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Fortney JC, Kaysen DL, Engel CC, Cerimele JM, Nolan JP, Chase E, Blanchard BE, Hauge S, Bechtel J, Moore DL, Taylor A, Acierno R, Nagel N, Sripada RK, Painter JT, DeBeer BB, Bluett E, Teo AR, Morland LA, Heagerty PJ. Sequenced treatment effectiveness for posttraumatic stress (STEPS) trial: A protocol for a pragmatic comparative effectiveness trial with baseline results. Contemp Clin Trials 2024; 144:107606. [PMID: 38866094 DOI: 10.1016/j.cct.2024.107606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2024] [Revised: 05/16/2024] [Accepted: 06/09/2024] [Indexed: 06/14/2024]
Abstract
BACKGROUND There have only been two efficacy trials reporting a head-to-head comparison of medications and psychotherapy for PTSD, and neither was conducted in primary care. Therefore, this protocol paper describes a pragmatic trial that compares outcomes of primary care patients randomized to initially receive a brief trauma-focused psychotherapy or a choice of three antidepressants. In addition, because there are few trials examining the effectiveness of subsequent treatments for patients not responding to the initial treatment, this pragmatic trial also compares the outcomes of those switching or augmenting treatments. METHOD Patients screening positive for PTSD (n = 700) were recruited from the primary care clinics of 7 Federally Qualified Health Centers (FQHC) and 8 Department of Veterans Affairs (VA) Medical Centers and randomized in the ratio 1:1:2 to one of three treatment sequences: 1) selective serotonin reuptake inhibitor (SSRI) followed by augmentation with Written Exposure Therapy (WET), 2) SSRI followed by a switch to serotonin-norepinephrine reuptake inhibitor (SNRI), or 3) WET followed by a switch to SSRI. Participants complete surveys at baseline, 4 months, and 8 months. The primary outcome is PTSD symptom severity as measured by the PTSD Checklist (PCL-5). RESULTS Average PCL-5 scores (M = 52.8, SD = 11.1) indicated considerable severity. The most common bothersome traumatic event for VA enrollees was combat (47.8%), and for FQHC enrollees was other (28.2%), followed by sexual assault (23.4%), and child abuse (19.8%). Only 22.4% were taking an antidepressant at baseline. CONCLUSION Results will help healthcare systems and clinicians make decisions about which treatments to offer to patients.
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Affiliation(s)
- John C Fortney
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle, WA, USA; VA Health Systems Research, Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound, Seattle, WA, USA.
| | - Debra L Kaysen
- Departments of Psychiatry and Behavioral Sciences and Public Mental Health & Population Sciences, School of Medicine, Stanford University, Palo Alto, CA, USA
| | - Charles C Engel
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle, WA, USA; VA Health Systems Research, Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound, Seattle, WA, USA
| | - Joseph M Cerimele
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle, WA, USA; VA Health Systems Research, Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound, Seattle, WA, USA
| | | | - Erin Chase
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle, WA, USA
| | - Brittany E Blanchard
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle, WA, USA
| | - Stephanie Hauge
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle, WA, USA
| | - Jared Bechtel
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle, WA, USA
| | - Danna L Moore
- School of Economic Sciences, Washington State University, Pullman, WA, USA
| | - Ashley Taylor
- Primary Care Behavioral Health, VA Bedford Healthcare System, Bedford, MA, USA
| | - Ron Acierno
- Ralph H. Johnson VA Healthcare System, USA; Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center, Houston, TX, USA
| | - Nancy Nagel
- Primary Care Mental Health Integration, Cincinnati VA Medical Center, Cincinnati, OH, USA
| | - Rebecca K Sripada
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA; VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - Jacob T Painter
- Health Systems Research Center for Mental Health and Outcomes Research, Central Arkansas Veterans Healthcare System, North Little Rock, AR, USA; College of Pharmacy, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Bryann B DeBeer
- Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Denver, CO, USA; VA Rocky Mountain Mental Illness, Research, Education, and Clinical Center for Suicide Prevention, Denver, CO, USA
| | - Ellen Bluett
- University of Montana, Family Medicine Residency
| | - Alan R Teo
- Department of Psychiatry, Oregon Health & Science University, Portland, OR, USA; Center to Improve Veteran Involvement in Care, Health Systems Research, VA Portland Health Care System, Portland, OR, USA
| | - Leslie A Morland
- Department of Psychiatry, Medical University of South Carolina, Charleston, SC, USA; VA San Diego Healthcare System, San Diego, CA, USA
| | - Patrick J Heagerty
- Department of Biostatistics, School of Public Health, University of Washington, Seattle, WA, USA
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Ross DC, McCallum N, Truuvert AK, Butt A, Behdinan T, Rojas D, Soklaridis S, Vigod S. The development and evaluation of a virtual, asynchronous, trauma-focused treatment program for adult survivors of childhood interpersonal trauma. J Ment Health 2024:1-10. [PMID: 38572918 DOI: 10.1080/09638237.2024.2332797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 08/05/2023] [Indexed: 04/05/2024]
Abstract
BACKGROUND The long-term mental and physical health implications of childhood interpersonal trauma on adult survivors is immense, however, there is a lack of available trauma-focused treatment services that are widely accessible. This study, utilizing a user-centered design process, sought feedback on the initial design and development of a novel, self-paced psychoeducation and skills-based treatment intervention for this population. AIMS To explore the views and perspectives of adult survivors of childhood interpersonal trauma on the first two modules of an asynchronous trauma-focused treatment program. METHODS Fourteen participants from our outpatient hospital service who completed the modules consented to provide feedback on their user experience. A thematic analysis of the three focus groups was conducted. RESULTS Four major themes emerged from the focus groups: (1) technology utilization, (2) module content, (3) asynchronous delivery, and (4) opportunity for interactivity. Participants noted the convenience of the platform and the use of multimedia content to increase engagement and did not find the modules to be emotionally overwhelming. CONCLUSIONS Our research findings suggest that an asynchronous virtual intervention for childhood interpersonal trauma survivors may be a safe and acceptable way to provide a stabilization-focused intervention on a wider scale.
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Affiliation(s)
- Dana C Ross
- Women's College Hospital and Research Institute, Toronto, ON, Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Nancy McCallum
- Women's College Hospital and Research Institute, Toronto, ON, Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Annie K Truuvert
- Women's College Hospital and Research Institute, Toronto, ON, Canada
| | - Aysha Butt
- Women's College Hospital and Research Institute, Toronto, ON, Canada
| | - Tina Behdinan
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - David Rojas
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- The Wilson Centre, University of Toronto, Toronto, ON, Canada
| | - Sophie Soklaridis
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- The Wilson Centre, University of Toronto, Toronto, ON, Canada
- Centre for Addictions and Mental Health, Toronto, ON, Canada
| | - Simone Vigod
- Women's College Hospital and Research Institute, Toronto, ON, Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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Ponzini GT, Hundt NE, Christie IC, Chen PV, Ecker AH, Lindsay JA, Teng EJ, Storch EA, Myers US, Roussev MS, Fletcher TL. A protocol for a randomized controlled trial of exposure and response prevention for veterans with obsessive compulsive disorder. Contemp Clin Trials 2024; 138:107445. [PMID: 38237674 DOI: 10.1016/j.cct.2024.107445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 01/02/2024] [Accepted: 01/15/2024] [Indexed: 01/23/2024]
Abstract
BACKGROUND Obsessive compulsive disorder (OCD) is effectively treated with exposure and response prevention (ERP), yet very few veterans receive ERP for OCD within the Veterans Health Administration (VHA). Veterans are a clinically complex population, and no prior research has evaluated the effectiveness of ERP in veterans with OCD or comorbid OCD and posttraumatic stress disorder (PTSD). Given the limited accessibility of ERP-trained providers within VHA, assessment of video telehealth (VTH) delivery of ERP is warranted. METHODS A sample of 160 veterans with OCD (80 diagnosed with comorbid PTSD) will be randomly assigned to receive up to 16 sessions of ERP or a stress management training control delivered via VTH. Assessments will occur at baseline, posttreatment, and 6-month follow-up. The primary outcome will evaluate the impact of ERP on participants' functioning, and secondary outcomes will include quality of life and OCD symptoms. At posttreatment, qualitative interviews with veterans, clinicians, and administrators will explore barriers and facilitators to treatment delivery, and the implementation potential of ERP. CONCLUSIONS Results will provide direction for the treatment of OCD and comorbid PTSD in veterans, as well as guidance for future implementation efforts for ERP within VHA. CLINICALTRIALS gov Identifier:NCT05240924.
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Affiliation(s)
- Gabriella T Ponzini
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA Health Care System, 411 W. Chapel Hill St., Durham, NC 27701, USA.
| | - Natalie E Hundt
- VA HSR&D Houston Center of Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, (MEDVAMC 152), 2002 Holcombe Blvd., Houston, TX 77030, USA; Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA; VA South Central Mental Illness Research, Education and Clinical Center, Houston, TX (a virtual center), USA.
| | - Israel C Christie
- VA HSR&D Houston Center of Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, (MEDVAMC 152), 2002 Holcombe Blvd., Houston, TX 77030, USA; Department of Medicine, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA.
| | - Patricia V Chen
- VA HSR&D Houston Center of Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, (MEDVAMC 152), 2002 Holcombe Blvd., Houston, TX 77030, USA; Department of Medicine, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA.
| | - Anthony H Ecker
- VA HSR&D Houston Center of Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, (MEDVAMC 152), 2002 Holcombe Blvd., Houston, TX 77030, USA; Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA; VA South Central Mental Illness Research, Education and Clinical Center, Houston, TX (a virtual center), USA.
| | - Jan A Lindsay
- VA HSR&D Houston Center of Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, (MEDVAMC 152), 2002 Holcombe Blvd., Houston, TX 77030, USA; Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA; VA South Central Mental Illness Research, Education and Clinical Center, Houston, TX (a virtual center), USA.
| | - Ellen J Teng
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA; Mental Health Care Line, Michael E. DeBakey VA Medical Center, 2002 Holcombe Blvd., Houston, TX 77030, USA.
| | - Eric A Storch
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA.
| | - Ursula S Myers
- Charleston Health Equity and Rural Outreach Innovation Center and Mental Health Service Line, Ralph H. Johnson Health Care System, Charleston, SC, USA; Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 109 Bee St., Charleston, SC 29401, USA.
| | - Milena S Roussev
- VISN 20 Clinical Resource Hub, 500 W. Fort St., Boise, ID 83702, USA.
| | - Terri L Fletcher
- VA HSR&D Houston Center of Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, (MEDVAMC 152), 2002 Holcombe Blvd., Houston, TX 77030, USA; Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA; VA South Central Mental Illness Research, Education and Clinical Center, Houston, TX (a virtual center), USA.
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Dhaliwal R, Yap S, Talarico F, Al-Shamali H, Mcweeny R, Reeson M, Shalaby R, Chen T, Spronk E, Snodgrass R, Tu E, Erick T, Marshall T, Kennedy M, Greenshaw AJ, Winkler O, Burback L. Synchronous Web-Based Psychotherapy for Mental Disorders From a Health Quality Perspective: Scoping Review. J Med Internet Res 2023; 25:e40710. [PMID: 37921863 PMCID: PMC10656669 DOI: 10.2196/40710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 09/12/2023] [Accepted: 10/11/2023] [Indexed: 11/04/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic necessitated rapid changes to health care delivery, including a shift from in-person to digitally delivered psychotherapy. While these changes helped ensure timely psychotherapy provision, many concerns exist, including clinical, cultural, practical, privacy, and security issues. OBJECTIVE This scoping review systematically mapped existing peer-reviewed research on synchronous, therapist-delivered web-based psychotherapy for individuals with a diagnosed mental illness. Data were analyzed through the lens of the Alberta Quality Matrix for Health (AQMH) to assess to what degree this literature addresses key indicators of health care quality. This analysis aided in the identification and organization of knowledge gaps with regard to web-based psychotherapies, highlighting potential disparities between previously prioritized dimensions of care and those requiring further attention. METHODS This review adhered to the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines. We included peer-reviewed primary research studies in the English language investigating synchronous, therapist-delivered remote psychotherapy delivered to adults (aged 18 years and older) with a Diagnostic and Statistical Manual of Mental Disorders or International Statistical Classification of Diseases diagnosed mental illness. All other citations were excluded. Relevant studies were identified through MEDLINE, APA PsycINFO, Embase (OVID), Web of Science: Core Collection (Clarivate), Cochrane Library (Wiley), and Scopus (Elsevier) databases. Databases were searched on March 18, 2021. For every publication that was taken into consideration, the data were charted independently by 2 reviewers, and in the event of a discrepancy, the principal investigator validated the choice of either extractor. Results were thematically described according to the 6 AQMH dimensions: acceptability, accessibility, appropriateness, effectiveness, efficiency, and safety. RESULTS From 13,209 publications, 48 articles were included, largely from North American studies. Most studies measured treatment effectiveness (n=48, 100%) and acceptability (n=29, 60%) health quality dimensions. Over 80% (40/48) of studies investigated either a cognitive or exposure intervention for either posttraumatic stress disorder or a mood or anxiety disorder, generally indicating comparable results to in-person therapy. Safety (n=5, 10%) was measured in fewer studies, while treatment accessibility, appropriateness, and efficiency were not explicitly measured in any study, although these dimensions were mentioned as a future direction, hypothesis, or potential outcome. CONCLUSIONS In relation to web-based therapist-delivered psychotherapies for those with a diagnosed mental illness, important aspects of health care quality (accessibility, appropriateness, efficiency, and safety) have received little scientific examination, underscoring a need to address these gaps. There are also significant issues related to the generalizability of this literature, including the underrepresentation of many geographic regions, cultures, populations, clinical contexts, and psychotherapy modalities. Qualitative research in underrepresented populations and settings may uncover important patient and contextual factors important for the future implementation of quality web-based psychotherapy.
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Affiliation(s)
- Raman Dhaliwal
- Department of Psychiatry, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Sidney Yap
- Department of Psychiatry, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Fernanda Talarico
- Department of Psychiatry, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Huda Al-Shamali
- Department of Psychiatry, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Robert Mcweeny
- Department of Psychiatry, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Matthew Reeson
- Department of Psychiatry, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Reham Shalaby
- Department of Psychiatry, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Teresa Chen
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Elena Spronk
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Rayven Snodgrass
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Eileen Tu
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Taylor Erick
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Tyler Marshall
- Department of Psychiatry, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Megan Kennedy
- Geoffrey and Robyn Sperber Health Sciences Library, University of Alberta, Edmonton, AB, Canada
| | - Andrew J Greenshaw
- Department of Psychiatry, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Olga Winkler
- Department of Psychiatry, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Lisa Burback
- Department of Psychiatry, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
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ÇİLLER A, KÖSKÜN T, AKCA AYE. Post Traumatic Stress Disorder and Behavioral Therapy Intervention Techniques Used in Treatment. PSIKIYATRIDE GUNCEL YAKLASIMLAR - CURRENT APPROACHES IN PSYCHIATRY 2022. [DOI: 10.18863/pgy.1096518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Post-traumatic stress disorder (PTSD) is a disorder that significantly reduces the functionality of people with symptoms of this disorder and negatively affects their psychological health. Behavioral therapy is an empirically based therapy approach used in the treatment of this psychological disorder and many other psychological disorders. In this study, the articles on behavioral therapy intervention techniques used in the treatment of PTSD and the empirical basis of these techniques were compiled. The literature review in Turkish and English revealed that psychoeducation, real-life exposure, imaginary exposure, prolonged exposure, breathing exercises, relaxation training and systematic desensitization behavioral therapy intervention techniques are commonly used in the treatment of PTSD and that these techniques are effective in the treatment of the disorder.
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Comparing Trauma Treatment Outcomes Between Homeless and Housed Veterans in a VA PTSD Clinical Program. Community Ment Health J 2022; 59:797-807. [PMID: 36459286 DOI: 10.1007/s10597-022-01061-2] [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: 06/09/2022] [Accepted: 11/18/2022] [Indexed: 12/03/2022]
Abstract
Homeless veterans are likely to experience Post Traumatic Stress Disorder (PTSD). Homelessness itself is traumatic, and PTSD may exacerbate homelessness risk for veterans. Often, PTSD goes untreated in this subpopulation of veterans. Our study examined trauma-focused treatment (TFT) and non-TFT initiation and completion in a sample of housed and homeless veterans being served by a PTSD clinical team in Washington, DC. Findings included a high percentage of veterans who experienced homelessness in the sample and lower treatment completion rates among homeless veterans compared to housed veterans. This difference was no longer significant when comparing only those veterans who engaged in treatment, reinforcing the critical role of treatment engagement in successful treatment completion across populations.
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Brown WJ, Saulnier KG, Allan NP, Wojtalik JA, Zampogna AM, Grubaugh AL. Dropout from prolonged exposure among individuals with posttraumatic stress disorder and comorbid severe mental illness. JOURNAL OF AFFECTIVE DISORDERS REPORTS 2022. [DOI: 10.1016/j.jadr.2022.100405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Palitsky R, Kaplan DM, Brodt MA, Anderson MR, Athey A, Coffino JA, Egbert A, Hallowell ES, Han GT, Hartmann MA, Herbitter C, Herrera Legon M, Hughes CD, Jao NC, Kassel MT, Le TAP, Levin-Aspenson HF, López G, Maroney MR, Medrano M, Reznik SJ, Rogers ML, Stevenson BL. Systemic Challenges in Internship Training for Health-Service Psychology: A Call to Action From Trainee Stakeholders. Clin Psychol Sci 2022; 10:819-845. [PMID: 36465892 PMCID: PMC9718483 DOI: 10.1177/21677026211072232] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/03/2023]
Abstract
The challenges observed in health service psychology (HSP) training during COVID-19 revealed systemic and philosophical issues that preexisted the pandemic, but became more visible during the global health crisis. In a position paper written by 23 trainees across different sites and training specializations, the authors use lessons learned from COVID-19 as a touchstone for a call to action in HSP training. Historically, trainee voices have been conspicuously absent from literature about clinical training. We describe longstanding dilemmas in HSP training that were exacerbated by the pandemic and will continue to require resolution after the pandemic has subsided. The authors make recommendations for systems-level changes that would advance equity and sustainability in HSP training. This article advances the conversation about HSP training by including the perspective of trainees as essential stakeholders.
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Affiliation(s)
- R Palitsky
- 1. Warren Alpert Medical School at Brown University, Department of Psychiatry and Human Behavior
| | - D M Kaplan
- 1. Warren Alpert Medical School at Brown University, Department of Psychiatry and Human Behavior
- 12. Brown University, Center for Alcohol and Addiction Studies
| | - M A Brodt
- 2. Oklahoma State University, Counseling and Counseling Psychology Department, College of Education and Human Sciences
| | - M R Anderson
- 1. Warren Alpert Medical School at Brown University, Department of Psychiatry and Human Behavior
| | - A Athey
- 3. Johns Hopkins University School of Public Health
| | - J A Coffino
- 4. Department of Population Health, New York University School of Medicine
| | - A Egbert
- 1. Warren Alpert Medical School at Brown University, Department of Psychiatry and Human Behavior
- 5. The Miriam Hospital, Providence, RI
| | - E S Hallowell
- 1. Warren Alpert Medical School at Brown University, Department of Psychiatry and Human Behavior
| | - G T Han
- 6. Yale Child Study Center, Yale School of Medicine
| | | | - C Herbitter
- 8. VA Boston Healthcare System
- 18. Boston University Medical School
| | | | - C D Hughes
- 1. Warren Alpert Medical School at Brown University, Department of Psychiatry and Human Behavior
| | - N C Jao
- 1. Warren Alpert Medical School at Brown University, Department of Psychiatry and Human Behavior
- 5. The Miriam Hospital, Providence, RI
| | | | - T-A P Le
- 11. Capital OCD and Anxiety Practice
| | - H F Levin-Aspenson
- 1. Warren Alpert Medical School at Brown University, Department of Psychiatry and Human Behavior
| | - G López
- 12. Brown University, Center for Alcohol and Addiction Studies
| | - M R Maroney
- 13. Werklund School of Education, University of Calgary
| | | | - S J Reznik
- 15. Texas Institute for Excellence in Mental Health, University of Texas at Austin
| | - M L Rogers
- 16. Icahn School of Medicine, Mount Sinai Beth Israel
| | - B L Stevenson
- 17. University of Minnesota Department of Psychiatry
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Lopez CM, Gilmore AK, Brown WJ, Hahn CK, Muzzy W, Grubaugh A, Acierno R. Effects of Emotion Dysregulation on Post-treatment Post-traumatic Stress Disorder and Depressive Symptoms Among Women Veterans With Military Sexual Trauma. JOURNAL OF INTERPERSONAL VIOLENCE 2022; 37:NP13143-NP13161. [PMID: 33775153 DOI: 10.1177/08862605211005134] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Military sexual trauma (MST), defined as sexual assault or repeated, threatening sexual harassment while in the military, is associated with increased risk of long-term mental and physical health problems, with the most common being symptoms of post-traumatic stress disorder (PTSD) and depression. In addition to PTSD and depression, MST is linked to difficulties in emotion regulation as well as poor treatment engagement. Thus, it is important to examine these correlates, and how they affect postintervention symptom reduction in this vulnerable population. The current study presents secondary data analyses from a randomized clinical trial comparing the efficacy of in-person versus telemedicine delivery of prolonged exposure therapy for female veterans with MST-related PTSD (n = 151). Results of the study found that changes in difficulties with emotion regulation predicted postintervention depressive symptoms but not postintervention PTSD symptoms. Neither postintervention depressive nor PTSD symptoms were affected by treatment dosing (i.e., number of sessions attended) nor treatment condition (i.e., in-person vs. telemedicine). Findings from the current study provide preliminary evidence that decreases in difficulties with emotion regulation during PTSD treatment are associated with decreases in depressive symptom severity.
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Affiliation(s)
| | | | | | | | - Wendy Muzzy
- Medical University of South Carolina, Charleston, SC, USA
| | - Anouk Grubaugh
- Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC, USA
| | - Ron Acierno
- University of Texas Health Sciences Center at Houston, TX, USA
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Watkins LE, Patton SC, Drexler K, A. M. Rauch S, Rothbaum BO. Clinical Effectiveness of an Intensive Outpatient Program for Integrated Treatment of Comorbid Substance Abuse and Mental Health Disorders. COGNITIVE AND BEHAVIORAL PRACTICE 2022. [DOI: 10.1016/j.cbpra.2022.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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11
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Fortney JC, Rajan S, Reisinger HS, Moeckli J, Nolan JP, Wong ES, Rise P, Petrova VV, Sayre GG, Pyne JM, Grubaugh A, Simsek-Duran F, Grubbs KM, Morland LA, Felker B, Schnurr PP. Deploying a telemedicine collaborative care intervention for posttraumatic stress disorder in the U.S. Department of Veterans Affairs: A stepped wedge evaluation of an adaptive implementation strategy. Gen Hosp Psychiatry 2022; 77:109-117. [PMID: 35596963 DOI: 10.1016/j.genhosppsych.2022.03.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 03/08/2022] [Accepted: 03/23/2022] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To address barriers to trauma-focused psychotherapy for veterans with posttraumatic stress disorder (PTSD), we compared two implementation strategies to promote the deployment of telemedicine collaborative care. METHOD We conducted a Hybrid Type III Effectiveness Implementation trial at six VA medical centers and their 12 affiliated Community Based Outpatient Clinics. The trial used a stepped wedge design and an adaptive implementation strategy that started with standard implementation, followed by enhanced implementation for VA medical centers that did not achieve the performance benchmark. Implementation outcomes for the 544 veterans sampled from the larger population targeted by the intervention were assessed from chart review (care management enrollment and receipt of trauma-focused psychotherapy) and telephone survey (perceived access and PTSD symptoms) after each implementation phase. The primary outcome was enrollment in care management. RESULTS There was no significant difference between standard implementation and enhanced implementation on any of the implementation outcomes. 41.6% of sampled veterans had a care manager encounter, but only 6.0% engaged in trauma-focused psychotherapy. CONCLUSIONS While telemedicine collaborative care was shown to be effective at engaging veterans in trauma-focused psychotherapy in a randomized controlled trial, neither standard nor enhanced implementation strategies were sufficient to support successful deployment into routine care. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02737098.
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Affiliation(s)
- John C Fortney
- VA HSR&D Center for Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, Seattle, WA, United States of America; Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States of America.
| | - Suparna Rajan
- VA HSR&D Center for Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, Seattle, WA, United States of America
| | - Heather S Reisinger
- VA HSR&D Center for Access & Delivery Research and Evaluation, Iowa City VA Health Care System, IA, United States of America; Department of Internal Medicine, University of Iowa, Iowa City, IA, United States of America
| | - Jane Moeckli
- VA HSR&D Center for Access & Delivery Research and Evaluation, Iowa City VA Health Care System, IA, United States of America
| | | | - Edwin S Wong
- VA HSR&D Center for Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, Seattle, WA, United States of America; Department of Health and Systems and Population Health, University of Washington, Seattle, WA, United States of America
| | - Peter Rise
- VA HSR&D Center for Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, Seattle, WA, United States of America
| | - Valentina V Petrova
- VA HSR&D Center for Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, Seattle, WA, United States of America
| | - George G Sayre
- VA HSR&D Center for Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, Seattle, WA, United States of America
| | - Jeffrey M Pyne
- VA HSR&D Center for Mental Health and Outcomes Research, Central Arkansas Veterans Healthcare System, Little Rock, AR, United States of America; Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, United States of America
| | - Anouk Grubaugh
- VA HSR&D Charleston Health Equity and Rural Outreach Innovation Center, Charleston, SC, United States of America; Department of Psychiatry, Medical University of South Carolina, Charleston, SC, United States of America
| | - Fatma Simsek-Duran
- Iowa City VA Health Care System, IA, United States of America; Department of Psychiatry, University of Iowa, Iowa City, IA, United States of America
| | - Kathleen M Grubbs
- VA San Diego Healthcare System, San Diego, CA, United States of America; Department of Psychiatry, University of California-San Diego, San Diego, CA, United States of America
| | - Leslie A Morland
- VA San Diego Healthcare System, San Diego, CA, United States of America; Department of Psychiatry, University of California-San Diego, San Diego, CA, United States of America
| | - Bradford Felker
- VA HSR&D Center for Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, Seattle, WA, United States of America; Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States of America
| | - Paula P Schnurr
- National Center for PTSD, VA Medical Center, White River Junction, VT, United States of America; Geisel School of Medicine at Dartmouth, Hanover, NH, United States of America
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12
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Kehle-Forbes SM, Ackland PE, Spoont MR, Meis LA, Orazem RJ, Lyon A, Valenstein-Mah HR, Schnurr PP, Zickmund SL, Foa EB, Chard KM, Alpert E, Polusny MA. Divergent experiences of U.S. veterans who did and did not complete trauma-focused therapies for PTSD: A national qualitative study of treatment dropout. Behav Res Ther 2022; 154:104123. [PMID: 35644083 PMCID: PMC9873271 DOI: 10.1016/j.brat.2022.104123] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 05/04/2022] [Accepted: 05/13/2022] [Indexed: 01/26/2023]
Abstract
Prolonged Exposure (PE) and Cognitive Processing Therapy (CPT) are first-line treatments for posttraumatic stress disorder (PTSD) and have been disseminated throughout the U.S. Veterans Health Administration. Treatment non-completion is common and lessens clinical effectiveness; however, prior work has failed to identify factors consistently associated with non-completion. Semi-structured interviews were conducted with a national sample of veterans who recently completed (n = 60) or did not complete (n = 66) PE or CPT. Non-completer interviews focused on factors that contributed to veterans' decisions to drop out and efforts undertaken to complete PE/CPT. Completer interviews focused on challenges faced in completing treatment and facilitators of completion. Transcripts were coded using a mixed deductive/inductive approach; constant comparison was used to identify differences between completers and non-completers. Completers and non-completers differed in the extent of treatment-specific therapist support received, therapists' flexibility in treatment delivery, the type of encouragement offered by the care team and social supports, their interpretation of symptom worsening, the perceived impact of treatment on functioning, and the impact of stressors on their treatment engagement. Treatment-specific therapist support, more patient-centered and flexible treatment delivery, leveraging the full care team, and addressing functional concerns are potential targets for PE and CPT engagement interventions.
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Affiliation(s)
- Shannon M. Kehle-Forbes
- Center for Care Delivery & Outcomes Research, Minneapolis VA Healthcare System, One Veterans Drive, Minneapolis, MN, 55417, USA,Women’s Health Sciences Division at VA Boston, National Center for PTSD, 150 S Huntington Ave, Boston, MA, 02130, USA,University of Minnesota, Department of Medicine, 420 Delaware St SE, Minneapolis, MN, 55455, USA,Corresponding author. Center for Care Delivery & Outcomes Research, Minneapolis VA Healthcare System, One Veterans Drive, Minneapolis, MN, 55417, USA. (S.M. Kehle-Forbes)
| | - Princess E. Ackland
- Center for Care Delivery & Outcomes Research, Minneapolis VA Healthcare System, One Veterans Drive, Minneapolis, MN, 55417, USA,University of Minnesota, Department of Medicine, 420 Delaware St SE, Minneapolis, MN, 55455, USA
| | - Michele R. Spoont
- Center for Care Delivery & Outcomes Research, Minneapolis VA Healthcare System, One Veterans Drive, Minneapolis, MN, 55417, USA,University of Minnesota, Department of Medicine, 420 Delaware St SE, Minneapolis, MN, 55455, USA,National Center for PTSD, Pacific Islands Division, 459 Patterson Rd, Honolulu, HI, 96819, USA
| | - Laura A. Meis
- Center for Care Delivery & Outcomes Research, Minneapolis VA Healthcare System, One Veterans Drive, Minneapolis, MN, 55417, USA,University of Minnesota, Department of Medicine, 420 Delaware St SE, Minneapolis, MN, 55455, USA
| | - Robert J. Orazem
- Center for Care Delivery & Outcomes Research, Minneapolis VA Healthcare System, One Veterans Drive, Minneapolis, MN, 55417, USA
| | - Alexandra Lyon
- Center for Care Delivery & Outcomes Research, Minneapolis VA Healthcare System, One Veterans Drive, Minneapolis, MN, 55417, USA
| | - Helen R. Valenstein-Mah
- Center for Care Delivery & Outcomes Research, Minneapolis VA Healthcare System, One Veterans Drive, Minneapolis, MN, 55417, USA
| | - Paula P. Schnurr
- National Center for PTSD, Department of Veterans Affairs, 163 Veterans Dr, White River Junction, VT, 05009, USA,Geisel School of Medicine, Dartmouth College, 1 Rope Ferry Rd, Hanover, NH, 03755, USA
| | - Susan L. Zickmund
- Informatics, Decision-Enhancement & Analytic Sciences Center, Salt Lake City VA, 500 S Foothill Blvd, Salt Lake City, UT, 84108, USA
| | - Edna B. Foa
- Department of Psychiatry, University of Pennsylvania, 6th Gateway, 3535 Market St, Philadelphia, PA, 19104, USA
| | - Kathleen M. Chard
- Cincinnati VA Medical Center, 3200 Vine St, Cincinnati, OH, 45220, USA
| | - Elizabeth Alpert
- Women’s Health Sciences Division at VA Boston, National Center for PTSD, 150 S Huntington Ave, Boston, MA, 02130, USA
| | - Melissa A. Polusny
- Center for Care Delivery & Outcomes Research, Minneapolis VA Healthcare System, One Veterans Drive, Minneapolis, MN, 55417, USA,University of Minnesota, Department of Psychiatry, 420 Delaware St SE, Minneapolis, MN, 55455, USA
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13
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Ghafoori B, Matos M, Gonçalves M. Dropout from evidence-based trauma treatment in a community mental health clinic serving victims of interpersonal violence. J Trauma Stress 2022; 35:1025-1041. [PMID: 35229367 DOI: 10.1002/jts.22811] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 12/29/2021] [Accepted: 01/02/2022] [Indexed: 11/10/2022]
Abstract
Trauma-focused psychotherapies are increasingly offered in community-based mental health centers, but little is known about treatment dropout in these settings. The current study explored dropout at different stages of treatment in a treatment-seeking sample of 1,186 adults who experienced interpersonal violence and were offered trauma-focused and non-trauma-focused therapies. A total of 31.6% of participants dropped out before treatment initiation, 28.0% dropped out after treatment initiation and completed a mean of 4.02 (SD = 2.41) sessions, and 40.4% completed a full course of PTSD treatment. Being unemployed, p < .001, and scoring lower on measures of environment factors, p = .045, were significant predictors of pretreatment dropout. Being female, p < .001; Latinx, p = .032; and scoring higher on a measure of social relationships, p = .024, were independent predictors of postinitiation dropout. Individuals who completed nine sessions of treatment displayed significantly lower levels of posttraumatic stress disorder, depression, and anxiety symptoms. The present study provides preliminary evidence that survivors of interpersonal violence who seek therapy tend to drop out early during treatment, and most who complete treatment attain symptom reduction.
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Affiliation(s)
- Bita Ghafoori
- Department of Advanced Studies in Education and Counseling, California State University Long Beach, Long Beach, California, USA
| | - Marlene Matos
- Psychology Research Center, School of Psychology, University of Minho, Braga, Portugal
| | - Mariana Gonçalves
- Psychology Research Center, School of Psychology, University of Minho, Braga, Portugal
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14
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Maglione MA, Chen C, Franco M, Gizaw M, Shahidinia N, Baxi S, Hempel S. Effect of patient characteristics on posttraumatic stress disorder treatment retention among veterans: A systematic review. J Trauma Stress 2022; 35:718-728. [PMID: 34800059 DOI: 10.1002/jts.22757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 08/19/2021] [Accepted: 08/21/2021] [Indexed: 11/08/2022]
Abstract
To identify baseline patient characteristics (i.e., demographic and psychological factors, military background) associated with better posttraumatic stress disorder (PTSD) treatment retention among veterans, we conducted a systematic review. After an electronic database search for studies of PTSD treatment in veterans, two reviewers independently screened the literature for eligibility, abstracted study-level information, and assessed risk of bias. As most studies used multivariate models to assess multiple potential predictors of retention simultaneously, the results were described narratively. The GRADE approach, adapted for prognostic literature, was used to assess the overall quality of evidence (QoE). In total, 19 studies reported in 25 publications met the inclusion criteria (n = 6 good quality, n = 9 fair quality, n = 4 poor quality). Definitions of treatment completion and dropout varied, and some studies lumped different therapy approaches together. Older age and higher treatment expectations were associated with better retention (moderate QoE). In 5 of 6 studies, baseline PTSD severity was not associated with retention, and the remaining study reported an association between better retention and more severe PTSD symptoms; the presence of more co-occurring psychiatric disorders was associated with better retention (moderate QoE). QoE was low or insufficient to support conclusions for any other characteristics due to inconsistent results, imprecision, potential publication bias, possible study population overlap, study limitations, or lack of studies. More research is needed regarding the associations between modifiable factors (e.g., motivation, barriers, expectations) and retention, and consistent definitions of treatment completion and minimally adequate treatment should be adopted throughout the field.
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Affiliation(s)
- Margaret A Maglione
- RAND Corporation, Santa Monica, California, USA.,Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | | | | | | | | | | | - Susanne Hempel
- Keck School of Medicine, University of Southern California, Los Angeles, California, USA
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15
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Rodriguez JL, Hale AC, Marston HN, Sage-Germain CE, Wright TP, Driesenga SA, Martin SM, Sripada RK. The Association Between Service Connection and Treatment Outcome in Veterans Undergoing Residential PTSD Treatment. Psychiatr Q 2022; 93:285-296. [PMID: 34532825 DOI: 10.1007/s11126-021-09940-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/05/2021] [Indexed: 11/26/2022]
Abstract
The Department of Veterans Affairs has invested significant time and resources into the treatment of posttraumatic stress disorder (PTSD). Despite concerted efforts, a significant portion of patients do not respond optimally to trauma-focused treatment. One of the factors that has been hypothesized to be associated with treatment response is participation in the Veterans Benefits Administration service-connected disability process. This factor may be particularly relevant in the residential treatment setting, where most participants are engaged in the compensation seeking process. We conducted a retrospective chart review of 105 veterans who completed Cognitive Processing Therapy (CPT) in a residential rehabilitation program. ANCOVAs that adjusted for baseline PTSD severity compared symptom change between those who were and were non-compensation seeking at the time of treatment. Compensation seeking status was associated with significantly less symptom improvement over the course of CPT after adjusting for baseline PTSD severity (F(1, 102) = 4.29, p < .001, η2 = .03). Sensitivity analyses did not detect a similar effect during a prior coping skills phase of treatment. During CPT, clinically significant change was met by 66.7% of non-compensation seeking veterans (M = -15, SD = 14.56) and by 40.1% of the compensation seeking group (M = -7.1, SD = 12.24). Compensation-seeking may be associated with reduced response to trauma-focused treatment in certain settings. Future research is needed to better understand the mechanisms underlying this effect.
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Affiliation(s)
- Jessica L Rodriguez
- Psychology Service, Battle Creek VA Medical Center, 5500 Armstrong Road, Battle Creek, MI, 49037, USA.
| | - Andrew C Hale
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System/Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Holloway N Marston
- Psychology Service, Battle Creek VA Medical Center, 5500 Armstrong Road, Battle Creek, MI, 49037, USA
| | - Chelsea E Sage-Germain
- Psychology Service, Battle Creek VA Medical Center, 5500 Armstrong Road, Battle Creek, MI, 49037, USA
| | - Theodore P Wright
- Psychology Service, Battle Creek VA Medical Center, 5500 Armstrong Road, Battle Creek, MI, 49037, USA
| | - Scott A Driesenga
- Psychology Service, Battle Creek VA Medical Center, 5500 Armstrong Road, Battle Creek, MI, 49037, USA
| | - Shannon M Martin
- Department of Psychology, Converse College, Spartanburg, SC, USA
| | - Rebecca K Sripada
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System/Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
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16
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Wong ES, Rajan S, Liu CF, Morland LA, Pyne JM, Simsek-Duran F, Reisinger HS, Moeckli J, Fortney JC. Economic costs of implementing evidence-based telemedicine outreach for posttraumatic stress disorder in VA. IMPLEMENTATION RESEARCH AND PRACTICE 2022; 3:26334895221116771. [PMID: 37091111 PMCID: PMC9924252 DOI: 10.1177/26334895221116771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Telemedicine outreach for posttraumatic stress disorder (TOP) is a virtual evidence-based practice (EBP) involving telephone care management and telepsychology that engages rural patients in trauma-focused psychotherapy. This evaluation examined implementation and intervention costs attributable to deploying TOP from a health system perspective. Methods Costs were ascertained as part of a stepped wedge cluster randomized trial at five sites within the Veterans Affairs (VA) Healthcare System. All sites initially received a standard implementation strategy, which included internal facilitation, dissemination of an internal facilitators operational guide, funded care manager, care managing training, and technical support. A subset of clinics that failed to meet performance metrics were subsequently randomized to enhanced implementation, which added external facilitation that focused on incorporating TOP clinical processes into existing clinic workflow. We measured site-level implementation activities using project records and structured activity logs tracking personnel-level time devoted to all implementation activities. We monetized time devoted to implementation activities by applying an opportunity cost approach. Intervention costs were measured as accounting-based costs for telepsychiatry/telepsychology and care manager visits, ascertained using VA administrative data. We conducted descriptive analyses of strategy-specific implementation costs across five sites. Descriptive analyses were conducted instead of population-level cost-effectiveness analysis because previous research found enhanced implementation was not more successful than the standard implementation in improving uptake of TOP. Results Over the 40-month study period, four of five sites received enhanced implementation. Mean site-level implementation cost per month was $919 (SD = $238) during standard implementation and increased to $1,651 (SD = $460) during enhanced implementation. Mean site-level intervention cost per patient-month was $46 (SD = $28) during standard implementation and $31 (SD = $21) during enhanced implementation. Conclusions Project findings inform the expected cost of implementing TOP, which represents one factor health systems should consider in the decision to broadly adopt this EBP. Plain Language Summary: What is already known about the topic: Trauma-focused psychotherapy delivered through telemedicine has been demonstrated as an effective approach for the treatment of post-traumatic stress disorder (PTSD). However, uptake of this evidence-based approach by integrated health systems such as the Veterans Affairs (VA) Health Care System is low. What does this paper add: This paper presents new findings on the costs of two implementation approaches designed to increase adoption telemedicine outreach for PTSD from a health system perspective. What are the implications for practice, research, and policy: Cost estimates from this paper can be used by health systems to inform the relative value of candidate implementation strategies to increase adoption of evidence-based treatments for PTSD or other mental health conditions.
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Affiliation(s)
- Edwin S. Wong
- Center for Innovation for Veteran-Centered and Value-Driven Care, Puget Sound Health Care System, Seattle, WA
- Department of Health Systems and Population Health, University of Washington, Seattle, WA
| | - Suparna Rajan
- Center for Innovation for Veteran-Centered and Value-Driven Care, Puget Sound Health Care System, Seattle, WA
| | - Chuan-Fen Liu
- Center for Innovation for Veteran-Centered and Value-Driven Care, Puget Sound Health Care System, Seattle, WA
- Department of Health Systems and Population Health, University of Washington, Seattle, WA
| | - Leslie A. Morland
- VA San Diego Healthcare System, San Diego, CA
- Department of Psychiatry, University of California-San Diego, San Diego, CA
| | - Jeffrey M. Pyne
- Center for Mental Health and Outcomes Research, Central Arkansas Veterans Healthcare System, Little Rock, AR
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Fatma Simsek-Duran
- Iowa City VA Health Care System, Iowa City, IA
- Department of Psychiatry, University of Iowa, Iowa City, IA
| | - Heather S. Reisinger
- Center for Access & Delivery Research and Evaluation, Iowa City VA Health Care System, Iowa City, IA
- Department of Internal Medicine, University of Iowa, Iowa
City, IA
| | - Jane Moeckli
- Center for Access & Delivery Research and Evaluation, Iowa City VA Health Care System, Iowa City, IA
| | - John C. Fortney
- Center for Innovation for Veteran-Centered and Value-Driven Care, Puget Sound Health Care System, Seattle, WA
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA
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17
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Cassiello-Robbins C, Rosenthal MZ, Ammirati RJ. Delivering Transdiagnostic Treatment Over Telehealth During the COVID-19 Pandemic: Application of the Unified Protocol. COGNITIVE AND BEHAVIORAL PRACTICE 2021; 28:555-572. [PMID: 34108830 PMCID: PMC8177307 DOI: 10.1016/j.cbpra.2021.04.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 04/19/2021] [Indexed: 01/23/2023]
Abstract
The COVID-19 pandemic has necessitated an abrupt transition to remote delivery of psychology services at a time when patients and practicing clinicians are experiencing an increase in life stressors (e.g., job loss, social isolation, need to adapt to telehealth practice), which can exacerbate mental health concerns and contribute to clinician burnout. Because the COVID-19 pandemic is affecting diverse individuals in myriad ways, these circumstances can elicit a wide range of emotions and emotional responses. Thus, treatment during this time must be able to address heterogeneous presenting problems while placing minimal burden on clinicians who are adjusting to continuously changing circumstances. Transdiagnostic, emotion-focused, cognitive behavioral treatments (CBT), such as the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders (UP), may be particularly well suited to address the challenges faced by practicing psychologists, and their patients, in the current COVID-19 pandemic. This paper discusses the applicability and adaptability of transdiagnostic treatments to telehealth, focusing primarily on the UP in the context of the COVID-19 pandemic. Further, while many CBT skills (e.g., mindfulness) can be easily translated to tele-delivery, other skills, such as exposure, can be more difficult to implement remotely, especially in the midst of a pandemic. Thus, this paper also provides practical suggestions for clinicians with regard to implementing the UP remotely.
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18
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Anger and predictors of drop-out from PTSD treatment of veterans and first responders. Behav Cogn Psychother 2021; 50:237-251. [PMID: 34569465 DOI: 10.1017/s1352465821000382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Drop-out is an important barrier in treating post-traumatic stress disorder (PTSD) with consequences that negatively impact clients, clinicians and mental health services as a whole. Anger is a common experience in people with PTSD and is more prevalent in military veterans. To date, no research has examined if anger may predict drop-out in military veterans or first responders. AIMS The present study aimed to determine the variables that predict drop-out among individuals receiving residential treatment for PTSD. METHOD Ninety-five military veterans and first responders completed pre-treatment measures of PTSD symptom severity, depression, anxiety, anger, and demographic variables. Logistic regression analyses were used to determine if these variables predicted drop-out from treatment or patterns of attendance. RESULTS Female gender was predictive of drop-out. However, when analysed by occupation female gender was predictive of drop-out among first responders and younger age was predictive of drop-out in military participants. Anger, depression, anxiety and PTSD symptom severity were not predictive of drop-out in any of the analyses. No variables were found to predict attendance patterns (consistent or inconsistent) or early versus late drop-out from the programme. CONCLUSION These results suggest that although anger is a relevant issue for treating PTSD, other factors may be more pertinent to drop-out, particularly in this sample. In contrast with other findings, female gender was predictive of drop-out in this study. This may indicate that in this sample, there are unique characteristics and possible interacting variables that warrant exploration in future research.
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Thomas N, McDonald C, de Boer K, Brand RM, Nedeljkovic M, Seabrook L. Review of the current empirical literature on using videoconferencing to deliver individual psychotherapies to adults with mental health problems. Psychol Psychother 2021; 94:854-883. [PMID: 33620133 PMCID: PMC8451850 DOI: 10.1111/papt.12332] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 01/02/2021] [Indexed: 02/06/2023]
Abstract
PURPOSE The COVID-19 pandemic has resulted in a widespread adoption of videoconferencing as a communication medium in mental health service delivery. This review considers the empirical literature to date on using videoconferencing to deliver psychological therapy to adults presenting with mental health problems. METHOD Papers were identified via search of relevant databases. Quantitative and qualitative data were extracted and synthesized on uptake, feasibility, outcomes, and participant and therapist experiences. RESULTS Videoconferencing has an established evidence base in the delivery of cognitive behavioural therapies for post-traumatic stress disorder and depression, with prolonged exposure, cognitive processing therapy, and behavioural activation non-inferior to in-person delivery. There are large trials reporting efficacy for health anxiety and bulimia nervosa compared with treatment-as-usual. Initial studies show applicability of cognitive behavioural therapies for other anxiety and eating disorders and obsessive-compulsive spectrum disorders, but there has yet to be study of use in severe and complex mental health problems. Therapists may find it more difficult to judge non-verbal behaviour, and there may be initial discomfort while adapting to videoconferencing, but client ratings of the therapeutic alliance are similar to in-person therapy, and videoconferencing may have advantages such as being less confronting. There may be useful opportunities for videoconferencing in embedding therapy delivery within the client's own environment. CONCLUSIONS Videoconferencing is an accessible and effective modality for therapy delivery. Future research needs to extend beyond testing whether videoconferencing can replicate in-person therapy delivery to consider unique therapeutic affordances of the videoconferencing modality. PRACTITIONER POINTS Videoconferencing is an efficacious means of delivering behavioural and cognitive therapies to adults with mental health problems. Trial evidence has established it is no less efficacious than in-person therapy for prolonged exposure, cognitive processing therapy, and behavioural activation. While therapists report nonverbal feedback being harder to judge, and clients can take time to adapt to videoconferencing, clients rate the therapeutic alliance and satisfaction similarly to therapy in-person. Videoconferencing provides opportunities to integrate therapeutic exercises within the person's day-to-day environment.
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Affiliation(s)
- Neil Thomas
- National eTherapy CentreSwinburne University of TechnologyMelbourneVictoriaAustralia
- Centre for Mental HealthSwinburne University of TechnologyMelbourneVictoriaAustralia
- Alfred HospitalMelbourneVictoriaAustralia
| | - Caity McDonald
- Centre for Mental HealthSwinburne University of TechnologyMelbourneVictoriaAustralia
| | - Kathleen de Boer
- Centre for Mental HealthSwinburne University of TechnologyMelbourneVictoriaAustralia
| | - Rachel M. Brand
- Centre for Mental HealthSwinburne University of TechnologyMelbourneVictoriaAustralia
- School of Health and Behavioural SciencesUniversity of the Sunshine CoastSippy DownsQldAustralia
| | - Maja Nedeljkovic
- National eTherapy CentreSwinburne University of TechnologyMelbourneVictoriaAustralia
- Centre for Mental HealthSwinburne University of TechnologyMelbourneVictoriaAustralia
| | - Liz Seabrook
- National eTherapy CentreSwinburne University of TechnologyMelbourneVictoriaAustralia
- Centre for Mental HealthSwinburne University of TechnologyMelbourneVictoriaAustralia
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20
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Barnett P, Goulding L, Casetta C, Jordan H, Sheridan-Rains L, Steare T, Williams J, Wood L, Gaughran F, Johnson S. Implementation of Telemental Health Services Before COVID-19: Rapid Umbrella Review of Systematic Reviews. J Med Internet Res 2021; 23:e26492. [PMID: 34061758 PMCID: PMC8335619 DOI: 10.2196/26492] [Citation(s) in RCA: 61] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 03/30/2021] [Accepted: 04/30/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Telemental health care has been rapidly adopted for maintaining services during the COVID-19 pandemic, and a substantial interest is now being devoted in its future role. Service planning and policy making for recovery from the pandemic and beyond should draw on both COVID-19 experiences and the substantial research evidence accumulated before this pandemic. OBJECTIVE We aim to conduct an umbrella review of systematic reviews available on the literature and evidence-based guidance on telemental health, including both qualitative and quantitative literature. METHODS Three databases were searched between January 2010 and August 2020 for systematic reviews meeting the predefined criteria. The retrieved reviews were independently screened, and those meeting the inclusion criteria were synthesized and assessed for risk of bias. Narrative synthesis was used to report these findings. RESULTS In total, 19 systematic reviews met the inclusion criteria. A total of 15 reviews examined clinical effectiveness, 8 reported on the aspects of telemental health implementation, 10 reported on acceptability to service users and clinicians, 2 reported on cost-effectiveness, and 1 reported on guidance. Most reviews were assessed to be of low quality. The findings suggested that video-based communication could be as effective and acceptable as face-to-face formats, at least in the short term. Evidence on the extent of digital exclusion and how it can be overcome and that on some significant contexts, such as children and young people's services and inpatient settings, was found to be lacking. CONCLUSIONS This umbrella review suggests that telemental health has the potential to be an effective and acceptable form of service delivery. However, we found limited evidence on the impact of its large-scale implementation across catchment areas. Combining previous evidence and COVID-19 experiences may allow realistic planning for the future implementation of telemental health.
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Affiliation(s)
- Phoebe Barnett
- Centre for Outcomes Research and Effectiveness, Division of Psychology and Language Sciences, University College London, London, United Kingdom.,NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, London, United Kingdom
| | - Lucy Goulding
- King's Improvement Science, Centre for Implementation Science, King's College London, London, United Kingdom
| | - Cecilia Casetta
- NIHR Applied Research Collaboration, King's College London, London, United Kingdom
| | - Harriet Jordan
- NIHR Applied Research Collaboration, King's College London, London, United Kingdom.,Institute of Psychiatry, Psychology and Neuroscience, King's College London and South London and Maudsley NHS Trust, London, United Kingdom
| | - Luke Sheridan-Rains
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, London, United Kingdom
| | - Thomas Steare
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, London, United Kingdom
| | - Julie Williams
- Centre for Implementation Science, Health Service and Population Research Department, King's College London, London, United Kingdom
| | - Lisa Wood
- Division of Psychiatry, University College London, London, United Kingdom
| | - Fiona Gaughran
- NIHR Applied Research Collaboration, King's College London, London, United Kingdom.,Institute of Psychiatry, Psychology and Neuroscience, King's College London and South London and Maudsley NHS Trust, London, United Kingdom
| | - Sonia Johnson
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, London, United Kingdom.,Camden and Islington NHS Foundation Trust, London, United Kingdom
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Morgan AA, Landers AL, Simpson JE, Russon JM, Case Pease J, Dolbin‐MacNab ML, Bland KN, Jackson JB. The transition to teletherapy in marriage and family therapy training settings during COVID-19: What do the data tell us? JOURNAL OF MARITAL AND FAMILY THERAPY 2021; 47:320-341. [PMID: 33742728 PMCID: PMC8250895 DOI: 10.1111/jmft.12502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 02/11/2021] [Accepted: 02/14/2021] [Indexed: 06/12/2023]
Abstract
In the wake of the COVID-19 pandemic, little is known about how university training programs transitioned to teletherapy. This study describes the transition of two university marriage and family therapy (i.e., master's and doctoral) training clinics to teletherapy and presents preliminary analyses of the types of clients and cases that converted to teletherapy. A series of chi-square analyses, a t-test, a logistic regression model, and a multiple linear regression model were employed. Four key findings emerged: (1) most cases converted to teletherapy; (2) Hispanic ethnicity was the only demographic characteristic to significantly predict conversion to teletherapy; (3) individual cases were significantly more likely to convert to teletherapy than relational cases; and (4) the number of prior in-person sessions attended significantly predicted conversion to teletherapy. Teletherapy conversion implications are discussed across four systemic levels: client, student trainee, supervision, and larger systems.
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Affiliation(s)
- Amy A. Morgan
- Department of Family ScienceSchool of Public HealthUniversity of MarylandCollege ParkMDUSA
| | - Ashley L. Landers
- Department of Human Development and Family ScienceCollege of Liberal Arts and Human SciencesVirginia TechBlacksburg & Falls ChurchVAUSA
| | - Jessica E. Simpson
- Department of Family Social ScienceCollege of Education and Human DevelopmentUniversity of MinnesotaSt PaulMNUSA
| | - Jody M. Russon
- Department of Human Development and Family ScienceCollege of Liberal Arts and Human SciencesVirginia TechBlacksburg & Falls ChurchVAUSA
| | - Jenene Case Pease
- Department of Human Development and Family ScienceCollege of Liberal Arts and Human SciencesVirginia TechBlacksburg & Falls ChurchVAUSA
| | - Megan L. Dolbin‐MacNab
- Department of Human Development and Family ScienceCollege of Liberal Arts and Human SciencesVirginia TechBlacksburg & Falls ChurchVAUSA
| | - Krista N. Bland
- Department of Human Development and Family ScienceCollege of Liberal Arts and Human SciencesVirginia TechBlacksburg & Falls ChurchVAUSA
| | - Jeffrey B. Jackson
- Department of Human Development and Family ScienceCollege of Liberal Arts and Human SciencesVirginia TechBlacksburg & Falls ChurchVAUSA
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22
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Stuke H, Schoofs N, Johanssen H, Bermpohl F, Ülsmann D, Schulte-Herbrüggen O, Priebe K. Predicting outcome of daycare cognitive behavioural therapy in a naturalistic sample of patients with PTSD: a machine learning approach. Eur J Psychotraumatol 2021; 12:1958471. [PMID: 34589175 PMCID: PMC8475102 DOI: 10.1080/20008198.2021.1958471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Identifying predictors for treatment outcome in patients with posttraumatic stress disorder (PTSD) is important in order to provide an effective treatment, but robust and replicated treatment outcome predictors are not available up to now. OBJECTIVES We investigated predictors of treatment outcome in a naturalistic sample of patients with PTSD admitted to an 8-week daycare cognitive behavioural therapy programme following a wide range of traumatic events. METHOD We used machine learning (linear and non-linear regressors and cross-validation) to predict outcome at discharge for 116 patients and sustained treatment effects 6 months after discharge for 52 patients who had a follow-up assessment. Predictions were based on a wide selection of demographic and clinical assessments including age, gender, comorbid psychiatric disorders, trauma history, posttraumatic symptoms, posttraumatic cognitions, depressive symptoms, general psychopathology and psychosocial functioning. RESULTS We found that demographic and clinical variables significantly, but only modestly predicted PTSD treatment outcome at discharge (r = 0.21, p = .021 for the best model) and follow-up (r = 0.31, p = .026). Among the included variables, more severe posttraumatic cognitions were negatively associated with treatment outcome. Early response in PTSD symptomatology (percentage change of symptom scores after 4 weeks of treatment) allowed more accurate predictions of outcome at discharge (r = 0.56, p < .001) and follow-up (r = 0.43, p = .001). CONCLUSION Our results underscore the importance of early treatment response for short- and long-term treatment success. Nevertheless, it remains an unresolved challenge to identify variables that can robustly predict outcome before the initiation of treatment.
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Affiliation(s)
- Heiner Stuke
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Nikola Schoofs
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Helen Johanssen
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Felix Bermpohl
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Dominik Ülsmann
- Friedrich Von Bodelschwingh-Clinic for Psychiatry, Psychotherapy and Psychosomatics, Berlin, Germany
| | - Olaf Schulte-Herbrüggen
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Friedrich Von Bodelschwingh-Clinic for Psychiatry, Psychotherapy and Psychosomatics, Berlin, Germany
| | - Kathlen Priebe
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Berlin, Germany
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23
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Eficacia de la Telepsicología en intervenciones del área clínica y de la salud: una revisión sistemática de la literatura. REVISTA IBEROAMERICANA DE PSICOLOGÍA 2020. [DOI: 10.33881/2027-1786.rip.13306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
La telepsicología es una herramienta de intervención prometedora que puede aumentar el acceso a los servicios psicológicos reduciendo las barreras de accesibilidad al tratamiento. De este modo, se realizó una búsqueda sistemática en bases de datos con el objetivo de revisar la evidencia sobre la eficacia en intervenciones de telepsicología en el área clínica y de la salud en los últimos 10 años. De un total de 86 registros identificados, 15 estudios empíricos cumplieron con los criterios de selección y fueron incluidos en la revisión, de los cuales: 6 investigaron la efectividad de la telepsicología mediante videoconferencia; 3 mediante intervención telefónica, y 6 estudios por la modalidad vía internet. Palabras clave: Telepsicología, videoconferencia, intervención vía internet, vía telefónica.
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24
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Wheeler M, Cooper NR, Andrews L, Hacker Hughes J, Juanchich M, Rakow T, Orbell S. Outdoor recreational activity experiences improve psychological wellbeing of military veterans with post-traumatic stress disorder: Positive findings from a pilot study and a randomised controlled trial. PLoS One 2020; 15:e0241763. [PMID: 33237906 PMCID: PMC7688151 DOI: 10.1371/journal.pone.0241763] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 10/15/2020] [Indexed: 11/19/2022] Open
Abstract
Exposure to the natural environment is increasingly considered to benefit psychological health. Recent reports in the literature also suggest that outdoor exposure that includes recreational pursuits such as surfing or fishing coupled with opportunities for social interaction with peers may be beneficial to Armed Forces Veterans experiencing Post-Traumatic Stress Disorder (PTSD). Two studies were conducted to evaluate this possibility. In particular, these studies aimed to test the hypothesis that a brief group outdoor activity would decrease participants’ symptoms as assessed by established measures of PTSD, depression, anxiety and perceived stress, and increase participants’ sense of general social functioning and psychological growth. Experiment one employed a repeated measures design in which UK men and women military veterans with PTSD (N = 30) participated in a group outdoor activity (angling, equine care, or archery and falconry combined). Psychological measures were taken at 2 weeks prior, 2 weeks post, and at 4 month follow up. We obtained a significant within participant main effect indicating significant reduction in PTSD symptoms. Experiment two was a waitlist controlled randomised experiment employing an angling experience (N = 18) and 2 week follow up. In experiment 2 the predicted interaction of Group (Experimental vs. Waitlist Control) X Time (2 weeks pre vs. 2 weeks post) was obtained indicating that the experience resulted in significant reduction in PTSD symptoms relative to waitlist controls. The effect size was large. Additional analyses confirmed that the observed effects might also be considered clinically significant and reliable. In sum, peer outdoor experiences are beneficial and offer potential to complement existing provision for military veterans with Post Traumatic Stress Disorder.
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Affiliation(s)
- Mark Wheeler
- Department of Psychology, University of Essex, Colchester, Essex, United Kingdom
| | - Nicholas R. Cooper
- Department of Psychology, University of Essex, Colchester, Essex, United Kingdom
- * E-mail:
| | - Leanne Andrews
- Department of Health and Social Care, University of Essex, Colchester, Essex, United Kingdom
| | - Jamie Hacker Hughes
- Northern Hub for Veterans and Families Research, University of Northumbria, Newcastle upon Tyne, United Kingdom
| | - Marie Juanchich
- Department of Psychology, University of Essex, Colchester, Essex, United Kingdom
| | - Tim Rakow
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience; King’s College, London, United Kingdom
| | - Sheina Orbell
- Department of Psychology, University of Essex, Colchester, Essex, United Kingdom
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25
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Batastini AB, Paprzycki P, Jones ACT, MacLean N. Are videoconferenced mental and behavioral health services just as good as in-person? A meta-analysis of a fast-growing practice. Clin Psychol Rev 2020; 83:101944. [PMID: 33227560 DOI: 10.1016/j.cpr.2020.101944] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 10/19/2020] [Accepted: 11/02/2020] [Indexed: 12/11/2022]
Abstract
The use of videoconferencing technologies (VCT) is on the rise given its potential to close the gap between mental health care need and availability. Yet, little is known about the effectiveness of these services compared to those delivered in-person. A series of meta-analyses were conducted using 57 empirical studies (43 examining intervention outcomes; 14 examining assessment reliability) published over the past two decades that included a variety of populations and clinical settings. Using conventional and HLM3 meta-analytical approaches, VCT consistently produced treatment effects that were largely equivalent to in-person delivered interventions across 281 individual outcomes and 4336 clients, with female clients and those treated in medical facilities tending to respond more favorably to VCT than in-person. Results of an HLM3 model suggested assessments conducted using VCT did not appear to lead to differential decisions compared to those conducted in-person across 83 individual outcomes and 332 clients/examinees. Although aggregate findings support the use of VCT as a viable alternative to in-person service delivery of mental healthcare, several limitations in the current literature base were revealed. Most concerning was the relatively limited number of randomized controlled trials and the inconsistent (and often incomplete) reporting of methodological features and results. Recommendations for reporting the findings of telemental health research are provided.
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Affiliation(s)
- Ashley B Batastini
- University of Southern Mississippi, USA; University of Mississippi Medical Center Department of Psychiatry, USA.
| | - Peter Paprzycki
- University of Southern Mississippi, USA; Mississippi Center for Clinical and Translational Research, USA; University of Toledo, USA
| | | | - Nina MacLean
- Michigan Department of Health & Human Services - Center for Forensic Psychiatry, USA
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26
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Rees CS, Maclaine E. A Systematic Review of Videoconference‐Delivered Psychological Treatment for Anxiety Disorders. AUSTRALIAN PSYCHOLOGIST 2020. [DOI: 10.1111/ap.12122] [Citation(s) in RCA: 69] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Clare S Rees
- School of Psychology and Speech Pathology, Faculty of Health Sciences, Curtin University,
| | - Ellen Maclaine
- School of Psychology and Speech Pathology, Faculty of Health Sciences, Curtin University,
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27
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Chubarov E, Bar-Nir M. Occupational therapy practice in the child and adolescent day ward at the Geha Mental Health Center during the Coronavirus pandemic. WORLD FEDERATION OF OCCUPATIONAL THERAPISTS BULLETIN 2020. [DOI: 10.1080/14473828.2020.1840768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Elena Chubarov
- Occupational Therapy Department, Geha Mental Health Center, Petah Tikva, Israel
| | - Maya Bar-Nir
- Occupational Therapy Department, Geha Mental Health Center, Petah Tikva, Israel
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28
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Reich K, Nemeth LS, Mueller M, Sternke LM, Acierno R. Does Psychosocial Functioning Improve With Prolonged Exposure in Veterans With PTSD?: Exploring Traditional and Home-Based Telehealth Delivery Methods. J Psychosoc Nurs Ment Health Serv 2020; 59:31-40. [PMID: 33095268 DOI: 10.3928/02793695-20201015-01] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Accepted: 07/28/2020] [Indexed: 12/21/2022]
Abstract
The current study explored whether prolonged exposure (PE), delivered in person or via home-based telehealth, had a therapeutic effect on psychosocial functioning in combat Veterans with posttraumatic stress disorder (PTSD). The effects of home-based telehealth on these metrics were also evaluated. In addition, we examined whether race, type of war conflict, and service-connected disability rating moderated the effect of PE on psychosocial functioning and whether PTSD, anxiety, and/or depression mediated the effect of PE on psychosocial functioning. We did not find moderating or mediating effects in our study. Improvements in PTSD, depression, and anxiety were associated with improvements in psychosocial functioning. We did not identify statistically significant differences in scores representing change in overall and each domain of psychosocial functioning between groups. Within-group analysis indicated psychosocial functioning improved in both groups but was mostly not statistically significant. However, some clinically relevant improvement may have occurred. [Journal of Psychosocial Nursing and Mental Health Services, 59(2), 31-40.].
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29
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LaFrance WC, Ho WLN, Bhatla A, Baird GL, Altalib HH, Godleski L. Treatment of psychogenic nonepileptic seizures (PNES) using video telehealth. Epilepsia 2020; 61:2572-2582. [PMID: 33015831 DOI: 10.1111/epi.16689] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 08/18/2020] [Accepted: 08/18/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Previous studies have shown the effectiveness of manual-based treatment for psychogenic nonepileptic seizures (PNES), but access to mental health care still remains a problem, especially for patients living in areas without medical professionals who treat conversion disorder. Thus, we evaluated patients treated with cognitive behavioral therapy-informed psychotherapy for seizures with clinical video telehealth (CVT). We evaluated neuropsychiatric and seizure treatment outcomes in veterans diagnosed with PNES seen remotely via telehealth. We hypothesized that seizures and comorbidities will improve with treatment. METHODS This was a single-arm, prospective, observational, cohort, consecutive outpatient study. Patients with video-electroencephalography-confirmed PNES (n = 32) documented their seizure counts daily and comorbid symptoms prospectively over the course of treatment. Treatment was provided using a 12-session manual-based psychotherapy treatment given once per week, via CVT with a clinician at the Providence Veterans Affairs Medical Center. RESULTS The primary outcome, seizure reduction, was 46% (P = .0001) per month over the course of treatment. Patients also showed significant improvements in global functioning (Global Assessment of Functioning, P = < .0001), quality of life (Quality of Life in Epilepsy Inventory-31, P = .0088), and health status scales (Short Form 36 Health Survey, P < .05), and reductions in both depression (Beck Depression Inventory-II, P = .0028) and anxiety (Beck Anxiety Inventory, P = .0013) scores. SIGNIFICANCE Patients with PNES treated remotely with manual-based seizure therapy decreased seizure frequency and comorbid symptoms and improved functioning using telehealth. These results suggest that psychotherapy via telehealth for PNES is a viable option for patients across the nation, eliminating one of the many barriers of access to mental health care.
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Affiliation(s)
- William Curt LaFrance
- Providence Veterans Affairs Medical Center, Providence, Rhode Island, USA.,Departments of Psychiatry and Neurology, Brown University, Providence, Rhode Island, USA.,Division of Neuropsychiatry and Behavioral Neurology, Rhode Island Hospital, Providence, Rhode Island, USA
| | - Wing Lam Natalie Ho
- Providence Veterans Affairs Medical Center, Providence, Rhode Island, USA.,Departments of Psychiatry and Neurology, Brown University, Providence, Rhode Island, USA
| | - Alana Bhatla
- Providence Veterans Affairs Medical Center, Providence, Rhode Island, USA.,Departments of Psychiatry and Neurology, Brown University, Providence, Rhode Island, USA
| | - Grayson L Baird
- Providence Veterans Affairs Medical Center, Providence, Rhode Island, USA.,Departments of Psychiatry and Neurology, Brown University, Providence, Rhode Island, USA.,Department of Biostatistics, Rhode Island Hospital, Providence, Rhode Island, USA
| | - Hamada Hamid Altalib
- Department of Psychiatry, Yale University, New Haven, Connecticut, USA.,Department of Neurology, West Haven Veterans Affairs Medical Center, West Haven, Connecticut, USA
| | - Linda Godleski
- Department of Psychiatry, Yale University, New Haven, Connecticut, USA.,Department of Neurology, West Haven Veterans Affairs Medical Center, West Haven, Connecticut, USA
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30
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Jones C, Miguel-Cruz A, Smith-MacDonald L, Cruikshank E, Baghoori D, Kaur Chohan A, Laidlaw A, White A, Cao B, Agyapong V, Burback L, Winkler O, Sevigny PR, Dennett L, Ferguson-Pell M, Greenshaw A, Brémault-Phillips S. Virtual Trauma-Focused Therapy for Military Members, Veterans, and Public Safety Personnel With Posttraumatic Stress Injury: Systematic Scoping Review. JMIR Mhealth Uhealth 2020; 8:e22079. [PMID: 32955456 PMCID: PMC7536597 DOI: 10.2196/22079] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 07/28/2020] [Accepted: 08/01/2020] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND A necessary shift from in-person to remote delivery of psychotherapy (eg, teletherapy, eHealth, videoconferencing) has occurred because of the COVID-19 pandemic. A corollary benefit is a potential fit in terms of the need for equitable and timely access to mental health services in remote and rural locations. Owing to COVID-19, there may be an increase in the demand for timely, virtual delivery of services among trauma-affected populations, including public safety personnel (PSP; eg, paramedics, police, fire, correctional officers), military members, and veterans. There is a lack of evidence on the question of whether digital delivery of trauma-therapies for military members, veterans, and PSP leads to similar outcomes to in-person delivery. Information on barriers and facilitators and recommendations regarding digital-delivery is also scarce. OBJECTIVE This study aims to evaluate the scope and quality of peer-reviewed literature on psychotherapeutic digital health interventions delivered remotely to military members, veterans, and PSP and synthesize the knowledge of needs, gaps, barriers to, and facilitators for virtual assessment of and virtual interventions for posttraumatic stress injury. METHODS Relevant studies were identified using MEDLINE (Medical Literature Analysis and Retrieval System Online), EMBASE (Excerpta Medica dataBASE), APA (American Psychological Association) PsycINFO, CINAHL (Cumulative Index of Nursing and Allied Health Literature) Plus with Full Text, and Military & Government Collection. For collation, analysis, summarizing, and reporting of results, we used the CASP (Critical Skills Appraisal Program) qualitative checklist, PEDro (Physiotherapy Evidence Database) scale, level of evidence hierarchy, PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews), and narrative synthesis. RESULTS A total of 38 studies were included in this review. Evidence for the effectiveness of digital delivery of prolonged exposure therapy, cognitive processing therapy, behavioral activation treatment with therapeutic exposure to military members, veterans, and PSP was rated level 1a, whereas evidence for cognitive behavioral therapy was conflicting. The narrative synthesis indicated that virtual delivery of these therapies can be as effective as in-person delivery but may reduce stigma and cost while increasing access to therapy. Issues of risk, safety, potential harm (ie, suicidality, enabling avoidance), privacy, security, and the match among the therapist, modality, and patient warrant further consideration. There is a lack of studies on the influences of gender, racial, and cultural factors that may result in differential outcomes, preferences, and/or needs. An investigation into other therapies that may be suitable for digital delivery is needed. CONCLUSIONS Digital delivery of trauma therapies for military members, veterans, and PSP is a critical area for further research. Although promising evidence exists regarding the effectiveness of digital health within these populations, many questions remain, and a cautious approach to more widespread implementation is warranted.
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Affiliation(s)
- Chelsea Jones
- Heroes in Mind Advocacy and Research Consortium, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada.,1 Field Ambulance Physical Rehabilitation Department, Canadian Armed Forces Health Services, Department of National Defense, Edmonton, AB, Canada
| | - Antonio Miguel-Cruz
- Heroes in Mind Advocacy and Research Consortium, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada.,Department of Occupational Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada.,Glenrose Rehabilitation Hospital Research Innovation and Technology (GRRIT), Glenrose Rehabilitation Hospital, Edmonton, AB, Canada
| | - Lorraine Smith-MacDonald
- Heroes in Mind Advocacy and Research Consortium, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
| | - Emily Cruikshank
- Heroes in Mind Advocacy and Research Consortium, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada.,Department of Educational Psychology, Faculty of Education, University of Alberta, Edmonton, AB, Canada
| | - Delaram Baghoori
- Heroes in Mind Advocacy and Research Consortium, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada.,Rehabilitation Science, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
| | - Avneet Kaur Chohan
- Heroes in Mind Advocacy and Research Consortium, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada.,Department of Occupational Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
| | - Alexa Laidlaw
- Heroes in Mind Advocacy and Research Consortium, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada.,Department of Occupational Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
| | - Allison White
- Heroes in Mind Advocacy and Research Consortium, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada.,Department of Occupational Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
| | - Bo Cao
- Heroes in Mind Advocacy and Research Consortium, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada.,Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Vincent Agyapong
- Heroes in Mind Advocacy and Research Consortium, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada.,Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Lisa Burback
- Heroes in Mind Advocacy and Research Consortium, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada.,Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Olga Winkler
- Heroes in Mind Advocacy and Research Consortium, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada.,Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Phillip R Sevigny
- Heroes in Mind Advocacy and Research Consortium, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada.,Department of Educational Psychology, Faculty of Education, University of Alberta, Edmonton, AB, Canada
| | - Liz Dennett
- Heroes in Mind Advocacy and Research Consortium, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada.,Scott Health Sciences Library, University of Alberta, Edmonton, AB, Canada
| | - Martin Ferguson-Pell
- Heroes in Mind Advocacy and Research Consortium, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada.,Rehabilitation Science, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
| | - Andrew Greenshaw
- Heroes in Mind Advocacy and Research Consortium, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada.,Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Suzette Brémault-Phillips
- Heroes in Mind Advocacy and Research Consortium, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada.,Department of Occupational Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
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31
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Melton H, Meader N, Dale H, Wright K, Jones-Diette J, Temple M, Shah I, Lovell K, McMillan D, Churchill R, Barbui C, Gilbody S, Coventry P. Interventions for adults with a history of complex traumatic events: the INCiTE mixed-methods systematic review. Health Technol Assess 2020; 24:1-312. [PMID: 32924926 DOI: 10.3310/hta24430] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND People with a history of complex traumatic events typically experience trauma and stressor disorders and additional mental comorbidities. It is not known if existing evidence-based treatments are effective and acceptable for this group of people. OBJECTIVE To identify candidate psychological and non-pharmacological treatments for future research. DESIGN Mixed-methods systematic review. PARTICIPANTS Adults aged ≥ 18 years with a history of complex traumatic events. INTERVENTIONS Psychological interventions versus control or active control; pharmacological interventions versus placebo. MAIN OUTCOME MEASURES Post-traumatic stress disorder symptoms, common mental health problems and attrition. DATA SOURCES Cumulative Index to Nursing and Allied Health Literature (CINAHL) (1937 onwards); Cochrane Central Register of Controlled Trials (CENTRAL) (from inception); EMBASE (1974 to 2017 week 16); International Pharmaceutical Abstracts (1970 onwards); MEDLINE and MEDLINE Epub Ahead of Print and In-Process & Other Non-Indexed Citations (1946 to present); Published International Literature on Traumatic Stress (PILOTS) (1987 onwards); PsycINFO (1806 to April week 2 2017); and Science Citation Index (1900 onwards). Searches were conducted between April and August 2017. REVIEW METHODS Eligible studies were singly screened and disagreements were resolved at consensus meetings. The risk of bias was assessed using the Cochrane risk-of-bias tool and a bespoke version of a quality appraisal checklist used by the National Institute for Health and Care Excellence. A meta-analysis was conducted across all populations for each intervention category and for population subgroups. Moderators of effectiveness were assessed using metaregression and a component network meta-analysis. A qualitative synthesis was undertaken to summarise the acceptability of interventions with the relevance of findings assessed by the GRADE-CERQual checklist. RESULTS One hundred and four randomised controlled trials and nine non-randomised controlled trials were included. For the qualitative acceptability review, 4324 records were identified and nine studies were included. The population subgroups were veterans, childhood sexual abuse victims, war affected, refugees and domestic violence victims. Psychological interventions were superior to the control post treatment for reducing post-traumatic stress disorder symptoms (standardised mean difference -0.90, 95% confidence interval -1.14 to -0.66; number of trials = 39) and also for associated symptoms of depression, but not anxiety. Trauma-focused therapies were the most effective interventions across all populations for post-traumatic stress disorder and depression. Multicomponent and trauma-focused interventions were effective for negative self-concept. Phase-based approaches were also superior to the control for post-traumatic stress disorder and depression and showed the most benefit for managing emotional dysregulation and interpersonal problems. Only antipsychotic medication was effective for reducing post-traumatic stress disorder symptoms; medications were not effective for mental comorbidities. Eight qualitative studies were included. Interventions were more acceptable if service users could identify benefits and if they were delivered in ways that accommodated their personal and social needs. LIMITATIONS Assessments about long-term effectiveness of interventions were not possible. Studies that included outcomes related to comorbid psychiatric states, such as borderline personality disorder, and populations from prisons and humanitarian crises were under-represented. CONCLUSIONS Evidence-based psychological interventions are effective and acceptable post treatment for reducing post-traumatic stress disorder symptoms and depression and anxiety in people with complex trauma. These interventions were less effective in veterans and had less of an impact on symptoms associated with complex post-traumatic stress disorder. FUTURE WORK Definitive trials of phase-based versus non-phase-based interventions with long-term follow-up for post-traumatic stress disorder and associated mental comorbidities. STUDY REGISTRATION This study is registered as PROSPERO CRD42017055523. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 24, No. 43. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Hollie Melton
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Nick Meader
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Holly Dale
- School of Health Sciences, University of Manchester, Manchester, UK
| | - Kath Wright
- Centre for Reviews and Dissemination, University of York, York, UK
| | | | | | | | - Karina Lovell
- Division of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK
| | - Dean McMillan
- Department of Health Sciences, University of York, York, UK.,Hull York Medical School, University of York, York, UK
| | - Rachel Churchill
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Corrado Barbui
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Simon Gilbody
- Department of Health Sciences, University of York, York, UK.,Hull York Medical School, University of York, York, UK
| | - Peter Coventry
- Centre for Reviews and Dissemination, University of York, York, UK.,Department of Health Sciences, University of York, York, UK
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Gilmore AK, Lopez C, Muzzy W, Brown WJ, Grubaugh A, Oesterle DW, Acierno R. Emotion Dysregulation Predicts Dropout from Prolonged Exposure Treatment among Women Veterans with Military Sexual Trauma-Related Posttraumatic Stress Disorder. Womens Health Issues 2020; 30:462-469. [PMID: 32843240 DOI: 10.1016/j.whi.2020.07.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 03/19/2020] [Accepted: 07/17/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Military sexual trauma (MST) is notably prevalent among military personnel and can result in mental and physical health problems, including post-traumatic stress disorder (PTSD). Although there are several evidence-based treatments for MST-related PTSD, including prolonged exposure (PE) therapy, it is unclear what factors are associated with premature termination (i.e., dropout) from this treatment. Given the popularity of PE as an evidence-based treatment for PTSD, the examination of variables that influence dropout from PE among women veterans with MST is warranted. Identification of these specific factors may assist clinicians in addressing the unique symptom profiles and potential barriers to treatment access for individual MST survivors. METHODS The current study presents secondary data analyses from an ongoing randomized clinical trial that compared the effectiveness of PE delivered in person to delivery via telemedicine for women veterans with MST-related PTSD (n = 136). RESULTS A total of 50% of participants dropped out from the study (n = 68). Difficulties with emotion regulation at baseline were associated with treatment dropout (odds ratio, 1.03; p < .01), whereas baseline PTSD and demographic factors were not. CONCLUSIONS Findings from the current study indicate that emotion regulation skills deficits contribute to PE dropout and may be an appropriate target to address in future clinical trials for PTSD treatment.
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Affiliation(s)
- Amanda K Gilmore
- Department of Health Policy and Behavioral Sciences and Mark Chaffin Center for Healthy Development, School of Public Health, Georgia State University, Atlanta, Georgia.
| | - Cristina Lopez
- College of Nursing, Medical University of South Carolina, Charleston, South Carolina
| | - Wendy Muzzy
- College of Nursing, Medical University of South Carolina, Charleston, South Carolina
| | - Wilson J Brown
- School of Humanities & Social Sciences, Pennsylvania State University, The Behrend College, Erie, Pennsylvania
| | - Anouk Grubaugh
- Ralph H. Johnson Veterans Affairs Medical Center, Charleston, South Carolina; Military Sciences Division, Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina
| | - Daniel W Oesterle
- Department of Health Policy and Behavioral Sciences and Mark Chaffin Center for Healthy Development, School of Public Health, Georgia State University, Atlanta, Georgia; Department of Psychological Sciences, College of Health and Human Sciences, Purdue University, West Lafayette, Indiana
| | - Ron Acierno
- Ralph H. Johnson Veterans Affairs Medical Center, Charleston, South Carolina; University of Texas Health Science Center at Houston, Houston, Texas
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Creedon TB, Schrader KE, O'Brien PL, Lin JR, Carroll CD, Mulvaney-Day N. Rural-Nonrural Differences in Telemedicine Use for Mental and Substance Use Disorders Among Medicaid Beneficiaries. Psychiatr Serv 2020; 71:756-764. [PMID: 32290806 DOI: 10.1176/appi.ps.201900444] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This study investigated recent rural-nonrural trends in the prevalence and amount of mental and substance use disorder telemedicine received by adult Medicaid beneficiaries. METHODS An analysis of 2012-2017 claims data from the IBM MarketScan Multi-State Medicaid Database for adult beneficiaries ages 18-64 years with mental and substance use disorder diagnoses (N= 1,603,066) identified telemedicine services by using procedure modifier codes and ICD-9 and ICD-10 diagnosis codes. Unadjusted trends in telemedicine use were examined, and multivariate regression models compared the prevalence and amount of telemedicine and in-person outpatient treatment received by rural (N=428,697) and nonrural (N= 1,174,369) beneficiaries and by diagnosis. RESULTS Rates of telemedicine treatment for mental and substance use disorders among Medicaid beneficiaries increased during the study period but remained low. Among rural beneficiaries, there was a 5.9 percentage point increase in telemedicine for mental disorders and a 1.9 percentage point increase in telemedicine for substance use disorders. After control for other individual characteristics, rural beneficiaries were more likely than nonrural beneficiaries to receive any telemedicine for mental disorder (2.2 percentage points more likely) or substance use disorder (0.6 percentage points) treatment. Receipt of telemedicine was associated with receipt of more in-person outpatient services by rural beneficiaries (11.2 more visits for mental disorders and 8.2 more for substance use disorders). CONCLUSIONS Although provision of telemedicine for mental and substance use disorders increased during the study period and was somewhat more common among rural Medicaid beneficiaries, it remains an underused resource for addressing care shortages in rural areas.
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Affiliation(s)
- Timothy B Creedon
- Health Equity Research Lab, Cambridge Health Alliance, Cambridge, Massachusetts (Creedon); IBM Watson Health, Cambridge, Massachusetts (Schrader, O'Brien, Lin, Mulvaney-Day); Substance Abuse and Mental Health Services Administration, Rockville, Maryland (Carroll)
| | - Kristin E Schrader
- Health Equity Research Lab, Cambridge Health Alliance, Cambridge, Massachusetts (Creedon); IBM Watson Health, Cambridge, Massachusetts (Schrader, O'Brien, Lin, Mulvaney-Day); Substance Abuse and Mental Health Services Administration, Rockville, Maryland (Carroll)
| | - Peggy L O'Brien
- Health Equity Research Lab, Cambridge Health Alliance, Cambridge, Massachusetts (Creedon); IBM Watson Health, Cambridge, Massachusetts (Schrader, O'Brien, Lin, Mulvaney-Day); Substance Abuse and Mental Health Services Administration, Rockville, Maryland (Carroll)
| | - Janice R Lin
- Health Equity Research Lab, Cambridge Health Alliance, Cambridge, Massachusetts (Creedon); IBM Watson Health, Cambridge, Massachusetts (Schrader, O'Brien, Lin, Mulvaney-Day); Substance Abuse and Mental Health Services Administration, Rockville, Maryland (Carroll)
| | - Christopher D Carroll
- Health Equity Research Lab, Cambridge Health Alliance, Cambridge, Massachusetts (Creedon); IBM Watson Health, Cambridge, Massachusetts (Schrader, O'Brien, Lin, Mulvaney-Day); Substance Abuse and Mental Health Services Administration, Rockville, Maryland (Carroll)
| | - Norah Mulvaney-Day
- Health Equity Research Lab, Cambridge Health Alliance, Cambridge, Massachusetts (Creedon); IBM Watson Health, Cambridge, Massachusetts (Schrader, O'Brien, Lin, Mulvaney-Day); Substance Abuse and Mental Health Services Administration, Rockville, Maryland (Carroll)
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Wells SY, Morland LA, Wilhite ER, Grubbs KM, Rauch SA, Acierno R, McLean CP. Delivering Prolonged Exposure Therapy via Videoconferencing During the COVID-19 Pandemic: An Overview of the Research and Special Considerations for Providers. J Trauma Stress 2020; 33:380-390. [PMID: 32881116 PMCID: PMC7461321 DOI: 10.1002/jts.22573] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 07/14/2020] [Accepted: 07/16/2020] [Indexed: 11/11/2022]
Abstract
Leveraging technology to provide evidence-based therapy for posttraumatic stress disorder (PTSD), such as prolonged exposure (PE), during the COVID-19 pandemic helps ensure continued access to first-line PTSD treatment. Clinical video teleconferencing (CVT) technology can be used to effectively deliver PE while reducing the risk of COVID-19 exposure during the pandemic for both providers and patients. However, provider knowledge, experience, and comfort level with delivering mental health care services, such as PE, via CVT is critical to ensure a smooth, safe, and effective transition to virtual care. Further, some of the limitations associated with the pandemic, including stay-at-home orders and physical distancing, require that providers become adept at applying principles of exposure therapy with more flexibility and creativity, such as when assigning in vivo exposures. The present paper provides the rationale and guidelines for implementing PE via CVT during COVID-19 and includes practical suggestions and clinical recommendations.
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Affiliation(s)
- Stephanie Y. Wells
- Durham VA Health Care SystemDurhamNorth CarolinaUSA,VISN‐6 Mid‐Atlantic MIRECCDurhamNorth CarolinaUSA,Department of PsychiatryDuke UniversityDurhamNorth CarolinaUSA
| | - Leslie A. Morland
- VA San Diego Healthcare SystemSan DiegoCaliforniaUSA,Department of PsychiatryUniversity of California San DiegoSan DiegoCaliforniaUSA,National Center for PTSDPacific Islands DivisionHonoluluHawaiiUSA
| | | | | | - Sheila A.M. Rauch
- VA Atlanta Healthcare SystemAtlantaGeorgiaUSA,Department of Psychiatry Emory University School of MedicineAtlantaGeorgiaUSA
| | - Ron Acierno
- Faillace Department of PsychiatryUniversity of Texas Health Sciences CenterHouston TexasUSA,Ralph H. Johnson VA Medical CenterCharlestonSouth CarolinaUSA
| | - Carmen P. McLean
- National Center for PTSDVA Palo Alto Health Care SystemPalo AltoCaliforniaUSA,Stanford UniversityPalo AltoCaliforniaUSA
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Kanzler KE, Ogbeide S. Addressing trauma and stress in the COVID-19 pandemic: Challenges and the promise of integrated primary care. PSYCHOLOGICAL TRAUMA-THEORY RESEARCH PRACTICE AND POLICY 2020; 12:S177-S179. [PMID: 32584101 DOI: 10.1037/tra0000761] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Integrated primary care settings are ideal locations for treatment of posttraumatic stress concerns as primary care is the principal access point for mental health treatment in the United States. The COVID-19 global pandemic will increase the necessity of posttraumatic stress-related psychological care for vulnerable populations and frontline providers through traditional and virtual methods; integrated primary care settings are rapidly adapting to meet this need. Integrating more behavioral health clinicians into primary care clinics will provide better access to whole-person care when it is needed most. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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Addressing Diversity in PTSD Treatment: Disparities in Treatment Engagement and Outcome Among Patients of Color. ACTA ACUST UNITED AC 2020. [DOI: 10.1007/s40501-020-00212-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Ali A, Wolfert S, McGovern JE, Nguyen J, Aharoni A. A trauma-informed analysis of monologues constructed by military veterans in a theater-based treatment program. QUALITATIVE RESEARCH IN PSYCHOLOGY 2020. [DOI: 10.1080/14780887.2018.1442704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Spivak S, Spivak A, Cullen B, Meuchel J, Johnston D, Chernow R, Green C, Mojtabai R. Telepsychiatry Use in U.S. Mental Health Facilities, 2010-2017. Psychiatr Serv 2020; 71:121-127. [PMID: 31615370 DOI: 10.1176/appi.ps.201900261] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The study examined the use of telepsychiatry in U.S. mental health facilities between 2010 and 2017. METHODS Changes over time in the availability of telepsychiatry were examined by using multiple waves of a national survey of mental health facilities. State and facility correlates of offering telepsychiatry in 2017 were examined. RESULTS The proportion of state facilities that self-reported offering telepsychiatry increased significantly from 15.2% in 2010 to 29.2% in 2017, with wide variability among states.. In 2017, facilities with telepsychiatry were more commonly publicly owned than to have others forms of ownership (odds ratio [OR]=2.72, 95% confidence interval [CI]=2.47-2.99, p<0.001), although the percentage of privately owned facilities offering telepsychiatry has increased significantly since 2010 (OR=2.94, 95% CI=2.14-4.05, p<.001). Facilities offering telepsychiatry had lower odds of receiving funding from Medicaid (OR=0.86, 95% CI=0.75-0.98, p<0.001) but higher odds of receiving funding from all other sources. Facilities in states that did not fund telepsychiatry had lower odds of offering these services in 2017 (OR=0.57, 95% CI=0.51-0.62, p<0.001). Telepsychiatry was more commonly offered in states with higher proportions of rural population (OR=1.64, 95% CI=1.45-1.85, p<0.001) and designated medically underserved areas (OR=1.36, 95% CI=1.25-1.47, p<0.001), compared with other states. CONCLUSIONS Nearly twice as many U.S. mental health facilities offered telepsychiatry in 2017 than in 2010. Medicaid funding lagged behind other funding sources, suggesting state administrative barriers. Telepsychiatry was commonly used by facilities in medically underserved and rural areas.
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Affiliation(s)
- Stanislav Spivak
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (S. Spivak, Cullen, Meuchel, Johnston, Mojtabai); National Trafficking Shelter Alliance, Baltimore (A. Spivak); Department of Mental Health, Johns Hopkins University School of Public Health, Baltimore (Cullen, Mojtabai); Johns Hopkins Health Systems, Baltimore (Chernow, Green)
| | - Amethyst Spivak
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (S. Spivak, Cullen, Meuchel, Johnston, Mojtabai); National Trafficking Shelter Alliance, Baltimore (A. Spivak); Department of Mental Health, Johns Hopkins University School of Public Health, Baltimore (Cullen, Mojtabai); Johns Hopkins Health Systems, Baltimore (Chernow, Green)
| | - Bernadette Cullen
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (S. Spivak, Cullen, Meuchel, Johnston, Mojtabai); National Trafficking Shelter Alliance, Baltimore (A. Spivak); Department of Mental Health, Johns Hopkins University School of Public Health, Baltimore (Cullen, Mojtabai); Johns Hopkins Health Systems, Baltimore (Chernow, Green)
| | - Jennifer Meuchel
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (S. Spivak, Cullen, Meuchel, Johnston, Mojtabai); National Trafficking Shelter Alliance, Baltimore (A. Spivak); Department of Mental Health, Johns Hopkins University School of Public Health, Baltimore (Cullen, Mojtabai); Johns Hopkins Health Systems, Baltimore (Chernow, Green)
| | - Deirdre Johnston
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (S. Spivak, Cullen, Meuchel, Johnston, Mojtabai); National Trafficking Shelter Alliance, Baltimore (A. Spivak); Department of Mental Health, Johns Hopkins University School of Public Health, Baltimore (Cullen, Mojtabai); Johns Hopkins Health Systems, Baltimore (Chernow, Green)
| | - Rachel Chernow
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (S. Spivak, Cullen, Meuchel, Johnston, Mojtabai); National Trafficking Shelter Alliance, Baltimore (A. Spivak); Department of Mental Health, Johns Hopkins University School of Public Health, Baltimore (Cullen, Mojtabai); Johns Hopkins Health Systems, Baltimore (Chernow, Green)
| | - Charee Green
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (S. Spivak, Cullen, Meuchel, Johnston, Mojtabai); National Trafficking Shelter Alliance, Baltimore (A. Spivak); Department of Mental Health, Johns Hopkins University School of Public Health, Baltimore (Cullen, Mojtabai); Johns Hopkins Health Systems, Baltimore (Chernow, Green)
| | - Ramin Mojtabai
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (S. Spivak, Cullen, Meuchel, Johnston, Mojtabai); National Trafficking Shelter Alliance, Baltimore (A. Spivak); Department of Mental Health, Johns Hopkins University School of Public Health, Baltimore (Cullen, Mojtabai); Johns Hopkins Health Systems, Baltimore (Chernow, Green)
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Cooper SE, Campbell LF, Smucker Barnwell S. Telepsychology: A Primer for Counseling Psychologists. COUNSELING PSYCHOLOGIST 2020. [DOI: 10.1177/0011000019895276] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Telepsychology is having a profound influence on professional practice. Currently, however, many psychologists lack the requisite knowledge and skill to provide ethical and competent telepractice services. Moreover, the field has lagged in developing the educational and supervised experiences required to achieve competency. Yet, there is great opportunity as well. The purpose of this article is to identify the natural integration of the pillars of counseling psychology with the major domains of telepractice and to link telepractice to the values and mission of counseling psychologists. We present aspects of telepsychology including ethical and legal factors, asynchronous and synchronous practice, and group-focused practice along with technologies and the rules that govern them. We also describe interjurisdictional practice, and introduce a proposed curriculum based upon the benchmark competencies for infusion of telepsychology into training across the professional lifespan.
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Jacobs JC, Blonigen DM, Kimerling R, Slightam C, Gregory AJ, Gurmessa T, Zulman DM. Increasing Mental Health Care Access, Continuity, and Efficiency for Veterans Through Telehealth With Video Tablets. Psychiatr Serv 2019; 70:976-982. [PMID: 31378193 DOI: 10.1176/appi.ps.201900104] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE In 2016, the Veterans Health Administration (VHA) began distributing video-enabled tablets to veterans with access barriers. This study evaluated the implementation of this initiative for veterans with mental health conditions, including the impact of tablet receipt on access to and continuity of mental health care, missed opportunities for care, and use of urgent care. METHODS A retrospective matched cohort study was conducted, matching tablet recipients with diagnoses of mental disorders (N=728) to a comparison group (N=1,020) on the basis of sociodemographic characteristics, mental health utilization and diagnoses, and wireless coverage. A difference-in-differences approach was used to compare 6-month pre-post changes in number of psychotherapy and medication management visits, continuity of psychotherapy based on VHA's quality metric for mental health care continuity, missed opportunity rate (i.e., the proportion of mental health appointments that were missed or canceled), and probability of any and number of emergency department (ED) or urgent care visits. RESULTS Compared with the matched control group, tablet recipients experienced an increase of 1.94 (p<0.001) psychotherapy encounters, an increase of 1.05 (p<0.001) medication management visits, an 18.54 percentage point (p<0.001) increase in their likelihood of receiving recommended mental health care necessary for continuity of care, and a 20.24 percentage point (p<.001) decrease in their missed opportunity rate in the 6-month period following receipt of tablets (or the index date for the matched sample). No significant differences in ED or urgent care use were found. CONCLUSIONS Distributing video-enabled tablets to veterans with mental health conditions appeared to improve access to and continuity of mental health services while also improving clinical efficiency by decreasing missed opportunities for care.
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Affiliation(s)
- Josephine C Jacobs
- U.S. Department of Veterans Affairs (VA) Health Economics Resource Center, Menlo Park, California (Jacobs); VA Center for Innovation to Implementation, Menlo Park (Blonigen, Kimerling, Slightam, Gregory, Gurmessa, Zulman); Department of Psychiatry and Behavioral Sciences (Blonigen) and Division of Primary Care and Population Health (Zulman), Stanford University School of Medicine, Stanford, California; VA National Center for Post-Traumatic Stress Disorder, Menlo Park (Kimerling)
| | - Daniel M Blonigen
- U.S. Department of Veterans Affairs (VA) Health Economics Resource Center, Menlo Park, California (Jacobs); VA Center for Innovation to Implementation, Menlo Park (Blonigen, Kimerling, Slightam, Gregory, Gurmessa, Zulman); Department of Psychiatry and Behavioral Sciences (Blonigen) and Division of Primary Care and Population Health (Zulman), Stanford University School of Medicine, Stanford, California; VA National Center for Post-Traumatic Stress Disorder, Menlo Park (Kimerling)
| | - Rachel Kimerling
- U.S. Department of Veterans Affairs (VA) Health Economics Resource Center, Menlo Park, California (Jacobs); VA Center for Innovation to Implementation, Menlo Park (Blonigen, Kimerling, Slightam, Gregory, Gurmessa, Zulman); Department of Psychiatry and Behavioral Sciences (Blonigen) and Division of Primary Care and Population Health (Zulman), Stanford University School of Medicine, Stanford, California; VA National Center for Post-Traumatic Stress Disorder, Menlo Park (Kimerling)
| | - Cindie Slightam
- U.S. Department of Veterans Affairs (VA) Health Economics Resource Center, Menlo Park, California (Jacobs); VA Center for Innovation to Implementation, Menlo Park (Blonigen, Kimerling, Slightam, Gregory, Gurmessa, Zulman); Department of Psychiatry and Behavioral Sciences (Blonigen) and Division of Primary Care and Population Health (Zulman), Stanford University School of Medicine, Stanford, California; VA National Center for Post-Traumatic Stress Disorder, Menlo Park (Kimerling)
| | - Amy J Gregory
- U.S. Department of Veterans Affairs (VA) Health Economics Resource Center, Menlo Park, California (Jacobs); VA Center for Innovation to Implementation, Menlo Park (Blonigen, Kimerling, Slightam, Gregory, Gurmessa, Zulman); Department of Psychiatry and Behavioral Sciences (Blonigen) and Division of Primary Care and Population Health (Zulman), Stanford University School of Medicine, Stanford, California; VA National Center for Post-Traumatic Stress Disorder, Menlo Park (Kimerling)
| | - Tolessa Gurmessa
- U.S. Department of Veterans Affairs (VA) Health Economics Resource Center, Menlo Park, California (Jacobs); VA Center for Innovation to Implementation, Menlo Park (Blonigen, Kimerling, Slightam, Gregory, Gurmessa, Zulman); Department of Psychiatry and Behavioral Sciences (Blonigen) and Division of Primary Care and Population Health (Zulman), Stanford University School of Medicine, Stanford, California; VA National Center for Post-Traumatic Stress Disorder, Menlo Park (Kimerling)
| | - Donna M Zulman
- U.S. Department of Veterans Affairs (VA) Health Economics Resource Center, Menlo Park, California (Jacobs); VA Center for Innovation to Implementation, Menlo Park (Blonigen, Kimerling, Slightam, Gregory, Gurmessa, Zulman); Department of Psychiatry and Behavioral Sciences (Blonigen) and Division of Primary Care and Population Health (Zulman), Stanford University School of Medicine, Stanford, California; VA National Center for Post-Traumatic Stress Disorder, Menlo Park (Kimerling)
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Goetter EM, Blackburn AM, Bui E, Laifer LM, Simon N. Veterans' Prospective Attitudes About Mental Health Treatment Using Telehealth. J Psychosoc Nurs Ment Health Serv 2019; 57:38-43. [DOI: 10.3928/02793695-20190531-02] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 03/04/2019] [Indexed: 11/20/2022]
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Predictors of attendance and dropout in three randomized controlled trials of PTSD treatment for active duty service members. Behav Res Ther 2019; 118:7-17. [DOI: 10.1016/j.brat.2019.03.003] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 02/12/2019] [Accepted: 03/04/2019] [Indexed: 11/18/2022]
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Murphy D, Turgoose D. Evaluating an Internet-based video cognitive processing therapy intervention for veterans with PTSD: A pilot study. J Telemed Telecare 2019; 26:552-559. [PMID: 31208264 DOI: 10.1177/1357633x19850393] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
INTRODUCTION There remain a number of UK military veterans who are not able to access psychological therapies for post-traumatic stress disorder (PTSD). Some of these barriers are practical, including the need to balance work and other life commitments with attendance at residential or outpatient appointments. There is a need to investigate more accessible and flexible methods of delivering psychological therapies to veterans. One such alternative is to use remote-access video technology, often referred to as tele-therapy. The aims of the present study were to explore the feasibility of using tele-therapy in this population, whilst also reporting mental health outcomes for those who accessed the intervention. METHODS Participants were recruited from a UK veterans mental health charity. The intervention consisted of 12 sessions of cognitive processing therapy delivered via Skype. Participants completed various measures of mental health, including PTSD at three time points: pre-treatment, post-treatment and at three months follow-up. A measure of therapeutic alliance was also completed by participants and the clinician. RESULTS A total of 27 participants engaged in tele-therapy, with a treatment completion rate of 79% and a 'did not attend' rate of 12%, which compared well against similar outpatient services. All mental health outcomes showed maintained improvement at three months follow-up, with the highest effect size recorded for PTSD. Therapeutic alliance was also rated highly by both participants and the clinician. DISCUSSION The findings suggest that tele-therapy could provide a viable alternative format for delivering trauma-focused psychological therapies to veterans. Limitations and recommendations for future research are also presented.
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Affiliation(s)
- Dominic Murphy
- Combat Stress, King's Centre for Military Health Research, Leatherhead, Surrey, UK
| | - David Turgoose
- Combat Stress, King's Centre for Military Health Research, Leatherhead, Surrey, UK
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Holder N, Holliday R, Wiblin J, LePage JP, Surís A. Predictors of dropout from a randomized clinical trial of cognitive processing therapy for female veterans with military sexual trauma-related PTSD. Psychiatry Res 2019; 276:87-93. [PMID: 31030005 DOI: 10.1016/j.psychres.2019.04.022] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Revised: 04/19/2019] [Accepted: 04/21/2019] [Indexed: 12/30/2022]
Abstract
Many veterans do not complete evidence-based treatments (EBTs) for posttraumatic stress disorder (PTSD). Veterans with military sexual trauma (MST)-related PTSD were shown to have higher than average rates of dropout from PTSD treatment in a national study of EBT implementation. Although predictors of dropout from EBTs have been identified, these factors are largely unmodifiable (e.g., age, service era). The purpose of the present study was to identify dynamic psychosocial predictors of dropout among female veterans from cognitive processing therapy (CPT). Data were utilized from 56 female veterans who participated in a randomized clinical trial investigating the effectiveness of CPT for MST-related PTSD. Dropout was defined continuously (i.e., number of sessions attended) and dichotomously (i.e., attending six or more sessions). Potential predictors included sociodemographic factors, psychotherapist fidelity, PTSD-related service connection, psychiatric symptom severity (i.e., PTSD, depression), trauma-related negative cognitions (about self, self-blame, world), and treatment expectations. Higher trauma-related negative cognitions about self-blame and lower trauma-related negative cognitions about self were protective against dropout. The current study generated testable hypotheses for further research on dynamic predictors of dropout from CPT in female veterans with MST-related PTSD. With replication, results may assist with identifying pre-treatment strategies to reduce dropout in this clinical population.
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Affiliation(s)
- Nicholas Holder
- Veterans Affairs North Texas Health Care System, Research Service (151), 4500 S. Lancaster Rd., Dallas, TX 75216, USA; University of Texas Southwestern Medical Center, Department of Psychiatry, 5323 Harry Hines Blvd., Dallas, TX 75390, USA.
| | - Ryan Holliday
- Rocky Mountain Mental Illness Research, Education, and Clinical Center for Suicide Prevention, 1700N Wheeling St (G-3-116M), Aurora, CO 80045, USA; University of Colorado Anschutz Medical Campus, Building 500, Mail Stop F546, 13001 East 17th Place, Aurora, CO 80045, USA
| | - Jessica Wiblin
- Veterans Affairs North Texas Health Care System, Research Service (151), 4500 S. Lancaster Rd., Dallas, TX 75216, USA; University of Texas Southwestern Medical Center, Department of Psychiatry, 5323 Harry Hines Blvd., Dallas, TX 75390, USA
| | - James P LePage
- Veterans Affairs North Texas Health Care System, Research Service (151), 4500 S. Lancaster Rd., Dallas, TX 75216, USA; University of Texas Southwestern Medical Center, Department of Psychiatry, 5323 Harry Hines Blvd., Dallas, TX 75390, USA
| | - Alina Surís
- Veterans Affairs North Texas Health Care System, Research Service (151), 4500 S. Lancaster Rd., Dallas, TX 75216, USA; University of Texas Southwestern Medical Center, Department of Psychiatry, 5323 Harry Hines Blvd., Dallas, TX 75390, USA
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Abstract
The delivery of teletherapy is an important advancement in clinical care for the treatment of eating disorders (EDs). Specifically, it seems to improve access to highly specialized ED treatment. Research on the application of videoconferencing-based psychotherapy services for EDs is minimal; however, results suggest that this treatment format leads to significant improvements in clinical symptoms and is well accepted by patients. General telemedicine guidelines and administrative and clinical recommendations specific to the treatment of ED patients have been identified. With careful planning and thoughtful application, Internet-based therapy seems to be a valuable resource for practitioners seeking to disseminate specialized ED treatments.
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Berryhill MB, Culmer N, Williams N, Halli-Tierney A, Betancourt A, Roberts H, King M. Videoconferencing Psychotherapy and Depression: A Systematic Review. Telemed J E Health 2019; 25:435-446. [DOI: 10.1089/tmj.2018.0058] [Citation(s) in RCA: 139] [Impact Index Per Article: 27.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Affiliation(s)
- Micha Blake Berryhill
- Department of Human Development and Family Studies, The University of Alabama, Tuscaloosa, Alabama
| | - Nathan Culmer
- College of Community Health Sciences, The University of Alabama, Tuscaloosa, Alabama
| | - Nelle Williams
- College of Community Health Sciences, The University of Alabama, Tuscaloosa, Alabama
| | - Anne Halli-Tierney
- College of Community Health Sciences, The University of Alabama, Tuscaloosa, Alabama
| | - Alex Betancourt
- Department of Human Development and Family Studies, The University of Alabama, Tuscaloosa, Alabama
| | - Hannah Roberts
- Department of Human Development and Family Studies, The University of Alabama, Tuscaloosa, Alabama
| | - Michael King
- Department of Human Development and Family Studies, The University of Alabama, Tuscaloosa, Alabama
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Hale AC, Bohnert KM, Ganoczy D, Sripada RK. Predictors of Treatment Adequacy During Evidence-Based Psychotherapy for PTSD. Psychiatr Serv 2019; 70:367-373. [PMID: 30784379 DOI: 10.1176/appi.ps.201800361] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The U.S. Department of Veterans Affairs (VA) has placed increased emphasis on the availability and use of evidence-based psychotherapies (EBPs) for posttraumatic stress disorder (PTSD). However, many individuals do not complete a full course of EBP. The current study aimed to quantify the percentage of veterans receiving adequate EBP in VA hospitals and identify factors related to treatment completion. METHODS A national sample of 16,559 VA patients who began cognitive processing therapy (CPT) or prolonged exposure (PE) during fiscal year 2015 was obtained via administrative data. Generalized estimating equations were used to evaluate individual-level predictors of treatment adequacy, defined as eight sessions within 14 weeks. Generalized linear models were used to examine facility-level factors. RESULTS A total of 5,142 (31.1%) veterans completed eight or more sessions of psychotherapy. Older age was associated with greater odds of completing eight or more sessions (odds ratio OR=1.02, 95% confidence interval [CI]=1.01, 1.02, p<0.001), and comorbid bipolar or psychotic disorders were associated with reduced odds of completion (OR=0.89, 95% CI=0.80, 0.99, p=0.03). The percentage of patients who completed eight or more sessions was higher at facilities with higher percentages of EBP use among all patients with PTSD (β=6.55, SE=1.97, p=0.001) and greater numbers of EBP-certified providers (β=0.004, SE=0.002, p=0.038) and lower at facilities with a higher percentage of patients receiving a PTSD Checklist (β=-1.16, SE=0.46, p=0.011). CONCLUSIONS A minority of VA patients with PTSD complete an adequate dose of EBPs for PTSD. Individual and facility-level factors related to treatment adequacy may point to opportunities for intervention.
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Affiliation(s)
- Andrew C Hale
- U.S. Department of Veterans Affairs (VA) Center for Clinical Management Research, Ann Arbor, Michigan; Department of Psychiatry, University of Michigan, Ann Arbor (Hale, Bohnert, Sripada)
| | - Kipling M Bohnert
- U.S. Department of Veterans Affairs (VA) Center for Clinical Management Research, Ann Arbor, Michigan; Department of Psychiatry, University of Michigan, Ann Arbor (Hale, Bohnert, Sripada)
| | - Dara Ganoczy
- U.S. Department of Veterans Affairs (VA) Center for Clinical Management Research, Ann Arbor, Michigan; Department of Psychiatry, University of Michigan, Ann Arbor (Hale, Bohnert, Sripada)
| | - Rebecca K Sripada
- U.S. Department of Veterans Affairs (VA) Center for Clinical Management Research, Ann Arbor, Michigan; Department of Psychiatry, University of Michigan, Ann Arbor (Hale, Bohnert, Sripada)
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Ali A, Wolfert S, Homer BD. In the Service of Science: Veteran-Led Research in the Investigation of a Theatre-Based Posttraumatic Stress Disorder Treatment. JOURNAL OF HUMANISTIC PSYCHOLOGY 2019. [DOI: 10.1177/0022167819839907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Valentine LM, Donofry SD, Broman RB, Smith ER, Rauch SA, Sexton MB. Comparing PTSD treatment retention among survivors of military sexual trauma utilizing clinical video technology and in-person approaches. J Telemed Telecare 2019; 26:443-451. [PMID: 30975048 DOI: 10.1177/1357633x19832419] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Interventions such as Prolonged Exposure (PE) and Cognitive Processing Therapy (CPT) have demonstrated efficacy for the treatment of post-traumatic stress disorder (PTSD) following military sexual trauma (MST). However, MST survivors report a number of logistical and social barriers that impede treatment engagement. In an effort to address these barriers, the Veterans Health Administration offers remote delivery of services using clinical video technology (CVT). Evidence suggests PE and CPT can be delivered effectively via CVT. However, it is unclear whether rates of veteran retention in PTSD treatment for MST delivered remotely is comparable to in-person delivery in standard care. METHODS Data were drawn from veterans (N = 171, 18.1% CVT-enrolled) with PTSD following MST who were engaged in either PE or CPT delivered either via CVT or in person. Veterans chose their preferred treatment modality and delivery format in collaboration with providers. Data were analysed to evaluate full completion (FP) of the protocol and completion of a minimally adequate care (MAC) number of sessions. RESULTS FP treatment completion rates did not differ significantly by treatment delivery format. When evaluating receipt of MAC care, CVT utilizers were significantly less likely to complete. Kaplan-Meier analyses of both survival periods detected significant differences in attrition speed, with the CVT group having higher per-session attrition earlier in treatment. DISCUSSION Disengagement from CVT-delivered treatment generally coincided with early imaginal exposures and writing of trauma narratives. CVT providers may have to take special care to develop rapport and problem-solve anticipated barriers to completion to retain survivors in effective trauma-focused interventions.
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Affiliation(s)
- Lisa M Valentine
- VA Ann Arbor Healthcare System, Ann Arbor, MI, USA.,Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Shannon D Donofry
- VA Ann Arbor Healthcare System, Ann Arbor, MI, USA.,Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA.,Department of Psychiatry, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | | | - Erin R Smith
- VA Ann Arbor Healthcare System, Ann Arbor, MI, USA.,Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Sheila Am Rauch
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA.,VA Atlanta Healthcare System, Atlanta, GA, USA
| | - Minden B Sexton
- VA Ann Arbor Healthcare System, Ann Arbor, MI, USA.,Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA
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Ghafoori B, Wolf MG, Nylund-Gibson K, Felix ED. A naturalistic study exploring mental health outcomes following trauma-focused treatment among diverse survivors of crime and violence. J Affect Disord 2019; 245:617-625. [PMID: 30445387 DOI: 10.1016/j.jad.2018.11.060] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2018] [Revised: 09/23/2018] [Accepted: 11/03/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Although considerable research has tested evidence-based practices in clinical trials, research is needed on the use of trauma-focused treatments by victims of crime and violence in naturalistic settings. This study investigated four trauma-focused treatments, prolonged exposure therapy (PE), cognitive behavioral therapy (CBT), eclectic therapy, and person-centered therapy (PCT), and assessed treatment dropout and symptom improvement over five assessment time-points. METHODS Descriptive comparisons and pattern mixture multigroup growth models were used to assess differences between treatments on time in treatment, rate of dropout, and improvement in posttraumatic stress (PTSD) and depression symptoms in an outpatient sample of 526 clients seeking routine clinical care. RESULTS PCT was significantly associated with the highest number of therapy sessions completed and the lowest rate of dropout (41.75%) compared to CBT and eclectic treatments. All treatment groups reported PTSD symptom improvement with no significant differences based on therapy type. For depression, the rate of improvement for clients in PCT who dropped out of treatment after session 3 was significantly steeper than the rate of improvement for clients in eclectic treatment who dropped out of treatment after session 3. Clients who stayed in treatment longer generally had larger decreases in symptoms compared to those who dropped out earlier. LIMITATIONS The small sample size in each of the treatment groups may have limited power to detect change. CONCLUSIONS Several trauma-focused treatments offered in a community-based setting may result in significant symptomatic improvement.
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Affiliation(s)
- Bita Ghafoori
- California State University, Department of Advanced Studies in Education and Counseling, Long Beach, 1250 Bellflower Boulevard, Long Beach, CA 90840-2201, United States.
| | | | | | - Erika D Felix
- University of California, Santa Barbara, CA, United States
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