Videoconferencing Psychotherapy and Depression: A Systematic Review

Feasibility and acceptability of a videoconference-based cognitive-behavioral intervention for caregivers of individuals living with mild cognitive impairment or early Alzheimer's disease

Objective

The objective of the current pilot study was to investigate the feasibility and acceptability of a videoconference-based cognitive behavioral (CBT) intervention for caregivers of individuals living with mild cognitive impairment or early Alzheimer's disease. The intervention included psychoeducation on emotions, strategies for management of unhelpful emotions and thoughts, behavioral activation, breathing and relaxation, strategies for communication and information on external resources.

Methods

This study used a cross-sectional design with two groups of four caregivers who received an 8-week CBT-based intervention via videoconference. Measures of feasibility and acceptability were collected post-intervention as well as suggestions for improvements.

Results

Eight female caregivers were enrolled in the intervention, one participant opted out at the seventh session. Of those who completed the program, all participants reported that it was very easy to participate using the online modality. All participants felt that the intervention was at least partly adapted to their experience and needs as a caregiver. Five out of seven participants (71%) indicated that they felt better and would recommend the intervention to another caregiver.

Conclusion

The current study demonstrated that it is feasible and acceptable to use a videoconference CBT-based group intervention with MCI or mild AD female caregivers.

Innovation

This is the first videoconference-based cognitive behavioral intervention for caregivers of individuals living with MCI or mild AD.

Electronic interventions in primary care to address substance use: A systematic review

The present systematic review aims to identify electronic interventions for addressing substance use and understand their effectiveness in primary care settings. A systematic search was carried out in the Web of Science, PubMed/MEDLINE, Scopus, and Cochrane Library. The search included the keywords "electronic intervention", "substance use", "primary care" and synonyms. To determine the quality and recommendation of the analyzed interventions, the efficacy results reported by the studies were considered, as well as the Mixed Methods Appraisal Tool (MMAT) assessment and the GRADE Evidence Assessment. Twenty-one electronic interventions in Primary Care were identified: internet, mobile or tablet applications, text messages, emails, automated telephone calls, or electronic self-reports. These interventions had diverse components, incorporating theories that have proven effective in face-to-face interventions as their theoretical frameworks. Some of them were complementary to in-person treatment, while others replaced it. Six interventions (28.5 %) displayed high quality: HealthCall, AB-CASI, Quit Genius, eCHECKUP-TOGO, CBI, and TES. Another nine interventions (42.8 %) were found to have moderate-high quality: Alcohol y Salud, IVR-BI, Program of Wallace et al., Let's Talk About Smoking, SMSalud, ESCAPE, AAC-ASPIRE, iQuit, and Programa VIH. One intervention (4.7 %) had moderate-low quality: Vive sin tabaco ¡Decídete! The remaining five interventions (23.8 %) were found to have very low quality: Connection to health, cSBI, Teen Well Check, the program of Helzer et al. (2008), and Down your drink. The programs with the highest recommendation for addressing alcohol-related issues are HealthCall and AB-CASI; for tobacco use, it is Quit Genius; for cannabis use, it is eCHECKUP-TOGO; for addressing both legal and illegal substances, it is CBI and TES. Finally, for specific illicit drug use, the only recommended program is CBI. This last intervention, CBI, is of the highest quality and, therefore, can be considered a model intervention for dissemination in the primary care setting.

[Indication and Contraindication of Video-Based Psychotherapy: A Qualitative Delphi Survey to Capture Psychotherapists' Reflection and Deliberation Processes]

OBJECTIVE

The Corona pandemic forced many psychotherapists to make a rapid transition to video setting. Even after the acute phase of the pandemic, video-based treatments can be determined to a certain extent in practice. Thus, indication and contraindication recommendations are essential to ensure treatment quality. However, empirical studies are almost completely lacking in this regard. In the context of this work, the decision-making and consideration processes of psychotherapists regarding video-based treatments are to be recorded and those factors that can have an effect on the indication are to be identified.

METHODS

Two-stage, qualitative Delphi survey with psychodynamically oriented psychotherapists (n=9) and behavioural therapists (n=7) who can be assigned to the fields of research and practice.

RESULTS

The quality of the therapeutic alliance guides the participants' choice of setting. An indication for video setting results from the feasibility of therapeutic interventions and the respective treatment goal. The therapists weighed the costs and benefits of video setting for various disorders. The changed feeling of control on both sides and the possibility of improving health care are decisive factors.

DISCUSSION

Based on the results, a decision tree for psychotherapists was created, which includes the identified indication criteria.

Outcomes of a Virtual Day Treatment Program for Adults With Eating Disorders-Comparison With In-Person Day Treatment

OBJECTIVE

Previous studies have indicated that virtual treatments for eating disorders (EDs) are roughly as effective as are in-person treatments; the present nonrandomized study aimed to expand on the current body of evidence by comparing outcomes from a virtual day treatment program with those of an in-person program in an adult ED sample.

METHOD

Participants were 109 patients who completed at least 60% of day treatment sessions (n = 55 in-person and n = 54 virtual). Outcome measures included ED and comorbid symptoms, and motivation.

RESULTS

Linear mixed models showed that global EDE-Q scores decreased during treatment (AIC = 376.396, F = 10.94, p = 0.002), irrespective of treatment modality (p = 0.186). BMI significantly increased over time (AIC = 389.029, F = 27.97, p < 0.001), with no effect of treatment modality (p = 0.779).

DISCUSSION

Our findings suggest that the virtual delivery of day treatments produces comparable outcomes to those obtained using in-person formats, and that virtual formats may represent a pragmatic treatment option, especially in situations in which access to in-person care is limited.

The Effects of Switching to Video Therapy on In-Session Processes in Psychotherapy During the COVID-19 Pandemic

OBJECTIVE AND AIM

This study aimed to assess the impact of switching from face-to-face (f2f) psychotherapy to video therapy (VT) due to the COVID-19 pandemic on in-session processes, i.e., the therapeutic alliance, coping skills, and emotional involvement, as rated by both patients and therapists.

METHODS

A total of N = 454 patients with mood or anxiety disorders were examined. The intervention group (IG) consisted of n = 227 patient-therapist dyads, who switched from f2f to VT, while the control group (CG) consisted of n = 227 patient-therapist dyads, who were treated f2f before the pandemic. To evaluate the effects of switching to VT on in-session processes, three longitudinal piecewise multilevel models, one per process variable, were fitted. Each process variable was regressed on the session number with a slope for the three sessions before switching to VT and a second slope for up to six VT sessions afterwards.

RESULTS

The therapeutic alliance significantly increased after switching from f2f to VT across the two groups (IG and CG) and raters (patients and therapists) with no differences between IG and CG. On average, patients rated the therapeutic alliance better than therapists. Coping skills significantly increased after switching from f2f to VT across the two groups and raters, but the CG rated coping skills higher than the IG after the switch. Overall, therapists rated coping skills higher than patients. Emotional involvement did not significantly increase after switching to VT across the two groups and raters and there was no significant difference between patient and therapist ratings.

DISCUSSION

In conclusion, the switch to VT had no negative impact on the therapeutic alliance and emotional involvement. However, more coping skills were reported in the CG than in the IG after the switch to VT, which was mainly due to a stagnation in patient-rated coping skills in the IG.

Can you tell me more about that? An examination of self-disclosure in videoconference and face-to-face psychological interviewing

OBJECTIVES

Videoconference psychotherapy (VCP) is a crucial component of many health care systems, allowing for remote delivery of services. However, little is known about the mechanisms of change within VCP. Previous research has suggested that self-disclosure may be greater in VCP than face-to-face modalities and was investigated in the current study.

DESIGN

Young adults aged 18-25 years (N = 57) were randomly allocated to face-to-face or VCP interview conditions, with measures completed pre- and post-interview.

METHODS

Participants completed an autobiographical memory task, requiring them to describe specific memories in response to positive and negative valence cue words. Measures included self-reported self-disclosure, blind observer-rated self-disclosure, memory specificity, and mean number of words per response.

RESULTS

No significant differences were found between conditions with regard to self-reported self-disclosure, capacity to recall specific memories, or words uttered per response. However, observer-rated depth of self-disclosure was significantly higher for participants in the face-to-face than VCP condition. Self-disclosure and memory specificity were also significantly greater for negative than positive valence cue words, regardless of condition.

CONCLUSIONS

The findings indicate that whilst participants may be able to draw on memories with equal ease regardless of interview modality, in VCP, emotional processing of these memories may require increased support and guidance from the therapist.

The long shadow of early-change patterns: a 3-year follow-up after the use of a web-based intervention for mild to moderate depressive symptoms

Web-based interventions can be effective in treating depressive symptoms. Patients with risk not responding to treatment have been identified by early change patterns. This study aims to examine whether early changes are superior to baseline parameters in predicting long-term outcome. In a randomized clinical trial with 409 individuals experiencing mild to moderate depressive symptoms using the web-based intervention deprexis, three latent classes were identified (early response after registration, early response after screening and early deterioration) based on early change in the first four weeks of the intervention. Baseline variables and these classes were included in a Stepwise Cox Proportional Hazard Multiple Regression to identify predictors associated with the onset of remission over 36-months. Early change class was a significant predictor of remission over 36 months. Compared to early deterioration after screening, both early response after registration and after screening were associated with a higher likelihood of remission. In sensitivity and secondary analyses, only change class consistently emerged as a predictor of long-term outcome. Early improvement in depression symptoms predicted long-term outcome and those showing early improvement had a higher likelihood of long-term remission. These findings suggest that early changes might be a robust predictor for long-term outcome beyond baseline parameters.

Evaluation of effectiveness and acceptability of a psychological treatment for smoking cessation combined with a smartphone App: A pilot study

Despite the increasing number of mobile-based interventions to quit smoking over the last years, few studies have investigated the efficacy of smoking cessation interventions blended with smartphone Apps. The present pilot study aims to examine the preliminary effectiveness and acceptability of a cognitive-behavioral treatment combined with a smartphone App, compared to the same psychological treatment without the App. The sample comprised 206 treatment-seeking smokers, who were assigned to: 1) an experimental group receiving a cognitive-behavioral intervention combined with the "Non Fumo" App (n = 102), and 2) a control group receiving only the cognitive-behavioral intervention to quit smoking (n = 104). Results concerning the primary outcomes showed no significant differences between conditions in point-prevalence abstinence rates at 12-month follow-up (35.30 % in the experimental group vs. 31.70 % in the control group) and in treatment acceptability. Regarding the secondary outcomes, both groups obtained similar point-prevalence abstinence rates at the end of treatment (61.80 % vs. 65.40 %), at 3-month (42.20 % vs. 45.20 %, respectively) and 6-month follow-ups (37.30 % vs. 37.50 %). No significant differences were found between conditions in prolonged abstinence rates at 6-month (35.3 % vs. 35.6 %) and 12-month follow-ups (30.4 % vs. 26.9 %). Overall, good abstinence rates and treatment acceptability were obtained, although there were no significant differences between conditions. More research is needed to establish clear conclusions about the efficacy of psychological smoking cessation treatments blended with smartphone Apps.

The Impact of Digital Mental Health Services on Loneliness and Mental Health: Results from a Prospective, Observational Study

BACKGROUND

Loneliness has increased since the COVID-19 pandemic and negatively impacts mental health. This study examined relationships between loneliness and mental health among adults using a digital mental health platform.

METHODS

A purposive sample of 919 participants (97% response rate) who were newly enrolled in the platform completed a survey on loneliness, depression, anxiety, well-being, stress, social support, and comorbidities at baseline and 3 months. Platform engagement was tracked during this period. We examined baseline differences between lonely and non-lonely participants; associations between loneliness, mental health symptoms, and comorbidities; and changes in loneliness and mental health through engagement in any form of care.

RESULTS

At baseline, 57.8% of the sample were categorized as lonely. Loneliness was associated with younger age, fewer years of education, and the presence of a comorbidity (p values < .05). Baseline loneliness was associated with greater depression, anxiety, and stress and lower well-being and social support (ps < .001). The percentage of lonely participants decreased at follow-up (57.6% to 52.9%, p = .03). Those who improved in loneliness improved in mental health symptoms, well-being, and social support (ps < .001). Lonely participants who engaged in any form of care reported a greater reduction in loneliness than those who did not engage (p = .04).

CONCLUSIONS

This study confirms previous findings of the high prevalence of loneliness among adults and risk factors for increased loneliness. Findings highlight the potential of digital platforms to reach lonely individuals and alleviate loneliness through remote mental health support.

Effectiveness of video-based psychiatric rehabilitation for patients with early-phase schizophrenia spectrum: A randomized controlled trial

AIM

This study aimed to establish a comprehensive set of recovery-oriented rehabilitation programs for individuals with schizophrenia, comparing the efficacy of video-based rehabilitation to traditional face-to-face interventions. The primary objective was to assess whether video-based rehabilitation could serve as a viable alternative for individuals with schizophrenia residing in remote areas.

METHODS

A randomized controlled study was used to recruit 80 patients with schizophrenia in a stable post-hospitalization stage following discharge. Participants were categorized into three groups: 24 in the control group, 21 in the face-to-face group, and 35 in the remote group. Assessment parameters included psychiatric symptoms, social skills, family function and self-stigma.

RESULTS

A total of 68 participants completed the program. The findings indicated significant differences (p < .05) between the control group and intervention group, particularly in the Positive and Negative Syndrome Scale (PANSS) and the Personal and Social Performance Scale (PSP).

CONCLUSIONS

The rehabilitation program, tailored for patients in the early phase of the schizophrenia spectrum, demonstrates both effectiveness and feasibility in enhancing clinical symptoms and social functions. Notably, interventions conducted via video proved to be equally effective as those administered face-to-face.

START NOW WebApp-promoting emotion regulation and resilience in residential youth care and correctional institutions: study protocol for a cluster randomized controlled trial

BACKGROUND

Adolescents and young adults in residential care and correctional institutions face various challenges, leading to negative life outcomes. Implementation barriers within these institutions, such as limited financial and spatial resources, pose significant hurdles to providing necessary support. Web-based approaches address these challenges by offering cost-effective, accessible solutions. This study aims to assess the efficacy of a newly developed web-based version of the existing evidence-based START NOW skills training in fostering emotion regulation and resilience among institutionalized adolescents and young adults. We present the study protocol (Version 5, August 2023) of the trial titled "Implementation of an e-version of the skills training START NOW for promoting emotion regulation and resilience in residential youth care and correctional institutions".

METHODS

The study is a monocentric, prospective, confirmatory randomized controlled trial with 150 institutionalized adolescents and young adults with a need to improve resilience (predefined cut-offs). Participating institutions will be randomized to one of three conditions: (i) 9-week web-based group training guided by a facilitator, (ii) 9-week web-based self-help training, (iii) and treatment as usual. The primary endpoint is the change in psychological flexibility, assessed by the Avoidance and Fusion Questionnaire for Youth score, from baseline to follow-up 12 weeks post skills training. Secondary objectives encompass assessing pre-post changes in psychological flexibility and other psychological health-related outcome measures in participating adolescents, young adults, and caretakers from baseline, to post training, and to 12- and 24-week follow-ups.

DISCUSSION

This study evaluates the efficacy of START NOW as web-based training for institutionalized adolescents and young adults, providing valuable insights into web-based interventions and aiming to optimize support levels. TRIAL REGISTRATION {2A AND 2B}: ClinicalTrials.gov NCT05313581. Registered on 6 April 2022.

Acceptability of Tele-mental Health Services Among Users: A Systematic Review and Meta-analysis

BACKGROUND

Mental disorders are currently a global public health concern, particularly after the coronavirus disease 2019 (COVID-19) pandemic. Mental health services gradually transitioned to teleservices, employing various methods like texting and videoconferencing. This meta-analysis aimed mainly to quantify the acceptability of tele-mental health services among both beneficiaries and providers. Secondary objectives included quantifying the usability of and satisfaction with these services.

METHODS

We conducted a systematic search of the following databases PubMed Central, SAGE, Google Scholar, Scopus, Web of Science, PubMed Medline, and EBSCO according to Preferred Reporting Items of the Systematic Reviews and Meta-Analysis (PRISMA) guidelines until December 2022.

RESULTS

Out of 3366 search results, 39 studies fully met the inclusion criteria. The pooled acceptability of tele-mental health services among beneficiaries was [71.0% with a 95% confidence interval (CI) of 63.0 - 78.5%, I2 = 98%]. Using meta-regression, four key factors contributed to this heterogeneity (R2 = 99.75%), namely, year of publication, type of mental disorder, participant category, and the quality of included studies. While acceptability among providers was [66.0% (95%CI, 52.0 - 78.0%), I2 = 95%]. The pooled usability of tele-mental health services among participants was [66.0% (95%CI, 50.0 - 80.0%), I2 = 83%]. Subgroup analysis revealed statistically significant results (p = 0.003), indicating that usability was higher among beneficiaries compared to providers.

CONCLUSIONS

The study highlighted a high acceptability of tele-mental health services. These findings suggest a promising outlook for the integration and adoption of tele-mental health services and emphasize the importance of considering user perspectives and addressing provider-specific challenges to enhance overall service delivery and effectiveness.

[Video-Based Online Metta-Meditation Therapy for Depression: A Pilot Trial Evaluating the Acceptability and Feasibility]

Background

In the course of the Covid-19 pandemic, it has become clear what relevance non-contact psychotherapeutic online interventions in mental health care could possibly have in the future. The present pilot study aims to test whether a Metta-based group program is also an acceptable and feasible treatment when conducted as video-based intervention. Metta meditations aim at showing unconditional benevolence and kindness to oneself and to other people.

Methods

Eight patients with depressive disorder participated in a video-based implementation of the Metta-based group program. Quality of the therapeutic relationship, the implementation of methods as well as the acceptance of the video-based therapy on the part of the participants were surveyed as target variables.

Results

Data indicated good feasibility in terms of a sustainable therapeutic relationship, the possibility of teaching meditation techniques, and the establishment of a concentrated working atmosphere. Videobased therapy met with good acceptance among the participants. Potential indications for its clinical effectiveness are evident.

Conclusion

Teaching Metta meditation in a group program for the treatment of depression can be practicably implemented in a video-based therapy and meets with good acceptance by the patients. Further studies on moderators of acceptance and efficacy of video-based therapy are needed.

Italian adolescents' perception of tele-psychodrama treatment during the COVID-19 Pandemic

BACKGROUND

Psychodrama is an experiential group psychotherapy that is used to enhance adolescents' wellbeing. The COVID-19 pandemic forced the adaptation of this method to an online setting.

OBJECTIVE

This qualitative study investigated whether and how tele-psychodrama provides psychological support to adolescents, in order to better understand its strengths and weaknesses.

PARTICIPANTS

14 adolescents from Northern and Central Italy.

METHOD

14 interviews were conducted at the end of group tele-psychodrama treatment and were analysed with qualitative thematic analysis.

RESULTS

Three themes were identified: (1) contribution of tele-psychodrama to adolescents' well-being; (2) implementation of psychodrama to the online setting; and (3) (the) shortcomings of tele-psychodrama.

CONCLUSIONS

Despite the differences between online and in-person psychodrama, all the participants expressed their appreciation of group tele-psychodrama, which contributed to their overall psychological wellbeing and helped them process difficulties that emerged during the lockdowns.

Impact of Telemedicine on Utilization of Psychiatric Resources in New York City during the COVID-19 Pandemic

This study sought to evaluate the impact of telepsychiatry during the COVID-19 pandemic among patients discharged from psychiatric inpatient units in the New York City Health and Hospitals Corporation system. We compared patients discharged to telepsychiatry (April 2020, n = 739) and in-person follow-up (May 2019, n = 527); we collected number, timing and attendance for follow-up appointments and number and timing of emergency room (ER) visits and readmissions. We used logistic regression to evaluate the odds of having these encounters and Kaplan-Meier analyses to compare time to these encounters. Patients discharged in 2020 were more likely to have a follow-up (29.4 vs. 19.9%, p < 0.001) and an ER visit or readmission (40.5 vs. 28.7%, p < 0.001). Kaplan-Meier analyses showed shorter time to first follow-up (chi-square = 14.69, d.f.=1, p < 0.0001, follow-ups = 322) and ER visit or readmission (chi-square = 19.57, d.f.=1, p < 0.0001, ER visits or admissions = 450) in the 2020 cohort. In multivariable analyses, patients discharged in 2020 were more likely to have a follow-up visit (adjusted OR 1.85, 95% confidence interval 1.40, 2.45, p < 0.0001). We found an increase in psychiatric service utilization during the pandemic, with an increase in and shorter time until outpatient visits and ER visits or readmissions. Although increased use of psychiatric services during the height of the COVID-19 pandemic is encouraging, it also points to the depth of the crisis among vulnerable populations; this pattern warrants further exploration and intervention.

How to promote usage of telehealth interventions for farmers' mental health? A qualitative study on supporting and hindering aspects for acceptance and satisfaction with a personalized telephone coaching for depression prevention

Low-threshold and remotely delivered preventive interventions, like telephone coaching, are warranted for farmers who experience multiple risk factors for depression, live in underserved areas, and show low help-seeking behavior. Factors facilitating uptake and actual use of effective remote interventions are important to reduce depression disease burden. This study aimed at identifying factors that potentially can influence acceptance of and satisfaction with a telephone coaching in this occupational group.Semi-structured interviews were based on the 'Unified Theory of Acceptance and Use of Technology', the 'Evaluation', and 'Discrepancy' models for satisfaction. Interviews were conducted with 20 of 66 invited participants of a 6-months telephone coaching during an effectiveness or implementation study. Audio-recorded interviews were transcribed and analyzed (deductive-inductive qualitative content analysis). Independent coding by two persons resulted in good agreement (Κ = 0.80). Participants validated results via questionnaire.Overall, 32 supporting (SF) and 14 hindering factors (HF) for acceptance and satisfaction were identified and organized into five dimensions: Coaching result (SF = 9, HF = 3), coach (SF = 9, HF = 1), organization (SF = 5, HF = 2), the telephone as communication medium (SF = 4, HF = 5) and participant characteristics (SF = 5, HF = 3). Most named SFs were 'Flexible appointment arrangement' (n = 19/95 %) and 'low effort' (n = 17/85 %), while most reported HFs were 'lack of visual cues' (n = 12/60 %) and 'social/professional involvement restricts change process' (n = 10/50 %).The perceived changes initiated by coaching, a low effort through telephone conduct, and the indicated personalization were identified as important influencing factors on acceptance and satisfaction based on interviewees' statements. Both may be further enhanced by offering choice and advice for delivery formats (e.g., video-calls) and training of coaches in farm-related issues.

Study registration

German Clinical Trial Registrations: DRKS00017078 and DRKS00015655.

Perceived Quality of Online Music Therapy Sessions by Older Adults Aging at Home

Online delivery is new to the field of music therapy (MT). This research investigated older adults' perceived quality of MT online by certified music therapists. In this feasibility study, applying both process and outcome assessments, nine older adults volunteered to participate. Zoom was used, and a virtual music therapy (VMT) kit was developed as a resource. Surveys and observed technical difficulties revealed that perceived quality varied slightly by level of technical difficulty experienced; however, overall mean perceived quality was 7.2 out of 9. Post-study interviews revealed three main themes: (a) individual experiences with VMT, (b) individuals' suggestions for further development of VMT sessions, and (c) individuals' personal outcomes from VMT sessions. Participants reported overall positive experiences with VMT. Despite a slight decline in perceived quality when more technical difficulties were present, each participant reported a desire for more sessions, and they would recommend it to others.

Understanding psychology students' perspective on video psychotherapy and their intention to offer it after graduation: a mixed-methods study

Introduction

Video psychotherapy (VPT) demonstrated strong clinical efficacy in the past, with patients and psychotherapists expressing satisfaction with its outcomes. Despite this, VPT only gained full recognition from the German healthcare system during the COVID-19 pandemic. As society increasingly relies on new media, it seems likely that VPT will become even more relevant. Previous studies surveyed practicing psychotherapists and patients about advantages and disadvantages of VPT. In contrast, our approach targets a younger generation, specifically psychology students intending to become licensed practitioners after graduation.

Methods

Our mixed-methods study was conducted in an online survey format and had two main objectives. Firstly, we investigated which person-related variables are associated with psychology students' behavioral intention to offer VPT after graduation, using a multiple regression analysis. Secondly, we explored psychology students' perception of advantages and disadvantages of VPT and identified their desired learning opportunities regarding VPT in their study program, using qualitative content analysis.

Results

A sample of 255 psychology students participated. The multiple regression model explains 73% of inter-individual variance in the intention to offer VPT, with attitudes toward VPT showing the strongest relationship with intention to offer VPT. Expected usefulness, satisfaction with video conferencing, and subjective norm also showed significant relations. The students provided 2,314 statements about advantages, disadvantages, and desired learning opportunities, which we coded by means of three category systems. In terms of advantages, the most frequently mentioned categories were low inhibition threshold, flexibility in terms of location, and no need to travel. For disadvantages, the predominant categories included lack of closeness between patient and psychotherapist, lack of nonverbal cues, and problems with technology or internet connection. Regarding desired learning opportunities, training for technical skills, practical application through role-playing and self-experience, and general information about VPT were the most mentioned categories. In addition, we identified numerous other aspects related to these topics, reflecting a differentiated and balanced assessment of VPT.

Discussion

We discuss the theoretical and practical implications of our findings for training the next generation of psychotherapists and outline a specific five-step plan for integrating VPT into study programs.

Videoconferencing psychotherapy from a psychodynamic point of view. A qualitative analysis

There is a growing interest in delivering videoconferencing psychotherapy (VCP) due to the enormous impact of the COVID-19 pandemic on our lives since the beginning of severe restrictions worldwide in March 2020. Scientific literature has provided interesting results about the transition to remote sessions and its implications, considering different psychotherapy orientations. Less is known about whether and how VCP affects psychodynamic psychotherapeutic approaches and reports on remote work with severe and complex mental health problems such as severe personality disorders are still scarce. The aim of the study was to examine the experiences of psychodynamic psychotherapists, mainly delivering Transference-Focused Psychotherapy (TFP), with the transition and delivery of VCP during the first wave of the COVID-19 pandemic. Four hundred seventy-nine licensed psychotherapists completed an online survey during the peak of the pandemic. Survey data were analyzed using qualitative analysis. Results are presented and discussed concerning advantages and disadvantages regarding the access to psychotherapy, the specificity of the online video setting, bodily aspects, the quality of the therapeutic relationship, the therapeutic process including technical aspects and therapist's experience. Furthermore, we analyzed and discussed the statements concerning transference and countertransference reactions differentiating between high-level borderline and neurotic patients and low-level borderline patients. Our results support the importance to identify patients who potentially benefit from VCP. Further research including more prospective randomized controlled trials are needed to investigate the therapeutic implications of the findings.

Online versus in-person delivery of cognitive behaviour therapy for obsessive compulsive disorder: An examination of effectiveness

Cognitive behavioural therapy (CBT) including exposure and response prevention is the first-line psychological treatment for obsessive compulsive disorder (OCD). Given changes in the clinical landscape, there are increasing efforts to evaluate its effectiveness in online contexts. Mirroring the traditional in-person delivery, few studies have assessed the role of therapist-guided, manual-based CBT for OCD delivered in real-time via videoconferencing methods. The present study sought to fill this gap by comparing in-person and online delivery of group-based CBT for the treatment of OCD. A convenience sample of participants with moderate to severe OCD (n = 144) were recruited from a naturalistic database from two large OCD specialty assessment and treatment centres. Patients received group-based CBT that was provided in-person (pre-COVID-19 pandemic; March 2018 to March 2020) or online via videoconferencing (during the COVID-19 pandemic; March 2020 to April 2021). In both delivery methods, treatment consisted of 2-h weekly sessions led by trained clinicians. Analyses revealed that, regardless of treatment modality, both in-person and online groups demonstrated significant, reliable, and statistically equivalent improvements in OCD symptoms post-treatment. Videoconferenced, clinician-led CBT may be a promising alternative to in-person delivery for those with moderate to severe OCD symptoms.

Pilot Study of Group Interpersonal Psychotherapy for Depression Among Young People With Chronic Illness

OBJECTIVE

Interpersonal psychotherapy (IPT) is an evidence-based treatment for depression, demonstrating efficacy with adolescents and young adults. Social support is proposed to be an important treatment component and may be helpful for adolescents and young adults with chronic illness. The authors sought to assess the feasibility of delivering IPT to this population and to examine changes in depressive symptoms and perceived social support.

METHODS

An open-label feasibility trial of group-based IPT was conducted for adolescents and young adults with chronic illness (N=17). The 12-session group IPT was concurrent with group members' individual psychotherapy, and group IPT was focused on providing support in navigating interpersonal challenges related to the participants' chronic illness. Participants completed questionnaires assessing depressive symptoms and social support before treatment, midtreatment (6 weeks), and after treatment (12 weeks). Generalized estimating equation models, adjusted for repeated measures, were used to assess changes in depressive symptoms and social support over the course of treatment.

RESULTS

Deidentified clinical examples illustrated how IPT was practiced in a community mental health setting. Evidence for the feasibility of group IPT was mixed. Although participants had poor session attendance, there was a significant decrease in depressive symptoms (β=-2.94, 95% CI=-5.30 to -0.59, p=0.014) and a significant increase in perceived social support (β=4.24, 95% CI=0.51 to 7.98, p=0.026) by the end of treatment.

CONCLUSIONS

IPT may help address depressive symptoms and enhance social support among adolescents and young adults with chronic illness. Further research and adaptation are needed to address feasibility challenges in delivering group IPT to this population.

Making Lemonade out of Lemons: Dialectical Behavior Therapy via Telehealth During a Pandemic

The COVID-19 pandemic has created a burden on healthcare systems and increased demand for mental healthcare at a time when in-person services are limited. Many programs offering dialectical behavior therapy (DBT) for complex clients have pivoted to telehealth in order to increase access to critical mental healthcare. There is, however, limited research on the provision of telehealth treatment for clients with complex psychopathology more broadly, or the telehealth implementation of DBT more specifically. The aim of this study was to examine the use of telehealth services and related clinician attitudes and experiences in the context of DBT. We examined the degree of telehealth platform adoption among DBT clinicians, as well as changes in stress and self-care strategies. A supplemental aim was to gather clinicians' recommendations for providing DBT via telehealth. Participants included N = 99 DBT practitioners (79.8% female; 20.2% male). Qualitative and quantitative methods were used for data analysis. Findings show that telehealth DBT has been widely adopted among DBT clinicians, and that clinicians' attitudes to telehealth DBT are cautiously optimistic. Participants described three main areas of stress associated with DBT via telehealth provision, as well as lost and novel self-care strategies.

Exploring putative therapeutic mechanisms of change in a hybrid compassion-focused, ecological momentary intervention: Findings from the EMIcompass trial

Compassion-focused interventions represent a promising transdiagnostic approach, but the mechanisms involved in hybrid delivery combining face-to-face sessions and an ecological momentary intervention remain unexplored. The current study aimed at exploring associations of putative mechanisms with clinical outcomes at post-intervention/follow-up and mediation of outcome at follow-up by preceding pre-to post-intervention changes in putative mechanisms. The compassion-focused EMIcompass intervention was applied in an exploratory randomized controlled trial (treatment as usual (TAU) vs. TAU + EMIcompass) with youth with early mental health problems. Data was collected before randomization, at post-intervention and at four-week follow-up. We recruited N = 92 participants, N = 46 were allocated to the experimental condition. After control for baseline levels of the target outcomes, baseline-to post-intervention improvement in adaptive emotion regulation was associated with lower levels of clinical outcomes (e.g. psychological distress b = -1.15; 95%CI = -1.92 to -0.39) across time points. We could not detect indirect effects, but we observed associations of change in self-compassion and adaptive emotion regulation with outcomes at follow-up in the mediation analysis (e.g., β = -0.35, 95%CI = -0.52 to -0.16). If successfully targeted by interventions, self-compassion and emotion regulation may be promising putative therapeutic mechanisms of change.

Improving older adults' autobiographical memory through video-conferencing intervention during COVID-19

BACKGROUND

Autobiographical memory (AM) is valuable not only as an indicator of mental health and cognitive function, but also as a target of therapeutic intervention for older adults. In the context of the COVID-19 pandemic, the demand for online psychosocial interventions and assessment services has sharply increased. Thus, the present study examined the effectiveness of videoconferencing AM (vAM) intervention using the Ecological Momentary Assessment (EMA) method in addition to the traditional paper-and-pencil assessment among samples of community dwelling older adults.

METHODS

Twenty-seven older adults (aged 66-86 years) participated in a vAM intervention composed of 4 weekly 90-min sessions. The primary outcome was AM specificity, with secondary outcomes as depressive symptom and cognitive function, measured before and after the intervention. In addition, daily emotions were measured through EMA over 4 weeks of intervention. The EMA data were analyzed using a multilevel analysis.

RESULTS

The results showed low dropout rates (7%) and high EMA response rates (85%). Autobiographical memory specificity increased (Cohen's d = 0.678), and the level of depression declined significantly (Cohen's d = 0.375) after the program. Additionally, measures assessing cognitive function, such as Seoul Verbal Learning Test and DSC (Digit Symbol Coding), showed significant improvements. The EMA results indicated a decrease in the intensity and proportion of negative emotions experienced during the program.

CONCLUSIONS

This study is the first to utilize videoconferencing and EMA to deliver an AM intervention targeting older adults. The intervention was effective in improving mental health and cognitive function, including AM in older adults. Additionally, EMA was found to be a feasible tool for use in older adults.

Decreased inpatient psychiatric admissions with telepsychiatry use during the COVID-19 pandemic

Objective

This study examines the quality of care provided through telepsychiatry by comparing psychiatric hospitalization rates among patients receiving in-person psychiatric care prior to the COVID-19 pandemic with rates among patients receiving virtual psychiatric care during the COVID-19 pandemic.

Methods

Mental health-related hospitalization rates among patients enrolled in a large academic hospital's outpatient psychiatry programs between March 1, 2018 and February 28, 2022 were retrospectively analyzed. Four time periods were created, spanning March 1 to February 28 of the following year. Demographic and clinical data were collected from the electronic health record, and descriptive statistics were calculated. Change in hospitalization rate between time periods was evaluated using McNemar's test.

Results

In the 2018 time period, 7.38% of all enrolled patients were hospitalized, compared to 7.70% hospitalized in the 2019 period, 5.74% in the 2020 period, and 5.38% in the 2021 period. Patients enrolled in both the 2018 and the 2019 periods saw no difference in hospitalization rate between the 2 years (2.93% in 2018, 2.83% in 2019; p = 0.830); patients enrolled in both 2019 and 2020 saw significantly lower hospitalization rates in 2020 (5.47% in 2019, 4.58% in 2020; p = 0.022); and patients enrolled in both 2020 and 2021 saw no difference (3.34% in 2020, 3.23% in 2021; p = 0.777).

Conclusion

Psychiatric hospitalization rates significantly decreased between the 2019 and the 2020 periods, suggesting a decrease in admissions associated with adoption of telepsychiatry. Future research should differentiate the roles played by telepsychiatry and COVID-19-related factors in reducing hospitalization rates during the pandemic.

Characteristics of effective teletherapy for major depression: A systematic review

BACKGROUND

People would prefer to have psychotherapy as treatment over medication for major depression. There is evidence that psychotherapy does not require in-person delivery to be effective. Other modes of delivery, such as videoconferencing teletherapy, may make it a more accessible treatment.

METHOD

The aim of this review was to identify the characteristics of effective psychotherapy delivered by videoconference for adults in primary care with a primary diagnosis of depression. A quantitative systematic review was conducted and reported according to PRISMA guidelines.

RESULTS

There were 8 studies included in the review. The therapies studied were tele problem-solving therapy, behavioural activation and cognitive behavioural therapy. All studies had a medium to high risk of bias. Six were randomized controlled trials, one was a pragmatic retrospective cohort study and one was an open-label design. Four studies found similar outcomes to the in-person comparators, one study found tele problem-solving therapy was more effective than behavioural activation, and one study found cognitive behavioural therapy to be similar to usual care.

LIMITATIONS

The search identified only 8 studies. Due to the heterogeneity of outcome measures and comparators, a meta-analysis could not be conducted.

CONCLUSIONS

No definitive conclusions can be drawn about the effectiveness of teletherapy in primary care based on this review, however, there is emerging evidence to suggest it has similar outcomes to in-person therapy for people with a primary diagnosis of depression. There is no evidence regarding the superiority of one model of therapy over the others.

Patient experience with telehealth service in a mental health setting

The purpose of the quality improvement project is to explore the patient experience of telehealth services in a mental health setting during the COVID-19 pandemic. A cross-sectional survey design was deployed in an outpatient psychiatric setting. Forty-five participants completed the survey, and the smartphone was the most frequently used and preferred device for their telehealth service. Participants exhibited a high level of usability for telehealth services (Mean = 5.82, SD = 1.21). Telehealth can be a way to solve the problem of not having enough mental health services available, even though there are potential barriers such as digital literacy and human engagement.

Telemedicine during the COVID-19 pandemic in Germany: Results from three nationally representative surveys on use, attitudes and barriers among adults affected by depression

Introduction

The COVID-19 pandemic has necessitated a reduction in face-to-face consultations, resulting in significant limitations in healthcare for individuals with depression. To ensure safe and adequate care, e-health services, such as telemedicine, gained a more prominent role. Governments have eased restrictions on the use of telemedicine, enabling healthcare professionals to increasingly offer video and telephone consultations.

Objective

This study examines, 1) possible changes over the course of the pandemic in reported use of video and telephone consultations and intended future use of video consultations with healthcare professionals among adults with diagnosed depression; 2) their attitudes towards video and telephone consultations and perceived barriers towards using e-health after prolonged time of the pandemic; and 3) differences in results between subgroups based on sociodemographic and clinical characteristics.

Methods

Three population-representative online surveys were conducted in Germany at different timepoints (t) during the COVID-19 pandemic. Respondents aged 18-69 years with a professionally diagnosed depression were included in the present analyses (t1: June/July 2020 with n = 1094; t2: February 2021 with n = 1038; t3: September 2021 with n = 1255).

Results

The overall proportion of adults with depression who used video or telephone consultations did not change significantly in the time surveyed (t1: 16.51 %, n = 179; t2: 20.23 %, n = 210; t3: 18.47 %, n = 230). However, among users, reported use of video consultations with a psychotherapist increased significantly from t1 (34.83 %, n = 62) to t3 (44.98 %, n = 102, p = .023). Intended future use of VC for healthcare varied depending on the purpose of the consultation. Significant differences over time were only found for the purpose of using VC to discuss clinical findings, laboratory results and diagnostic analyses with a doctor, with higher intentions reported at t2 during lockdown in Germany. At t3, the majority of adults with depression felt that video and telephone consultations were too impersonal and considered them more as a helpful support rather than an alternative to face-to-face psychotherapy. Key barriers to using e-health were found within the societal context and the lacking support from significant others for using e-health, while knowledge and skills represented facilitators for using e-health.

Conclusion

Despite ambivalent attitudes towards video and telephone consultations among adults with depression, reported use of video consultations with a psychotherapist increased during the COVID-19 pandemic.

A service evaluation to examine the effectiveness of chronic pain management programmes delivered using video conferencing technology compared to in-person

Introduction

The Covid-19 pandemic required rapid substitution of in-person Pain Management Programmes (PMP) delivery with delivery via videoconferencing technologies (VCT). No prior published VCT-PMP effectiveness findings were found, so an evaluation was conducted to explore effectiveness of this method and to compare psychometric outcomes with pre-pandemic, in-person- PMPs, delivered in routine clinical settings.

Methods

Participants were routinely attending PMPs. A consecutive series of six in-person-PMPs (n = 61) immediately prior to the pandemic were compared with the first series of six VCT-PMPs (n = 64) delivered in the same services. A within-subjects comparison of clinical outcomes (pre-post for VCT-PMP and in-person PMP) and a between-subjects comparison of delivery type was conducted (two-way mixed ANOVA). Reliable change indices examined reliable improvements and deteriorations by delivery type.

Results

Both PMP delivery format groups made significant improvements in anxiety, depression, pain self-efficacy, chronic pain acceptance and pain catastrophising. No significant difference was found between VCT-PMP and in-person-PMP on each of the measures. Reliable change indices indicated similar levels of improvement and deterioration with each delivery format with improvements far outweighing deteriorations. Attrition was greater in the VCT format (33%) versus in-person-PMP (18%).

Conclusion

This study indicates that meaningful change as measured by standard psychometric questionnaires can occur in PMPs delivered via VCT and appear broadly equivalent to that achieved through in-person delivery. Physical performance outcomes such as quality and amount of movement were not measured or explored.

Psychosocial Support Programs and Telepsychiatry Services Implemented in the World and Türkiye during the Pandemic

In this study, which addresses the psychosocial dimension of the COVID-19 pandemic, it is seen that the pandemic has increased the frequency of anxiety, anxiety, fear, and depression in the society. In this process in the world and in Türkiye, the majority of psychosocial support programs and mental health services are provided on online platforms and the frequency of use of telepsychiatry services has increased. In this study, Google Scholar and Pub Med were scanned and relevant domestic and international studies were examined. The aim of this article was to draw attention to the innovations brought about by the epidemic in the provision of mental health services to people and suggestions were made in order to contribute to the relevant literature.

Clinical Guidelines When Addressing Abuse over Telemental Health

Providing therapy services via Telemental Health (TMH), or teletherapy, has exponentially increased since the COVID-19 pandemic. Although previous research demonstrates that TMH is as effective as in-person therapy, there is a dearth of research on how therapists should address technology-perpetrated abuse and intimate partner violence (IPV) over TMH. This is extremely problematic given the frequency in which violence occurs in romantic relationships. This manuscript aims to address this gap by providing concrete clinical guidelines based on existing literature and professional experience with engaging in TMH services. The authors review literature on technology-perpetrated abuse and discuss innovative ways to assess and treat IPV over TMH by adapting protocols from Domestic Violence-Focused Couple's Therapy. Within this, the authors integrate research on high-conflict couples to provide new suggestions on how to manage couples who escalate quickly and who are prone to violence. The manuscript will conclude with future directions for research.

[Therapists' Perspectives on Changes in the Therapeutic Relationship after Switching from in-Person to Online Video Therapy Due to Corona: A Qualitative Analysis]

OBJECTIVE

The aim of this study was to investigate the extent to which the therapeutic relationship changed as a result of the COVID-19-related switch from face-to-face to video therapy.

METHOD

Twenty-one psychotherapists, who had changed the setting of therapy from face-to-face to video therapy were interviewed. The interviews were then transcribed, coded and superordinate themes were created in the context of a qualitative analysis.

RESULTS

More than half of the therapists reported that the therapeutic relationship with their patients remained stable. In addition, the majority of therapists described uncertainties in dealing with and responding to non-verbal signals, as well as maintaining an appropriate distance to their patients. Overall, both an improvement and a deterioration of the therapeutic relationship was reported.

DISCUSSION

The stability of the therapeutic relationship was mainly attributed to the therapists' previous face-to-face contact with their patients. The uncertainties expressed could be interpreted as risk factors for the therapeutic relationship. Although the sample represented only a small portion of working therapists, the findings from this study represent an important milestone in understanding how psychotherapy has changed as a result of the COVID-19 pandemic.

CONCLUSION

The therapeutic relationship remained stable despite the change from face-to-face to video therapy.

Improving access to psychological therapies: Analysis of effects associated with remote provision during COVID-19

BACKGROUND

COVID-19 had an immediate impact on the way Improving Access to Psychological Therapy (IAPT) services in the United Kingdom were delivered, requiring services to move to remote therapy. While remote therapy has been shown to be effective, little is known about the effects associated with moving to remote therapy delivered during COVID-19 within IAPT services.

OBJECTIVE

The objective of the study was to assess the characteristics of those undergoing remote therapy and test the effects associated with the effect of remote delivery on anxiety and depression symptoms compared with in-person therapy before lockdown.

METHODS

We conducted a retrospective, cross-sectional benchmark comparison of remote therapy across four IAPT services in Greater Manchester. Routinely collected measures of anxiety (GAD-7) and depression (PHQ-9) were used to compare effects across the two time periods. A mixed-effects model was conducted to assess within and between group changes in anxiety and depression, while controlling for pre-specified confounders.

FINDINGS

Remote therapy did not appear to impact on service provision, with the number of sessions offered and attended being similar to those prior to COVID-19. Both face-to-face (pre-COVID-19) and remote therapy (during COVID-19) were associated with variable improvements in anxiety and depression with no significant difference between them. However, remote therapy was associated with a more rapid decrease in symptoms in comparison with face-to-face treatment. Mean improvement in symptoms was small and increased as number of sessions/time increased and analysis of rates of improvement indicated that both face-to-face and remote therapy might need more time to reach target cut-off points on measures.

CONCLUSIONS

Both face-to-face and remote therapies delivered under IAPT were associated with improvements in symptoms with no apparent difference apart from the finding that remote therapy was associated with more rapid change.

CLINICAL IMPLICATIONS

Remote therapy delivery in IAPT does not appear to confer a disadvantage over face-to-face contact, but at a group mean level the magnitude of improvement associated with both treatments was small. Remote therapy provision may widen patient access to and engagement with psychological services.

Multidisciplinary implementation of family-based treatment delivered by videoconferencing (FBT-V) for adolescent anorexia nervosa during the COVID-19 pandemic

Family-Based Treatment (FBT)-the most widely supported treatment for pediatric eating disorders-transitioned to virtual delivery in many programs due to COVID-19. Using a blended implementation approach, we systematically examined therapist adherence to key components of FBT and fidelity to FBT by videoconferencing (FBT-V), preliminary patient outcomes, and team experiences with our FBT-V implementation approach as well as familial perceptions of FBT-V effectiveness. We examined our implementation approach across four pediatric eating disorder programs in Ontario, Canada, using mixed methods. Participants included therapists (n = 8), medical practitioners (n = 4), administrators (n = 6), and families (n = 5; 21 family members in total). We developed implementation teams at each site, provided FBT-V training, and offered clinical and implementation consultation. Therapists submitted video recordings of their first four FBT-V sessions for fidelity rating, and patient outcomes. Therapists self-reported readiness, attitudes, confidence, and adherence to FBT-V. Focus groups were conducted with each team and family after the first four sessions of FBT-V. Quantitative data were analyzed using repeated measures ANOVA. Qualitative data were analyzed using directed and summative content analysis. Therapists adhered to key FBT components and maintained FBT-V fidelity. Changes in therapists' readiness, attitudes, and confidence in FBT-V over time were not significant. All patients gained weight. Focus groups revealed implementation facilitators/barriers, positives/negatives surrounding FBT-V training and consultation, suggestions for improvement, and effectiveness attributed to FBT-V. Our implementation approach appeared to be feasible and acceptable. Future research with a larger sample is required, furthering our understanding of this approach and exploring how organizational factors influence treatment fidelity.

A Narrative Review on REM Sleep Deprivation: A Promising Non-Pharmaceutical Alternative for Treating Endogenous Depression

Endogenous depression represents a severe mental health condition projected to become one of the worldwide leading causes of years lived with disability. The currently available clinical and non-clinical interventions designed to alleviate endogenous depression-associated symptoms encounter a series of inconveniences, from the lack of intervention effectiveness and medication adherence to unpleasant side effects. In addition, depressive individuals tend to be more frequent users of primary care units, which markedly affects the overall treatment costs. In parallel with the growing incidence of endogenous depression, researchers in sleep science have discovered multiple links between rapid eye movement (REM) sleep patterns and endogenous depression. Recent findings suggest that prolonged periods of REM sleep are associated with different psychiatric disorders, including endogenous depression. In addition, a growing body of experimental work confidently describes REM sleep deprivation (REM-D) as the underlying mechanism of most pharmaceutical antidepressants, proving its utility as either an independent or adjuvant approach to alleviating the symptoms of endogenous depression. In this regard, REM-D is currently being explored for its potential value as a sleep intervention-based method for improving the clinical management of endogenous depression. Therefore, this narrative review represents a comprehensive inventory of the currently available evidence supporting the potential use of REM-D as a reliable, non-pharmaceutical approach for treating endogenous depression, or as an adjuvant practice that could improve the effectiveness of currently used medication.

Long-term psychodynamic psychotherapy in a face-to-face versus videoconferencing setting: A single case study

OBJECTIVE

Due to the coronavirus pandemic and crisis, psychotherapists around the world were forced to switch to video- or tele-based treatments overnight. To date, only a few studies on the effectiveness of video-based psychodynamic psychotherapy via the Internet exist. Therefore, the goal of the present study was to examine symptom improvement, therapeutic relationship, nonverbal synchrony processes, and intersession processes within a systematic single case design and compare face-to-face to video-based approaches in long-term psychodynamic-oriented psychotherapy.

METHODS

We examined 85 sessions of a client with major depression whose psychodynamic psychotherapy changed from a face-to-face setting to a video-based setting. Video recordings were analyzed using motion energy analysis, and nonverbal synchrony was computed using a surrogate synchrony approach. Time series analyses were performed to analyze changes in symptom severity, therapeutic relationship, and intersession processes.

RESULTS

The results showed that symptom severity improved descriptively, but not significantly, across the entire course of psychotherapy. There were significant differences, however, in the therapeutic relationship, intersession experiences, and synchronous behavior between the face-to-face and video-based settings.

CONCLUSION

The results indicate that the presented methodology is well situated to investigate the question whether psychodynamic psychotherapy in video-based setting works in the sameway as in a face-to-face setting.

Mental Health Service Utilization Rates Among Commercially Insured Adults in the US During the First Year of the COVID-19 Pandemic

Importance

The COVID-19 pandemic has been associated with an elevated prevalence of mental health conditions and disrupted mental health care throughout the US.

Objective

To examine mental health service use among US adults from January through December 2020.

Design, Setting, and Participants

This cohort study used county-level service utilization data from a national US database of commercial medical claims from adults (age >18 years) from January 5 to December 21, 2020. All analyses were conducted in April and May 2021.

Main Outcomes and Measures

Per-week use of mental health services per 10 000 beneficiaries was calculated for 5 psychiatric diagnostic categories: major depressive disorder (MDD), anxiety disorders, bipolar disorder, adjustment disorders, and posttraumatic stress disorder (PTSD). Changes in service utilization rates following the declaration of a national public health emergency on March 13, 2020, were examined overall and by service modality (in-person vs telehealth), diagnostic category, patient sex, and age group.

Results

The study included 5 142 577 commercially insured adults. The COVID-19 pandemic was associated with more than a 50% decline in in-person mental health care service utilization rates. At baseline, there was a mean (SD) of 11.66 (118.00) weekly beneficiaries receiving services for MDD per 10 000 enrollees; this declined by 6.44 weekly beneficiaries per 10 000 enrollees (β, -6.44; 95% CI, -8.33 to -4.54). For other disorders, these rates were as follows: anxiety disorders (mean [SD] baseline, 12.24 [129.40] beneficiaries per 10 000 enrollees; β, -5.28; 95% CI, -7.50 to -3.05), bipolar disorder (mean [SD] baseline, 3.32 [60.39] beneficiaries per 10 000 enrollees; β, -1.81; 95% CI, -2.75 to -0.87), adjustment disorders (mean [SD] baseline, 12.14 [129.94] beneficiaries per 10 000 enrollees; β, -6.78; 95% CI, -8.51 to -5.04), and PTSD (mean [SD] baseline, 4.93 [114.23] beneficiaries per 10 000 enrollees; β, -2.00; 95% CI, -3.98 to -0.02). Over the same period, there was a 16- to 20-fold increase in telehealth service utilization; the rate of increase was lowest for bipolar disorder (mean [SD] baseline, 0.13 [16.72] beneficiaries per 10 000 enrollees; β, 1.40; 95% CI, 1.04-1.76) and highest for anxiety disorders (mean [SD] baseline, 0.20 [9.28] beneficiaries per 10 000 enrollees; β, 9.12; 95% CI, 7.32-10.92). When combining in-person and telehealth service utilization rates, an overall increase in care for MDD, anxiety, and adjustment disorders was observed over the period.

Conclusions and Relevance

In this cohort study of US adults, we found that the COVID-19 pandemic was associated with a rapid increase in telehealth services for mental health conditions, offsetting a sharp decline in in-person care and generating overall higher service utilization rates for several mental health conditions compared with prepandemic levels.

[Video-based psychotherapy: current framework conditions, developments, and recommendations for practical implementation]

Video-based psychotherapy is a digital way to deliver psychotherapeutic treatment when traditional on-site psychotherapy cannot be provided due to structural barriers, such as those related to the COVID-19 pandemic. The use of this digital approach has proven to be both effective and accepted among therapists and patients. Legal frameworks for German therapists and recommendations for practical implementation are summarized in this article.

Adaptations of cognitive remediation therapy for adolescents with anorexia nervosa for delivery via telehealth

OBJECTIVE

The COVID-19 pandemic hastened a transition to treatment delivery via telehealth. While barriers still exist, the increased uptake of telehealth has the potential to increase access to mental health treatment for all diagnoses, including eating disorders. Delivery of evidence-based treatment as well as adjunctive treatments, including those that are hard to find in-person, have been modified to virtual format to increase accessibility and allow for continuity of care for adolescents with anorexia nervosa.

METHOD

We describe how to modify and deliver Cognitive Remediation Therapy for youth with anorexia nervosa (CRT-AN) via a telehealth platform. Preliminary and practical guidance for best practice for both group and individual delivery is established.

RESULTS

With minimal modifications, CRT-AN can be delivered via telehealth for both individual and group delivery. More disengagement in group delivery was noted; however, overall application of the treatment via a remote platform was observed.

DISCUSSION

As more treatment moves to a telehealth format, highlighting how an adjunctive treatment like CRT-AN can combined with other treatments in a telehealth format has the potential to increase research in its implementation and furthermore increase its dissemination.

PUBLIC SIGNIFICANCE

Cognitive Remediation Therapy for Anorexia Nervosa (CRT-AN) requires significant manipulation of materials and supplementary human guidance. Suggestions for how to modify CRT-AN for remote delivery via telehealth are provided. Modifications grew out of immediate changes made during the beginning of the COVID-19 pandemic and can be used to inform changes therapists and programs can make to continue to or begin to use CRT-AN in a remote fashion.

Preferences for telehealth: A qualitative study with people accessing a new mental health service

Objectives

To examine preferences for telehealth versus in-person services for people who sought mental health support from an unfamiliar service during the COVID-19 pandemic and to identify the factors that influenced these preferences.

Methods

Data are drawn from semi-structured interviews with 45 participants (32 people who accessed mental health services, 7 informal support people, and 6 people who accessed services themselves as well as identifying as informal supports). Data relating to experiences of telehealth, comparisons with in-person services and preferences were coded inductively and analysed using qualitative content analysis.

Results

Just over half of the participants in our sample preferred telehealth or at least regarded it as a suitable option. Those who preferred telehealth were more likely to have had direct experience, particularly via videoconferencing, as part of their access to this new mental health service. Reasons for preferring in-person services included belief in the superiority of interpersonal communication in these settings, compatibility with personal communication style and discomfort with technology. Those preferring telehealth cited its convenience, elimination of the need to travel for services, the comfort and safety afforded by accessing services at home and the ability to communicate more openly.

Conclusions

Hybrid models of care which harness the unique benefits of both in-person and remote service modalities appear to have a legitimate place in models of mental health care outside of pandemic situations. These results illuminate the potential of telehealth services when engaging with people seeking mental health help for the first time and in situations where existing relationships with service providers have not yet been established.

Videoconferencing analytic psychodrama in treating young adults' psychological suffering: preliminary results

The study aims to explore the effects that videoconferencing Analytic Psychodrama (AP) has on the psychological wellbeing and emotional competence of young adults who are suffering from mental health problems. Twenty-two undergraduate students, asking for help at the Psychological Counselling Service of the University of Bologna for anxiety-depressive problems, took part in the three online groups that met weekly from October 2020 to July 2021. The Clinical Outcomes in Routine Evaluation Outcome Measure, the Trait Emotional Intelligence Questionnaire Short Form, the Toronto Alexithymia Scale, the Interpersonal Reactivity Index, and the Group Climate Questionnaire were used as test-retest questionnaires for clinical outcomes, emotional competence, and group climate evaluations. There was a statistically significant difference between the pre-test and 10-month scores for patients in clinical outcomes. Alexithymia significantly decreased and emotional intelligence and group engagement increased post-intervention. Videoconferencing AP sounds promising for alleviating psychological problems and to improve young adults' emotional competence.

Male involvement in randomised trials testing psychotherapy or behavioural interventions for depression: a scoping review

The prevalence of Major Depressive Disorder in men is half that of women, yet depression affects approximately 109 million men worldwide. Alarmingly, men account for three quarters of suicides in Western countries but are unlikely to seek help for mental health concerns. It is possible that existing mental health treatments are not engaging or accessible to men. The aim of this review was to quantify the number of men involved in randomised trials of psychotherapy or lifestyle behaviour change targeting depression. Results found men represented 26% of participants in 110 eligible articles compared to 73% women. Men's representation was low across all intervention characteristics (e.g., delivery mode). No studies used a completely male sample, compared to 19 studies targeting women only. Men are substantially underrepresented in research trials targeting depression.

Supplementary information

The online version contains supplementary material available at 10.1007/s12144-022-04017-7.

Telemedicine Interventions as an Attempt to Improve the Mental Health of Populations during the COVID-19 Pandemic-A Narrative Review

Published reports indicate the need for psychological interventions and the integration of psychiatric care into crisis management plans in people with mental health issues caused by the COVID-19 pandemic. It seems crucial to identify the root causes of the health-social-economic crisis and identify potential opportunities for widely implemented psychological assistance. This narrative literature review aims to identify the types of interventions deployed as telemedicine-based mental health support and their effectiveness. The PubMed and Web of Science electronic databases were searched. From a total of 48 articles, 46 were analysed after removing duplicates. From these, thirty-seven records were excluded according to the inclusion criteria and nine (eight RCT and one cross-over) were assessed as full texts. The included publications were randomised clinical trials or cross-over studies focused on remote mental support interventions. In all studies, participants represented both sexes and had an average age range of 6-64. Studies included participants from seven countries and the overall number of participants in the included studies was 687. The content of these intervention programmes includes both established psychotherapeutic programmes, as well as new interventions. Remote support was implemented through three approaches: phone/video calls, mobile applications, and internet-based programs. The results of the included studies indicate a higher or equal efficacy of telemedicine interventions compared to traditional forms. The review also revealed a relatively wide range of targeted research groups: from children with social anxiety through to their caregivers; adolescents with neurological disorders; and from college students to adults with psychiatric or orthopaedic disorders. Analysis of the included papers found that telemedicine interventions show promising results as an attempt to improve population mental health during the COVID-19 pandemic.

Efficacy of nondrug interventions in perinatal depression: A meta-analysis

Perinatal depression causes significant harm to mothers and unborn infants. Nondrug intervention is a common and acceptable method for reducing perinatal depression in pregnant women; however, it lacks an evidence-based basis. This study aimed to evaluate the effectiveness of nondrug interventions, such as cognitive behavioral therapy (CBT), interpersonal psychotherapy (IPT), and yoga, in reducing perinatal depression. Randomized controlled trials (RCTs) of CBT, IPT, and yoga for improving perinatal depression were searched in the Cochrane Library, PubMed, Web of Science, Embase, ProQuest, ScienceDirect, ClinicalKey, Wanfang Data (Chinese database), and China Knowledge Resource Integrated Database. The retrieval time limit was set from the establishment of the database to December 2021. Twenty-one studies involving a total of 1981 participants were included.The present meta-analysis showed that CBT and IPT could effectively alleviate depressive symptoms in perinatal women, and the curative effect of IPT was better than that of CBT. There was no significant difference in the improvement effect of yoga on participants with depressive symptoms compared with that in the controls.This study was registered with the International Prospective Register of Systematic Reviews (PROSPERO, CRD42022307675).

The Best Predictor of the Future-the Metaverse, Mental Health, and Lessons Learned From Current Technologies

The metaverse-a virtual world accessed via virtual reality technology-has been heralded as the next key digital experience. It is meant to provide the next evolution of human interaction after social media and telework. However, in the context of the growing awareness of the risks to mental health posed by current social media technologies, there is a great deal of uncertainty as to the potential effects of this new technology on mental health. This uncertainty is compounded by a lack of clarity regarding what form the metaverse will ultimately take and how widespread its application will be. Despite this, given the nascent state of the metaverse, there is an opportunity to plan the research and regulatory approaches needed to understand it and promote its positive effects while protecting vulnerable groups. In this viewpoint, we examine the following three current technologies whose functions comprise a portion of what the metaverse seeks to accomplish: teleworking, virtual reality, and social media. We attempted to understand in what ways the metaverse may have similar benefits and pitfalls to these technologies but also how it may fundamentally differ from them. These differences suggest potential research questions to be addressed in future work. We found that current technologies have enabled tools such as virtual reality-assisted therapy, avatar therapy, and teletherapy, which have had positive effects on mental health care, and that the metaverse may provide meaningful improvements to these tools. However, given its similarities to social media and its expansion upon the social media experience, the metaverse raises some of the same concerns that we have with social media, such as the possible exacerbation of certain mental health problems. These concerns led us to consider questions such as how the users will be protected and what regulatory mechanisms will be put in place to ensure user safety. Although clear answers to these questions are challenging in this early phase of metaverse research, in this viewpoint, we use the context provided by comparator technologies to provide recommendations to maximize the potential benefits and limit the putative harms of the metaverse. We hope that this paper encourages discussions among researchers and policy makers.

Evidence of Phone vs Video-Conferencing for Mental Health Treatments: A Review of the Literature

PURPOSE OF REVIEW

The goal of this paper is to provide a comparative review of using phone (audio-only) or video for mental health treatments. Our review includes evidence of phone and video's effectiveness in terms of reduced symptomology, retention, satisfaction, therapeutic alliance, and other outcomes of interest. This review also discusses how patients and providers' experiences and attitudes differ between these two modalities. Finally, we present information on different usage rates of phone and video across patient populations and mental health provider types, and different implementation strategies.

RECENT FINDINGS

Treatments through phone and video are both able to reduce symptoms related to mental health conditions and have both been found to be non-inferior to in-person care. Both phone and video are more convenient to patients. Video offers important visual information that can be important to diagnosing mental health conditions. Phone, however, is more broadly accessible and may come with fewer technological issues. In the context of mental health care, where non-verbal cues are tied to symptomology and diagnosing, and a strong relationship between patient and provider can enhance treatment, we encourage the use of video, especially for psychotherapeutic services. However, as phone is more accessible, we ultimately recommend an accommodating approach, one that flexibly makes use of both phone and video. Future studies on telehealth should focus on direct, head-to-head comparisons between phone and video and conduct more rigorous testing on whether clinical differences exist.

Implementation Science of Telepsychotherapy for Anxiety, Depression, and Somatization in Health Care Workers Dealing with COVID-19

Introduction: Cognitive behavioral therapy (CBT) has proven to be effective in treating affective and somatic symptoms, which are among the leading mental health problems of health care workers (HCWs) dealing with COVID-19 (HCW-COVID-19). However, efforts to develop and evaluate the strategies required to promote its implementation in clinical practice are still scarce, particularly in low- and middle-income countries. Objective: To describe and evaluate the implementation process and clinical impact of a brief, remote, manualized CBT-based intervention for moderate anxiety, depressive, and somatic symptoms among Mexican HCW-COVID-19 ≥18 years old. Methods: The implementation process comprises community engagement, intervention systematization and education, leadership engagement, and team-based coaching as main strategies. A total of 26 participants completed self-report measures of symptoms before and after treatment, and a subsample of 21 answered a final questionnaire on the acceptability of the intervention. Therapists registered the techniques used in each case, regardless of whether they were part of the intervention manual. Results: The number of sessions was 4.6 (2.43). The most frequently employed techniques were those included in the intervention manual, especially identifying and modifying maladaptive thoughts, used to treat 70% of HCW-COVID-19. Supplementary techniques were implemented to enhance treatment or meet HCW-COVID-19s special needs (such as workplace issues, insomnia, COVID-19 status, and bereavement). The intervention had a significant effect (delta Cohen's coefficients ≥1), and the majority of HCW-COVID-19 were "totally satisfied" with its contents and considered it "not complex" (95.2% and 76.1%, respectively). Conclusions: Telepsychotherapy for anxiety, depression, and somatization in HCW coping with health emergencies in middle-income countries is a feasible, clinically valuable, and acceptable form of treatment.