1
|
Smith KA, Ostinelli EG, Ede R, Allard L, Thomson M, Hewitt K, Brown P, Zangani C, Jenkins M, Hinze V, Ma G, Pothulu P, Henshall C, Malhi GS, Every-Palmer S, Cipriani A. Assessing the Impact of Evidence-Based Mental Health Guidance During the COVID-19 Pandemic: Systematic Review and Qualitative Evaluation. JMIR Ment Health 2023; 10:e52901. [PMID: 38133912 PMCID: PMC10760515 DOI: 10.2196/52901] [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] [Received: 09/20/2023] [Revised: 10/30/2023] [Accepted: 11/03/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND During the COVID-19 pandemic, the Oxford Precision Psychiatry Lab (OxPPL) developed open-access web-based summaries of mental health care guidelines (OxPPL guidance) in key areas such as digital approaches and telepsychiatry, suicide and self-harm, domestic violence and abuse, perinatal care, and vaccine hesitancy and prioritization in the context of mental illness, to inform timely clinical decision-making. OBJECTIVE This study aimed to evaluate the practice of creating evidence-based health guidelines during health emergencies using the OxPPL guidance as an example. An international network of clinical sites and colleagues (in Australia, New Zealand, and the United Kingdom) including clinicians, researchers, and experts by experience aimed to (1) evaluate the clinical impact of the OxPPL guidance, as an example of an evidence-based summary of guidelines; (2) review the literature for other evidence-based summaries of COVID-19 guidelines regarding mental health care; and (3) produce a framework for response to future global health emergencies. METHODS The impact and clinical utility of the OxPPL guidance were assessed using clinicians' feedback via an international survey and focus groups. A systematic review (protocol registered on Open Science Framework) identified summaries or syntheses of guidelines for mental health care during and after the COVID-19 pandemic and assessed the accuracy of the methods used in the OxPPL guidance by identifying any resources that the guidance had not included. RESULTS Overall, 80.2% (146/182) of the clinicians agreed or strongly agreed that the OxPPL guidance answered important clinical questions, 73.1% (133/182) stated that the guidance was relevant to their service, 59.3% (108/182) said that the guidelines had or would have a positive impact on their clinical practice, 42.9% (78/182) that they had shared or would share the guidance, and 80.2% (146/182) stated that the methodology could be used during future health crises. The focus groups found that the combination of evidence-based knowledge, clinical viewpoint, and visibility was crucial for clinical implementation. The systematic review identified 2543 records, of which 2 syntheses of guidelines met all the inclusion criteria, but only 1 (the OxPPL guidance) used evidence-based methodology. The review showed that the OxPPL guidance had included the majority of eligible guidelines, but 6 were identified that had not been included. CONCLUSIONS The study identified an unmet need for web-based, evidence-based mental health care guidance during the COVID-19 pandemic. The OxPPL guidance was evaluated by clinicians as having a real-world clinical impact. Robust evidence-based methodology and expertise in mental health are necessary, but easy accessibility is also needed, and digital technology can materially help. Further health emergencies are inevitable and now is the ideal time to prepare, including addressing the training needs of clinicians, patients, and carers, especially in areas such as telepsychiatry and digital mental health. For future planning, guidance should be widely disseminated on an international platform, with allocated resources to support adaptive updates.
Collapse
Affiliation(s)
- Katharine A Smith
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
- Oxford Health NHS Foundation Trust, Oxford, United Kingdom
- Oxford Precision Psychiatry Lab, NIHR Oxford Health Biomedical Research Centre, Oxford, United Kingdom
| | - Edoardo G Ostinelli
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
- Oxford Precision Psychiatry Lab, NIHR Oxford Health Biomedical Research Centre, Oxford, United Kingdom
| | - Roger Ede
- Oxford Health NHS Foundation Trust, Oxford, United Kingdom
| | - Lisa Allard
- Pharmacy Department, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | | | - Kiran Hewitt
- Lincolnshire Partnership NHS Foundation Trust, Lincoln, United Kingdom
| | - Petra Brown
- Pennine Care NHS Foundation Trust, Manchester, United Kingdom
- Department of Pharmacy and Optometry, University of Manchester, Manchester, United Kingdom
| | - Caroline Zangani
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
- Oxford Health NHS Foundation Trust, Oxford, United Kingdom
- Oxford Precision Psychiatry Lab, NIHR Oxford Health Biomedical Research Centre, Oxford, United Kingdom
| | - Matthew Jenkins
- Department of Psychological Medicine, University of Otago, Wellington, New Zealand
| | - Verena Hinze
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
- Oxford Precision Psychiatry Lab, NIHR Oxford Health Biomedical Research Centre, Oxford, United Kingdom
| | - George Ma
- Pharmacy Department, The Prince Charles Hospital, Metro North Health, Brisbane, Australia
| | - Prajnesh Pothulu
- Pharmacy Department, Princess Alexandra Hospital, Brisbane, Australia
| | - Catherine Henshall
- Oxford Health NHS Foundation Trust, Oxford, United Kingdom
- Oxford Institute of Applied Health Research, Oxford Brookes University, Oxford, United Kingdom
- Nursing and Midwifery Office, National Institute for Health and Care Research, London, United Kingdom
| | - Gin S Malhi
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
- Academic Department of Psychiatry, Faculty of Medicine and Health, Kolling Institute, Northern Clinical School, The University of Sydney, Sydney, Australia
- CADE Clinic and Mood-T, Royal North Shore Hospital, Northern Sydney Local Health District, St. Leonards, New South Wales, Australia
| | - Susanna Every-Palmer
- Department of Psychological Medicine, University of Otago, Wellington, New Zealand
| | - Andrea Cipriani
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
- Oxford Health NHS Foundation Trust, Oxford, United Kingdom
- Oxford Precision Psychiatry Lab, NIHR Oxford Health Biomedical Research Centre, Oxford, United Kingdom
| |
Collapse
|
2
|
Smaik N, Simmons LA, Abdulhaq B, Dardas LA. The feasibility and preliminary efficacy of narrative exposure therapy on post-traumatic stress disorder among Syrian refugees in Jordan. Int J Nurs Sci 2023; 10:518-526. [PMID: 38020837 PMCID: PMC10667293 DOI: 10.1016/j.ijnss.2023.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 09/01/2023] [Accepted: 09/16/2023] [Indexed: 12/01/2023] Open
Abstract
Objectives Post-traumatic stress disorder (PTSD), anxiety, and depression are common mental health disorders among refugees, and all require immediate mental health support to prevent short- and long-term detrimental health outcomes. The purpose of this study was to evaluate the feasibility and preliminary efficacy of narrative exposure therapy (NET) in reducing symptoms of PTSD, depression, and anxiety among Syrian refugees residing in Jordan. Methods A two-arm randomized control trial was utilized. A total of 40 Syrian refugees aged 18 to 64 diagnosed with PTSD were randomly allocated to either the NET intervention group (n = 20) or the waitlist control group (n = 20) using a computer-generated allocation list with 1:1 allocation. PTSD symptoms were evaluated using the Arabic rendition of the Harvard Trauma Questionnaire, while depression and anxiety symptoms were appraised using the Arabic adaptation of the Hopkins Symptoms Checklist-25. Descriptive statistics were employed to characterize the sample and survey data. Independent t-tests were conducted to assess mean score differences in PTSD, anxiety, and depression between the intervention and control groups. Results Post NET intervention, significant reductions in PTSD (t = -10.00, P < 0.001), anxiety (t = -9.46, P < 0.001), and depression (t = -6.00, P < 0.001) scores were observed in the intervention group compared to the control group. Effect sizes were moderate for the trauma (Cohen's d = 0.73) and depression (Cohen's d = 0.79) symptoms and notably large for anxiety symptoms (Cohen's d = 0.97). There were no adverse events related to study participation. The intervention achieved a 100% participant retention rate. Conclusions The results pertaining to retention rate, adherence to the study protocol, data completeness, cultural congruence, and participants' satisfaction provided strong support for the future implementation of the full-scale RCT. NET may be a feasible and helpful approach for refugees and other patients with PTSD, anxiety, and depression.
Collapse
Affiliation(s)
- Nadeen Smaik
- School of Nursing, The University of Jordan, Amman, Jordan
| | - Leigh Ann Simmons
- The Betty Irene Moore School of Nursing, UC Davis, Sacramento, CA, USA
| | | | | |
Collapse
|
3
|
Olthuis JV, Kaltenbach E, Giberson E, Saryeddine T, Asmundson GJG, Carleton RN, Cramm H, Crombach A, Devlin J, Mack J, Lingley-Pottie P, Rao S, Sullivan M, Wozney L, McGrath PJ. Paraprofessional delivery of online narrative exposure therapy for firefighters. J Trauma Stress 2023; 36:772-784. [PMID: 37291963 DOI: 10.1002/jts.22941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 03/21/2023] [Accepted: 04/08/2023] [Indexed: 06/10/2023]
Abstract
Firefighters are at increased risk for developing posttraumatic stress disorder (PTSD) and face numerous barriers to accessing mental health care. Innovative ways to increase access to evidence-based interventions are needed. This study was a case series testing the acceptability, feasibility, and preliminary effectiveness of a paraprofessional-delivered, virtual narrative exposure therapy (eNET) intervention for PTSD. Participants were 21 firefighters who met the criteria for clinical or subclinical probable PTSD and completed 10-12 sessions of eNET via videoconference. Participants completed self-report measures pre- and postintervention and at 2- and 6-month follow-ups as well as a postintervention qualitative interview. Paired samples t tests evidenced statistically significant decreases in PTSD, anxiety, and depressive symptom severity and functional impairment from pre- to postintervention, ds = 1.08-1.33, and in PTSD and anxiety symptom severity and functional impairment from preintervention to 6-month follow-up, ds = 0.69-1.10. The average PTSD symptom severity score fell from above to below the clinical cutoff for probable PTSD at postintervention and follow-ups. Qualitative interviews indicated that paraprofessionals were considered central to participants' success and experience with the intervention. No adverse events or safety concerns were raised. This study is an important step in demonstrating that appropriately trained and supervised paraprofessionals can effectively deliver eNET to firefighters with PTSD.
Collapse
Affiliation(s)
- Janine V Olthuis
- Department of Psychology, University of New Brunswick, Fredericton, New Brunswick, Canada
| | | | - Emma Giberson
- Department of Psychology, University of New Brunswick, Fredericton, New Brunswick, Canada
| | - Tina Saryeddine
- Canadian Association of Fire Chiefs, Ottawa, Ontario, Canada
- Telfer School of Management, University of Ottawa, Ottawa, Ontario, Canada
| | | | - R Nicholas Carleton
- Department of Psychology, University of Regina, Regina, Saskatchewan, Canada
| | - Heidi Cramm
- School of Rehabilitation Therapy, Queen's University, Kingston, Ontario, Canada
| | - Anselm Crombach
- Department of Psychology, Universität des Saarlandes, Saarbrücken, Germany
| | - Julie Devlin
- Conservation and Protection, Fisheries and Oceans Canada, Ottawa, Ontario, Canada
| | - Jeff Mack
- Fredericton Fire Department, Fredericton, New Brunswick, Canada
| | - Patricia Lingley-Pottie
- IWK Health Centre, Halifax, Nova Scotia, Canada
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Sanjay Rao
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Michael Sullivan
- Department of Psychology, McGill University, Montreal, Québec, Canada
| | - Lori Wozney
- IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Patrick J McGrath
- IWK Health Centre, Halifax, Nova Scotia, Canada
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada
| |
Collapse
|
4
|
Serpeloni F, Narrog JA, Pickler B, Avanci JQ, Assis SGD, Koebach A. Treating post-traumatic stress disorder in survivors of community and domestic violence using narrative exposure therapy: a case series in two public health centers in Rio de Janeiro/Brazil. CIENCIA & SAUDE COLETIVA 2023; 28:1619-1630. [PMID: 37255140 DOI: 10.1590/1413-81232023286.16532022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 11/15/2022] [Indexed: 06/01/2023] Open
Abstract
Prevalence of violence in Brazil is high, which contributes to an increasing number of trauma-related disorders, especially post-traumatic stress disorder (PTSD). This study aims to present a case series of PTSD patients treated with narrative exposure therapy (NET) in two public health centers in Rio de Janeiro (Brazil). Health professionals were trained in a two-week workshop to deliver NET. Exposure to violence and other potentially traumatic events, as well as PTSD were assessed by interviewers before treatment and six months later in follow-up interviews conducted by blind assessors. Multiple traumatic events, including different types of childhood and sexual abuse, intimate partner violence and community violence were reported. Five patients were exposed to community violence, and one to domestic violence, during or after NET treatment. Treatment delivery was integrated into the routine of health centers. Eight patients completed NET and presented a substantial reduction in PTSD severity at six-month follow-up. NET is a feasible and effective treatment for PTSD patients exposed to ongoing violence, and can be integrated into established public health services.
Collapse
Affiliation(s)
- Fernanda Serpeloni
- Departamento de Estudos sobre Violência e Saúde Jorge Careli, Fundação Oswaldo Cruz (Claves/Fiocruz). Av. Brasil 4.036, sala 700, Manguinhos. 21040-361 Rio de Janeiro RJ Brasil.
- ONG vivo international. Konstanz Alemanha
| | | | - Bianca Pickler
- Departamento de Estudos sobre Violência e Saúde Jorge Careli, Fundação Oswaldo Cruz (Claves/Fiocruz). Av. Brasil 4.036, sala 700, Manguinhos. 21040-361 Rio de Janeiro RJ Brasil.
| | - Joviana Quintes Avanci
- Departamento de Estudos sobre Violência e Saúde Jorge Careli, Fundação Oswaldo Cruz (Claves/Fiocruz). Av. Brasil 4.036, sala 700, Manguinhos. 21040-361 Rio de Janeiro RJ Brasil.
| | - Simone Gonçalves de Assis
- Departamento de Estudos sobre Violência e Saúde Jorge Careli, Fundação Oswaldo Cruz (Claves/Fiocruz). Av. Brasil 4.036, sala 700, Manguinhos. 21040-361 Rio de Janeiro RJ Brasil.
- Programa de Pós-Graduação em Neurologia, Universidade Federal do Estado do Rio de Janeiro. Rio de Janeiro RJ Brasil
| | - Anke Koebach
- ONG vivo international. Konstanz Alemanha
- Departamento de Psicologia, Universidade de Konstanz. Alemanha
| |
Collapse
|
5
|
Griffith B, Archbold H, Sáez Berruga I, Smith S, Deakin K, Cogan N, Tanner G, Flowers P. Frontline experiences of delivering remote mental health supports during the COVID-19 pandemic in Scotland: innovations, insights and lessons learned from mental health workers. PSYCHOL HEALTH MED 2023; 28:964-979. [PMID: 36408950 DOI: 10.1080/13548506.2022.2148698] [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] [Indexed: 11/23/2022]
Abstract
COVID-19 restrictions drove rapid adaptations to service delivery and new ways of working within Scotland's mental health sector. This study explores mental health workers' (MHWs') experiences of delivering their services remotely. Twenty participants, who had worked in mental health professions in the National Health Service (NHS) in Scotland throughout the COVID-19 pandemic, took part in online semi-structured interviews. Data was transcribed then analysed using an inductive thematic analysis. Two major themes are reported: (1) 'Improved Flexibility for both MHWs and Service Users' and (2) 'Teletherapies Challenge Therapeutic Boundaries'. In relation to (1) virtual platforms were seen as vital in maintaining patient care throughout the COVID-19 pandemic and a valuable resource for service users (SUs) who had previously struggled with mobility or social anxieties when accessing face-to-face services. Some MHWs' also noted benefits for their productivity and comfort. Regarding (2) MHWs highlighted that whilst conducting teletherapies from home, work-life boundaries became blurred and, in some instances, typically comforting spaces became associated with the traumatic content discussed by SUs. These stressors seemed to be compounded by MHWs' isolation, as they were less able to draw upon their colleagues for support. Further, confidentiality could not be assured, as MHWs and SUs alike had to accommodate their family members. These findings highlight important insights from MHWs in adapting to rapid changes in mental health working practices, particularly in relation to the challenges of delivering quality, safe and equitable services and the increased use of teletherapies. Such insights are vital in informing service developments and supporting future pandemic preparedness across a range of healthcare contexts and countries seeking to adopt hybrid models of mental health service delivery.
Collapse
Affiliation(s)
- Bethany Griffith
- School of Psychological Sciences and Health, University of Strathclyde, Glasgow, UK
| | - Heather Archbold
- School of Psychological Sciences and Health, University of Strathclyde, Glasgow, UK
| | - Isabel Sáez Berruga
- School of Psychological Sciences and Health, University of Strathclyde, Glasgow, UK
| | - Samantha Smith
- School of Psychological Sciences and Health, University of Strathclyde, Glasgow, UK
| | - Karen Deakin
- School of Psychological Sciences and Health, University of Strathclyde, Glasgow, UK
| | - Nicola Cogan
- School of Psychological Sciences and Health, University of Strathclyde, Glasgow, UK
| | - Gary Tanner
- School of Psychological Sciences and Health, University of Strathclyde, Glasgow, UK
| | - Paul Flowers
- School of Psychological Sciences and Health, University of Strathclyde, Glasgow, UK
| |
Collapse
|
6
|
Julian JM, Held JI, Hixson K, Conn BM. The Implementation of Narrative Exposure Therapy (NET) for Transgender and Gender Diverse Adolescents and Young Adults. JOURNAL OF CHILD & ADOLESCENT TRAUMA 2023:1-10. [PMID: 37359461 PMCID: PMC10009357 DOI: 10.1007/s40653-023-00530-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 03/02/2023] [Indexed: 06/28/2023]
Abstract
Purpose There is limited information available regarding the use of trauma modalities within the transgender and gender diverse community (TGD) to address gender-based trauma, including discrimination and invalidation, particularly for adolescents and young adults (AYA). The purpose of this paper is to describe a novel treatment approach to addressing post-traumatic stress disorder (PTSD) symptoms within TGD AYA, inclusive of gender-based trauma. Methods Narrative Exposure Therapy (NET) was implemented as a brief intervention for TGD AYA who had a positive screening for PTSD symptomatology. Measures were used to assess PTSD symptoms, as well as changes in self-perceived resilience and positive well-being. Two case vignettes are provided to demonstrate the adaptations made to be responsive to the unique needs of TGD AYA for trauma processing. Results Preliminary outcomes from two case studies indicate the strength of NET when working with TGD AYA who face multiple traumatic events and continue to experience invalidation. Conclusion NET shows promise as an effective brief intervention to reduce PTSD symptomology and increase resiliency in TGD AYA.
Collapse
Affiliation(s)
- Jamie M. Julian
- Division of Adolescent and Young Adult Medicine, Children’s Hospital Los Angeles, Los Angeles, CA USA
| | - Jordan I. Held
- Division of Adolescent and Young Adult Medicine, Children’s Hospital Los Angeles, Los Angeles, CA USA
| | | | - Bridgid M. Conn
- Division of Adolescent and Young Adult Medicine, Children’s Hospital Los Angeles, Los Angeles, CA USA
- Division of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA USA
| |
Collapse
|
7
|
Tissue A, Specker P, Hoffman J, Uppal S, Cloitre M, Neuner F, O’Donnell M, Nickerson A. Skills Training in Affective and Interpersonal Regulation for Refugees Integrated With Narrative Exposure Therapy: A Case Study on the Treatment of PTSD and Emotion Dysregulation for Refugees and Asylum-Seekers. Clin Case Stud 2022. [DOI: 10.1177/15346501221133315] [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] [Indexed: 11/15/2022]
Abstract
The prevalence of post-traumatic stress disorder (PTSD) in individuals affected by war and conflict is high, with approximately 1 in 3 refugees and asylum-seekers meeting diagnostic criteria for PTSD. PTSD in refugees and asylum-seekers is associated with significant emotion dysregulation which may arise from chronic trauma exposure and post-migration stressors and lead to impaired day-to-day functioning. There is evidence that treatments that target emotion regulation skills prior to implementing exposure-based therapies lead to improved treatment response and reduced attrition in survivors of interpersonal traumas such as sexual abuse. The current case study details the use of a novel adaptation of one such treatment – Skills Training in Affective and Interpersonal Regulation for refugees and asylum-seekers (STAIR-R). In this case study, we report on the implementation of STAIR-R in combination with Narrative Exposure Therapy (NET) with Sara, a 60-year-old Iraqi woman who presented with high levels of nightmares, avoidance and emotion dysregulation following exposure to war- and conflict-related trauma and post-migration stressors. In this case study, we explore the intersection of emotion regulation skills training (in STAIR-R) and exposure therapy (in NET), and the potential for this combined intervention to improve emotion regulation skills, enhance coping with post-migration stressors and facilitate engagement with exposure-based treatment for PTSD.
Collapse
Affiliation(s)
- Avalon Tissue
- University of New South Wales, Sydney, NSW, Australia
| | | | - Joel Hoffman
- University of New South Wales, Sydney, NSW, Australia
| | - Shivani Uppal
- University of New South Wales, Sydney, NSW, Australia
| | - Marylene Cloitre
- National Centre for PTSD (NCPTSD) Dissemination and Training Division VA, Palo Alto, CA, USA
| | | | | | | |
Collapse
|
8
|
Notermans J, Philippot P. Psychotherapy Under Lockdown: The Use and Experience of Teleconsultation by Psychotherapists During the First Wave of the COVID-19 Pandemic. CLINICAL PSYCHOLOGY IN EUROPE 2022; 4:e6821. [PMID: 36398003 PMCID: PMC9667335 DOI: 10.32872/cpe.6821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 05/31/2022] [Indexed: 11/25/2022] Open
Abstract
Background Facing the COVID-19 pandemic, some psychotherapists had to propose remote consultations, i.e., teleconsultation. While some evidence suggests positive outcomes from teleconsultation, professionals still hold negative beliefs towards it. Additionally, no rigorous and integrative practice framework for teleconsultation has yet been developed. This article aims to explore the use and experience of teleconsultation by 1) investigating differences between psychotherapists proposing and not proposing it; 2) evaluating the impact of negative attitudes towards teleconsultation on various variables; 3) determining the perceived detrimental effect of teleconsultation, as opposed to in-person, on the therapeutic relationship and personal experience; and 4) providing insights for the development of a teleconsultation practice framework. Method An online survey was distributed via different professional organisations across several countries to 246 (195 women) French-speaking psychotherapists. Results Psychotherapists who did not propose teleconsultation believed it to be more technically challenging than psychotherapists who proposed it, but felt less constrained to propose it, and had less colleagues offering it. Attitudes towards teleconsultation showed no significant associations with therapeutic relationship, personal experience, and percentage of teleconsultation. As compared to in-person, empathy, congruence, and therapeutic alliance were perceived to significantly deteriorate online, whereas work organisation was perceived to be significantly better. While most psychotherapists proposed remote consultations, they did not provide adaptations to such setting (e.g., ascertaining a neutral video background); nor used videoconferencing platforms meeting privacy and confidentiality criteria. Conclusion Training and evidenced-based information should be urgently provided to practitioners to develop rigorous guidelines and an ethically and legally safe practice framework.
Collapse
Affiliation(s)
- Jessica Notermans
- Consultations Psychologiques Spécialisées, Université Catholique de Louvain, Louvain-La-Neuve, Belgium
- Laboratory for Experimental Psychopathology, Université Catholique de Louvain, Louvain-La-Neuve, Belgium
| | - Pierre Philippot
- Consultations Psychologiques Spécialisées, Université Catholique de Louvain, Louvain-La-Neuve, Belgium
- Laboratory for Experimental Psychopathology, Université Catholique de Louvain, Louvain-La-Neuve, Belgium
| |
Collapse
|
9
|
Li F, Mintz J, Sebastian V, Wang C, Kennedy C, Vyas S, Velligan DI. The Acceptability of Remotely Delivered Cognitive Adaptation Training. SCHIZOPHRENIA BULLETIN OPEN 2022; 3:sgac062. [PMID: 36277257 PMCID: PMC9569425 DOI: 10.1093/schizbullopen/sgac062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 04/22/2023]
Abstract
Cognitive Adaptation Training (CAT) is a psychosocial treatment using environmental supports such as signs, checklists, technology, and the organization of belongings to bypass cognitive and motivational impairments for those with serious behavioral health problems. We conducted a survey of 204 members of managed Medicaid in Texas to examine the acceptability of, opinions about and preferences for CAT delivered in-person (CAT) or remotely (R-CAT) where supplies would be mailed and visits would occur via videoconferencing. The telephone survey presented descriptions of CAT and R-CAT in counterbalanced order eliciting general opinions about the treatments, such as (1) whether they would accept the treatments if they were offered the day of the survey at no cost, (2) which treatment was preferred, and (3) the extent to which they agreed or disagreed with a number of statements about components of the treatments. Results indicated that both R-CAT and CAT were acceptable to respondents with overall acceptance rates significantly higher for R-CAT 87% than for CAT (78%). With respect to preferences, 27% and 28% of respondents preferred CAT and R-CAT, respectively, and 41% of respondents preferred both equally. Black respondents more often preferred in-person CAT to other alternatives. Respondents agreed that they needed help, that they were comfortable with technology, and that they believed the programs would help them. The vast majority of qualitative comments about the treatments were positive. Results suggest that it will be important to assess the efficacy and effectiveness of CAT delivered remotely in randomized trials.
Collapse
Affiliation(s)
- Feiyu Li
- Department of Psychiatry, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Jim Mintz
- Department of Psychiatry, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Veronica Sebastian
- Department of Psychiatry, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Chenyi Wang
- Department of Psychiatry, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Cory Kennedy
- Department of Psychiatry, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Shail Vyas
- Department of Psychiatry, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Dawn I Velligan
- To whom correspondence should be addressed; Department of Psychiatry, University of Texas Health Science Center, San Antonio, TX, USA 7703 Floyd Curl Drive Mail Stop 7797 San Antonio, TX 78229-3900, USA; tel: 210-567-5508, fax: 210-567-1291,
| |
Collapse
|
10
|
Kaltenbach E, Chisholm M, Xiong T, Thomson D, Crombach A, McGrath PJ. Online narrative exposure therapy for parents of children with neurodevelopmental disabilities suffering from posttraumatic stress symptoms - study protocol of a randomized controlled trial. Eur J Psychotraumatol 2021; 12:1991650. [PMID: 34868484 PMCID: PMC8635605 DOI: 10.1080/20008198.2021.1991650] [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: 11/29/2022] Open
Abstract
BACKGROUND Parents of children with intellectual and neurodevelopmental disorders (IDD) often experience traumatic events in the care of their children. This leads to comparatively high numbers of mental health problems such as posttraumatic stress disorder (PTSD) in those parents. Intervention approaches for parents of children with IDD are scarce and many parents remain without support. OBJECTIVE This study aims to test the feasibility and efficacy of online Narrative Exposure Therapy (eNET) with parents of children with IDD. METHODS The study follows a randomized waitlist-control design. eNET is an exposure-based PTSD intervention and includes 8-12 90-minute sessions. All sessions will be conducted via video calls with trained paraprofessionals. We aim to include 50 parents, approximately 25 in the immediate intervention group and 25 in the waitlist group. Waitlist participants will receive the same intervention after a three-month wait period. All participants need to either fulfill full or subclinical PTSD symptoms according to DSM-5. Feasibility and efficacy of the intervention will be measured with pre, post, and 2 and 6 months follow-up surveys focusing on PTSD symptoms. Secondary outcomes include other health-related outcomes such as physical symptoms, depression symptoms, anxiety symptoms and functionality. CONCLUSIONS The proposed study allows us to test the feasibility and efficacy of eNET in a sample of parents of children with IDD. There are so far no published studies on the evidence of eNET; this study is one of the first randomized controlled trials investigating the feasibility and efficacy of eNET and therefore will have implications on further research and practice.Clinical trial registration: NCT04385927Date and version identifier: 22 July 2021.
Collapse
Affiliation(s)
- Elisa Kaltenbach
- Centre for Research in Family Health, IWK Health Centre, Halifax, Canada
| | - Michelle Chisholm
- Centre for Research in Family Health, IWK Health Centre, Halifax, Canada
| | - Ting Xiong
- Department of Psychiatry, Dalhousie University, Halifax, Canada
| | | | - Anselm Crombach
- Department of Clinical Psychology in Childhood and Adolescence, University of Konstanz, Konstanz, Germany.,Department of Psychology, Clinical Psychology and Psychotherapy for Children and Adolescents at the University of Saarland, Saarbrücken, Germany
| | - Patrick J McGrath
- Centre for Research in Family Health, IWK Health Centre, Halifax, Canada.,Department of Psychiatry, Dalhousie University, Halifax, Canada
| |
Collapse
|