Technological advances in the treatment of trauma: a review of promising practices

Feasibility and initial impact of single-session internet-delivered acceptance vs change skills for emotions for stress- and trauma-related problems: a randomized controlled trial

BACKGROUND

Current psychological trauma-focused interventions have left a gap for individuals who may not be ready for trauma-focused treatment and/or who present with other forms of clinically significant distress, such as subthreshold post-traumatic stress disorder (PTSD). Emotion regulation is a possible transdiagnostic mechanism of change that may promote and maintain some of the varied mental health problems related to trauma exposure.

AIMS

This study examines the feasibility and initial impact of two brief emotion regulation skill trainings targeting different processes hypothesized to reduce trauma-related problems, compared with an active control.

METHOD

Subjects (n = 156) were randomized to receive one of three brief internet-based trainings: (1) skill training on accepting emotions, (2) skill training on changing emotions, or (3) stress psychoeducation (control). Participants completed measures of emotion regulation, mindfulness, and affect intensity 24 hours pre- and immediately post-training.

RESULTS

Results suggested that a brief internet-based skills training programme was feasible and acceptable, with 91.9% completing the training programme to which they were randomized. Results showed that participants in all conditions demonstrated significant decreases in emotion regulation problems over time; yet these improvements did not vary by condition. Participants in the Change condition with higher PTSD symptoms were significantly more likely to have greater increases in positive affect compared with those with lower PTSD symptoms.

CONCLUSIONS

Although the three conditions did not show different outcomes, all three brief internet-delivered trainings were feasible. Results provide direction for future studies to evaluate the delivery of emotion regulation skills in individuals with trauma-related distress.

Examining the Effectiveness, Acceptability, and Feasibility of Virtually Delivered Trauma-Focused Domestic Violence and Sexual Violence Interventions: A Rapid Evidence Assessment

The COVID-19 pandemic has forced a rapid shift to virtual delivery of treatment and care to individuals affected by domestic violence and sexual violence. A rapid evidence assessment (REA) was undertaken to examine the effectiveness, feasibility and acceptability of trauma-focused virtual interventions for persons affected by domestic violence and sexual violence. The findings from this review will provide guidance for service providers and organizational leaders with the implementation of virtual domestic violence and sexual violence-focused interventions. The REA included comprehensive search strategies and systematic screening of and relevant articles. Papers were included into this review (1) if they included trauma-focused interventions; (2) if the intervention was delivered virtually; and (3) if the article was published in the English-language. Twenty-one papers met inclusion criteria and were included for analysis. Findings from the rapid review demonstrate that virtual interventions that incorporate trauma-focused treatment are scarce. Online interventions that incorporate trauma-focused treatment for this at-risk group are limited in scope, and effectiveness data are preliminary in nature. Additionally, there is limited evidence of acceptability, feasibility and effectiveness of virtual interventions for ethnically, culturally, and linguistically diverse populations experiencing domestic violence and sexual violence. Accessing virtual interventions was also highlighted as a barrier to among participants in studies included in the review. Despite the potential of virtual interventions to respond to the needs of individuals affected by domestic violence and/or sexual violence, the acceptability and effectiveness of virtual trauma-focused care for a diverse range of populations at risk of violence are significantly understudied.

Digital Health Interventions for Delivery of Mental Health Care: Systematic and Comprehensive Meta-Review

BACKGROUND

The COVID-19 pandemic has shifted mental health care delivery to digital platforms, videoconferencing, and other mobile communications. However, existing reviews of digital health interventions are narrow in scope and focus on a limited number of mental health conditions.

OBJECTIVE

To address this gap, we conducted a comprehensive systematic meta-review of the literature to assess the state of digital health interventions for the treatment of mental health conditions.

METHODS

We searched MEDLINE for secondary literature published between 2010 and 2021 on the use, efficacy, and appropriateness of digital health interventions for the delivery of mental health care.

RESULTS

Of the 3022 records identified, 466 proceeded to full-text review and 304 met the criteria for inclusion in this study. A majority (52%) of research involved the treatment of substance use disorders, 29% focused on mood, anxiety, and traumatic stress disorders, and >5% for each remaining mental health conditions. Synchronous and asynchronous communication, computerized therapy, and cognitive training appear to be effective but require further examination in understudied mental health conditions. Similarly, virtual reality, mobile apps, social media platforms, and web-based forums are novel technologies that have the potential to improve mental health but require higher quality evidence.

CONCLUSIONS

Digital health interventions offer promise in the treatment of mental health conditions. In the context of the COVID-19 pandemic, digital health interventions provide a safer alternative to face-to-face treatment. However, further research on the applications of digital interventions in understudied mental health conditions is needed. Additionally, evidence is needed on the effectiveness and appropriateness of digital health tools for patients who are marginalized and may lack access to digital health interventions.

Post-Traumatic Stress Disorder Treatment Outcomes in Military Clinics

INTRODUCTION

Despite a wide literature describing the impact of PTSD on military personnel, there is limited information concerning the results of PTSD treatment within military clinics mental health. Having such information is essential for making predictions about service members' chances of recovery, choosing best treatments, and for understanding if new interventions improve upon the standard of care.

MATERIALS AND METHODS

We reviewed data from the Psychological Health Pathways (PHP) database. Psychological Health Pathways is a standardized battery of demographics and psychometric outcome measures, including measurement of PTSD symptom severity, that is collected in military mental health clinics. We examined changes in PTSD symptom severity scores over time and developed logistic regression models to predict who responded to treatment, showed clinical success, or improved to the point that they could likely stay in the military.

RESULTS

After about 10 weeks in mental health clinics, severity scores for PTSD, sleep, depression, resilience, and disability all improved significantly. Of 681 patients tracked, 38% had clinically significant reductions on the PTSD Checklist (PCL) (i.e., "treatment response"), 28% no longer met criteria for PTSD on the PCL, and 23% did both (i.e., "clinical treatment success"). For the ultimate end point of "military treatment success," defined as meeting criteria for both clinical treatment success and reporting that their work-related disability was mild or better, 12.8% of patients succeeded. Depression scores were the most powerful predictor of treatment failure.

CONCLUSIONS

Recovery from PTSD is possible during military service, but it is less likely in individuals with certain negative prognostic factors, most notably severe depression.

EFFECTIVENESS OF INTERNET-DELIVERED COGNITIVE BEHAVIORAL THERAPY FOR POSTTRAUMATIC STRESS DISORDER: A SYSTEMATIC REVIEW AND META-ANALYSIS

BACKGROUND

Internet-delivered cognitive behavioral therapy (iCBT) is a relatively novel treatment method that may improve the accessibility of mental health care for individuals with posttraumatic stress disorder (PTSD). The aim of this meta-analysis was to evaluate the effectiveness of iCBT compared to inactive (waitlist control and treatment-as-usual (TAU)) and active other interventions in reducing PTSD symptoms.

METHODS

A meta-analysis of 12 randomized controlled trials (14 comparisons) and 1,306 participants was conducted.

RESULTS

The pooled effect size of the 11 comparisons (10 studies, 1,139 participants) that compared iCBT to waitlist and TAU control was moderate (g = 0.71, 95% CI [0.49-0.93], P < .001), and showed moderate heterogeneity. The pooled effect size of the three studies (three comparisons) comparing iCBT to other interventions was small (g = 0.28, 95% CI [-0.00 to 0.56], P = .05), with low heterogeneity.

CONCLUSION

The findings of this systematic review and meta-analysis show that iCBT is an effective treatment for individuals with PTSD and comorbid depressive symptoms. However, further research is needed for effective dissemination of iCBT in clinical practice.

Usefulness of telepsychiatry: A critical evaluation of videoconferencing-based approaches

Telepsychiatry, i.e., the use of information and communication technologies to provide psychiatric services from a distance, has been around for more than half a century now. Research over this period has shown that videoconferencing-based telepsychiatry is an enabling and empowering form of service delivery, which promotes equality of access, and high levels of satisfaction among patients. The range of services offered by videoconferencing-based telepsychiatry, potential users and points of delivery of such services are theoretically limitless. Telepsychiatry has both clinical utility and non-clinical uses such as administrative, learning and research applications. A large body of accumulated evidence indicates that videoconferencing-based telepsychiatric assessments are reliable, and clinical outcomes of telepsychiatric interventions are comparable to conventional treatment among diverse patient populations, ages and diagnostic groups, and on a wide range of measures. However, on many aspects of effectiveness, the evidence base is still relatively limited and often compromised by methodological problems. The lack of cost-effectiveness data in particular, is a major hindrance, raising doubts about the continued viability of telepsychiatric services. Added to this are the vagaries of technology, negative views among clinicians, poor uptake by providers, and several legal, ethical and administrative barriers. These hamper the widespread implementation of telepsychiatry and its integration with routine care. Though further advances in technology and research are expected to solve many of these problems, the way forward would be to promote telepsychiatry as an adjunct to conventional care, and to develop hybrid models, which incorporate both traditional and telepsychiatric forms of mental health-care.

Characteristics of successful technological interventions in mental resilience training

In the last two decades, several effective virtual reality-based interventions for anxiety disorders have been developed. Virtual reality interventions can also be used to build resilience to psychopathology for populations at risk of exposure to traumatic experiences and developing mental disorders as a result, such as for people working in vulnerable professions. Despite the interest among mental health professionals and researchers in applying new technology-supported interventions for pre-trauma mental resilience training, there is a lack of recommendations about what constitutes potentially effective technology-supported resilience training. This article analyses the role of technology in the field of stress-resilience training. It presents lessons learned from technology developers currently working in the area, and it identifies some key clinical requirements for the supported resilience interventions. Two processes made up this research: 1) developers of technology-assisted resilience programs were interviewed regarding human-computer interaction and system development; 2) discussions with clinicians were prompted using technology-centered concept storyboards to elicit feedback, and to refine, validate and extend the initial concepts. A qualitative analysis of the interviews produced a set of development guidelines that engineers should follow and a list of intervention requirements that the technology should fulfill. These recommendations can help bridge the gap between engineers and clinicians when generating novel resilience interventions for people in vulnerable professions.