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Saxler E, Schindler T, Philipsen A, Schulze M, Lux S. Therapeutic alliance in individual adult psychotherapy: a systematic review of conceptualizations and measures for face-to-face- and online-psychotherapy. Front Psychol 2024; 15:1293851. [PMID: 38993343 PMCID: PMC11238262 DOI: 10.3389/fpsyg.2024.1293851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 06/17/2024] [Indexed: 07/13/2024] Open
Abstract
Background The therapeutic alliance (TA) is a robust and pantheoretical predictor of treatment outcome in Face-to-Face- (F2F-) and Online-psychotherapy (Online-PT). Many authors have proposed several conceptualizations of TA, which are oftentimes operationalized. The resulting diversity of conceptualizations and measures is presented in this review. Methods We performed a three-parted literature search for self-report-instruments of TA in individual, voluntary F2F-PT with adults (1. utilization of past reviews, 2. systematic literature search yielding 5,205 articles, 3. reference lists). Analogously, we conducted a systematic literature search for instruments of TA in the Online-setting (yielding 200 articles). Additionally, we analyzed the content of the instruments qualitatively. Results A current overview of 48 instruments for measuring TA (46 for F2F-PT, 2 for Online-PT) including their conceptual backgrounds, characteristics and main content aspects is presented. Most instruments (n = 24) operationalize one or more theoretical conceptualizations of TA. Other instruments are adaptation/syntheses of existing measures (n = 14), based on literature searches (n = 3) or on an empirical survey (n = 3) and two instruments provide no conceptual background information. The content of the instruments mainly focused on the following aspects: 1. Self-disclosure and authenticity; 2. Agreement; 3. Active participation, motivation and compliance; 4. Trust and secure attachment; and 5. Considering needs/abilities/wishes of the patient. Additionally, a narrative review of various approaches to conceptualize TA is presented and linked to respective corresponding instruments. Discussion The broad variety of conceptualizations and measures of TA makes coherent research on TA difficult. There are conceptual challenges such as the role of attachment style in TA that remain to be clarified. The current conceptualizations and measures do not incorporate the practical experience and expertise of psychotherapists and patients sufficiently. A metatheoretical conceptualization and measure of TA based on an empirical survey of psychotherapists and patients could address these issues.
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Affiliation(s)
- Eva Saxler
- Deutsches Zentrum für Neurodegnerative Erkrankungen, University Clinic of Bonn, Bonn, Germany
| | - Theresa Schindler
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Alexandra Philipsen
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Marcel Schulze
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Silke Lux
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
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Doukani A, Quartagno M, Sera F, Free C, Kakuma R, Riper H, Kleiboer A, Cerga-Pashoja A, van Schaik A, Botella C, Berger T, Chevreul K, Matynia M, Krieger T, Hazo JB, Draisma S, Titzler I, Topooco N, Mathiasen K, Vernmark K, Urech A, Maj A, Andersson G, Berking M, Baños RM, Araya R. Comparison of the Working Alliance in Blended Cognitive Behavioral Therapy and Treatment as Usual for Depression in Europe: Secondary Data Analysis of the E-COMPARED Randomized Controlled Trial. J Med Internet Res 2024; 26:e47515. [PMID: 38819882 PMCID: PMC11179025 DOI: 10.2196/47515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 02/09/2024] [Accepted: 02/11/2024] [Indexed: 06/01/2024] Open
Abstract
BACKGROUND Increasing interest has centered on the psychotherapeutic working alliance as a means of understanding clinical change in digital mental health interventions in recent years. However, little is understood about how and to what extent a digital mental health program can have an impact on the working alliance and clinical outcomes in a blended (therapist plus digital program) cognitive behavioral therapy (bCBT) intervention for depression. OBJECTIVE This study aimed to test the difference in working alliance scores between bCBT and treatment as usual (TAU), examine the association between working alliance and depression severity scores in both arms, and test for an interaction between system usability and working alliance with regard to the association between working alliance and depression scores in bCBT at 3-month assessments. METHODS We conducted a secondary data analysis of the E-COMPARED (European Comparative Effectiveness Research on Blended Depression Treatment versus Treatment-as-usual) trial, which compared bCBT with TAU across 9 European countries. Data were collected in primary care and specialized services between April 2015 and December 2017. Eligible participants aged 18 years or older and diagnosed with major depressive disorder were randomized to either bCBT (n=476) or TAU (n=467). bCBT consisted of 6-20 sessions of bCBT (involving face-to-face sessions with a therapist and an internet-based program). TAU consisted of usual care for depression. The main outcomes were scores of the working alliance (Working Alliance Inventory-Short Revised-Client [WAI-SR-C]) and depressive symptoms (Patient Health Questionnaire-9 [PHQ-9]) at 3 months after randomization. Other variables included system usability scores (System Usability Scale-Client [SUS-C]) at 3 months and baseline demographic information. Data from baseline and 3-month assessments were analyzed using linear regression models that adjusted for a set of baseline variables. RESULTS Of the 945 included participants, 644 (68.2%) were female, and the mean age was 38.96 years (IQR 38). bCBT was associated with higher composite WAI-SR-C scores compared to TAU (B=5.67, 95% CI 4.48-6.86). There was an inverse association between WAI-SR-C and PHQ-9 in bCBT (B=-0.12, 95% CI -0.17 to -0.06) and TAU (B=-0.06, 95% CI -0.11 to -0.02), in which as WAI-SR-C scores increased, PHQ-9 scores decreased. Finally, there was a significant interaction between SUS-C and WAI-SR-C with regard to an inverse association between higher WAI-SR-C scores and lower PHQ-9 scores in bCBT (b=-0.030, 95% CI -0.05 to -0.01; P=.005). CONCLUSIONS To our knowledge, this is the first study to show that bCBT may enhance the client working alliance when compared to evidence-based routine care for depression that services reported offering. The working alliance in bCBT was also associated with clinical improvements that appear to be enhanced by good program usability. Our findings add further weight to the view that the addition of internet-delivered CBT to face-to-face CBT may positively augment experiences of the working alliance. TRIAL REGISTRATION ClinicalTrials.gov NCT02542891, https://clinicaltrials.gov/study/NCT02542891; German Clinical Trials Register DRKS00006866, https://drks.de/search/en/trial/DRKS00006866; Netherlands Trials Register NTR4962, https://www.onderzoekmetmensen.nl/en/trial/25452; ClinicalTrials.Gov NCT02389660, https://clinicaltrials.gov/study/NCT02389660; ClinicalTrials.gov NCT02361684, https://clinicaltrials.gov/study/NCT02361684; ClinicalTrials.gov NCT02449447, https://clinicaltrials.gov/study/NCT02449447; ClinicalTrials.gov NCT02410616, https://clinicaltrials.gov/study/NCT02410616; ISRCTN Registry ISRCTN12388725, https://www.isrctn.com/ISRCTN12388725?q=ISRCTN12388725&filters=&sort=&offset=1&totalResults=1&page=1&pageSize=10; ClinicalTrials.gov NCT02796573, https://classic.clinicaltrials.gov/ct2/show/NCT02796573. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.1186/s13063-016-1511-1.
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Affiliation(s)
- Asmae Doukani
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Matteo Quartagno
- Medical Research Council Clinical Trials Unit, University College London, London, United Kingdom
| | - Francesco Sera
- Department of Statistics, Computer Science and Applications "G. Parenti", University of Florence, Florance, Italy
| | - Caroline Free
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Ritsuko Kakuma
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Heleen Riper
- Department of Psychiatry, Amsterdam University Medial Centre, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Annet Kleiboer
- Department Clinical, Neuro, and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- Amsterdam Public Health Institute, Amsterdam, Netherlands
| | - Arlinda Cerga-Pashoja
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Anneke van Schaik
- Department of Psychiatry, Amsterdam University Medial Centre, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- Academic Department for Depressive Disorders, Dutch Mental Health Care, Amsterdam, Netherlands
| | - Cristina Botella
- Department of Basic Psychology, Clinical and Psychobiology, Universitat Jaume I, Castellón de la Plana, Spain
- Centro de Investigación Biomédica en Red Fisiopatología Obesidad y Nutrición, Instituto Carlos III, Madrid, Spain
| | - Thomas Berger
- Department of Clinical Psychology and Psychotherapy, University of Bern, Bern, Switzerland
| | - Karine Chevreul
- Unité de Recherche Clinique in Health Economics, Assistance Publique-Hôpitaux de Paris, Paris, France
- Health Economics Research Unit, Inserm, University of Paris, Paris, France
| | - Maria Matynia
- Faculty of Psychology, SWPS University, Warsaw, Poland
| | - Tobias Krieger
- Department of Clinical Psychology and Psychotherapy, University of Bern, Bern, Switzerland
| | - Jean-Baptiste Hazo
- Unité de Recherche Clinique in Health Economics, Assistance Publique-Hôpitaux de Paris, Paris, France
- Health Economics Research Unit, Inserm, University of Paris, Paris, France
| | - Stasja Draisma
- Department on Aging, Netherlands Institute of Mental Health and Addiction (Trimbos Institute), Utrecht, Netherlands
| | - Ingrid Titzler
- Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Naira Topooco
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
| | - Kim Mathiasen
- Department of Clinical Medicine, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
- Centre for Digital Psychiatry, Mental Health Services of Southern Denmark, Odense, Denmark
| | - Kristofer Vernmark
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
| | - Antoine Urech
- Department of Clinical Psychology and Psychotherapy, University of Bern, Bern, Switzerland
- Department of Neurology, Inselspital Bern, Bern University Hospital, Bern, Switzerland
| | - Anna Maj
- Faculty of Psychology, SWPS University, Warsaw, Poland
| | - Gerhard Andersson
- Department of Behavioral Sciences and Learning, Linköping University, Linköping, Sweden
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Matthias Berking
- Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Rosa María Baños
- Centro de Investigación Biomédica en Red Fisiopatología Obesidad y Nutrición, Instituto Carlos III, Madrid, Spain
- Department of Personality, Evaluation and Psychological Treatments, Universidad de Valencia, Valencia, Spain
| | - Ricardo Araya
- Department of Health Service and Population Research, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
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Goldberg SB, Jiwani Z, Bolt DM, Riordan KM, Davidson RJ, Hirshberg MJ. Evidence for Bidirectional, Cross-Lagged Associations Between Alliance and Psychological Distress in an Unguided Mobile-Health Intervention. Clin Psychol Sci 2024; 12:517-525. [PMID: 38863442 PMCID: PMC11164554 DOI: 10.1177/21677026231184890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/13/2024]
Abstract
Bidirectional associations between changes in symptoms and alliance are established for in-person psychotherapy. Alliance may play an important role in promoting engagement and effectiveness within unguided mobile health (mHealth) interventions. Using models disaggregating alliance and psychological distress into within- and between-person components (random intercept cross-lagged panel model), we report bidirectional associations between alliance and distress over the course of a 4-week smartphone-based meditation intervention (n=302, 80.0% elevated depression/anxiety). Associations were stable across time with effect sizes similar to those observed for psychotherapy (βs=-.13 to -.14 and -.09 to -.10, for distress to alliance and alliance to distress, respectively). Alliance may be worth measuring to improve the acceptability and effectiveness of mHealth tools. Further empirical and theoretical work characterizing the role and meaning of alliance in unguided mHealth is warranted.
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Affiliation(s)
- Simon B Goldberg
- Department of Counseling Psychology, UW-Madison, Madison, WI, USA
- Center for Healthy Minds, UW-Madison, Madison, WI, USA
| | - Zishan Jiwani
- Department of Counseling Psychology, UW-Madison, Madison, WI, USA
- Center for Healthy Minds, UW-Madison, Madison, WI, USA
| | - Daniel M Bolt
- Department of Educational Psychology, UW-Madison, Madison, WI, USA
| | - Kevin M Riordan
- Department of Counseling Psychology, UW-Madison, Madison, WI, USA
- Center for Healthy Minds, UW-Madison, Madison, WI, USA
| | - Richard J Davidson
- Center for Healthy Minds, UW-Madison, Madison, WI, USA
- Department of Psychology, UW-Madison, Madison, WI, USA
- Department of Psychiatry, UW-Madison, Madison, WI, USA
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Jørgensen SW, Petersen EN, Harnow S, Lee K, Nørgaard B. The meaning that people with severe mental illnesses ascribe to e-health in encounters with healthcare professionals - A repeat interview study. Int J Ment Health Nurs 2024; 33:62-72. [PMID: 37658655 DOI: 10.1111/inm.13221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 08/21/2023] [Accepted: 08/22/2023] [Indexed: 09/03/2023]
Abstract
This study sought to explore the meaning that people with severe mental illnesses attribute to e-health solutions regarding user involvement and encounters with healthcare professionals. A qualitative design with a social phenomenological approach was applied, and data were collected via repeat interviews. Using a purposive sampling strategy, eight people with severe mental illness were interviewed two times between August 2021 to May 2022, at three different treatment sites in southern Denmark. To be included, participants needed to be 18-65 years of age, diagnosed with severe mental illness (schizophrenia, bipolar disorder, or depression), and using an e-health solution in collaboration with a health professional. The interviews lasted between 20 and 70 min and were audio recorded and then transcribed. The data were analysed with Braun and Clarke's 6-step thematic analysis. Participants experienced the use of an e-health solution as helpful for structuring their everyday lives, and e-health used together with healthcare professionals was considered to have a positive impact on the collaboration. The participants experienced feeling involved and in control when e-health solutions were used, which engaged them in their treatment. Furthermore, the participants found it important to have had some in-person meetings with healthcare professionals to build trust before the e-health solutions could be implemented successfully. E-health solutions used in collaboration with a trusted healthcare professional whom the participants had met in person tended to affect treatment engagement positively.
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Affiliation(s)
| | - Esben Nedenskov Petersen
- Department of Media, Design, Education and Cognition, University of Southern Denmark, Odense, Denmark
| | - Søren Harnow
- Department of Media, Design, Education and Cognition, University of Southern Denmark, Odense, Denmark
| | - Kim Lee
- Department of Public Health, University of Southern Denmark, Odense, Denmark
- University College South Denmark, Esbjerg, Denmark
| | - Birgitte Nørgaard
- Department of Public Health, University of Southern Denmark, Odense, Denmark
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Savard J, Filion C, Brearty CM, Caplette‐Gingras A, Chiquette J, Dorval M. Fear of cancer recurrence in breast cancer survivors carrying a BRCA1/2 mutation: A qualitative study. Cancer Med 2024; 13:e6889. [PMID: 38192174 PMCID: PMC10807624 DOI: 10.1002/cam4.6889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 11/23/2023] [Accepted: 12/16/2023] [Indexed: 01/10/2024] Open
Abstract
BACKGROUND There is preliminary evidence suggesting that FCR is a major problem for breast cancer survivors carrying a BRCA1/2 mutation. The goal of this qualitative study, conducted among women who were treated for breast cancer, was to provide a deeper understanding of how FCR is experienced in the context of a genetic predisposition to breast cancer. METHOD Three focus groups (90-110 min) were conducted with 19 breast cancer survivors carrying a BRCA1/2 mutation. The semistructured interview probed FCR level and impact, the role FCR played in the decision to have a prophylactic bilateral mastectomy and/or salpingo-oophorectomy, the effect that surgery had on FCR, and the relevance of offering a psychological intervention targeting FCR to this population. RESULTS Findings indicated that FCR was a significant issue in these women, even though a majority had undergone a prophylactic surgery. Patients strongly affirmed the need to develop and provide access to FCR interventions that are specifically adapted to the needs of this group. DISCUSSION These results suggest that, although being the most effective medical option to reduce the actual risk of local recurrence (or second breast cancer), prophylactic surgery only partially reduces FCR. A psychological intervention targeting specifically FCR would be an appropriate complement to preventive surgery.
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Affiliation(s)
- Josée Savard
- School of PsychologyUniversité LavalQuébecQuébecCanada
- Centre de recherche du CHU de Québec‐Université LavalQuébecQuébecCanada
- Université Laval Cancer Research CenterQuébecQuébecCanada
| | - Catherine Filion
- Centre de recherche du CHU de Québec‐Université LavalQuébecQuébecCanada
- Université Laval Cancer Research CenterQuébecQuébecCanada
| | - Claudia Mc Brearty
- School of PsychologyUniversité LavalQuébecQuébecCanada
- Centre de recherche du CHU de Québec‐Université LavalQuébecQuébecCanada
- Université Laval Cancer Research CenterQuébecQuébecCanada
| | - Aude Caplette‐Gingras
- Centre de recherche du CHU de Québec‐Université LavalQuébecQuébecCanada
- Centre des maladies du sein, CHU de Québec‐Université LavalQuébecQuébecCanada
| | - Jocelyne Chiquette
- Centre de recherche du CHU de Québec‐Université LavalQuébecQuébecCanada
- Centre des maladies du sein, CHU de Québec‐Université LavalQuébecQuébecCanada
- Faculty of MedicineUniversité LavalQuébecQuébecCanada
| | - Michel Dorval
- Université Laval Cancer Research CenterQuébecQuébecCanada
- Faculty of PharmacyUniversité LavalQuébecQuébecCanada
- CISSS de Chaudière‐Appalaches Research CenterLévisQuébecCanada
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Ramachandran M, Brinton C, Wiljer D, Upshur R, Gray CS. The impact of eHealth on relationships and trust in primary care: a review of reviews. BMC PRIMARY CARE 2023; 24:228. [PMID: 37919688 PMCID: PMC10623772 DOI: 10.1186/s12875-023-02176-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Accepted: 10/11/2023] [Indexed: 11/04/2023]
Abstract
BACKGROUND Given the increasing integration of digital health technologies in team-based primary care, this review aimed at understanding the impact of eHealth on patient-provider and provider-provider relationships. METHODS A review of reviews was conducted on three databases to identify papers published in English from 2008 onwards. The impact of different types of eHealth on relationships and trust and the factors influencing the impact were thematically analyzed. RESULTS A total of 79 reviews were included. Patient-provider relationships were discussed more frequently as compared to provider-provider relationships. Communication systems like telemedicine were the most discussed type of technology. eHealth was found to have both positive and negative impacts on relationships and/or trust. This impact was influenced by a range of patient-related, provider-related, technology-related, and organizational factors, such as patient sociodemographics, provider communication skills, technology design, and organizational technology implementation, respectively. CONCLUSIONS Recommendations are provided for effective and equitable technology selection, application, and training to optimize the impact of eHealth on relationships and trust. The review findings can inform providers' and policymakers' decision-making around the use of eHealth in primary care delivery to facilitate relationship-building.
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Affiliation(s)
- Meena Ramachandran
- Bridgepoint Collaboratory for Research and Innovation, Lunenfeld-Tanenbaum Research Institute, Sinai Health, 1 Bridgepoint Dr, Toronto, ON, M4M 2B5, Canada.
- School of Physical and Occupational Therapy, McGill University, 3654 Promenade Sir-William-Osler, Montreal, QC, H3G 1Y5, Canada.
| | - Christopher Brinton
- Bridgepoint Collaboratory for Research and Innovation, Lunenfeld-Tanenbaum Research Institute, Sinai Health, 1 Bridgepoint Dr, Toronto, ON, M4M 2B5, Canada
- Michael G. DeGroote School of Medicine, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4L8, Canada
| | - David Wiljer
- Education Technology Innovation, University Health Network, 190 Elizabeth St, Toronto, ON, M5G 2C4, Canada
- Department of Psychiatry, University of Toronto, 155 College St, Toronto, ON, M5T 3M6, Canada
- Institute for Health Policy, Management and Evaluation, University of Toronto, 155 College St, Toronto, ON, M5T 3M6, Canada
- Centre for Addiction and Mental Health, 1000 Queen St W, Toronto, ON, M6J 1H4, Canada
| | - Ross Upshur
- Bridgepoint Collaboratory for Research and Innovation, Lunenfeld-Tanenbaum Research Institute, Sinai Health, 1 Bridgepoint Dr, Toronto, ON, M4M 2B5, Canada
- Dalla Lana School of Public Health, University of Toronto, 155 College St, Toronto, ON, M5T 3M6, Canada
| | - Carolyn Steele Gray
- Bridgepoint Collaboratory for Research and Innovation, Lunenfeld-Tanenbaum Research Institute, Sinai Health, 1 Bridgepoint Dr, Toronto, ON, M4M 2B5, Canada
- Institute for Health Policy, Management and Evaluation, University of Toronto, 155 College St, Toronto, ON, M5T 3M6, Canada
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Haller K, Becker P, Niemeyer H, Boettcher J. Who benefits from guided internet-based interventions? A systematic review of predictors and moderators of treatment outcome. Internet Interv 2023; 33:100635. [PMID: 37449052 PMCID: PMC10336165 DOI: 10.1016/j.invent.2023.100635] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 05/23/2023] [Accepted: 06/07/2023] [Indexed: 07/18/2023] Open
Abstract
To our knowledge, no systematic review has been conducted on predictors or moderators of treatment outcome across diagnoses in guided internet-based interventions (IBIs) for adults. To identify who benefits from this specific format and therein inform future research on improving patient-treatment fit, we aimed to aggregate results of relevant studies. 2100 articles, identified by searching the databases PsycInfo, Ovid Medline, and Pubmed and through snowballing, were screened in April/May 2021 and October 2022. Risk of bias and intra- and interrater reliability were assessed. Variables were grouped by predictor category, then synthesized using vote counting based on direction of effect. N = 60 articles were included in the review. Grouping resulted in 88 predictors/moderators, of which adherence, baseline symptoms, education, age, and gender were most frequently assessed. Better adherence, treatment credibility, and working alliance emerged as conclusive predictors/moderators for better outcome, whereas higher baseline scores predicted more reliable change but higher post-treatment symptoms. Results of all other predictors/moderators were inconclusive or lacked data. Our review highlights that it is currently difficult to predict, across diagnoses, who will benefit from guided IBIs. Further rigorous research is needed to identify predictors and moderators based on a sufficient number of studies. PROSPERO registration: CRD42021242305.
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Affiliation(s)
- Katrin Haller
- Clinical Psychological Interventions, Freie Universität Berlin, Berlin, Germany
- Clinical Psychology and Psychotherapy, Psychologische Hochschule Berlin, Berlin, Germany
| | - Pauline Becker
- Clinical Psychology and Psychotherapy, Psychologische Hochschule Berlin, Berlin, Germany
| | - Helen Niemeyer
- Clinical Psychological Interventions, Freie Universität Berlin, Berlin, Germany
| | - Johanna Boettcher
- Clinical Psychology and Psychotherapy, Psychologische Hochschule Berlin, Berlin, Germany
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8
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Pilch M, van Rietschoten T, Ortiz-Catalan M, Lendaro E, van der Sluis CK, Hermansson L. Interplay Between Innovation and Intersubjectivity: Therapists Perceptions of Phantom Motor Execution Therapy and Its Effect on Phantom Limb Pain. J Pain Res 2023; 16:2747-2761. [PMID: 37577161 PMCID: PMC10422994 DOI: 10.2147/jpr.s412895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 07/12/2023] [Indexed: 08/15/2023] Open
Abstract
Purpose Interpersonal processes, including therapeutic alliance, may modulate the impact of interventions on pain experience. However, the role of interpersonal context on the effects of technology-enhanced interventions remains underexplored. This study elicited therapists' perspectives on how a novel rehabilitative process, involving Phantom Motor Execution (PME), may impact phantom limb pain. The mediating role of therapeutic alliance, and the way PME influenced its formation, was investigated. Methods A qualitative descriptive design, using a framework method, was used to explore therapists' (n=11) experiences of delivering PME treatment. Semi-structured online-based interviews were conducted. Results A 3-way interaction between therapist, patient, and the PME device was an overarching construct tying four themes together. It formed the context for change in phantom limb experience. The perceived therapeutic effects (theme 1) extended beyond those initially hypothesised and highlighted the mediating role of the key actors and context (theme 2). The therapeutic relationship was perceived as a transformative journey (theme 3), creating an opportunity for communication, collaboration, and bonding. It was seen as a cause and a consequence of therapeutic effects. Future directions, including the role of expertise-informed adaptations and enabling aspects of customised solutions, were indicated (theme 4). Conclusion This study pointed to intrapersonal, interpersonal, and contextual factors that should be considered in clinical implementation of novel rehabilitative tools. The results demonstrated that therapists have unique insights and a crucial role in facilitating PME treatment. The study highlighted the need to consider the biopsychosocial model of pain in designing, evaluating, and implementing technology-supported interventions.
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Affiliation(s)
- Monika Pilch
- Centre for Health Policy & Management, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Tijn van Rietschoten
- University of Groningen, University Medical Center Groningen, Department of Rehabilitation Medicine, Groningen, the Netherlands
- University of Groningen, Faculty of Medical Sciences, Groningen, the Netherlands
| | - Max Ortiz-Catalan
- Center for Bionics and Pain Research, Mölndal, Sweden
- Bionics Institute, Melbourne, VC, Australia
- Department of Electrical Engineering, Chalmers University of Technology, Gothenburg, Sweden
| | - Eva Lendaro
- Department of Electrical Engineering, Chalmers University of Technology, Gothenburg, Sweden
- Department of Brain and Cognitive Sciences, McGovern Institute for Brain Research, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Corry K van der Sluis
- University of Groningen, University Medical Center Groningen, Department of Rehabilitation Medicine, Groningen, the Netherlands
| | - Liselotte Hermansson
- Department of Prosthetics and Orthotics, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
- University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
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Micklitz HM, Nagel Z, Jahn S, Oertelt-Prigione S, Andersson G, Sander LB. Digital self-help for people experiencing intimate partner violence: a qualitative study on user experiences and needs including people with lived experiences and services providers. BMC Public Health 2023; 23:1471. [PMID: 37533005 PMCID: PMC10394820 DOI: 10.1186/s12889-023-16357-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 07/20/2023] [Indexed: 08/04/2023] Open
Abstract
BACKGROUND Intimate partner violence (IPV) is a prevalent public health issue associated with multiple physical and mental health consequences for survivors. Digital interventions can provide low-threshold support to those experiencing IPV, but existing digital interventions have limited efficacy in improving the safety and mental health of IPV survivors. Digitally adapting an integrative intervention with advocacy-based and psychological content holds promise for increasing the efficacy of digital interventions in the context of IPV. METHODS This study examines the needs, acceptability and usability of an integrative digital intervention for people affected by IPV. We used the think-aloud method and semi-structured interviews with a sample of six people with lived experiences of IPV and six service providers. We analyzed the data using thematic analysis. RESULTS We identified the increasing general acceptance of digital support tools and the limited capacity of the current support system as societal context factors influencing the acceptance of and needs regarding digital interventions in the context of IPV. An integrative digital self-help intervention offers several opportunities to complement the current support system and to meet the needs of people affected by IPV, including the reduction of social isolation, a space for self-reflection and coping strategies to alleviate the situation. However, potentially ongoing violence, varying stages of awareness and psychological capacities, and as well as the diversity of IPV survivors make it challenging to develop a digital intervention suitable for the target group. We received feedback on the content of the intervention and identified design features required for intervention usability. CONCLUSION An integrative digital self-help approach, with appropriate security measures and trauma-informed design, has the potential to provide well-accepted, comprehensive and continuous psychosocial support to people experiencing IPV. A multi-modular intervention that covers different topics and can be personalized to individual user needs could address the diversity of the target population. Providing guidance for the digital intervention is critical to spontaneously address individual needs. Further research is needed to evaluate the efficacy of an integrative digital self-help intervention and to explore its feasibility it in different settings and populations.
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Affiliation(s)
- Hannah M Micklitz
- Medical Psychology and Medical Sociology, Faculty of Medicine, University of Freiburg, Hebelstraße 29, 79104, Freiburg, Germany.
| | - Zoë Nagel
- Department of Rehabilitation Psychology and Psychotherapy, Institute of Psychology, University of Freiburg, Freiburg, Germany
| | - Stella Jahn
- Department of Rehabilitation Psychology and Psychotherapy, Institute of Psychology, University of Freiburg, Freiburg, Germany
| | - Sabine Oertelt-Prigione
- Department of Primary and Community Care, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
- Department of Sex- and Gender-Sensitive Medicine, Medical Faculty OWL, University of Bielefeld, Bielefeld, Germany
| | - Gerhard Andersson
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Lasse B Sander
- Medical Psychology and Medical Sociology, Faculty of Medicine, University of Freiburg, Hebelstraße 29, 79104, Freiburg, Germany
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10
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Isaacs A, Mitchell EKL, Sutton K, Naughton M, Hine R, Bullock S, Azar D, Maybery D. Clinicians' and Users' Views and Experiences of a Tele-Mental Health Service Implemented Alongside the Public Mental Health System during the COVID-19 Pandemic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:ijerph20105870. [PMID: 37239597 DOI: 10.3390/ijerph20105870] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 05/11/2023] [Accepted: 05/15/2023] [Indexed: 05/28/2023]
Abstract
A tele-mental health model called Head to Health was implemented in the state of Victoria, Australia to address the crisis caused by the COVID-19 pandemic. It was a free centralized intake service that adopted a targeted approach with several novel elements, such as stepped care and telehealth. This study examines the views and experiences of clinicians and service users of the tele-mental health service in the Gippsland region of Victoria during the COVID-19 pandemic. Data from clinicians were obtained via an online 10-item open-ended survey instrument and from service users through semi-structured interviews. Data were obtained from 66 participants, including 47 clinician surveys and 19 service user interviews. Six categories emerged from the data. They were: 'Conditions where use of tele-mental health is appropriate', 'Conditions where tele-mental health may not be useful', 'Advantages of tele-mental health', 'Challenges in using tele-mental health', 'Client outcomes with tele-mental health', and 'Recommendations for future use'. This is one of a few studies where clinicians' and service users' views and experiences have been explored together to provide a nuanced understanding of perspectives on the efficacy of tele-mental health when it was implemented alongside public mental health services.
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Affiliation(s)
- Anton Isaacs
- School of Rural Health, Monash University, Warragul, VIC 3820, Australia
| | | | - Keith Sutton
- School of Rural Health, Monash University, Warragul, VIC 3820, Australia
| | - Michael Naughton
- School of Rural Health, Monash University, Warragul, VIC 3820, Australia
| | - Rochelle Hine
- School of Rural Health, Monash University, Warragul, VIC 3820, Australia
| | - Shane Bullock
- School of Rural Health, Monash University, Warragul, VIC 3820, Australia
| | - Denise Azar
- School of Rural Health, Monash University, Warragul, VIC 3820, Australia
- Gippsland Primary Health Network, Traralgon, VIC 3844, Australia
| | - Darryl Maybery
- School of Rural Health, Monash University, Warragul, VIC 3820, Australia
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11
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van Cappellen SM, Creemers HE, Hoogsteder L, van Horn J, Dekovic M, Asscher JJ. The effectiveness of blended versus regular Forensic Outpatient Systemic Therapy in the treatment of juvenile antisocial behavior: a study protocol of a randomized controlled trial. BMC Psychiatry 2023; 23:315. [PMID: 37143003 PMCID: PMC10158693 DOI: 10.1186/s12888-023-04831-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 04/30/2023] [Indexed: 05/06/2023] Open
Abstract
BACKGROUND Antisocial behavior during adolescence can have long-lasting negative effects and leads to high societal costs. Forensic Outpatient Systemic Therapy (Forensische Ambulante Systeem Therapie; FAST) is a promising treatment for juveniles aged 12-21 showing severe antisocial behavior. The intensity, content and duration of FAST can be adjusted to the needs of the juvenile and their caregiver(s), which is considered crucial for effective treatment. Next to the regular version of FAST (FASTr), a blended version (FASTb) in which face-to-face contacts are replaced by minimally 50% online contacts over the duration of intervention was developed during the Covid-19 pandemic. The current study will investigate whether FASTb is equally effective as FASTr, and through which mechanisms of change, for whom, and under which conditions FASTr and FASTb work. METHODS A randomized controlled trial (RCT) will be carried out. Participants (N = 200) will be randomly assigned to FASTb (n = 100) or FASTr (n = 100). Data collection will consist of self-report questionnaires and case file analysis, and include a pre-test at the start of the intervention, a post-test immediately after the intervention, and a six month follow-up. Mechanisms of change will be investigated using monthly questionnaires of key variables during treatment. Official recidivism data will be collected at two-year follow-up. DISCUSSION This study aims to improve the effectiveness and quality of forensic mental health care for juveniles with antisocial behavior by studying the effectiveness of blended care, which has not been studied before in treatment of externalizing behavior. If found to be at least as effective as face-to-face treatment, blended treatment can help meet the urgent need for more flexible and efficient interventions in this field. In addition, the proposed study aims to unravel what works for whom, knowledge urgently needed in mental health care for juveniles with severe antisocial behavior. TRIAL REGISTRATION This trial was registered at ClinicalTrials.gov on 07/11/2022, registration number NCT05606978.
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Affiliation(s)
- S Marjolein van Cappellen
- Department of Clinical Child & Family Studies, Utrecht University, P.O. Box 80140, Utrecht, 3584 CS, Netherlands.
| | - Hanneke E Creemers
- Faculty of Social and Behavioral Sciences, University of Amsterdam, P.O. Box 15776, 1011 NG, Amsterdam, Netherlands
| | - Larissa Hoogsteder
- Faculty of Social and Behavioral Sciences, University of Amsterdam, P.O. Box 15776, 1011 NG, Amsterdam, Netherlands
- De Waag, Outpatient forensic mental health care center, P.O. Box 1362, Utrecht, 3515 GA, Netherlands
| | - Joan van Horn
- De Waag, Outpatient forensic mental health care center, P.O. Box 1362, Utrecht, 3515 GA, Netherlands
| | - Maja Dekovic
- Department of Clinical Child & Family Studies, Utrecht University, P.O. Box 80140, Utrecht, 3584 CS, Netherlands
| | - Jessica J Asscher
- Department of Clinical Child & Family Studies, Utrecht University, P.O. Box 80140, Utrecht, 3584 CS, Netherlands
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12
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Janela D, Costa F, Weiss B, Areias AC, Molinos M, Scheer JK, Lains J, Bento V, Cohen SP, Correia FD, Yanamadala V. Effectiveness of biofeedback-assisted asynchronous telerehabilitation in musculoskeletal care: A systematic review. Digit Health 2023; 9:20552076231176696. [PMID: 37325077 PMCID: PMC10262679 DOI: 10.1177/20552076231176696] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 05/02/2023] [Indexed: 06/17/2023] Open
Abstract
Background Musculoskeletal conditions are the leading cause of disability worldwide. Telerehabilitation may be a viable option in the management of these conditions, facilitating access and patient adherence. Nevertheless, the impact of biofeedback-assisted asynchronous telerehabilitation remains unknown. Objective To systematically review and assess the effectiveness of exercise-based asynchronous biofeedback-assisted telerehabilitation on pain and function in individuals with musculoskeletal conditions. Methods This systematic review followed Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. The search was conducted using three databases: PubMed, Scopus, and PEDro. Study criteria included articles written in English and published from January 2017 to August 2022, reporting interventional trials evaluating exercise-based asynchronous telerehabilitation using biofeedback in adults with musculoskeletal disorders. The risks of bias and certainty of evidence were appraised using the Cochrane tool and Grading of Recommendations, Assessment, Development, and Evaluation (GRADE), respectively. The results are narratively summarized, and the effect sizes of the main outcomes were calculated. Results Fourteen trials were included: 10 using motion tracker technology (N = 1284) and four with camera-based biofeedback (N = 467). Telerehabilitation with motion trackers yields at least similar improvements in pain and function in people with musculoskeletal conditions (effect sizes: 0.19-1.45; low certainty of evidence). Uncertain evidence exists for the effectiveness of camera-based telerehabilitation (effect sizes: 0.11-0.13; very low evidence). No study found superior results in a control group. Conclusions Asynchronous telerehabilitation may be an option in the management of musculoskeletal conditions. Considering its potential for scalability and access democratization, additional high-quality research is needed to address long-term outcomes, comparativeness, and cost-effectiveness and identify treatment responders.
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Affiliation(s)
| | | | - Brandon Weiss
- Lake Erie College of Osteopathic Medicine, Erie, PA, USA
| | | | | | - Justin K. Scheer
- Department of Neurological Surgery, University of California, San Francisco, CA, USA
| | - Jorge Lains
- Rovisco Pais Medical and Rehabilitation Centre, Tocha, Portugal
- Faculty of Medicine, Coimbra University, Coimbra, Portugal
| | | | - Steven P. Cohen
- Departments of Anesthesiology & Critical Care Medicine, Physical Medicine and Rehabilitation, Neurology, and Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA
- Departments of Anesthesiology and Physical Medicine and Rehabilitation and Anesthesiology, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Fernando Dias Correia
- Sword Health, Inc, Draper, UT, USA
- Neurology Department, Centro Hospitalar e Universitário do Porto, Porto, Portugal
| | - Vijay Yanamadala
- Sword Health, Inc, Draper, UT, USA
- Department of Surgery, Quinnipiac University Frank H. Netter School of Medicine, Hamden, CT, USA
- Department of Neurosurgery, Hartford Healthcare Medical Group, Westport, CT, USA
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13
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Contreras M, Van Hout E, Farquhar M, McCracken LM, Gould RL, Hornberger M, Richmond E, Kishita N. Internet-delivered guided self-help Acceptance and Commitment Therapy for family carers of people with dementia (iACT4CARERS): a qualitative study of carer views and acceptability. Int J Qual Stud Health Well-being 2022; 17:2066255. [PMID: 35435153 PMCID: PMC9037213 DOI: 10.1080/17482631.2022.2066255] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Affiliation(s)
- Milena Contreras
- School of Health Sciences, University of East Anglia, Norwich, UK
| | - Elien Van Hout
- School of Health Sciences, University of East Anglia, Norwich, UK
| | - Morag Farquhar
- School of Health Sciences, University of East Anglia, Norwich, UK
| | | | - Rebecca L Gould
- Division of Psychiatry, University College London, London, UK
| | | | - Erica Richmond
- Older People’s Community Team, Norfolk and Suffolk NHS Foundation Trust, Norwich, UK
| | - Naoko Kishita
- School of Health Sciences, University of East Anglia, Norwich, UK
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Goldberg SB, Baldwin SA, Riordan KM, Torous J, Dahl CJ, Davidson RJ, Hirshberg MJ. Alliance With an Unguided Smartphone App: Validation of the Digital Working Alliance Inventory. Assessment 2022; 29:1331-1345. [PMID: 34000843 PMCID: PMC8599525 DOI: 10.1177/10731911211015310] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The working alliance may be relevant in unguided smartphone-based interventions, but no validated measure exists. We evaluated the psychometric properties of the six-item Digital Working Alliance Inventory (DWAI) using a cross-sectional survey of meditation app users (n = 290) and the intervention arm of a randomized trial testing a smartphone-based meditation app (n = 314). Exploratory factor analysis suggested a single-factor solution which was replicated using longitudinal confirmatory factor analysis. The DWAI showed adequate internal consistency and test-retest reliability. Discriminant validity was supported by a lack of association with social desirability, psychological distress, and preference for a waitlist condition. Convergent validity was supported by positive associations with perceived app effectiveness and preference for an app condition. Supporting predictive validity, DWAI scores positively predicted self-reported and objective app utilization. When assessed at Weeks 3 or 4 of the intervention, but not earlier, DWAI scores predicted pre-post reductions in psychological distress.
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15
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Costa F, Janela D, Molinos M, Moulder R, Bento V, Lains J, Scheer J, Yanamadala V, Cohen S, Dias Correia F. Impacts of Digital Care Programs for Musculoskeletal Conditions on Depression and Work Productivity: Longitudinal Cohort Study. J Med Internet Res 2022; 24:e38942. [PMID: 35714099 PMCID: PMC9361146 DOI: 10.2196/38942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 06/09/2022] [Accepted: 06/16/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Comorbidity between musculoskeletal (MSK) pain and depression is highly common, and is associated with a greater symptom burden and greater loss of work productivity than either condition alone. Multimodal care programs tackling both physical and mental health components may maximize productivity recovery and return to work. Digital delivery of such programs can facilitate access, ensure continuity of care, and enhance patient engagement. OBJECTIVE The aim of this study was to assess the impact of a completely remote multimodal digital care program (DCP) for MSK pain on mental health and work-related outcomes stratified by baseline depression levels. METHODS Ad hoc analysis of an interventional, single-arm, cohort study of individuals with MSK pain undergoing a DCP was performed. Three subgroups with different baseline depression severity levels were established based on responses to the Patient Health Questionnaire (PHQ-9): cluster 1 (score<5: minimal depression), cluster 2 (scores 5-10: mild depression), and cluster 3 (score≥10: moderate depression). The mean changes in depression, anxiety, fear-avoidance beliefs, work productivity, and activity impairment and adherence between baseline and end of program (8-12 weeks) were assessed across subgroups by latent growth curve analysis. RESULTS From a total of 7785 eligible participants, 6137 (78.83%) were included in cluster 1, 1158 (14.87%) in cluster 2, and 490 (6.29%) in cluster 3. Significant improvements in depression and anxiety scores were observed in clusters 2 and 3 but not in cluster 1, with average end-of-the program scores in clusters 2 and 3 below the initially defined cluster thresholds (score of 5 and 10, respectively). All clusters reported significant improvements in productivity impairment scores (mean changes from -16.82, 95% CI -20.32 to -13.42 in cluster 1 to -20.10, 95% CI -32.64 to -7.57 in cluster 3). Higher adherence was associated with higher improvements in depression in clusters 2 and 3, and with greater recovery in activities of daily living in cluster 3. Overall patient satisfaction was 8.59/10.0 (SD 1.74). CONCLUSIONS A multimodal DCP was able to promote improvements in productivity impairment scores comparable to those previously reported in the literature, even in participants with comorbid depression and anxiety. These results reinforce the need to follow a biopsychosocial framework to optimize outcomes in patients with MSK pain. TRIAL REGISTRATION ClinicalTrials.gov NCT04092946; https://clinicaltrials.gov/ct2/show/NCT04092946.
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Affiliation(s)
| | | | | | - Robert Moulder
- Institute for Cognitive Science, University of Colorado, Boulder, CO, United States
| | | | - Jorge Lains
- Rovisco Pais Medical and Rehabilitation Centre, Tocha, Portugal
- Faculty of Medicine, Coimbra University, Coimbra, Portugal
| | - Justin Scheer
- Department of Neurological Surgery, University of California, San Francisco, CA, United States
| | - Vijay Yanamadala
- SWORD Health Inc, Draper, UT, United States
- Department of Surgery, Frank H Netter School of Medicine, Quinnipiac University, Hamden, CT, United States
- Department of Neurosurgery, Hartford Healthcare Medical Group, Westport, CT, United States
| | - Steven Cohen
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, MD, United States
- Department of Physical Medicine and Rehabilitation, Uniformed Services University of the Health Sciences, Bethesda, MD, United States
| | - Fernando Dias Correia
- SWORD Health Inc, Draper, UT, United States
- Neurology Department, Centro Hospitalar e Universitário do Porto, Porto, Portugal
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Therapists’ perceptions and acceptability of providing internet-delivered guided self-help acceptance and commitment therapy (ACT) for family carers of people with dementia (iACT4CARERS): a qualitative study. COGNITIVE BEHAVIOUR THERAPIST 2021. [DOI: 10.1017/s1754470x21000337] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Abstract
This study aimed to explore therapists’ perceptions and acceptability of providing internet-delivered, therapist-guided, self-help acceptance and commitment therapy (ACT) for family carers of people with dementia (iACT4CARERS). To achieve this, a qualitative approach with semi-structured interviews was employed with eight novice therapists recruited from primary and secondary care services taking part in a feasibility study of iACT4CARERS. The interviews were audio-recorded, transcribed, and analysed using thematic analysis. Four over-arching themes were identified: (1) positive attitudes towards the intervention, (2) therapists’ workload, (3) therapists’ confidence to perform their role, and (4) connecting with family carers in a virtual context. Theme 1 included seeing their involvement as an opportunity for personal growth and perceiving benefits to the family carers, which contributed to greater acceptability. Theme 2 reflected that while workload and the user-friendliness of the online platform were highly acceptable among the therapists, there were also time-consuming cases that increased therapists’ burden. Theme 3 revealed that practical resources provided during the training, continued supervision, and opportunities to learn from other therapists, increased therapist confidence and facilitated greater acceptability. Finally, Theme 4 highlighted that improving the connection between therapists and carers was critical in a virtual context and strategies to improve the therapist–carer relationship were recommended. The implementation of iACT4CARERS was largely acceptable for the therapists involved in the trial. Ways to strengthen the therapeutic relationship in the virtual context and practical strategies to deal with common problems may enhance therapist experience and delivery in a full-scale effectiveness trial.
Key learning aims
(1)
To understand which factors facilitated therapists’ positive perceptions and acceptability of providing internet-delivered guided self-help ACT (iACT4CARERS).
(2)
To understand what challenges acted as barriers to therapists’ positive perceptions and acceptability of providing iACT4CARERS.
(3)
To learn what aspects of the training and the intervention can be refined to improve the acceptability to therapists in trials involving internet-delivered guided self-help interventions for family carers.
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Meyerhoff J, Haldar S, Mohr DC. The Supportive Accountability Inventory: Psychometric properties of a measure of supportive accountability in coached digital interventions. Internet Interv 2021; 25:100399. [PMID: 34026568 PMCID: PMC8122167 DOI: 10.1016/j.invent.2021.100399] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Revised: 04/28/2021] [Accepted: 04/29/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND One of the most widely used coaching models is Supportive Accountability (SA) which aims to provide intervention users with clear expectations for intervention use, regular monitoring, and a sense that coaches are trustworthy, benevolent, and have domain expertise. However, few measures exist to study the role of the SA model on coached digital interventions. We developed the Supportive Accountability Inventory (SAI) and evaluated the underlying factor structure and psychometric properties of this brief self-report measure. METHOD Using data from a two-arm randomized trial of a remote intervention for major depressive disorder (telephone CBT [tCBT] or a stepped care model of web-based CBT [iCBT] and tCBT), we conducted an Exploratory Factor Analysis on the SAI item pool and explored the final SAI's relationship to iCBT engagement as well as to depression outcomes. Participants in our analyses (n = 52) included those randomized to a receive iCBT, but were not stepped up to tCBT due to insufficient response to iCBT, had not remitted prior to the 10-week assessment point, and completed the pool of 8 potential SAI items. RESULTS The best fitting EFA model included only 6 items from the original pool of 8 and contained two factors: Monitoring and Expectation. Final model fit was mixed, but acceptable (χ 2 (4) = 5.24, p = 0.26; RMSR = 0.03; RMSEA = 0.091; TLI = 0.967). Internal consistency was acceptable at α = 0.68. The SAI demonstrated good convergent and divergent validity. The SAI at the 10-week/mid-treatment mark was significantly associated with the number of days of iCBT use (r = 0.29, p = .037), but, contrary to expectations, was not predictive of either PHQ-9 scores (F(2,46) = 0.14, p = .89) or QIDS-C scores (F(2,46) = 0.84, p = .44) at post-treatment. CONCLUSION The SAI is a brief measure of the SA framework constructs. Continued development to improve the SAI and expand the constructs it assesses is necessary, but the SAI represents the first step towards a measure of a coaching protocol that can support both coached digital mental health intervention adherence and improved outcomes.
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Affiliation(s)
- Jonah Meyerhoff
- Corresponding author at: Center for Behavioral Intervention Technologies, Northwestern University Feinberg School of Medicine, 750 North Lake Shore Drive, 10th Floor, Chicago, IL 60611, United States of America.
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Köhnen M, Dreier M, Seeralan T, Kriston L, Härter M, Baumeister H, Liebherz S. Evidence on Technology-Based Psychological Interventions in Diagnosed Depression: Systematic Review. JMIR Ment Health 2021; 8:e21700. [PMID: 33565981 PMCID: PMC7904404 DOI: 10.2196/21700] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 10/30/2020] [Accepted: 11/18/2020] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Evidence on technology-based psychological interventions (TBIs) for the treatment of depression is rapidly growing and covers a broad scope of research. Despite extensive research in this field, guideline recommendations are still limited to the general effectiveness of TBIs. OBJECTIVE This study aims to structure evidence on TBIs by considering different application areas (eg, TBIs for acute treatment and their implementation in health care, such as stand-alone interventions) and treatment characteristics (eg, therapeutic rationale of TBIs) to provide a comprehensive evidence base and to identify research gaps in TBIs for diagnosed depression. Moreover, the reporting of negative events in the included studies is investigated in this review to enable subsequent safety assessment of the TBIs. METHODS Randomized controlled trials on adults diagnosed with unipolar depression receiving any kind of psychotherapeutic treatment, which was at least partly delivered by a technical medium, were eligible for inclusion in our preregistered systematic review. We searched for trials in CENTRAL (Cochrane Central Register of Controlled Trials; until August 2020), MEDLINE, PsycINFO, PSYNDEX, CINAHL; until the end of January 2018), clinical trial registers, and sources of gray literature (until the end of January 2019). Study selection and data extraction were conducted by 2 review authors independently. RESULTS Database searches resulted in 15,546 records, of which 241 publications were included, representing 83 completed studies and 60 studies awaiting classification (ie, preregistered studies, study protocols). Almost all completed studies (78/83, 94%) addressed the acute treatment phase, being largely either implemented as stand-alone interventions (66/83, 80%) or blended treatment approaches (12/83, 14%). Studies on TBIs for aftercare (4/83, 5%) and for bridging waiting periods (1/83, 1%) were scarce. Most TBI study arms (n=107) were guided (59/107, 55.1%), delivered via the internet (80/107, 74.8%), and based on cognitive behavioral treatment approaches (88/107, 79.4%). Almost all studies (77/83, 93%) reported information on negative events, considering dropouts from treatment as a negative event. However, reports on negative events were heterogeneous and largely unsystematic. CONCLUSIONS Research has given little attention to studies evaluating TBIs for aftercare and for bridging waiting periods in people with depression, even though TBIs are seen as highly promising in these application areas; thus, high quality studies are urgently needed. In addition, the variety of therapeutic rationales on TBIs has barely been represented by identified studies hindering the consideration of patient preferences when planning treatment. Finally, future studies should use specific guidelines to systematically assess and report negative events. TRIAL REGISTRATION International Prospective Register of Systematic Reviews (PROSPERO) CRD42016050413; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42016050413. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.1136/bmjopen-2018-028042.
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Affiliation(s)
- Moritz Köhnen
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Mareike Dreier
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Tharanya Seeralan
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Levente Kriston
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Härter
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Harald Baumeister
- Department for Clinical Psychology and Psychotherapy, Ulm University, Ulm, Germany
| | - Sarah Liebherz
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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