.1016/j.invent.2022.100555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 06/07/2022] [Accepted: 06/22/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Although E-mental health (EMH) interventions have been shown to be effective in the treatment of mental health problems and empirical knowledge regarding EMH acceptance for different occupations in health care is established, little is known regarding EMH and psychotherapists-in-training. This seems particularly relevant as psychotherapists-in-training will shape the future health care system since they are as being the next generation of psychotherapists. With social distancing measures in place, COVID-19 has led to an increased demand for EMH, which is broadening the way psychological treatments are delivered. OBJECTIVE The present study aims to assess the acceptance of EMH and its determinants among psychotherapists-in-training of different EMH modalities and to retrospectively compare current acceptance with pre-COVID-19 times. METHODS Altogether, 29 training institutions in Switzerland and 232 training institutions in Germany were contacted, resulting in a sample of N = 216 psychotherapists-in-training (88.4 % female) who filled out the self-administered web-based questionnaire in summer 2020. The acceptance of EMH was assessed considering several different modalities (e.g., videoconference, guided self-help programs) as well as further possible predictors of EMH acceptance based on the Unified Theory of Acceptance and Use of Technology. Acceptance scores were categorized as low, moderate or high based on prior research and predicted using multiple regression. RESULTS Acceptance of EMH was moderate (M = 3.40, SD = 1.11) and increased significantly (t(215) = 12.03, p < .01; d = 0.88) compared to pre-COVID-19 (M = 2.67, SD = 1.11); however, acceptance varied significantly between modalities (F(2.6, 561.7) = 62.93, p < .01, partial η2 = 0.23), with videoconferencing being the most accepted and unguided programs the least. Stepwise regression including three of 14 variables (R2 = 0.55, F (14, 201) = 17.68, p < .001) identified performance expectancy, social influence and concerns about the therapeutic alliance as significant determinants of EMH acceptance. DISCUSSION Acceptance by psychotherapists-in-training was moderate and in line with prior research and comparable with other clinicians' acceptance scores. Performance expectancy, social influence and concerns about the therapeutic alliance were predictive of EMH acceptance, indicating their significance in the implementation of EMH in health care. CONCLUSION These findings underline the importance of the aforementioned determinants of EMH acceptance and the need for further studies investigating EMH acceptance in order to derive adequate educational programs and to facilitate dissemination among psychotherapists-in-training.
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Vis C, Kleiboer A, Mol M, Pedersen CD, Finch T, Smit J, Riper H. Organisational implementation climate in implementing internet-based cognitive behaviour therapy for depression. BMC Health Serv Res 2022; 22:720. [PMID: 35641927 PMCID: PMC9153170 DOI: 10.1186/s12913-022-08041-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 05/05/2022] [Indexed: 11/10/2022] Open
Abstract
Background Internet-based Cognitive Behaviour Therapy (iCBT) for depression have been implemented in routine care across Europe in varying ways, at various scales and with varying success. This study aimed to advance our understanding of organisational implementation climate from the perspectives of implementers and mental health service deliverers. Methods Qualitative and quantitative methods were combined to study the concept of organisational implementation climate in mental health care settings. Based on concept mapping, a qualitative workshop with implementers was used to conceptualise organisational implementation climate for optimizing iCBT use in routine practice. Service deliverers involved in the provision of iCBT were invited to participate in an explorative cross-sectional survey assessing levels of satisfaction and usability of iCBT, and organisational implementation climate in implementing iCBT. The two methods were applied independently to study viewpoints of implementers as well as service deliverers. Corresponding to the explorative nature of the study, inductive reasoning was applied to identify patterns and develop a reasonable explanation of the observations made. Correlative associations between satisfaction, usability and implementation climate were explored. Results Sixteen implementers representing fourteen service delivery organisations across Europe participated in the workshop. The top-three characteristics of a supportive organisational implementation climate included: (1) clear roles and skills of implementers, (2) feasible implementation targets, and (3) a dedicated implementation team. The top-three tools for creating a supportive implementation climate included: (1) feedback on job performance, (2) progress monitoring in achieving implementation targets, and (3) guidelines for assessing the impact of iCBT. The survey (n=111) indicated that service providers generally regarded their organisational implementation climate as supportive in implementing iCBT services. Organisational implementation climate was weakly associated with perceived usability and moderately with satisfaction with iCBT services. Conclusions Organisational implementation climate is a relevant factor to implementers and service deliverers in implementing iCBT in routine care. It is not only an inherent characteristic of the context in which implementation takes place, it can also be shaped to improve implementation of iCBT services. Future research should further theorise organisational implementation climate and empirically validate the measurement instruments such as used in this study. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08041-y.
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Affiliation(s)
- Christiaan Vis
- Department of Clinical, Neuro-, & Developmental Psychology, Faculty of Behavioural and Movement Sciences, VU Amsterdam, Van der Boechorststraat 7, Amsterdam, 1081 BT, The Netherlands. .,Amsterdam Public Health Research Institute - Mental Health, Amsterdam, Netherlands. .,World Health Organization (WHO) Collaborating Centre for Research and Dissemination of Psychological Interventions, Amsterdam, Netherlands.
| | - Annet Kleiboer
- Department of Clinical, Neuro-, & Developmental Psychology, Faculty of Behavioural and Movement Sciences, VU Amsterdam, Van der Boechorststraat 7, Amsterdam, 1081 BT, The Netherlands.,Amsterdam Public Health Research Institute - Mental Health, Amsterdam, Netherlands
| | - Mayke Mol
- Department of Clinical, Neuro-, & Developmental Psychology, Faculty of Behavioural and Movement Sciences, VU Amsterdam, Van der Boechorststraat 7, Amsterdam, 1081 BT, The Netherlands.,Amsterdam Public Health Research Institute - Mental Health, Amsterdam, Netherlands.,Dept. of Psychiatry, Amsterdam University Medical Centre (VUmc), Amsterdam, The Netherlands
| | | | - Tracy Finch
- Department of Nursing, Midwifery & Health, Northumbria University, Northumbria, United Kingdom
| | - Jan Smit
- Amsterdam Public Health Research Institute - Mental Health, Amsterdam, Netherlands.,Dept. of Psychiatry, Amsterdam University Medical Centre (VUmc), Amsterdam, The Netherlands
| | - Heleen Riper
- Department of Clinical, Neuro-, & Developmental Psychology, Faculty of Behavioural and Movement Sciences, VU Amsterdam, Van der Boechorststraat 7, Amsterdam, 1081 BT, The Netherlands.,Amsterdam Public Health Research Institute - Mental Health, Amsterdam, Netherlands.,Dept. of Psychiatry, Amsterdam University Medical Centre (VUmc), Amsterdam, The Netherlands
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Schwarz J, Mauche N, Oehler C, Rummel-Kluge C, Hegerl U, Strauß M. ["iFightDepression" in inpatient treatment : Evaluation of a web-based, therapist-guided self-management program on a specialized ward for affective disorders]. DER NERVENARZT 2022; 93:459-467. [PMID: 34652484 PMCID: PMC9061691 DOI: 10.1007/s00115-021-01214-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 09/09/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND E‑mental health mainly plays a role in the outpatient treatment of patients with depressive disorders. The goal of this study was to implement and evaluate the web-based, therapist-guided self-management tool "iFightDepression" (iFD) to clarify if there is a benefit for inpatient use. MATERIAL AND METHODS In this study 78 inpatients with affective disorders (ICD-10 F32.0‑3, F33.0-3) or dysthymia (F34) were recruited. The intervention duration with the iFD tool went from admission until discharge, therapeutic support was granted by the ward staff. Symptom severity, intervention expectations and experience with therapy were processed in an online questionnaire before the intervention (T0) while intervention satisfaction was captured after the intervention shortly before discharge (T1) in a paper-pencil questionnaire. RESULTS Out of 78 participating inpatients 42 used the iFD tool at least once. Moderate to high levels of expectation regarding the iFD tool and mildly above-average level of satisfaction after the intervention were observed. Of the active users 67% indicated they would continue to use the iFD tool after discharge. The main reasons for not using the iFD tool were short duration of stay, severity of disease and lack of digital literacy. CONCLUSION An implementation of the iFD tool is feasible on principle. Active users gave positive feedback concerning the intervention and most participants claimed to continue using the iFD tool after discharge; however, low usage rates among study participants (42/78, 54%) showed barriers of implementation that have to be addressed and underline the importance of adaptations regarding the use of the intervention in a clinical setting.
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Affiliation(s)
- Julian Schwarz
- Department für Psychische Gesundheit, Klinik und Poliklinik für Psychiatrie und Psychotherapie, Universitätsklinikum Leipzig, AöR, Semmelweisstr. 10, 04103, Leipzig, Deutschland
| | - Nicole Mauche
- Department für Psychische Gesundheit, Klinik und Poliklinik für Psychiatrie und Psychotherapie, Universitätsklinikum Leipzig, AöR, Semmelweisstr. 10, 04103, Leipzig, Deutschland
| | | | - Christine Rummel-Kluge
- Department für Psychische Gesundheit, Klinik und Poliklinik für Psychiatrie und Psychotherapie, Universitätsklinikum Leipzig, AöR, Semmelweisstr. 10, 04103, Leipzig, Deutschland
| | - Ulrich Hegerl
- Senckenberg Professur, Klinik für Psychiatrie, Psychosomatik und Psychotherapie, Goethe-Universität Frankfurt am Main, Frankfurt am Main, Deutschland
| | - Maria Strauß
- Department für Psychische Gesundheit, Klinik und Poliklinik für Psychiatrie und Psychotherapie, Universitätsklinikum Leipzig, AöR, Semmelweisstr. 10, 04103, Leipzig, Deutschland.
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Hindradjat J, Livana PH. Effectiveness of Using a Mixed of CBT, CT-R, and Oral Treatment in Reducing Depression and Anxiety. Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.8401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
This qualitative research with case study method aims to determine the effectiveness of the combined use of CBT, CT-R and oral treatment to reduce depression and anxiety. The subject in this study was a 55 years old woman. Data were obtained through observation, interviews, and measurement of depression and anxiety levels using the DASS and MCMI-IV instruments. The results of this study showed that the combined use of CBT, CT-R and oral treatment reduced depression level and anxiety as indicated by a decrease in persistent depression scores 75 to 14, major depression scores 102 to 12 and generalized anxiety scores 115 to 30 on MCMI-IV scale. Measurements using the DASS show a decrease in depression scores 25 as major depression to 3 as normal depression, and a decrease in anxiety 16 as severe anxiety to 4 as normal anxiety. The measurement results supported by physical, psychological and behavioral changes. In addition, there are changes in personalities from borderline, melancholic and dependent to turbulent, histrionic and compulsiveon MCMI-IV scale..
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Braun P, Drüge M, Hennemann S, Nitsch FJ, Staeck R, Apolinário-Hagen J. Acceptance of E-Mental Health Services for Different Application Purposes Among Psychotherapists in Clinical Training in Germany and Switzerland: Secondary Analysis of a Cross-Sectional Survey. Front Digit Health 2022; 4:840869. [PMID: 35295621 PMCID: PMC8918841 DOI: 10.3389/fdgth.2022.840869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 01/27/2022] [Indexed: 11/13/2022] Open
Abstract
Background Despite solid evidence supporting the efficacy of electronic mental health (EMH) services, their acceptance among psychotherapists is limited and uptake rates remain low. However, the acceptance of different EMH services has yet barely been examined in future generations of psychotherapists in a differentiated manner. The aims of this study were (1) to elaborate the intention to use various EMH services for different application purposes and (2) to determine predictors of EMH service acceptance among psychotherapists in clinical training (PiT). Materials and Methods Our paper is based on a secondary data analysis of a cross-sectional survey. Respondents were recruited via recognized educational institutions for psychotherapy within Germany and the German-speaking part of Switzerland between June and July of 2020. The survey contained items on the intention to use different EMH services (i.e., guided and unguided programs, virtual reality, psychotherapy by telephone and videoconference) for various application purposes (i.e., prevention, treatment addition, treatment substitute, aftercare). Potential predictors of EMH service acceptance (e.g., barriers and advantages) were examined based on an extension of the Unified Theory of Acceptance and Use of Technology (UTAUT). Results Most of the n = 216 respondents were female (88.4%) and located in Germany (72.2%). General acceptance of EMH was moderate (M = 3.4, SD = 1.12, range 1-5), while acceptance of psychotherapy via videoconference was highest (M = 3.7, SD = 1.15) and acceptance of unguided programs was lowest (M = 2.55, SD = 1.14). There was an interaction effect of EMH service and application purpose (η2 = 0.21). Barriers and advantages both had a uniform influence on EMH service acceptance (Pr > 0.999), while impersonality, legal concerns, concerns about therapeutic alliance, simplified information provision, simplified contact maintenance, time flexibility, and geographic flexibility were significant predictors (all p < 0.05). Results showed that the extended UTAUT model was the best fitting model to predict EMH service acceptance (Pr > 0.999). Conclusions The intention to use different EMH services varied between application purposes among PiT. To increase acceptance of EMH services and reduce misconceptions, we identified predictors that should be addressed in future acceptance-facilitating interventions when educating PiT.
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Affiliation(s)
- Pia Braun
- Faculty of Medicine, Institute for Occupational, Social and Environmental Medicine, Centre for Health and Society, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Marie Drüge
- Department of Clinical Psychology/Psychotherapy Research, Institute of Psychology, University of Zurich, Zurich, Switzerland
| | - Severin Hennemann
- Department of Clinical Psychology, Psychotherapy and Experimental Psychopathology, Institute of Psychology, University of Mainz, Mainz, Germany
| | - Felix Jan Nitsch
- Marketing Area, INSEAD, Fontainebleau, France
- Paris Brain Institute (ICM), INSERM U 1127, CNRS UMR 7225, Sorbonne Université, Paris, France
| | - Robert Staeck
- Department of Clinical Psychology/Psychotherapy Research, Institute of Psychology, University of Zurich, Zurich, Switzerland
| | - Jennifer Apolinário-Hagen
- Faculty of Medicine, Institute for Occupational, Social and Environmental Medicine, Centre for Health and Society, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
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Phillips EA, Himmler S, Schreyögg J. Preferences of psychotherapists for blended care in Germany: a discrete choice experiment. BMC Psychiatry 2022; 22:112. [PMID: 35151294 PMCID: PMC8841060 DOI: 10.1186/s12888-022-03765-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 02/02/2022] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES Digital treatment formats are emerging within mental health care. Evidence suggests that mental health care providers and recipients prefer a combination of digital and traditional elements within psychotherapy treatment formats, also called blended care (BC), over standalone digital formats. We examined the attitudes and preferences of licensed psychotherapists in Germany regarding such BC applications. METHODS We fielded a survey among psychotherapists, including questions about attitudes, previous experiences, and expectations regarding BC, as well as a discrete choice experiment. Attributes for the experiment were developed using a stepwise qualitative approach. A Bayesian D-efficient design was used to generate the choice tasks. The choice data were analyzed by applying mixed logit models. RESULTS The survey was completed by 200 psychotherapists. Attitudes towards BC were mainly positive, with strong reported intentions to use BC formats. In the choice experiment, recommendation from a professional society for a BC online component was the most important characteristic. Greater effectiveness and a larger share of face-to-face vs. online time were also desired features, while a financial incentive to use BC was less relevant.
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Affiliation(s)
- Elena A. Phillips
- grid.9026.d0000 0001 2287 2617Hamburg Center for Health Economics, University of Hamburg, Esplanade 36, 20354 Hamburg, Germany
| | - Sebastian Himmler
- Erasmus School of Health Policy & Management Health Economics, Burg. Oudlaan 50, 3062 Rotterdam, PA Netherlands
| | - Jonas Schreyögg
- grid.9026.d0000 0001 2287 2617Hamburg Center for Health Economics, University of Hamburg, Esplanade 36, 20354 Hamburg, Germany
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Ramos G, Aguilera A, Montoya A, Lau A, Wen CY, Cruz Torres V, Chavira D. App-Based Mindfulness Meditation for People of Color Who Experience Race-Related Stress: Protocol for a Randomized Controlled Trial (Preprint). JMIR Res Protoc 2021; 11:e35196. [PMID: 35436228 PMCID: PMC9052031 DOI: 10.2196/35196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 02/08/2022] [Accepted: 03/17/2022] [Indexed: 11/23/2022] Open
Abstract
Background People of color (POC) who experience race-related stress are at risk of developing mental health problems, including high levels of stress, anxiety, and depression. Mindfulness meditation may be especially well suited to help POC cope, given its emphasis on gaining awareness and acceptance of emotions associated with discriminatory treatment. However, mindfulness meditation rarely reaches POC, and digital approaches could reduce this treatment gap by addressing traditional barriers to care. Objective This study will test the effectiveness of a self-directed app-based mindfulness meditation program among POC who experience elevated levels of race-related stress. Implementation outcomes such as treatment acceptability, adherence, and satisfaction will be examined. Methods Participants (n=80) will be recruited online by posting recruitment materials on social media and sending emails to relevant groups. In-person recruitment will consist of posting flyers in communities with significant POC representation. Eligible participants will be block randomized to either the intervention group (n=40) that will complete a self-directed 4-week mindfulness meditation program or a wait-list control condition (n=40) that will receive access to the app after study completion. All participants will complete measures at baseline, midtreatment, and posttreatment. Primary outcomes include changes in stress, anxiety, and depression, and secondary outcomes constitute changes in mindfulness, self-compassion, rumination, emotion suppression, and experiential avoidance. Exploratory analyses will examine whether changes in the secondary outcomes mediate changes in primary outcomes. Finally, treatment acceptability, adherence, and satisfaction will be examined descriptively. Results Recruitment began in October 2021. Data will be analyzed using multilevel modeling, a statistical methodology that accounts for the dependence among repeated observations. Considering attrition issues in self-directed digital interventions and their potential effects on statistical significance and treatment effect sizes, we will examine data using both intention-to-treat and per-protocol analyses. Conclusions To our knowledge, this will be the first study to provide data on the effectiveness of a self-directed app-based mindfulness meditation program for POC recruited based on elevated race-related stress, a high-risk population. Similarly, meaningful clinical targets for POC affected by stressors related to race will be examined. Findings will provide important information regarding whether this type of intervention is an acceptable treatment among these marginalized groups. Trial Registration ClinicalTrials.gov NCT05027113; https://clinicaltrials.gov/ct2/show/NCT05027113 International Registered Report Identifier (IRRID) DERR1-10.2196/35196
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Affiliation(s)
- Giovanni Ramos
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, United States
| | - Adrian Aguilera
- School of Social Welfare, University of California, Berkeley, Berkeley, CA, United States
- Department of Psychiatry and Behavioral Sciences, University of California San Francisco, San Francisco, CA, United States
| | - Amanda Montoya
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, United States
| | - Anna Lau
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, United States
| | - Chu Yin Wen
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, United States
| | | | - Denise Chavira
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, United States
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Lawler K, Earley C, Timulak L, Enrique A, Richards D. Dropout From an Internet-Delivered Cognitive Behavioral Therapy Intervention for Adults With Depression and Anxiety: Qualitative Study. JMIR Form Res 2021; 5:e26221. [PMID: 34766909 PMCID: PMC8663602 DOI: 10.2196/26221] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 03/16/2021] [Accepted: 08/01/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Treatment dropout continues to be reported from internet-delivered cognitive behavioral therapy (iCBT) interventions, and lower completion rates are generally associated with lower treatment effect sizes. However, evidence is emerging to suggest that completion of a predefined number of modules is not always necessary for clinical benefit or consideration of the needs of each individual patient. OBJECTIVE The aim of this study is to perform a qualitative analysis of patients' experiences with an iCBT intervention in a routine care setting to achieve a deeper insight into the phenomenon of dropout. METHODS A total of 15 purposively sampled participants (female: 8/15, 53%) from a larger parent randomized controlled trial were interviewed via telephone using a semistructured interview schedule that was developed based on the existing literature and research on dropout in iCBT. Data were analyzed using a descriptive-interpretive approach. RESULTS The experience of treatment leading to dropout can be understood in terms of 10 domains: relationship to technology, motivation to start, background knowledge and attitudes toward iCBT, perceived change in motivation, usage of the program, changes due to the intervention, engagement with content, experience interacting with the supporter, experience of web-based communication, and termination of the supported period. CONCLUSIONS Patients who drop out of treatment can be distinguished in terms of their change in motivation: those who felt ready to leave treatment early and those who had negative reasons for dropping out. These 2 groups of participants have different treatment experiences, revealing the potential attributes and nonattributes of dropout. The reported between-group differences should be examined further to consider those attributes that are strongly descriptive of the experience and regarded less important than those that have become loosely affiliated.
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Affiliation(s)
- Kate Lawler
- E-Mental Health Research Group, School of Psychology, Trinity College Dublin, Dublin, Ireland.,Clinical Research and Innovation, SilverCloud Health, Dublin, Ireland
| | - Caroline Earley
- E-Mental Health Research Group, School of Psychology, Trinity College Dublin, Dublin, Ireland.,Clinical Research and Innovation, SilverCloud Health, Dublin, Ireland
| | - Ladislav Timulak
- E-Mental Health Research Group, School of Psychology, Trinity College Dublin, Dublin, Ireland
| | - Angel Enrique
- E-Mental Health Research Group, School of Psychology, Trinity College Dublin, Dublin, Ireland.,Clinical Research and Innovation, SilverCloud Health, Dublin, Ireland
| | - Derek Richards
- E-Mental Health Research Group, School of Psychology, Trinity College Dublin, Dublin, Ireland.,Clinical Research and Innovation, SilverCloud Health, Dublin, Ireland
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Romero D, Johansson M, Hermansson U, Lindner P. Impact of Users' Attitudes Toward Anonymous Internet Interventions for Cannabis vs. Alcohol Use: A Secondary Analysis of Data From Two Clinical Trials. Front Psychiatry 2021; 12:730153. [PMID: 34646175 PMCID: PMC8502932 DOI: 10.3389/fpsyt.2021.730153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 08/27/2021] [Indexed: 12/03/2022] Open
Abstract
Background: Numerous trials have demonstrated the efficacy of internet interventions targeting alcohol or cannabis use, yet a substantial proportion of users do not benefit from the format, warranting further research to identify moderators of treatment effects. Users' initial attitudes toward treatment is a potential moderator, yet no previous study has investigated users' attitudes in the context of internet interventions for addictive disorders. Method: In this secondary analysis on two internet-based trials targeting harmful alcohol use (n = 1,169) and regular cannabis use (n = 303), respectively, we compared user groups' attitudes at the item level; explored within-group heterogeneity by submitting attitude scores to a k-means cluster analysis; and investigated whether latent subgroups in each user group moderated the treatment effects. Outcome models were run using generalized linear models with 10,000 bias-corrected bootstraps accounting for subject-level clustering. Results: While substance groups and latent subgroups converged in enjoying the anonymity provided by the format, their interest toward treatment differed. Outcome analyses revealed a significant and negative time by subgroup effect on grams of cannabis consumed and screening test score (CAST), favoring the subgroup with positive treatment attitudes. There were not any significant effects of subgroup on alcohol consumption. Despite initial treatment reluctance, participants in the neutral subgroup decreased their cannabis use (gram) significantly when receiving the intervention vs. control. Conclusions: This first, exploratory study revealed key differences between substance groups' attitudes, but more importantly that within-group heterogeneity appear to affect cannabis outcomes. Assessing attitudes could be key in patient-treatment matching, yet more research is needed.
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Affiliation(s)
- Danilo Romero
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Region Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
- Centre for Dependency Disorders, Region Stockholm, Stockholm, Sweden
| | - Magnus Johansson
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Region Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
- Centre for Dependency Disorders, Region Stockholm, Stockholm, Sweden
| | - Ulric Hermansson
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Region Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
- Centre for Dependency Disorders, Region Stockholm, Stockholm, Sweden
| | - Philip Lindner
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Region Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
- Centre for Dependency Disorders, Region Stockholm, Stockholm, Sweden
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26
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Teles S, Ferreira A, Paúl C. Assessing attitudes towards online psychoeducational interventions: Psychometric properties of a Brief Attitudes Scale. HEALTH & SOCIAL CARE IN THE COMMUNITY 2021; 29:e1-e10. [PMID: 33170537 DOI: 10.1111/hsc.13227] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 07/20/2020] [Accepted: 10/20/2020] [Indexed: 06/11/2023]
Abstract
Participant attitudes are an explanatory factor for attrition in online health-related interventions. However, its assessment prior to interventions start is uncommon, partly because proper measures are missing. This study presents the psychometric properties of a new scale measuring attitudes towards online psychoeducational interventions (OPIs). Structural validity, reliability and screening performance of the Online Psychoeducational Intervention - Brief Attitudes Scale (OPI-BAS) were studied in a sample of 157 dementia caregivers. Scale cut-off scores were derived to categorise the participants into 'OPIs sympathisers' or 'non-sympathisers'. Groups were compared across sociodemographic and internet use variables. A parsimonious five-item version of OPI-BAS demonstrated good structural validity, with one factor explaining 63.3% of variance. Internal consistency of the scale was high (α = 0.85). OPI-BAS showed good screening performance in identifying individuals with either a preference to use conventional face-to-face or online psychoeducational interventions (area under the curve = 0.84). An optimal cut-off score of 20 was suggested by the receiver operating characteristic graph, providing good sensitivity (74%) and specificity (84%). No significant differences were found between groups on sociodemographic and internet use variables. Attitudes towards OPIs were overall positive, but face-to-face interventions were preferred. This study offers preliminary support to the psychometric quality of OPI-BAS. This short scale has practical applications for research and intervention.
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Affiliation(s)
- Soraia Teles
- Faculty of Medicine, University of Porto (FMUP), Porto, Portugal
- Center for Health Technology and Services Research (CINTESIS), Porto, Portugal
- Department of Behavioral Sciences, Institute of Biomedical Sciences Abel Salazar, University of Porto (ICBAS-UP), Porto, Portugal
| | - Ana Ferreira
- Faculty of Medicine, University of Porto (FMUP), Porto, Portugal
- Center for Health Technology and Services Research (CINTESIS), Porto, Portugal
| | - Constança Paúl
- Center for Health Technology and Services Research (CINTESIS), Porto, Portugal
- Department of Behavioral Sciences, Institute of Biomedical Sciences Abel Salazar, University of Porto (ICBAS-UP), Porto, Portugal
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Einfluss akzeptanzfördernder Interventionen auf die Nutzung einer Online-Selbsthilfe. PSYCHOTHERAPEUT 2021. [DOI: 10.1007/s00278-021-00530-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Zusammenfassung
Hintergrund
Trotz wachsender empirischer Evidenz zur Wirksamkeit in der Behandlung psychischer Erkrankungen sind internetbasierte Interventionen (IBI) mit geringen Akzeptanz- und hohen Abbruchraten konfrontiert. Akzeptanzfördernde Interventionen (AFI) stellen eine vielversprechende Maßnahme dar, um die Akzeptanz zukünftiger Nutzer*innen zu verbessern. Die Wirksamkeit von AFI auf die Adhärenz, die maßgeblichen Einfluss auf die Wirksamkeit von IBI hat, wurde bisher in nur wenigen empirischen Untersuchungen überprüft.
Ziel der Arbeit (Fragestellung)
Ziel der vorliegenden Untersuchung ist die Überprüfung des Einflusses einer AFI auf die Akzeptanz, die initiale Nutzung und die Adhärenz des transdiagnostischen psychodynamischen Online-Selbsthilfeprogramms „Die Kraft der eigenen Emotionen nutzen (KEN-Online)“.
Material und Methoden
Es wurden Routinedaten von 231 Patient*innen ausgewertet, die während ihrer (teil‑)stationären Behandlung im Rahmen einer ins Routinesetting integrierten AFI das Angebot bekommen haben, KEN-Online behandlungsbegleitend zu nutzen. Im Kohortendesign werden Patient*innen, die an einer AFI teilgenommen haben, mit einer historischen Kontrollgruppe von Patient*innen verglichen, die dieses Angebot nicht erhielten. Zudem wird der Zusammenhang zwischen der Einstellung und der Akzeptanz des Programms in der Untersuchungsgruppe (mit AFI) überprüft.
Ergebnisse
Sowohl die Akzeptanz als auch die initiale Nutzung von KEN-Online waren um knapp 20 % höher (jeweils p < 0,01) unter den Teilnehmenden der AFI-Gruppe, verglichen mit der Kontrollgruppe. In Bezug auf die Adhärenz von KEN-Online zeigte sich ein kleiner Unterschied dahingehend, dass Teilnehmende der Kontrollgruppe signifikant (p < 0,05) mehr Einheiten abgeschlossen haben als Teilnehmende der Interventionsgruppe. Allerdings war der Anteil der „completer“ von KEN-Online mit 13,4 % insgesamt sehr gering. Ein Einfluss der Einstellung auf die Akzeptanz wurde nicht nachgewiesen.
Diskussion
Die vorliegende Untersuchung zeigt, dass AFI dazu beitragen können, die Akzeptanz und initiale Nutzung von IBI zu fördern, indem Patient*innen der (teil‑)stationären Routineversorgung standardisiert und strukturiert über die Intervention informiert werden. Hinsichtlich der Förderung der Adhärenz sind jedoch zusätzliche Maßnahmen erforderlich.
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Bruhns A, Lüdtke T, Moritz S, Bücker L. A Mobile-Based Intervention to Increase Self-esteem in Students With Depressive Symptoms: Randomized Controlled Trial. JMIR Mhealth Uhealth 2021; 9:e26498. [PMID: 34255711 PMCID: PMC8314153 DOI: 10.2196/26498] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 02/22/2021] [Accepted: 04/15/2021] [Indexed: 01/19/2023] Open
Abstract
Background Depressive symptoms are one of the most common and ever-increasing mental health problems among students worldwide. Conventional treatment options, particularly psychotherapy, do not reach all students in need of help. Internet- and mobile-based interventions are promising alternatives for narrowing the treatment gap. Objective In the framework of a randomized controlled trial, we aim to investigate the effectiveness, acceptance, and side effects of a self-help smartphone app (MCT & More) based on cognitive behavioral therapy, mindfulness, acceptance and commitment therapy, and metacognitive training in a sample of students with self-reported depressive symptoms. Furthermore, we were interested in examining the influence of treatment expectations and attitudes toward internet- and mobile-based interventions on treatment adherence and effectiveness. Methods A total of 400 students were recruited via open access websites and randomized to either the intervention group (n=200), who received access to the self-help smartphone app MCT & More for a period of 4 weeks, or to a wait-list control group (n=200). The Patient Health Questionnaire-9 (depression) served as the primary outcome parameter, and the Rosenberg Self-esteem Scale (self-esteem) and the global item of the World Health Organization Quality of Life-abbreviated version (quality of life) served as the secondary outcome parameters. The Attitudes Towards Psychological Online Interventions was used to measure attitudes toward internet- and mobile-based interventions. Outcome expectations were assessed using the Patient Questionnaire on Therapy Expectation and Evaluation, and side effects were assessed using the Inventory for Assessing Negative Effects of Psychotherapy. Results Per-protocol (PP), complete-case, and intention-to-treat analyses showed a significantly higher reduction in depressive symptoms (PP: F1,222=3.98; P=.047; d=0.26) and a significantly higher increase in self-esteem (PP: F1,220=8.79; P=.003; d=0.40) in the intervention group than in the wait-list control group. Most participants regularly used the self-help smartphone app (91/120, 75.8%, at least once a week). The more positive the attitude toward internet- and mobile-based interventions (r=0.260; P=.004) and the more positive the outcome expectation (r=0.236; P=.009), the more frequently the self-help smartphone app was used. Conclusions The effectiveness of the self-help smartphone app MCT & More was demonstrated among students with depressive symptoms compared with a wait-list control group. The app could be offered regularly as a low-threshold intervention to enhance students’ health. Trial Registration German Clinical Trials Register DRKS00020941; https://tinyurl.com/pr84w6er
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Affiliation(s)
- Alina Bruhns
- University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Thies Lüdtke
- University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Steffen Moritz
- University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Lara Bücker
- University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
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Bendig E, Bauereiss N, Schmitt A, Albus P, Baumeister H. ACTonDiabetes-a guided psychological internet intervention based on Acceptance and Commitment Therapy (ACT) for adults living with type 1 or 2 diabetes: results of a randomised controlled feasibility trial. BMJ Open 2021; 11:e049238. [PMID: 34244277 PMCID: PMC8273455 DOI: 10.1136/bmjopen-2021-049238] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 06/02/2021] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVES This two-group randomised controlled trial evaluates the feasibility of an Acceptance and Commitment Therapy (ACT)-based internet intervention for diabetes distress in people with diabetes type 1 or type 2. Participants were assigned to a guided self-help intervention (EG) or waitlist control group (CG). SETTING Recruitment took place following an open recruitment strategy including different diabetes centres, self-help groups and social media platforms. PARTICIPANTS Eligibility criteria comprised being 18 years of age or older, self-reported diagnosis of type 1 or type 2 diabetes, internet access, sufficient German language skills and written informed consent. INTERVENTION ACTonDiabetes is an internet-based and mobile-based intervention and comprises an introduction and seven modules (one module per week, processing time about 45-60 min). Intervention contents are based on ACT. PRIMARY AND SECONDARY OUTCOME MEASURES Participants were assessed before and 8 weeks after randomisation. Primary outcome was feasibility (trial recruitment, acceptability). Potential group differences in diabetes distress and other outcomes at follow-up were analysed using linear regression models with baseline values as predictors. All analyses were based on an intention-to-treat principle, potential negative effects were analysed on per-protocol basis. RESULTS From October 2017 to April 2018, N=42 people with diabetes consented and were randomised (EG n=21, CG n=21). Forty-three per cent of the EG completed all treatment modules within 8 weeks. Across modules, formative user feedback revealed that contents could be optimised regarding comprehensibility (34%), individualisation (20%) and text amount (21%). Overall, 57% of participants dropped out prior to full treatment completion. There were reductions of diabetes distress in the EG (d=0.65, p=0.042). CONCLUSIONS Modifications of the intervention content according to the user feedback will be performed to further improve acceptability. Mechanisms to foster intervention adherence should be considered for lowering the attrition rate. ACTonDiabetes is feasible for the implementation in a confirmatory trial. TRIAL REGISTRATION NUMBER WHO International Clinical Trials Registry Platform via the German Clinical Trials Register (DRKS) (DRKS00013193).
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Affiliation(s)
- Eileen Bendig
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, Ulm University, Ulm, Germany
| | - Natalie Bauereiss
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, Ulm University, Ulm, Germany
| | - Andreas Schmitt
- Research Institute of the Diabetes Academy Mergentheim, Diabetes Academy Bad Mergentheim, Bad Mergentheim, Germany
- German Center for Diabetes Research (DZD), München-Neuherberg, Germany
| | - Patrick Albus
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, Ulm University, Ulm, Germany
| | - Harald Baumeister
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, Ulm University, Ulm, Germany
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Behandlungsschwierigkeiten bei geleiteter Online-Therapie. PSYCHOTHERAPEUT 2021. [DOI: 10.1007/s00278-021-00522-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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31
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Apolinário-Hagen J, Harrer M, Dederichs M, Fritsche L, Wopperer J, Wals F, Loerbroks A, Lehr D, Salewski C, Angerer P, Ebert DD. Exploring the influence of testimonial source on attitudes towards e-mental health interventions among university students: Four-group randomized controlled trial. PLoS One 2021; 16:e0252012. [PMID: 34038455 PMCID: PMC8153476 DOI: 10.1371/journal.pone.0252012] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 05/09/2021] [Indexed: 11/18/2022] Open
Abstract
Electronic mental health services (eMHSs) offer additional options for the dissemination of psychological interventions for university students. Still, many university students are reluctant to use eMHSs. Narrative messages may help increase the awareness and acceptance of quality-approved programs. However, little is known about the usefulness of narrative messages to improve attitudes towards eMHSs. In this experiment, we thus aimed to explore in how far different ways of targeting information to students affect their attitudes towards eMHSs for stress prevention and therapy, and to identify potential determinants of attitude change. N = 451 students (Mean = 32.6 years, SD = 10.2, 75% female, 7% with eMHS experience) were randomly assigned to one of four study arms involving information designed to induce different levels of perceived similarity. While the active control condition only received general information (arm 1, “information only”, n = 116), the other experimental arms were additionally exposed to testimonials on specific eMHSs either addressing an unspecified audience (arm 2, n = 112), employees (arm 3, n = 115) or working university students (arm 4, n = 108). Two-way ANOVA revealed no impact of information on the alteration of attitudes towards eMHSs for stress coping (d = 0.20). Only a small effect of target-group specific testimonials on attitudes towards online therapies was identified at post-intervention (d = 0.29). Regression analyses demonstrated significant influences of source credibility and perceived similarity on attitudes for preventative eMHSs (ps<0.01), as well as a partial mediation effect of perceived similarity in favor of testimonials targeted to students (95% CI [0.22, 0.50]). Overall, this study indicated no meaningful impact of information on attitudes and limited evidence for benefits of tailored narrative messages. Since attitudes were already positive at baseline, further research with a representative student sample mimicking real-world decision scenarios is needed to gain an in-depth understanding of acceptance-facilitating message features that may contribute to promote the adoption of evidence-based eMHSs.
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Affiliation(s)
- Jennifer Apolinário-Hagen
- Faculty of Medicine, Institute of Occupational, Social and Environmental Medicine, Centre for Health and Society, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
- * E-mail:
| | - Mathias Harrer
- Department of Clinical Psychology and Psychotherapy, Friedrich Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Melina Dederichs
- Faculty of Medicine, Institute of Occupational, Social and Environmental Medicine, Centre for Health and Society, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Lara Fritsche
- Faculty of Psychology, Department of Health Psychology, University of Hagen, Hagen, Germany
| | - Jeannette Wopperer
- Faculty of Psychology, Department of Health Psychology, University of Hagen, Hagen, Germany
| | - Frank Wals
- Faculty of Psychology, Department of Health Psychology, University of Hagen, Hagen, Germany
| | - Adrian Loerbroks
- Faculty of Medicine, Institute of Occupational, Social and Environmental Medicine, Centre for Health and Society, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Dirk Lehr
- Department of Health Psychology, Leuphana University Lueneburg, Lueneburg, Germany
| | - Christel Salewski
- Faculty of Psychology, Department of Health Psychology, University of Hagen, Hagen, Germany
| | - Peter Angerer
- Faculty of Medicine, Institute of Occupational, Social and Environmental Medicine, Centre for Health and Society, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - David Daniel Ebert
- Department of Clinical, Neuro- and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
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Kuhn E, Fiske A, Henningsen P, Buyx A. [Psychotherapy with an Autonomous Artifical Intelligence - Ethical Benefits and Challenges]. PSYCHIATRISCHE PRAXIS 2021; 48:S26-S30. [PMID: 33652484 DOI: 10.1055/a-1369-2938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE This paper provides an overview of a range of ethical aspects involved in the use of autonomous, virtual or embodied artificial intelligence (AI) in the care of people with mental health issues. METHODOLOGY The overview is based on a thematic literature review. It is guided by the principles of biomedical ethics together with the concept of epistemic (in)justice. RESULTS In addition to a risk-benefit analysis, (digital) health literacy, equity of access, issues of under- or misuse of care, and an adaptation of informed consent need to be considered. CONCLUSION The ethical assessment of autonomous AI in psychotherapy remains open; too many clinical, ethical, legal, and practical questions remain to be addressed. Quality criteria for AI application as well as guidelines for its clinical use need to be developed before wider clinical implementation.
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Affiliation(s)
- Eva Kuhn
- Sektion Global Health, Institut für Hygiene und Öffentliche Gesundheit, Universitätsklinikum Bonn
| | - Amelia Fiske
- Institut für Geschichte und Ethik der Medizin, Technische Universität München
| | - Peter Henningsen
- Klinik für Psychosomatische Medizin und Psychotherapie, Klinikum rechts der Isar der Technischen Universität München
| | - Alena Buyx
- Institut für Geschichte und Ethik der Medizin, Technische Universität München
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Quiñonez-Freire C, Vara MD, Herrero R, Mira A, García-Palacios A, Botella C, Baños RM. Cultural adaptation of the Smiling is Fun program for the treatment of depression in the Ecuadorian public health care system: A study protocol for a randomized controlled trial. Internet Interv 2021; 23:100352. [PMID: 33335847 PMCID: PMC7733006 DOI: 10.1016/j.invent.2020.100352] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 10/13/2020] [Accepted: 10/28/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Depression is one of the world's major health problems. Due to its high prevalence, it constitutes the first cause of disability among the Americas, where only a very low percentage of the population receives the adequate evidence-based psychological treatment. Internet-Based Interventions (IBIs) are a great alternative to reduce the treatment gap for mental disorders. Although there are several studies in low-and middle-income countries proving IBIs' feasibility and acceptability, there is still little evidence of the effectiveness in diverse social and cultural contexts such as Latin America. METHODS Two studies will be described: Study 1 is focused on the cultural adaptation of a cognitive-behavioral IBI Smiling is Fun (Botella et al. 2012, 2015) for Ecuadorian population with depression based on the procedure by Salamanca-Sanabria et al. (2018). Study 2 describes the design of a randomized controlled trial to test the preliminary efficacy of the culturally adapted intervention in a Public Health Care setting. A total of 153 patients with mild to moderate degree of depression as assessed with the Mini-International Neuropsychiatric Interview (M.I.N.I.) and the Patient Health Questionnaire-9 (PHQ-9) will be randomly assigned to either an IBI group using only automated support by the system; an IBI group including also minimal human support; or a waiting list group. The primary outcome (depression) and secondary outcomes (e.g., anxiety, affect, quality of life) will be collected at baseline, 3, 6 and 12 months. Mixed-model analyses with no ad hoc imputations will be conducted. DISCUSSION This paper is pioneering in exploring the role of an Internet-based culturally adapted intervention for depression in a public care context in Ecuador. Results obtained will offer new insights into the viability and effectiveness of digital technologies for the psychological treatment of mental illnesses in developing countries.
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Key Words
- APOI, Attitudes Towards Psychological Online Interventions
- AQoL-6D, Assessment of Quality of Life 6 Dimensions
- BDI-II, Beck Depression Inventory-II
- CEQ, Credibility and Expectancy Questionnaire
- CONSORT, Consolidated Standards of Reporting Trials
- CRQ, Cultural Relevance Questionnaire
- CSQ, Client Satisfaction Questionnaire
- Cultural adaptation
- Depression
- E-SF, Ecuadorian Cultural Version of Smiling is Fun
- EBPTs, Evidence-Based Psychological Treatments
- GAD-7, Generalized Anxiety Disorder-7
- IBIs, Internet-Based Interventions
- ICD-10, International Classification of Diseases-10
- ICERs, Incremental Cost-Effectiveness Ratios
- Internet-based intervention
- Latin America
- M.I.N.I. 5.0, MINI International Neuropsychiatric Interview 5.0
- MCAR, Missing Completely at Random
- OASIS, Overall Anxiety Severity and Impairment Scale
- ODSIS, Overall Depression Severity and Impairment Scale
- PANAS, Positive and Negative Affect Schedule
- PC, Primary Care
- PHC, Public Health Care
- PHQ-9, Patient Health Questionnaire-9
- Public Health Care
- QALYs, Quality-Adjusted Life-Years
- RCI, Reliable Change Index
- RCT, Randomized Control Trial
- Randomized Controlled Trial
- SPIRIT, Recommendations for Interventional Trials
- SUS, System Usability Scale
- TiC-P, Trimbos/iMTA Questionnaire on Costs on Psychiatric Illnesses
- WAI-TECH-SF, Working Alliance Inventory for Online Intervention-Short Form
- WL, Waiting List
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Affiliation(s)
- Carlos Quiñonez-Freire
- Department of Personality, Evaluation and Psychological Treatments, University of Valencia, Valencia, Spain
- Mental Health Unit, Hospital Dr, Gustavo Dominguez Z, Santo Domingo, Ecuador
| | - M. Dolores Vara
- Department of Personality, Evaluation and Psychological Treatments, University of Valencia, Valencia, Spain
- CIBER Pathophysiology of Obesity and Nutrition (CB06/03), Carlos III Institute of Health, Madrid, Spain
- Polibienestar Research Institute, University of Valencia, Valencia, Spain
| | - Rocío Herrero
- Department of Personality, Evaluation and Psychological Treatments, University of Valencia, Valencia, Spain
- CIBER Pathophysiology of Obesity and Nutrition (CB06/03), Carlos III Institute of Health, Madrid, Spain
- Polibienestar Research Institute, University of Valencia, Valencia, Spain
| | - Adriana Mira
- Department of Personality, Evaluation and Psychological Treatments, University of Valencia, Valencia, Spain
| | - Azucena García-Palacios
- CIBER Pathophysiology of Obesity and Nutrition (CB06/03), Carlos III Institute of Health, Madrid, Spain
- Department of Basic Psychology, Clinical and Psychobiology, Jaume I University, Castellón, Spain
| | - Cristina Botella
- CIBER Pathophysiology of Obesity and Nutrition (CB06/03), Carlos III Institute of Health, Madrid, Spain
- Department of Basic Psychology, Clinical and Psychobiology, Jaume I University, Castellón, Spain
| | - Rosa M. Baños
- Department of Personality, Evaluation and Psychological Treatments, University of Valencia, Valencia, Spain
- CIBER Pathophysiology of Obesity and Nutrition (CB06/03), Carlos III Institute of Health, Madrid, Spain
- Polibienestar Research Institute, University of Valencia, Valencia, Spain
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Ganapathy A, Clough BA, Casey LM. Organizational and Policy Barriers to the Use of Digital Mental Health by Mental Health Professionals. Telemed J E Health 2021; 27:1332-1343. [PMID: 33646057 DOI: 10.1089/tmj.2020.0455] [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] [Indexed: 11/12/2022] Open
Abstract
Background: Digital mental health (DMH) provides effective methods of overcoming issues of time constraints, accessibility, and availability of mental health care. They can provide a valuable means to deliver mental health care in the present pandemic. However, adoption of these methods has been slow. Mental health professional (MHP) concerns at the organizational and policy level that influence this slow adoption need to be examined. Materials and Methods: A narrative review was conducted to identify the barriers. Searches using the databases Scopus, Embase, and PubMed were conducted to identify research focused on barriers reported by MHPs to use DMH. Results: The search resulted in 356 unique citations, and 21 papers met the inclusion and exclusion criteria. Forward and backward sampling resulted in identifying an additional 19 relevant papers. Discussion: Unmet needs for information, training, and infrastructure, challenges to the workflow and excessive workloads, and ambiguous policies serve as barriers to DMH use. This article recommends strategies for researchers, organizations, DMH designers, and governmental institutions to ensure efficient utilization of DMH. Conclusion: Concerted efforts at individual, organizational, and governmental levels are essential to ensure efficient utilization of DMH.
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Affiliation(s)
- Aarthi Ganapathy
- School of Applied Psychology, Griffith University, Brisbane, Australia.,Menzies Health Institute, Mount Gravatt, Australia
| | - Bonnie A Clough
- School of Applied Psychology, Griffith University, Brisbane, Australia.,Menzies Health Institute, Mount Gravatt, Australia
| | - Leanne M Casey
- School of Applied Psychology, Griffith University, Brisbane, Australia.,Menzies Health Institute, Mount Gravatt, Australia
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Köhnen M, Dreier M, Seeralan T, Kriston L, Härter M, Baumeister H, Liebherz S. Evidence on Technology-Based Psychological Interventions in Diagnosed Depression: Systematic Review. JMIR Ment Health 2021; 8:e21700. [PMID: 33565981 PMCID: PMC7904404 DOI: 10.2196/21700] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 10/30/2020] [Accepted: 11/18/2020] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Evidence on technology-based psychological interventions (TBIs) for the treatment of depression is rapidly growing and covers a broad scope of research. Despite extensive research in this field, guideline recommendations are still limited to the general effectiveness of TBIs. OBJECTIVE This study aims to structure evidence on TBIs by considering different application areas (eg, TBIs for acute treatment and their implementation in health care, such as stand-alone interventions) and treatment characteristics (eg, therapeutic rationale of TBIs) to provide a comprehensive evidence base and to identify research gaps in TBIs for diagnosed depression. Moreover, the reporting of negative events in the included studies is investigated in this review to enable subsequent safety assessment of the TBIs. METHODS Randomized controlled trials on adults diagnosed with unipolar depression receiving any kind of psychotherapeutic treatment, which was at least partly delivered by a technical medium, were eligible for inclusion in our preregistered systematic review. We searched for trials in CENTRAL (Cochrane Central Register of Controlled Trials; until August 2020), MEDLINE, PsycINFO, PSYNDEX, CINAHL; until the end of January 2018), clinical trial registers, and sources of gray literature (until the end of January 2019). Study selection and data extraction were conducted by 2 review authors independently. RESULTS Database searches resulted in 15,546 records, of which 241 publications were included, representing 83 completed studies and 60 studies awaiting classification (ie, preregistered studies, study protocols). Almost all completed studies (78/83, 94%) addressed the acute treatment phase, being largely either implemented as stand-alone interventions (66/83, 80%) or blended treatment approaches (12/83, 14%). Studies on TBIs for aftercare (4/83, 5%) and for bridging waiting periods (1/83, 1%) were scarce. Most TBI study arms (n=107) were guided (59/107, 55.1%), delivered via the internet (80/107, 74.8%), and based on cognitive behavioral treatment approaches (88/107, 79.4%). Almost all studies (77/83, 93%) reported information on negative events, considering dropouts from treatment as a negative event. However, reports on negative events were heterogeneous and largely unsystematic. CONCLUSIONS Research has given little attention to studies evaluating TBIs for aftercare and for bridging waiting periods in people with depression, even though TBIs are seen as highly promising in these application areas; thus, high quality studies are urgently needed. In addition, the variety of therapeutic rationales on TBIs has barely been represented by identified studies hindering the consideration of patient preferences when planning treatment. Finally, future studies should use specific guidelines to systematically assess and report negative events. TRIAL REGISTRATION International Prospective Register of Systematic Reviews (PROSPERO) CRD42016050413; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42016050413. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.1136/bmjopen-2018-028042.
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Affiliation(s)
- Moritz Köhnen
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Mareike Dreier
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Tharanya Seeralan
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Levente Kriston
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Härter
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Harald Baumeister
- Department for Clinical Psychology and Psychotherapy, Ulm University, Ulm, Germany
| | - Sarah Liebherz
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Korecka N, Rabenstein R, Pieh C, Stippl P, Barke A, Doering B, Gossmann K, Humer E, Probst T. Psychotherapy by Telephone or Internet in Austria and Germany Which CBT Psychotherapists Rate It more Comparable to Face-to-Face Psychotherapy in Personal Contact and Have more Positive Actual Experiences Compared to Previous Expectations? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E7756. [PMID: 33114136 PMCID: PMC7660328 DOI: 10.3390/ijerph17217756] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 10/19/2020] [Accepted: 10/22/2020] [Indexed: 12/18/2022]
Abstract
Objectives: COVID-19 has led to changes in the provision in mental health services. The current study investigated influencing factors on: (i) the comparability of psychotherapy via internet/telephone with psychotherapy in face-to-face contact as well as (ii) the actual experience with psychotherapy via internet/telephone compared to respective prior expectations in CBT therapists. Methods: A quantitative cross-sectional study was conducted in the form of an online survey. The research samples, registered cognitive-behavioral therapy (CBT) psychotherapists in Austria and Germany, were contacted by e-mail. Results: One hundred and ninety CBT therapists were analyzed in this study. The total number of patients treated via telephone/internet is a decisive factor for the subjective evaluation of the comparability of psychotherapy via telephone/internet and psychotherapy in personal contact. This factor also influences the extent (positive/negative) of the assessment of the actual experience with psychotherapy via internet/telephone compared to previous expectations. Neither age nor gender were associated with comparability of psychotherapy via internet/telephone with psychotherapy in face-to-face contact or the actual experience with psychotherapy via internet/telephone compared to respective prior expectations. Conclusions: Implications of the results are that attitudes towards remote psychotherapy might be increased in CBT therapists when they treat more patients remotely and experiences with remote psychotherapies should be included in psychotherapy training.
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Affiliation(s)
- Nicole Korecka
- Department for Psychotherapy and Biopsychosocial Health, Danube University Krems, 3500 Krems, Austria; (N.K.); (R.R.); (C.P.); (E.H.)
| | - Rafael Rabenstein
- Department for Psychotherapy and Biopsychosocial Health, Danube University Krems, 3500 Krems, Austria; (N.K.); (R.R.); (C.P.); (E.H.)
| | - Christoph Pieh
- Department for Psychotherapy and Biopsychosocial Health, Danube University Krems, 3500 Krems, Austria; (N.K.); (R.R.); (C.P.); (E.H.)
| | - Peter Stippl
- Austrian Federal Association for Psychotherapy, Löwengasse 3, 1030 Vienna, Austria;
| | - Antonia Barke
- Clinical and Biological Psychology, Catholic University of Eichstätt-Ingolstadt, Ostenstraße 26, 85072 Eichstätt, Germany; (A.B.); (B.D.); (K.G.)
| | - Bettina Doering
- Clinical and Biological Psychology, Catholic University of Eichstätt-Ingolstadt, Ostenstraße 26, 85072 Eichstätt, Germany; (A.B.); (B.D.); (K.G.)
| | - Katharina Gossmann
- Clinical and Biological Psychology, Catholic University of Eichstätt-Ingolstadt, Ostenstraße 26, 85072 Eichstätt, Germany; (A.B.); (B.D.); (K.G.)
| | - Elke Humer
- Department for Psychotherapy and Biopsychosocial Health, Danube University Krems, 3500 Krems, Austria; (N.K.); (R.R.); (C.P.); (E.H.)
| | - Thomas Probst
- Department for Psychotherapy and Biopsychosocial Health, Danube University Krems, 3500 Krems, Austria; (N.K.); (R.R.); (C.P.); (E.H.)
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Dores AR, Geraldo A, Carvalho IP, Barbosa F. The Use of New Digital Information and Communication Technologies in Psychological Counseling during the COVID-19 Pandemic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17207663. [PMID: 33096650 PMCID: PMC7589044 DOI: 10.3390/ijerph17207663] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 10/11/2020] [Accepted: 10/13/2020] [Indexed: 12/20/2022]
Abstract
The use of digital information and communication technologies (ICTs) has enabled many professionals to continue to provide their services during the COVID-19 pandemic. However, little is known about the adoption of ICTs by psychologists and the impact of such technologies on their practice. This study aimed to explore psychologists’ practices related with the use of ICTs before and during the COVID-19 lockdown, to identify the main changes that the pandemic has brought and the impact that such changes have had on their practice with clients, and also identify the factors that potentially have affected such changes. The Portuguese Psychologists Association announced the study, and 108 psychologists responded to an online survey during the mandatory lockdown. The results showed that these professionals continued to provide their services due to having adopted ICTs. Comparing with face-to-face interventions, psychologists recognized that additional precautions/knowledge were needed to use such technologies. Despite the challenges identified, they described the experience with the use of ICTs as positive, meeting clients’ adherence, and yielding positive results. Psychologists with the most years of professional experience maintained their services the most, but those with average experience showed the most favorable attitudes toward the use of technologies and web-based interventions.
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Affiliation(s)
- Artemisa R. Dores
- Center for Rehabilitation Research, School of Health, Polytechnic Institute of Porto, 4200-072 Porto, Portugal
- Laboratory of Neuropsychophysiology, Faculty of Psychology and Education Sciences of University of Porto, 4200-135 Porto, Portugal; (A.G.); (F.B.)
- Correspondence:
| | - Andreia Geraldo
- Laboratory of Neuropsychophysiology, Faculty of Psychology and Education Sciences of University of Porto, 4200-135 Porto, Portugal; (A.G.); (F.B.)
| | - Irene P. Carvalho
- CINTESIS and Department of Clinical Neurosciences and Mental Health, School of Medicine, University of Porto (FMUP), 4200-319 Porto, Portugal;
| | - Fernando Barbosa
- Laboratory of Neuropsychophysiology, Faculty of Psychology and Education Sciences of University of Porto, 4200-135 Porto, Portugal; (A.G.); (F.B.)
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Schuster R, Topooco N, Keller A, Radvogin E, Laireiter AR. Advantages and disadvantages of online and blended therapy: Replication and extension of findings on psychotherapists' appraisals. Internet Interv 2020; 21:100326. [PMID: 32477885 PMCID: PMC7251770 DOI: 10.1016/j.invent.2020.100326] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 04/20/2020] [Accepted: 04/21/2020] [Indexed: 12/26/2022] Open
Abstract
Therapists hold a key role for the uptake of digital mental health interventions (DMHI) within regular care services but have demonstrated cautious attitudes towards such interventions. It is relevant to explore in detail what factors may positively influence therapists' perception when considering DMHI implementation within routine care. We recently assessed therapist views towards Internet-based and blended treatment in Austria (low implementation level). The present study aims at testing the reliability of previous findings, and moreover, it compares therapists' appraisals to a country with advanced DMHI implementation (Sweden). An online survey was conducted February through June of 2019. Respondents were recruited via email and social media. The survey assessed first-hand experience with Internet-based treatment (IT) and blended treatment (BT). To start, the survey presented a short informational video to half of the respondents, then assessed therapists' views on 17 advantages and 13 disadvantages of IT and BT on 6-point Likert scales. In total N = 300 therapists responded to the invitation, of which N = 165 provided full survey data (Germany 114/220, 52%; Sweden 51/80, 64%). German therapists rated the advantages of IT and BT as neutral (IT, M = 3.6; BT, M = 3.8) and to some extent agreed with disadvantages of IT (IT, M = 4.5; BT, M = 3.5). In comparison, Swedish therapists rated significantly greater advantages (IT, M = 4.6; BT, M = 4.5) and less disadvantages (IT, M = 3.2; BT, M = 2.8). Effect sizes ranged from d = 0.89 to d = 1.83; all P's < .001. Those with first-hand experience with DMHI reported more positive appraisals in both countries. No significant effect was found for exposure to the short informational video. The German sample represented essential characteristics of current German therapists; in comparison Swedish respondents skewed towards younger less experienced therapists (P's < .001). Those confounders accounted for a small non-significant proportion of variance (0.1-4.7%). We found that therapists considered blended treatment to have less disadvantages than Internet treatment, and that first-hand experience with DMHI, but not exposure to an acceptance facilitating video clip, predicted greater acceptability on individual level. The responses among German therapists closely resembled findings from our preceding study in Austria, indicating that reliable results can be achieved in small survey studies if sample and population parameters correspond. Swedish therapists held significantly more favorable attitudes towards both interventions. The comparison between countries, however, is limited by a number of potential confounding variables.
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Affiliation(s)
- Raphael Schuster
- Outpatient Center for Clinical Psychology, Psychotherapy and Health Psychology, Department of Psychology, University of Salzburg, Salzburg, Austria
- Department of Psychology, University of Salzburg, Salzburg, Austria
| | - Naira Topooco
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
- Center for mHealth, Palo Alto, CA, USA
| | - Antonia Keller
- Department of Psychology, University of Salzburg, Salzburg, Austria
| | - Ella Radvogin
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
| | - Anton-Rupert Laireiter
- Outpatient Center for Clinical Psychology, Psychotherapy and Health Psychology, Department of Psychology, University of Salzburg, Salzburg, Austria
- Faculty of Psychology, University of Vienna, Vienna, Austria
- Department of Psychology, University of Salzburg, Salzburg, Austria
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McCall HC, Sison AP, Burnett JL, Beahm JD, Hadjistavropoulos HD. Exploring Perceptions of Internet-Delivered Cognitive Behaviour Therapy among Public Safety Personnel: Informing Dissemination Efforts. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17176026. [PMID: 32824994 PMCID: PMC7503620 DOI: 10.3390/ijerph17176026] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Revised: 08/13/2020] [Accepted: 08/17/2020] [Indexed: 11/16/2022]
Abstract
Background Public safety personnel (PSP) experience high rates of mental health disorders but have limited access to treatment. To improve treatment access, there is a growing interest in offering internet-delivered cognitive behaviour therapy (ICBT) to PSP. As attitudes towards ICBT can both impact and inform ICBT implementation efforts, this study examines perceptions of ICBT among PSP who viewed a poster (a commonly used method of advertising ICBT) or a poster supplemented with a story of a PSP who benefitted from ICBT. Methods Participants (N = 132) from various PSP sectors were randomly assigned to view a poster or a poster and a story. Participants then completed an online survey assessing their perceptions of ICBT using both qualitative and quantitative questions. We used a mixed-methods approach to analyze the data. Results No differences in perceptions of ICBT were identified between the conditions. Ratings of credibility, treatment expectancy, anticipated treatment adherence, and acceptability suggested that PSP had positive perceptions of ICBT. Most participants (93%) reported that they would access ICBT if they needed help with mental health concerns. Participants ranked therapist-guided ICBT as their second most preferred treatment, with psychologists ranked first. Female participants found ICBT more credible than male participants. More experienced PSP reported lower acceptability and anticipated adherence to ICBT. Conclusions The findings suggest that many PSP are likely to be receptive to ICBT even when a simple poster is used as a method of informing PSP of this treatment option. Further attention to improving the perceptions of ICBT among certain groups may be warranted.
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Affiliation(s)
- Hugh C. McCall
- Department of Psychology, University of Regina, 3737 Wascana Pkwy, Regina, SK S4S 0A2, Canada; (H.C.M.); (A.P.S.); (J.L.B.); (J.D.B.)
- PSPNET, University of Regina, 2 Research Drive, Regina, SK S4T 2P7, Canada
| | - Angelo P. Sison
- Department of Psychology, University of Regina, 3737 Wascana Pkwy, Regina, SK S4S 0A2, Canada; (H.C.M.); (A.P.S.); (J.L.B.); (J.D.B.)
- PSPNET, University of Regina, 2 Research Drive, Regina, SK S4T 2P7, Canada
| | - Jody L. Burnett
- Department of Psychology, University of Regina, 3737 Wascana Pkwy, Regina, SK S4S 0A2, Canada; (H.C.M.); (A.P.S.); (J.L.B.); (J.D.B.)
- PSPNET, University of Regina, 2 Research Drive, Regina, SK S4T 2P7, Canada
| | - Janine D. Beahm
- Department of Psychology, University of Regina, 3737 Wascana Pkwy, Regina, SK S4S 0A2, Canada; (H.C.M.); (A.P.S.); (J.L.B.); (J.D.B.)
- PSPNET, University of Regina, 2 Research Drive, Regina, SK S4T 2P7, Canada
| | - Heather D. Hadjistavropoulos
- Department of Psychology, University of Regina, 3737 Wascana Pkwy, Regina, SK S4S 0A2, Canada; (H.C.M.); (A.P.S.); (J.L.B.); (J.D.B.)
- PSPNET, University of Regina, 2 Research Drive, Regina, SK S4T 2P7, Canada
- Correspondence:
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Baumeister H, Terhorst Y, Grässle C, Freudenstein M, Nübling R, Ebert DD. Impact of an acceptance facilitating intervention on psychotherapists' acceptance of blended therapy. PLoS One 2020; 15:e0236995. [PMID: 32785245 PMCID: PMC7423074 DOI: 10.1371/journal.pone.0236995] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Accepted: 07/17/2020] [Indexed: 11/19/2022] Open
Abstract
Blended therapy is a new approach combining advantages of face-to-face psychotherapy and Internet- and mobile-based interventions. Acceptance is a fundamental precondition for its implementation. The aim of this study was to assess 1) the acceptance of psychotherapists towards blended therapy, 2) the effectiveness of an acceptance facilitating intervention (AFI) on psychotherapists' acceptance towards blended therapy and 3) to identify potential effect moderators. Psychotherapists (N = 284) were randomly assigned to a control (CG) or an intervention group (IG). The IG received a short video showing an example of blended therapy, the CG an attention placebo video. Both groups received a reliable online questionnaire assessing acceptance, effort expectancy, performance expectancy, facilitating conditions, social influence and internet anxiety. Between group differences were examined using t-tests and Mann-Whitney tests. Exploratory analysis was conducted to identify moderators. Psychotherapists in CG showed mixed baseline acceptance towards blended therapy (low = 40%, moderate = 33%, high = 27%). IG showed significantly higher acceptance compared to CG (d = .27, pone-sided = .029; low = 24%, moderate = 47%, high = 30%). Bootstrapped confidence intervals were overlapping. Performance expectancy (d = .35), effort expectancy (d = .44) and facilitating conditions (d = .28) were significantly increased (p < .05). No effects on social influence and internet anxiety were found (p>.05). Exploratory analysis indicated psychodynamic oriented psychotherapists profiting particularly from the AFI. Blended therapy is a promising approach to improve healthcare. Psychotherapists show mixed acceptance, which might be improvable by AFIs, particularly in subpopulations of initially rather skeptical psychotherapists. Forthcoming studies should extend the present study by shifting focus from attitudes to the impact of different forms of AFIs on uptake.
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Affiliation(s)
- Harald Baumeister
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, Ulm University, Ulm, Germany
| | - Yannik Terhorst
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, Ulm University, Ulm, Germany
| | - Cora Grässle
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, Ulm University, Ulm, Germany
| | - Maren Freudenstein
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, Ulm University, Ulm, Germany
| | - Rüdiger Nübling
- Chamber of Psychotherapists Baden-Württemberg, Stuttgart, Germany
| | - David Daniel Ebert
- Faculty of Behavioural and Movement Sciences, Clinical, Neuro- & Developmental Psychology, VU Amsterdam, Amsterdam, The Netherlands
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Dockweiler C, Kupitz A, Palmdorf S, Hornberg C. [Online therapy for depressive disorders : An acceptance-based analysis from the perspective of therapists]. DER NERVENARZT 2020; 91:243-251. [PMID: 31165209 DOI: 10.1007/s00115-019-0730-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The supply of online therapy options for mild to moderate depressive disorders has substantially risen both nationally and internationally in the past years. While the efficacy and efficiency of specific online-based therapeutic services were indicated within the framework of scientific evaluations, little is known about the acceptance of these new therapy options. METHODS In a nationwide online survey of online-based therapy options for mild to moderate depressive disorders, the attitude and stance as well as the use intention and the subjectively perceived knowledge of 657 medical practitioners and therapists, active in psychotherapeutic and psychiatric treatment were collated. The impact of the potential predictors on the use intention of online-based therapies, based on the unified theory of acceptance and use of technology, was analyzed by means of a binary logistic regression model. RESULTS Besides the perceived performance and expense expectations, the supportive framework conditions, the influence of the cooperative environment, the individual technical affinity as well as the evaluation of the prospective significance of online-based therapy proved to be significantly influential predictors on the user intention. Special predictability for a positive user intention was shown related to the perceived potential of online therapy. CONCLUSION The results underline the relevance of further evidence-basing of online therapy for mild to moderate depressive disorders. A user-oriented, participatory technology development proves to be just as relevant as a comprehensive sensitization, elucidation and education of potential users for a successful implementation.
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Affiliation(s)
- Christoph Dockweiler
- Fakultät für Gesundheitswissenschaften, Universität Bielefeld, Universitätsstraße 25, 33501, Bielefeld, Deutschland.
| | - Anna Kupitz
- Deutsches Kinderschmerzzentrum, Universität Witten/Herdecke, Dr.-Friedrich-Steiner Str. 5, 45711, Datteln, Deutschland
| | - Sarah Palmdorf
- Fakultät für Gesundheitswissenschaften, Universität Bielefeld, Universitätsstraße 25, 33501, Bielefeld, Deutschland
| | - Claudia Hornberg
- Fakultät für Gesundheitswissenschaften, Universität Bielefeld, Universitätsstraße 25, 33501, Bielefeld, Deutschland
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Davies F, Shepherd HL, Beatty L, Clark B, Butow P, Shaw J. Implementing Web-Based Therapy in Routine Mental Health Care: Systematic Review of Health Professionals' Perspectives. J Med Internet Res 2020; 22:e17362. [PMID: 32706713 PMCID: PMC7413287 DOI: 10.2196/17362] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 06/05/2020] [Accepted: 06/11/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Web-based therapies hold great promise to increase accessibility and reduce costs of delivering mental health care; however, uptake in routine settings has been low. OBJECTIVE Our objective in this review was to summarize what is known about health care professionals' perceptions of the barriers to and facilitators of the implementation of web-based psychological treatments in routine care of adults in health care settings. METHODS We searched 5 major databases (MEDLINE, EMBASE, PsycINFO, CINAHL, and the Cochrane Library) for qualitative, quantitative, or mixed-methods studies exploring health professionals' views on computer- or internet-based psychological treatment programs. We coded included articles for risk of bias and extracted data using a prepiloted extraction sheet. RESULTS We identified 29 eligible articles: 14 qualitative, 11 quantitative, and 4 mixed methods. We identified the following themes: patient factors, health professional factors, the therapeutic relationship, therapy factors, organizational and system factors, and models of care. Health professionals supported web-based therapies only for patients with relatively straightforward, low-risk diagnoses, strong motivation and engagement, high computer literacy and access, and low need for tailored content. They perceived flexibility with timing and location as advantages of web-based therapy, but preferred blended therapy to facilitate rapport and allow active monitoring and follow-up of patients. They emphasized the need for targeted training and organizational support to manage changed workflows. Health professionals were concerned about the confidentiality and security of client data for web-based programs, suggesting that clear and transparent protocols need to be in place to reassure health professionals before they will be willing to refer. CONCLUSIONS Without health professionals' support, many people will not access web-based therapies. To increase uptake, it is important to ensure that health professionals receive education, familiarization, and training to support them in incorporating web-based therapies into their practice, and to design systems that support health professionals in this new way of working with patients and addressing their concerns. TRIAL REGISTRATION PROSPERO CRD42018100869; https://tinyurl.com/y5vaoqsk.
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Affiliation(s)
- Fiona Davies
- Psycho-Oncology Co-operative Research Group, School of Psychology, The University of Sydney, Sydney, Australia
| | - Heather L Shepherd
- Psycho-Oncology Co-operative Research Group, School of Psychology, The University of Sydney, Sydney, Australia
| | - Lisa Beatty
- Flinders Centre for Innovation in Cancer, College of Medicine & Public Health, Flinders University South Australia, Adelaide, Australia
| | - Brodie Clark
- Psycho-Oncology Co-operative Research Group, School of Psychology, The University of Sydney, Sydney, Australia
| | - Phyllis Butow
- Psycho-Oncology Co-operative Research Group, School of Psychology, The University of Sydney, Sydney, Australia
| | - Joanne Shaw
- Psycho-Oncology Co-operative Research Group, School of Psychology, The University of Sydney, Sydney, Australia
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Wehmann E, Köhnen M, Härter M, Liebherz S. Therapeutic Alliance in Technology-Based Interventions for the Treatment of Depression: Systematic Review. J Med Internet Res 2020; 22:e17195. [PMID: 32525484 PMCID: PMC7317632 DOI: 10.2196/17195] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 02/15/2020] [Accepted: 03/02/2020] [Indexed: 01/04/2023] Open
Abstract
Background There is growing evidence that technology-based interventions (TBIs) are effective for the treatment of depression. As TBIs are gaining acceptance, a question arises whether good therapeutic alliance, considered a key aspect of psychotherapy, can be established without or with minimal face-to-face contact or rather changes if blended concepts are applied. While therapeutic alliance has been studied extensively in the context of face-to-face therapy, only few studies have reviewed evidence on alliance ratings in TBIs. Objective The purpose of this study was to examine therapeutic alliance in technology-based psychological interventions for the treatment of depression. Methods We searched Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, PsycINFO, PSYNDEX, CINAHL, clinical trial registers, and sources of grey literature for randomized controlled trials on TBIs in the treatment of adults with unipolar depression. All publications were selected according to prespecified criteria. Data were extracted by two independent reviewers. Results A total of eight out of 98 studies (9.5%) included in the review on TBIs for depression considered therapeutic alliance as part of their evaluation. The available data covered eight different treatment conditions, including four stand-alone treatments (face-to-face psychotherapy, email, telephone, and internet program) and four combined treatments (face-to-face psychotherapy plus a smartphone app and an internet program combined with face-to-face psychotherapy, treatment as usual, or email/telephone). On average, patients rated the alliance positively across all groups. Importantly, no relevant group differences regarding therapeutic alliance sum scores were found in any of the studies. Five studies investigated the relationship between patients’ alliance ratings and treatment outcome, revealing mixed results. Conclusions Our results suggest that it is possible to establish a positive therapeutic alliance across a variety of different TBIs for depression, but this is based on a small number of studies. Future research needs to determine on what basis therapeutic alliance is formed in settings that do not allow for additional nonverbal cues, perhaps with adapted instruments to measure therapeutic alliance. Trial Registration PROSPERO International Prospective Register of Systematic Reviews CRD42016050413; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42016050413) International Registered Report Identifier (IRRID) RR2-10.1136/bmjopen-2018-028042
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Affiliation(s)
- Eileen Wehmann
- Department of Medical Psychology, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Moritz Köhnen
- Department of Medical Psychology, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Härter
- Department of Medical Psychology, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sarah Liebherz
- Department of Medical Psychology, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Ribeiro E, Sampaio A, Gonçalves MM, Taveira MDC, Cunha J, Maia Â, Matos M, Gonçalves S, Figueiredo B, Freire T, Soares T. Telephone-based psychological crisis intervention: the Portuguese experience with COVID-19. COUNSELLING PSYCHOLOGY QUARTERLY 2020. [DOI: 10.1080/09515070.2020.1772200] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Affiliation(s)
- Eugénia Ribeiro
- School of Psychology, Psychology Research Centre (CPsi)-university of Minho, Braga, Portugal
- Association of Psychology, University of Minho (Apsi-uminho), Braga, Portugal
| | - Adriana Sampaio
- School of Psychology, Psychology Research Centre (CPsi)-university of Minho, Braga, Portugal
- Association of Psychology, University of Minho (Apsi-uminho), Braga, Portugal
| | - Miguel M. Gonçalves
- School of Psychology, Psychology Research Centre (CPsi)-university of Minho, Braga, Portugal
- Association of Psychology, University of Minho (Apsi-uminho), Braga, Portugal
| | - Maria Do Céu Taveira
- School of Psychology, Psychology Research Centre (CPsi)-university of Minho, Braga, Portugal
- Association of Psychology, University of Minho (Apsi-uminho), Braga, Portugal
| | - Jácome Cunha
- , HASLab/INESC TEC & University of Minho, Braga, Portugal
| | - Ângela Maia
- School of Psychology, Psychology Research Centre (CPsi)-university of Minho, Braga, Portugal
- Association of Psychology, University of Minho (Apsi-uminho), Braga, Portugal
| | - Marlene Matos
- School of Psychology, Psychology Research Centre (CPsi)-university of Minho, Braga, Portugal
- Association of Psychology, University of Minho (Apsi-uminho), Braga, Portugal
| | - Sónia Gonçalves
- School of Psychology, Psychology Research Centre (CPsi)-university of Minho, Braga, Portugal
- Association of Psychology, University of Minho (Apsi-uminho), Braga, Portugal
| | - Bárbara Figueiredo
- School of Psychology, Psychology Research Centre (CPsi)-university of Minho, Braga, Portugal
- Association of Psychology, University of Minho (Apsi-uminho), Braga, Portugal
| | - Teresa Freire
- School of Psychology, Psychology Research Centre (CPsi)-university of Minho, Braga, Portugal
- Association of Psychology, University of Minho (Apsi-uminho), Braga, Portugal
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Bagarić B, Jokić‐Begić N. Measuring therapists' attitudes toward integration of technology in psychotherapy and predicting their use of technology. J Clin Psychol 2020; 76:1151-1172. [DOI: 10.1002/jclp.22967] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 03/31/2020] [Accepted: 04/13/2020] [Indexed: 11/12/2022]
Affiliation(s)
- Branka Bagarić
- Croatian Association for Behavioral‐Cognitive Therapies (CABCT)Zagreb Croatia
| | - Nataša Jokić‐Begić
- Department of Psychology, Faculty of Humanities and Social SciencesUniversity of ZagrebZagreb Croatia
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Probst T, Stippl P, Pieh C. Changes in Provision of Psychotherapy in the Early Weeks of the COVID-19 Lockdown in Austria. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E3815. [PMID: 32471295 PMCID: PMC7312759 DOI: 10.3390/ijerph17113815] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 05/16/2020] [Accepted: 05/26/2020] [Indexed: 12/19/2022]
Abstract
Reducing personal contacts is a central measure against the spreading of the novel coronavirus disease (COVID-19). This troubles mental health, but also mental health care as treatments usually take place in personal contact and switching to remote treatments might be necessary in times of COVID-19. The present study investigated the question how the provision of psychotherapy changed in the early weeks of the COVID-19 lockdown in Austria and whether there were differences between the four therapeutic orientations eligible in Austria (psychodynamic, humanistic, systemic, behavioral). Psychotherapists (N = 1547) completed an online survey. They entered their number of patients treated on average per week (in personal contact, via telephone, via Internet) in the early weeks of the COVID-19 lockdown in Austria as well as (retrospectively) in the months before. The number of patients treated on average per week in personal contact decreased (on average 81%; p < 0.001), whereas the number of patients treated on average per week via telephone and via Internet increased (on average 979% and 1561%; both p < 0.001). Yet, the decrease of psychotherapies through personal contact was not compensated for by increases of remote psychotherapies (p < 0.001). No differences between the four therapeutic orientations emerged. Results imply an undersupply of psychotherapy in the COVID-19 lockdown and that further changes are necessary to cover the increased need for timely psychotherapy in times of COVID-19.
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Affiliation(s)
- Thomas Probst
- Department for Psychotherapy and Biopsychosocial Health, Danube University Krems, 3500 Krems, Austria;
| | - Peter Stippl
- Austrian Federal Association for Psychotherapy, 1030 Vienna, Austria;
| | - Christoph Pieh
- Department for Psychotherapy and Biopsychosocial Health, Danube University Krems, 3500 Krems, Austria;
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Arndt A, Rubel J, Berger T, Lutz W. Outpatient and self-referred participants: Adherence to treatment components and outcome in an internet intervention targeting anxiety disorders. Internet Interv 2020; 20:100319. [PMID: 32346518 PMCID: PMC7178477 DOI: 10.1016/j.invent.2020.100319] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 02/14/2020] [Accepted: 04/02/2020] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVE While adherence is an important factor influencing the effectiveness of internet interventions, many studies operationalize adherence only by the number of sessions and do not report adherence to specific treatment components. The goal of this study was to investigate adherence to treatment components as well as outcome in outpatients and self-referred participants who participated in an internet intervention targeting anxiety. METHOD Outpatients (N = 50) were compared to self-referred (N = 37) participants and a matched outpatient waitlist sample (based on nearest neighbor matching): Using t-test and χ2 tests adherence to treatment components based on the number of completed exercises was compared between participant groups. A 2 × 2 repeated measures ANOVA was used to compare pre-to post symptom change between participant groups. Primary measures included the Generalized Anxiety Disorder Scale-7 (GAD-7) and the Mini Social Phobia Inventory (Mini-SPIN). Using nonparametric bootstrap analyses number of sessions and adherence to treatment components were investigated as potential mediators of the relationship between participant group and outcome. Finally, predictors of adherence to treatment components in outpatient participants were investigated using LASSO and logistic regression. RESULTS Self-referred participants were more adherent than outpatient participants, however the groups did not differ significantly in outcome. Outpatient participants who adhered to relaxation showed greater improvement during the waiting period than the matched outpatient waitlist sample. The effect of participant group on outcome was mediated via adherence to exposure and number of sessions. CONCLUSIONS In internet interventions adherence to treatment components differs between participant groups and has a mediating effect on treatment outcome. Therefore, it should be fostered, especially when participants are not self-referred. In line with these findings more studies should investigate relevant participant characteristics in more depth.
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Affiliation(s)
- Alice Arndt
- Department of Clinical Psychology and Psychotherapy, University of Trier, Germany
| | - Julian Rubel
- Department of Psychotherapy Research, Justus-Liebig-University, Giessen, Germany
| | - Thomas Berger
- Department of Clinical Psychology and Psychotherapy, University of Bern, Switzerland
| | - Wolfgang Lutz
- Department of Clinical Psychology and Psychotherapy, University of Trier, Germany,Corresponding author at: Department of Clinical Psychology and Psychotherapy, University of Trier, Am Wissenschaftspark 25+27, D-54286 Trier, Germany.
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Mendes-Santos C, Weiderpass E, Santana R, Andersson G. Portuguese Psychologists' Attitudes Toward Internet Interventions: Exploratory Cross-Sectional Study. JMIR Ment Health 2020; 7:e16817. [PMID: 32250273 PMCID: PMC7171568 DOI: 10.2196/16817] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 12/10/2019] [Accepted: 01/26/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Despite the significant body of evidence on the efficacy and cost-effectiveness of internet interventions, the implementation of such programs in Portugal is virtually non-existent. In addition, Portuguese psychologists' use and their attitudes towards such interventions is largely unknown. OBJECTIVE The aim of this study was to explore Portuguese psychologists' knowledge, training, use and attitudes towards internet interventions; to investigate perceived advantages and limitations of such interventions; identify potential drivers and barriers impacting implementation; and study potential factors associated to previous use and attitudes towards internet interventions. METHODS An online cross-sectional survey was developed by the authors and disseminated by the Portuguese Psychologists Association to its members. RESULTS A total of 1077 members of the Portuguese Psychologists Association responded to the questionnaire between November 2018 and February 2019. Of these, 37.2% (N=363) were familiar with internet interventions and 19.2% (N=188) considered having the necessary training to work within the field. 29.6% (N=319) of participants reported to have used some form of digital technology to deliver care in the past. Telephone (23.8%; N=256), e-mail (16.2%; N=175) and SMS (16.1%; N=173) services were among the most adopted forms of digital technology, while guided (1.3%; N=14) and unguided (1.5%; N=16) internet interventions were rarely used. Accessibility (79.9%; N=860), convenience (45.7%; N=492) and cost-effectiveness (45.5%; N=490) were considered the most important advantages of internet interventions. Conversely, ethical concerns (40.7%; N=438), client's ICT illiteracy (43.2%; N=465) and negative attitudes towards internet interventions (37%; N=398) were identified as the main limitations. An assessment of participants attitudes towards internet interventions revealed a slightly negative/neutral stance (Median=46.21; SD=15.06) and revealed greater acceptability towards blended treatment interventions (62.9%; N=615) when compared to standalone internet interventions (18.6%; N=181). Significant associations were found between knowledge (χ24=90.4; P<.001), training (χ24=94.6; P<.001), attitudes (χ23=38.4; P<.001) and previous use of internet interventions and between knowledge (χ212=109.7; P<.001), training (χ212=64.7; P<.001) and attitudes towards such interventions, with psychologists reporting to be ignorant and not having adequate training in the field, being more likely to present more negative attitudes towards these interventions and not having prior experience in its implementation. CONCLUSIONS This study revealed that most Portuguese psychologists are not familiar with and have no training or prior experience using internet interventions and had a slightly negative/neutral attitude towards such interventions. There was greater acceptability towards blended treatment interventions compared to standalone internet interventions. Lack of knowledge and training were identified as the main barriers to overcome, underlining the need of promoting awareness and training initiatives to ensure internet interventions successful implementation.
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Affiliation(s)
- Cristina Mendes-Santos
- Department of Culture and Society, Linköping University, Linköping, Sweden
- NOVA National School of Public Health, Public Health Research Centre, Universidade Nova de Lisboa, Lisboa, Portugal
| | | | - Rui Santana
- NOVA National School of Public Health, Public Health Research Centre, Universidade Nova de Lisboa, Lisboa, Portugal
| | - Gerhard Andersson
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
- Department of Clinical Neuroscience, Psychiatry Section, Karolinska Institutet, Stockholm, Sweden
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Kerst A, Zielasek J, Gaebel W. Smartphone applications for depression: a systematic literature review and a survey of health care professionals' attitudes towards their use in clinical practice. Eur Arch Psychiatry Clin Neurosci 2020; 270:139-152. [PMID: 30607530 DOI: 10.1007/s00406-018-0974-3] [Citation(s) in RCA: 69] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Accepted: 12/19/2018] [Indexed: 12/30/2022]
Abstract
Smartphone applications ("apps") may contribute to closing the treatment gap for depression by reaching large populations at relatively low costs. The general public seems open towards the use of apps for mental disorders but less is known about the attitudes of health care professionals. Therefore, the aim of this study was to examine the available evidence on the effectiveness of apps for depression and to explore the attitudes of health care professionals towards their use in practice. A systematic literature search was performed aimed at studies utilizing smartphone applications for depression. In addition, a survey was conducted to explore health care professionals' attitudes towards using these treatment apps in clinical practice. Twelve articles were identified in the systematic literature review. All included trials reported a decline in depressive symptoms after the intervention periods. In the survey, 72 health care professionals participated. Significant differences were found between the level of technology experience and how much the health care professional would consider the use of mobile applications in clinical practice. Survey participants reported openness towards therapeutic app use but very little knowledge and experience in the field. Apps appear to be a promising self-management tool for reducing depressive symptoms. Despite some concerns, health care professionals' attitudes towards the use of smartphone applications in clinical practice are quite positive. The provision of information on the potential benefits of e-health interventions as well as the training of professionals in the application of new technologies may increase health care professionals' awareness and knowledge about mobile apps for the treatment of mental disorders.
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Affiliation(s)
- Ariane Kerst
- Department of Psychiatry, Medical Faculty, LVR-Klinikum Düsseldorf, Heinrich-Heine-University, Düsseldorf, Germany.
- WHO Collaborating Center for Quality Assurance and Empowerment in Mental Health, Düsseldorf, Germany.
| | | | - Wolfgang Gaebel
- Department of Psychiatry, Medical Faculty, LVR-Klinikum Düsseldorf, Heinrich-Heine-University, Düsseldorf, Germany
- WHO Collaborating Center for Quality Assurance and Empowerment in Mental Health, Düsseldorf, Germany
- LVR-Institute for Healthcare Research, Cologne, Germany
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Bielinski L, Berger T. Internet Interventions for Mental Health: Current State of Research, Lessons Learned and Future Directions. КОНСУЛЬТАТИВНАЯ ПСИХОЛОГИЯ И ПСИХОТЕРАПИЯ 2020. [DOI: 10.17759/cpp.2020280305] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
This article gives an overview of current research on internet interventions in the field of mental health. As a result of COVID-19, the implementation of internet interventions has been given a boost in the mental health sectors of several countries all over the world. With regard to these developments, a definition of internet interventions is provided and the current state of research on different formats, treatment contents, and settings of internet interventions is discussed. Current research on the therapeutic alliance in internet interventions and possible negative effects is also described. The review closes with lessons learned from the past decades of research on internet interventions along with possible implications and future directions.
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