The future of online therapy

Effectiveness of compassion-based online therapy on suicidal thoughts and pain catastrophizing in female patients with multiple sclerosis in the relapsing-remitting phase

Introduction

According to research, multiple sclerosis is related to suicidal thoughts and pain catastrophizing as psycho-pathological variables, and on the other hand, compassion-based treatment can reduce mental disorders by targeting dimensions such as self-compassion. Also, since this disease is progressive and over time can cause movement restrictions in these people, online psychotherapy can be a better option for these people. So, the purpose of this study was to investigate the effectiveness of online compassion therapy on suicidal thoughts and pain catastrophizing in female patients with multiple sclerosis.

Methods

The current research was applied and quasi-experimental in a pre-test-post-test manner with a control group. The research sample consisted of 30 patients with multiple sclerosis living in Shiraz in 2019, who were randomly divided into two 15-person experimental and control groups. The participants were tested on scales of suicidal thoughts and pain catastrophizing, and the treatment plan based on compassion therapy was presented to the participants of the experimental group in 8 two-hour sessions online. The control group was placed on the waiting list until the completion of the treatment sessions and the post-test implementation, and after the post-test implementation, they received the treatment. Control variables in this study included gender and disease phase. Then, their scores were measured, after completing the treatment, and a three-month follow-up period. Descriptive statistics and covariance test were used to analyze the data.

Results

Patients showed a clear improvement in the severity of symptoms in both variables. So that the scores of suicidal thoughts and pain catastrophizing in the experimental group after receiving the treatment, as well as after a three-month follow-up period, were significantly reduced (p < 0.001).

Conclusion

Confirming the effectiveness of online therapy based on compassion on improving psychological outcomes in these patients, as an effective and online treatment method, is a clear step towards continuing the implementation of psychological interventions and paying attention to the dimension of mental health in this group of people.

Defining digital coaching: a qualitative inductive approach

The term 'digital coaching' is widely used but ill-defined. The present study therefore investigates how digital coaching is defined and how it differentiates from face-to-face coaching and other digital-technology-enabled (DT-enabled) formats, such as digital training, digital mentoring, or digital consulting. A qualitative inductive approach was chosen for more in-depth and open-minded content. Based on previous studies on the importance of asking coaches working in the field, 260 coaches working in the field of digital coaching were surveyed. The given answers depict the importance of differing between forms of DT-enabled coaching. Thus, digital coaching is a DT-enabled, synchronous conversation between a human coach and a human coachee, which is different to artificial intelligence (AI) coaching and coaching that is supported by asynchronous digital and learning communication technologies. Due to this definition and differentiation, future studies can explore the digital coaching process and its effectiveness - particularly in comparison to other formats. Furthermore, this clear definition enables practitioners to maintain professional standards and manage client's expectations of digital coaching while helping clients understand what to expect from digital coaching.

Characteristics of online user-generated text predict the emotional intelligence of individuals

Emotional intelligence is a well-established indicator of performance and the ability to maintain successful social relationships. Moreover, it is potentially an important factor in social dynamics occurring on large digital platforms, e.g., opinion polarization, social conflict, and social influence. Users publicly exchange enormous amounts of text on digital platforms, which can potentially be used to extract real-life insights. Yet, currently, the prevalent approach to measuring emotional intelligence uses mainly self-report surveys and tasks-considerably limiting the feasibility of real-life large-scale studies. We analyze the online public texts of users, who also completed emotional intelligence measures, to find that characteristics of online public texts can be used to predict emotional intelligence at a level like that of commonly used psychometric indicators (e.g., SATs) to predict real-life outcomes. For example, we find that high emotional intelligence individuals consistently use more positive-affect language, less negative-affect language and use more social-oriented language than low emotional intelligence individuals. Our findings provide insight into the role of personality on digital platforms and open the possibility of studying emotional intelligence in large and diverse real-life data. To support the use of online public text as a tool to research emotional intelligence, we provide an anonymized version of the data.

Breaking Down the Screen: Italian Psychologists' and Psychotherapists' Experiences of the Therapeutic Relationship in Online Interventions during the COVID-19 Pandemic

(1) Background: The COVID-19 pandemic posed new challenges to clinical practice and delineated future directions for online interventions in psychological care. The present study aimed to explore Italian psychologists' and psychotherapists' experiences of online interventions during the pandemic, focusing on the strategies they used to develop and maintain therapeutic relationships with their patients. (2) Methods: Between February and July 2021, 368 Italian psychologists and/or psychotherapists completed an online survey. A mixed-methods analysis was conducted, using Jamovi to analyze quantitative data and ATLAS.ti 9 to analyze qualitative data. (3) Results: Of the participants, 62% had never delivered online interventions before the pandemic; though 95.4% were delivering online interventions at the time of the survey, many reported facing technical disruptions (77.1%) and having little confidence in the online setting (45.3%). Feeling present in online sessions-facilitated by emotional attunement, active listening, and conversational spontaneity-was reported as "very important" by 93.6%. (4) Conclusions: Overall, the COVID-19 pandemic allowed a great leap forward in the use of online interventions by Italian psychologists and psychotherapists. This period of upheaval generated not only a positive change in their attitudes toward and intention to use online interventions but also revealed associated technical and relational issues that must be properly addressed.

'Isolated together': online group treatments during the COVID-19 pandemic. A systematic review

Considering the emerging need to face the negative impact of the pandemic on mental health, social support, and access to health services, it became a critical issue to adapt to online group settings and create new group interventions to face the developing distress during this time. The aim of the current study is to investigate the main findings on OPGI conducted during the COVID-19 pandemic from March 2020 until March 2022, with a particular focus on: i) the therapeutic group factors; ii) what kind of OPGI works and for whom; iii) settings and emerging dimensions. In accordance with PRISMA guidelines, we performed a systematic review on scientific databases (PsychINFO, PubMed, Web of Science and EBSCO) searching for studies published between March 2020 and March 2022. 'Group intervention' or 'group therapy' or 'group treatment' crossed with 'COVID-19' and synonymous, were used as keywords. Internet based intervention was used as an eligibility criteria during the full-text screening. A total of 1326 articles were identified, of which 24 met the inclusion criteria. Among all studies, with different participants and different orientations, data extracted supported psychological online group interventions as an effective approach to reducing psychological distress and increasing psychological resources in the interpersonal field. Our findings also showed that COVID-19 has led to new needs and issues, that require the investigation of new dimensions for online psychological interventions. Methodological and clinical implications will be discussed through a descriptive table related to setting characteristics. Recommendations are made for future research.

Content validity and perceived utility of a self-help online acceptance and commitment therapy program focused on repetitive negative thinking

Telehealth strategies have become essential for responding to the sanitary emergency due to the COVID-19 pandemic. In this context, developing online psychological interventions (OPIs) that can treat and prevent psychological difficulties is gaining more relevance. This article describes an acceptance and commitment therapy (ACT) based OPI focused on repetitive negative thinking (RNT). This OPI is called Disentangled, Aware, and Committed (DAC) and represents an attempt to adapt previous RNT-focused ACT protocols to this format type. Study 1 evaluated content validity through the assessment of four experts in ACT regarding clarity, utility, pertinence, conceptual adjustment, and therapeutic goal fulfillment for each component of the DAC program. In Study 2, forty-one undergraduate clinical psychology trainees rated the components of the DAC program according to its clarity and perceived utility. These participants were enrolled in a randomized controlled trial that analyzed the efficacy of the DAC to prevent the usually observed increase in emotional symptoms and RNT among this population. Expert reviewers in Study 1 rated all DAC components as clear and useful for potential users, following a logical order, theoretically coherent with the ACT model, and successfully fulfilling its stated goals. In Study 2, the participants also rated the DAC components as clear and potentially useful for their lives. In conclusion, the DAC appears to be a feasible transdiagnostic OPI for treating and preventing emotional symptoms, which warrants further studies analyzing its efficacy.

"There is Just a Different Energy": Changes in the Therapeutic Relationship with the Telehealth Transition

The therapeutic relationship (TR), including its therapeutic frame, is the foundation of the therapeutic endeavor. In response to the COVID-19 pandemic and the rapid transition to videoconferencing for therapeutic encounters, we employed a cross-sectional exploratory survey with 1490 respondents to understand how practitioners adapted to the changes. In this secondary analysis focused on the TR, we analyze the clinicians' (N = 448) spontaneous narratives about facets of the TR. Temporally, we focused on how these adaptations occurred during the initial part of the pandemic before vaccination was available and while the TR was still adapting to teletherapy videoconferencing under the duress of pandemic crises. We find three broad themes: (1) It is a "much more remote relationship"; (2) The "connection…remains surprisingly strong"; and (3) It is "energetically taxing." Each reflects clinicians' views of the TR as altered, but surprisingly resilient. Although grateful for the safety of virtual therapeutic encounters, clinicians mourned the loss of an embodied encounter, experienced depletion of energy beyond Zoom fatigue, and nonetheless recognized their clients' and their own abilities to adapt.

Wirken Online-Peer-Suizidpräventionsprogramme?

Zusammenfassung. Theoretischer Hintergrund. Suizid ist weltweit die zweithäufigste Todesursache bei jungen Menschen. Es scheint sinnvoll, speziell auf diese Zielgruppe zugeschnittene Angebote anzubieten. Fragestellung. Ziel dieser Untersuchung ist, den von den Nutzenden wahrgenommenen Beratungserfolg eines Online-Peer-Suizidpräventionsprogramms zu ermitteln und zu prüfen, welche Merkmale mit dem Beratungserfolg zusammenhängen. Methode. Daten eines Online-Fragebogens wurden ausgewertet ( N = 318). Ergebnisse. Bei zwei Drittel der Befragten verminderte sich die Suizidalität. Wichtige Variablen zur Vorhersage der Veränderung der Suizidalität waren der Eindruck der Ratsuchenden, dass die Peers die persönlichen Anliegen verstehen und die Anregung zu einer Verhaltensänderung. Das Peerverhalten trug signifikant zur Vorhersage der subjektiven Nützlichkeit und der allgemeinen Situation bei. Schlussfolgerungen. Die Studie liefert positive Ergebnisse hinsichtlich der Evaluierung der Online-Suizidpräventions-Beratung. Da das Verstanden fühlen und das Peerverhalten im Zusammenhang mit dem Beratungserfolg steht, könnte der Peer-Ansatz und die damit einhergehende positive Beziehungserfahrung wichtig sein.

Qualitative Investigation into Therapists' Experiences of Online Therapy: Implications for Working Clients

Online therapy has increasingly been utilised during the COVID-19 pandemic by many, including working populations. However, few qualitative studies have explored how online therapy is experienced in practice and discussed its implications for those working clients. Semi-structured interviews attended by nine integrative psychotherapists practising in California, the United States, were conducted. Thematic analysis of the transcripts identified three themes: (i) ‘Positive experiences of online therapy’, (ii) ‘Challenges experienced by therapists and clients in online therapy’, and (iii) ‘Preparation and training for online therapy’. Online therapy was assessed as being helpful, particularly in terms of mitigating against previous geographical and temporal barriers to uptake. However, due to technological disruptions and potential blurring of professional boundaries, online therapy may detract from the emotional salience of therapy, negatively impacting the therapeutic relationship and containment. Considering these positive experiences, participants expected that the demand for online therapy would continue to increase. Particularly in the occupational context, online therapy can offer interventions without fostering shame regarding mental health. The findings provide preliminary qualitative evidence that online therapy can be a useful adjunct to traditional forms of face-to-face therapy. However, therapists require more explicit training in implementing online therapy. Results are discussed in particular regarding the utility of this therapy for working clients.

Lost in the matrix: Dialectical tensions in facilitating virtual video groups during COVID-19 pandemic

The research phenomenologically explored the experience of facilitating virtual video groups during the COVID-19 pandemic. Research questions addressed relational processes in virtual video groups, including emotional presence, interpersonal communication, and intimacy. Specifically, we asked how facilitators can intervene effectively to promote these processes in the virtual space, within the context of social distancing. Semi-structured group interviews were held with 26 female group facilitators from various professional backgrounds during the first wave of COVID-19 in Israel in May 2020. Phenomenological analysis yielded five main themes addressing dialectical tensions that operate simultaneously in the virtual space, both enabling and hindering relational processes in virtual video groups: intimacy and intrusion in the domestic space; sharp transitions from presence to absence; fragmented processing despite abundant information; sterility and clarity in group communication; and the hyper-aware self - being a participant and an observer at the same time. Moving groups into a virtual sphere challenged the traditional role of facilitators, who struggled to create a safe space in an unstable virtual setting where the boundaries between personal and professional lives were reduced. Findings also point to the potential of the domestic space to promote closeness and intimacy and suggest the virtual space requires facilitators to embrace multiplicity as a state of mind when intervening. Facilitators must work with permeable boundaries between inner and outer group spaces, accept discontinuity as a basic property of the virtual, and acknowledge the limitations caused by multiple stimuli.

Contextual assessment: evaluating a novel self-guided online therapeutic assessment

BACKGROUND

Paper introduces Conflict Analysis (CA), an online self-guided therapeutic assessment. CA combines a diagnostic self-report scale with narrative exercises and self-analytical tasks. CA automatically generates detailed diagnostic records and frameworks for changes.

OBJECTIVE

To evaluate therapeutic and diagnostic benefits associated with CA over time.

METHODS

This online study compared CA over 2 weeks on outcome measures predicting psychotherapy outcome. Novel scale measuring perceived diagnostic benefit and perceived therapeutic benefit was delivered at post and follow-up. Cohort (n = 59, average age = 35, 50% female) was either in therapy or interested to start therapy in near future.

RESULTS

Repeated-measure ANOVAs suggest that scores significantly changed on measures predicting negative affect, depression, performance and appearance self-esteem, insight, and growth initiative. Agreement rates on items measuring perceived diagnostic and therapeutic benefits were at least 74.5% for both post and follow-up.

CONCLUSIONS

Evidence supports further exploration of CA as a self-guided diagnostic and therapeutic resource.Key pointsResults demonstrate feasibility and utility of online self-guided therapeutic assessment.Described model is associated with increased perceived diagnostic and therapeutic benefits.Described model illustrates therapeutic benefits over time.Results demonstrate that even self-guided assessment can have therapeutic implications.

Acceptability of an online relational intimacy and sexual enhancement (iRISE) intervention after breast cancer

The purpose of this study was to develop and evaluate an online relational intimacy and sexual enhancement (iRISE) intervention for couples experiencing sexual difficulties following breast cancer (BC). The acceptability of iRISE was evaluated using a single-arm, qualitative design, with 14 couples completing satisfaction surveys and posttreatment interviews. The intervention was found to be acceptable, as demonstrated by high satisfaction ratings and qualitative feedback regarding iRISE and its online delivery. Couples spoke about the helpfulness of iRISE and how the intervention improved their sexual relationship. The use of video conferencing (eTherapy) was widely accepted by participants, who highlighted several advantages of this modality. Overall, the results support the acceptability of this online psychosexual intervention for couples affected by BC. The empirical and theoretical basis for the design of iRISE along with findings from a qualitative analysis of couples' experiences of the intervention's helpfulness to them is discussed.

Intervention Outcomes, Anxiety, Self-Esteem, and Self-Efficacy With DHH Students in Universities

This article reports the impact of an online spiritual counseling (OSC) program in mitigating anxiety and building self-esteem and academic self-efficacy among deaf and hard-of-hearing (DHH) students in universities. Compared to online relaxation sessions, the OSC was more effective. Male DHH students and those whose parents were highly qualified exhibited less anxiety and higher self-esteem and self-efficacy at pretest (T1). Post-test (T2) male students having better educated parents responded better to the OSC. T2 anxiety was lower and self-esteem and academic self-efficacy was higher for liberal arts students and having stay-at-home parents compared with science and commerce students and whose parents worked outside home. Self-esteem was also positively moderated by better economic class and presence of siblings. Intervention compliance in terms of regular attendance and self-practice mediated the relationship between sociodemographic predictors and outcomes. Results support the biopsychosocial model and encourage the implementation of the OSC with DHH university students.

OMG, R U OK? Therapeutic Relationships between Caregivers and Youth at Risk on Social Media

The rising of social media has opened new opportunities for forming therapeutic relationships with youth at risk who have little faith in institutionalized interventions. The goal of this study is to examine whether and how youth care workers utilize social media communications for reaching out to detached adolescents and providing them emotional support. Qualitative in-depth interviews (N = 17) were conducted with counselors, social workers, and clinical psychologists who work with youth at risk. A thematic analysis of the interviews revealed three principal psychosocial usages of social media: (1) Reaching out and maintaining reciprocal and meaningful therapeutic relationships with youth at risk over time; (2) Identifying risks and emotional distress; and (3) "stepping in" and providing psychosocial assistance, when needed. These beneficial practices are made possible through the high accessibility and the sense of secured mediation that characterize social media communication and that complement the psychosocial needs of youth at risk. Alongside these advantages, the analysis yielded several significant challenges in social media therapeutic relationships, including privacy dilemmas and blurring of authority and boundaries. Given that social media communication is a relatively new phenomenon, the applied psychosocial practices are shaped through a process of trial and error, intuitive decisions, and peer learning. Although the main conclusion from this study supports the notion that the advantages of social media therapeutic relationships with youth at risk outweigh their problematic aspects, future research is recommended to establish clear guidelines for youth caregivers who wish to integrate the new media in their daily psychosocial work.

Analysis of the Emails From the Dutch Web-Based Intervention "Alcohol de Baas": Assessment of Early Indications of Drop-Out in an Online Alcohol Abuse Intervention

Nowadays, traditional forms of psychotherapy are increasingly complemented by online interactions between client and counselor. In (some) web-based psychotherapeutic interventions, meetings are exclusively online through asynchronous messages. As the active ingredients of therapy are included in the exchange of several emails, this verbal exchange contains a wealth of information about the psychotherapeutic change process. Unfortunately, drop-out-related issues are exacerbated online. We employed several machine learning models to find (early) signs of drop-out in the email data from the "Alcohol de Baas" intervention by Tactus. Our analyses indicate that the email texts contain information about drop-out, but as drop-out is a multidimensional construct, it remains a complex task to accurately predict who will drop out. Nevertheless, by taking this approach, we present insight into the possibilities of working with email data and present some preliminary findings (which stress the importance of a good working alliance between client and counselor, distinguish between formal and informal language, and highlight the importance of Tactus' internet forum).

Online psychotherapy practice by psychodynamic therapists

Online psychotherapy was recognized by the Federal Council of Psychology Resolution n. 11/2018. With the official recognition of this practice, many professionals raised questions about its equivalence to face-to-face psychotherapy and the possible need of technical adaptations. Considering the lack of research on this theme, this study aimed to explore how psychodynamic/psychoanalytical psychotherapists perceive their own practice in online settings, including technical and relational aspects of the therapeutic process, in comparison to their experience in face-to-face treatments. This is a qualitative study with an exploratory approach. Eight psychologists responded to videoconference interviews. The interviews were audiotaped, fully transcribed, and analyzed by thematic analysis. Results were organized in two major themes (online psychotherapy practice and technique and psychodynamic process in online psychotherapy). Main results indicate online psychodynamic psychotherapy has many distinctive features (e.g. relying on quality of internet connection, fostering focal process, occurring in a more vulnerable setting, and eliciting a different pattern of communication) that require adaptation from therapist. Implication of findings to psychotherapy training and practice are discussed.

Efficacy of the web-based PaarBalance program on relationship satisfaction, depression and anxiety - A randomized controlled trial

OBJECTIVE

Although relationship distress is strongly associated with mental health problems, poorer social functioning and lower quality of life, only a minority of distressed couples engage in effective couples therapy. Common barriers are the financial burden, fear of being stigmatized, long waitlists and logistical concerns, such as the difficulty in scheduling appointments. Therefore, more accessible help for relationship distress is needed, such as internet-based interventions.

METHOD

This study evaluates the efficacy of the German web-based PaarBalance program, an 18-sessions online program for couples and individuals in an intimate relationship. Participants with relationship distress recruited via the internet had access to the unguided self-help program for twelve weeks. A total of 117 individuals (N = 60 participated as couples, N = 57 participated without a partner) were randomly assigned to begin the intervention immediately or to a 12-week waitlist control group. The primary outcome was relationship satisfaction. Secondary outcomes included symptoms of depression and anxiety.

RESULTS

The intervention group showed significant improvement in relationship satisfaction (Cohen's d =0.77) compared with the waitlist control group. Small to medium effect sizes in favor of the intervention group, but no statistically significant differences were found regarding depression (d = 0.43) and anxiety (d = 0.45).

CONCLUSION

PaarBalance seems to be an effective self-guided intervention to improve relationship satisfaction in people with relationship problems.

A randomized controlled trial to improve psychological detachment from work and well-being among employees: a study protocol comparing online CBT-based and mindfulness interventions

BACKGROUND

The changing landscape of the work environment, which often encompasses expectations of employees being continuously available, makes it difficult to disengage from work and recover. This can have a negative impact on employees' well-being, resulting in burnout, depression and anxiety, among other difficulties. The current study will test the effectiveness of two different online interventions (i.e., cognitive behavioral therapy; CBT and mindfulness-based stress reduction; MBSR) on employees' psychological detachment, burnout and other variables related to general (e.g., life satisfaction) and work-specific (e.g., work engagement) well-being.

METHODS/DESIGN

The study is designed as a randomized control trial with two intervention groups (i.e., CBT, MBSR) and a waitlist control group. Participants will be full-time employees from a wide range of organizations from Slovenia, who report moderate difficulties with psychological detachment from work and burnout and are not receiving any other form of treatment. The online interventions will encompass 12 sessions over 6 weeks (2 sessions per week); each session will include 1) an active audio-guided session and 2) home assignments, accompanied by handouts and worksheets. The study outcomes (i.e., psychological detachment, burnout, general and work-specific well-being), potential mechanisms (i.e., work-related maladaptive thinking patterns, mindfulness) and moderators (e.g., supervisor support for recovery) will be assessed immediately before and after the interventions (pre and post measurement) and 3 months after intervention completion (follow-up). Additionally, participants will fill out questionnaires for the assessment of the central mechanisms and study outcomes each week.

DISCUSSION

We expect that the CBT-based intervention will lead to greater improvements in psychological detachment from work and burnout compared to the MBSR and the waitlist control group. Additionally, we expect that the CBT-based intervention will also lead to greater enhancement of both general and work-related well-being.

TRIAL REGISTRATION

https://doi.org/10.1186/ISRCTN98347361 [May 19, 2020].

Towards a Personalized Multi-Domain Digital Neurophenotyping Model for the Detection and Treatment of Mood Trajectories

The commercial availability of many real-life smart sensors, wearables, and mobile apps provides a valuable source of information about a wide range of human behavioral, physiological, and social markers that can be used to infer the user's mental state and mood. However, there are currently no commercial digital products that integrate these psychosocial metrics with the real-time measurement of neural activity. In particular, electroencephalography (EEG) is a well-validated and highly sensitive neuroimaging method that yields robust markers of mood and affective processing, and has been widely used in mental health research for decades. The integration of wearable neuro-sensors into existing multimodal sensor arrays could hold great promise for deep digital neurophenotyping in the detection and personalized treatment of mood disorders. In this paper, we propose a multi-domain digital neurophenotyping model based on the socioecological model of health. The proposed model presents a holistic approach to digital mental health, leveraging recent neuroscientific advances, and could deliver highly personalized diagnoses and treatments. The technological and ethical challenges of this model are discussed.

Sex, Drugs, and Impulse Regulation: A Perspective on Reducing Transmission Risk Behavior and Improving Mental Health Among MSM Living With HIV

Unprotected sexual contact continues to be a main cause of HIV transmission and poses certain key populations at increased risk for HIV infection. One of the populations at high risk are men who have sex with men. A subset of MSM engages in chemsex, whereby consumption of illicit drugs is used to facilitate or enhance sexual activity. This practice can have several negative consequences, such as sexually transmitted infections (including HIV) and mental health problems (including compulsive sexual behavior, addiction, and mood disorders). In this article, we provide our perspective on the current situation that medical professionals dealing with MSM living with HIV often feel empty-handed in how to deal with these behavioral and psychological issues. Close collaboration between somatic and mental health professionals is key to address treatment needs of people living with HIV, regarding the negative consequences of chemsex and their overall quality of life. In this article, we discuss possibilities for psychological treatment, including behavioral skills training to improve impulse control and reduce compulsive sexual behaviors among MSM living with HIV who persistently engage in sexual transmission risk behavior, based on our experience with implementing such an intervention. Important barriers and facilitators for further implementation of behavioral interventions will be discussed. Reduction of HIV transmission risk behavior is needed to achieve the WHO aim to end HIV as a public health threat by 2030. We propose that close collaboration between somatic and mental health professionals and implementation of behavioral interventions for risk populations are key to achieve this goal.

Towards text mining therapeutic change: A systematic review of text-based methods for Therapeutic Change Process Research

Therapeutic Change Process Research (TCPR) connects within-therapeutic change processes to outcomes. The labour intensity of qualitative methods limit their use to small scale studies. Automated text-analyses (e.g. text mining) provide means for analysing large scale text patterns. We aimed to provide an overview of the frequently used qualitative text-based TCPR methods and assess the extent to which these methods are reliable and valid, and have potential for automation. We systematically reviewed PsycINFO, Scopus, and Web of Science to identify articles concerning change processes and text or language. We evaluated the reliability and validity based on replicability, the availability of code books, training data and inter-rater reliability, and evaluated the potential for automation based on the example- and rule-based approach. From 318 articles we identified four often used methods: Innovative Moments Coding Scheme, the Narrative Process Coding Scheme, Assimilation of Problematic Experiences Scale, and Conversation Analysis. The reliability and validity of the first three is sufficient to hold promise for automation. While some text features (content, grammar) lend themselves for automation through a rule-based approach, it should be possible to automate higher order constructs (e.g. schemas) when sufficient annotated data for an example-based approach are available.

Public educational psychology services in Israel on the internet

Background

The public Educational Psychology Services provide mental health services for children and youth in Israel, alongside the Ministry of Health and the Ministry of Social Affairs and Services. The Psychological and Counseling Services Division of the Ministry of Education (known as SHEFI - Sherut Psychology Yeutzi), funds and supervises local Educational Psychology Services which are aimed at supporting child development and enhancing the emotional welfare of children and their families. The demand for the services of educational psychologists is increasing. Yet this demand is not being met due to the insufficient number of job slots allocated, the geographical distances in outlying peripheral areas, the already high loads in the psychologists’ daily routine, and other such problems. A wide range of effective psychological services can be offered via the internet. The internet therefore has the potential to serve as a useful and efficient missing link between the high demands for educational psychology services on the one hand and the ability and desire among educational psychologists to meet those needs on the other. Moreover, even if the services were fully staffed, the resources would still be insufficient to provide personal (face-to-face) treatment for all, so that internet-based access to services would still need to be developed. Those services provide unique advantages such as overcoming distance and enabling higher availability of mental health professionals. The objectives of the current study were to describe the prevalence of public educational psychology services available online in Israel, with specific focus on the Arab minority and the peripheral regions, and to highlight the benefits of expanding those services.

Method

During 2016, we conducted a survey comprising all 252 Public Educational Psychology Service units in Israel (n = 170 in the Jewish sector, and n = 82 in the Arab sector). The method used to search for online sites was in line with the actions taken by an average end-user searching for information on the internet.

Results

The survey found that 125 of the units in the Jewish sector (73.5% of those units) and all 82 units in the Arab sector had no online site at all, constituting 82.2% of all the units in Israel. Of the 45 Jewish websites located by the survey, 42 (93.3% of the sites) were not user friendly (not interactive), and only three offered the possibility of interacting with psychologists (6.7% of the sites). Nevertheless, all the sites (n = 45) offered a high degree of quality and variety that exceeded basic information.

Conclusion

We believe that the presence of educational psychologists on the internet is essential in order to meet the challenges presented by the growing needs of students, parents and teachers in the current digital era. The survey revealed that the public educational psychology system in Israel has not yet bridged the technological gap. Special attention should be directed to the peripheral regions and to the Arab sector, where the technological services can make a significant contribution. The local public services’ attempts to create and operate websites (45 Jewish websites according to the survey), are indicative of the determination to offer psychological support to the community at large, and of the ambition to overcome availability and accessibility problems. The concept of internet services might be useful not only for the SHEFI, but also for the array of mental health services for children and youth in Israel. Thus, we recommend that a policy should be formulated regarding internet-based mental health services for children and youth in Israel, and we call for a collaboration between the various ministries in implementing this process.

Instances of online suicide, the law and potential solutions

To understand the social and legal issues posed by suicide-related communications over the Internet (messages of threatened suicide and advocated suicide), this article examines a selection of cases involving different types of online baiting and harassment that illustrate different legal and technological issues. The anonymity afforded by computer-mediated communication allows bullies to harass vulnerable individuals and leak (disclose) their personal information. Computer mediation of communication potentially diffuses responsibility; imposes a temporal asynchrony between signified intent and audience response; and reduces the empathy that might motivate observers or witnesses to intervene and render assistance, factors that make online baiting a serious social, legal and technological problem. Potential actions (both legal and technological) for addressing this problem are outlined.

Treatment Activity, User Satisfaction, and Experienced Usability of Internet-Based Cognitive Behavioral Therapy for Adults With Depression and Anxiety After a Myocardial Infarction: Mixed-Methods Study

BACKGROUND

Knowledge about user experiences may lead to insights about how to improve treatment activity in Internet-based cognitive behavioral therapy (iCBT) to reduce symptoms of depression and anxiety among people with a somatic disease. There is a need for studies conducted alongside randomized trials, to explore treatment activity and user experiences related to such interventions, especially among people with older age who are recruited in routine care.

OBJECTIVE

The aim of the study was to explore treatment activity, user satisfaction, and usability experiences among patients allocated to treatment in the U-CARE Heart study, a randomized clinical trial of an iCBT intervention for treatment of depression and anxiety following a recent myocardial infarction.

METHODS

This was a mixed methods study where quantitative and qualitative approaches were used. Patients were recruited consecutively from 25 cardiac clinics in Sweden. The study included 117 patients allocated to 14 weeks of an iCBT intervention in the U-CARE Heart study. Quantitative data about treatment activity and therapist communication were collected through logged user patterns, which were analyzed with descriptive statistics. Qualitative data with regard to positive and negative experiences, and suggestions for improvements concerning the intervention, were collected through semistructured interviews with 21 patients in the treatment arm after follow-up. The interviews were analyzed with qualitative manifest content analysis.

RESULTS

Treatment activity was low with regard to number of completed modules (mean 0.76, SD 0.93, range 0-5) and completed assignments (mean 3.09, SD 4.05, range 0-29). Most of the participants initiated the introduction module (113/117, 96.6%), and about half (63/117, 53.9%) of all participants completed the introductory module, but only 18 (15.4%, 18/117) continued to work with any of the remaining 10 modules, and each of the remaining modules was completed by 7 or less of the participants. On average, patients sent less than 2 internal messages to their therapist during the intervention (mean 1.42, SD 2.56, range 0-16). Interviews revealed different preferences with regard to the internet-based portal, the content of the treatment program, and the therapist communication. Aspects related to the personal situation and required skills included unpleasant emotions evoked by the intervention, lack of time, and technical difficulties.

CONCLUSIONS

Patients with a recent myocardial infarction and symptoms of depression and anxiety showed low treatment activity in this guided iCBT intervention with regard to completed modules, completed assignments, and internal messages sent to their therapist. The findings call attention to the need for researchers to carefully consider the preferences, personal situation, and technical skills of the end users during the development of these interventions. The study indicates several challenges that need to be addressed to improve treatment activity, user satisfaction, and usability in internet-based interventions in this population.

Use of Computer and Mobile Technologies in the Treatment of Depression

Major depression (MDD) is a common and disabling disorder. Research has shown that most people with MDD receive either no treatment or inadequate treatment. Computer and mobile technologies may offer solutions for the delivery of therapies to untreated or inadequately treated individuals with MDD. The authors review currently available technologies and research aimed at relieving symptoms of MDD. These technologies include computer-assisted cognitive-behavior therapy (CCBT), web-based self-help, Internet self-help support groups, mobile psychotherapeutic interventions (i.e., mobile applications or apps), technology enhanced exercise, and biosensing technology.

Mobile Phones and Psychosocial Therapies with Vulnerable People: a First State of the Art

Mobile phones are becoming a communication tool commonly used by people all over the world; and they are started to be adopted in psychosocial therapies involving vulnerable people. We are herein presenting the results of an academic literature review. We identified scientific papers published between 2006 and 2015 resorting to academic databases available on the Internet, applying a systematic selection method based on quality criteria. Secondly, we analysed contents, highlighting the scarcity of research involving vulnerable people. The available literature specialized in psychosocial therapies offers investigation results which involve mobile phones and patients in general, focusing particularly on the clinical psychology field and, to a lesser extent, on the social work field. Particularly significant are the investigation works developed in the United States. In the present paper we introduce a first "state of the art", identifying opportunities and also the limitations surrounding the use of mobile phones in psychosocial therapies targeting the vulnerable. Issues concerning privacy and data confidentiality, and the access of vulnerable people to mobile phones and how they use them, pose significant challenges; but they offer the opportunity to reach isolated or impoverished populations, or even to facilitate access to social and healthcare services. We close this paper formulating possible orientations, hypotheses and goals to design new investigation works involving vulnerable populations.