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Sablone S, Bellino M, Lagona V, Franco TP, Groicher M, Risola R, Violante MG, Grattagliano I. Telepsychology revolution in the mental health care delivery: a global overview of emerging clinical and legal issues. Forensic Sci Res 2024; 9:owae008. [PMID: 39229280 PMCID: PMC11369075 DOI: 10.1093/fsr/owae008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 10/16/2023] [Indexed: 09/05/2024] Open
Abstract
Since the outbreak of the COVID-19 pandemic, remote healthcare delivery by technological devices has become a growing practice. It represented an unprecedented change in personal and professional activities, allowing health specialists to continue working online by assisting their patients from home. Psychological practice greatly benefited from this innovation, guaranteeing diagnostic and therapeutic effectiveness through cyber counseling. However, in many countries there have been no enactments of specific laws nor adaptations of the professional deontological code aimed at regulating this new psychological practice dimension, generally defined as telepsychology. This article aims to briefly review the scientific literature on this tool's effectiveness and especially analyze the legal and operational framework in which telepsychology has been to date practiced in Italy and other national realities, thus providing a global overview that may be useful to understand how to improve this valuable but still immature practice. Key points The coronavirus pandemic exposed to short- and long-term increase in psychological and psychiatric imbalances.Cyber counseling has been proven to be effective to treat a wide range of psychological disorders.Many of the current national and international legislations concerning the telepsychology practice are still immature. Ad hoc legal frameworks are required for each national context to guarantee a safe and effective cyber counseling delivery.
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Affiliation(s)
- Sara Sablone
- Section of Legal Medicine, Department of Interdisciplinary Medicine, Bari Policlinico Hospital, University of Bari, Bari, Italy
| | - Mara Bellino
- Section of Legal Medicine, Department of Interdisciplinary Medicine, Bari Policlinico Hospital, University of Bari, Bari, Italy
| | - Valeria Lagona
- Section of Legal Medicine, Department of Interdisciplinary Medicine, Bari Policlinico Hospital, University of Bari, Bari, Italy
| | - Tamara Patrizia Franco
- Department of Educational Sciences, Psychology, and Communication, University of Bari, Bari, Italy
| | - Matthew Groicher
- Department of Educational Sciences, Psychology, and Communication, University of Bari, Bari, Italy
| | - Roberta Risola
- Department of Educational Sciences, Psychology, and Communication, University of Bari, Bari, Italy
| | - Maria Grazia Violante
- Department of Educational Sciences, Psychology, and Communication, University of Bari, Bari, Italy
| | - Ignazio Grattagliano
- Department of Educational Sciences, Psychology, and Communication, University of Bari, Bari, Italy
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Vijayapriya CV, Tamarana R. Effectiveness of internet-delivered dialectical behavior therapy skills training on executive functions among college students with borderline personality traits: a non-randomized controlled trial. RESEARCH IN PSYCHOTHERAPY (MILANO) 2023; 26:694. [PMID: 37905964 PMCID: PMC10690726 DOI: 10.4081/ripppo.2023.694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 09/29/2023] [Indexed: 11/02/2023]
Abstract
Given the enormous influence of emotions on cognitive processes, individuals with borderline personality disorder (BPD) suffer from marked deficits in higher-order thinking abilities. Considering the prevalence of BPD among college students, this study aimed to investigate the changes in perceived executive functioning among college students with traits/presence of BPD undergoing internet-delivered dialectical behavior therapy skills training (DBT-ST) that included the mindfulness and emotion regulation modules. An internet-delivered version of DBT-ST was opted for, as technological advancements in the present era promote the use of online platforms for psychotherapy. This non-randomized controlled trial consisted of 36 college students with traits/presence of BPD. The intervention group attended 13 sessions of DBT-ST, and the control group attended 13 sessions of behavioral activation. Perceived executive functioning was assessed using the Behavior Rating Inventory of Executive Functions for Adults. A 2-way repeated measures analysis of variance was used to evaluate the treatment impact on the outcome variable. Results showed that the DBT-ST group had larger improvements in their abilities to initiate, plan, and organize current and future-oriented task demands and to organize their everyday environment, compared to the control group. Both, the DBT-ST group and the control group demonstrated improvements in emotional control, working memory, and their abilities to shift and task monitor. Findings suggest that the internet-delivered version of DBT-ST, consisting of the mindfulness and emotion regulation modules, can foster notable improvements in executive functions among college students with traits/presence of BPD. Improved executive functioning is one of the several multifaceted outcomes of dialectical behavior therapy.
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DeShong HL, Mason CK, Kelley K, Nelson SM, McDaniel C. Borderline personality disorder traits and rates of NSSI during the COVID-19 pandemic: An initial investigation. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2023:1-11. [PMID: 36947750 DOI: 10.1080/07448481.2023.2186139] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 12/29/2022] [Accepted: 02/26/2023] [Indexed: 06/18/2023]
Abstract
Objective: The current study evaluated frequency of nonsuicidal self-injury (NSSI) and associated maladaptive traits between three time periods: pre-pandemic, early pandemic, and later pandemic. Participants: Two college student samples (n = 362; n = 337) were collected via two online studies. Method: Participants completed measures assessing maladaptive borderline personality traits, engagement in NSSI over the past month, and reasons for and types of NSSI engaged in across the lifetime. Results: Results demonstrated a stable and potentially a slight increase in general rates of NSSI over the course of the pandemic. Further, specific maladaptive traits that underly borderline personality disorder (i.e., despondence, fragility, self-disturbance, and anxious-uncertainty) were related to engagement in NSSI 1-month post COVID. Conclusion: The study highlights the need for added interventions that might reach at risk populations during these heightened periods of stress.
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Affiliation(s)
- Hilary L DeShong
- Department of Psychology, Mississippi State University, Starkville, Mississippi State, USA
| | - Courtney K Mason
- Department of Psychology, Mississippi State University, Starkville, Mississippi State, USA
| | - Kren Kelley
- Department of Psychology, Mississippi State University, Starkville, Mississippi State, USA
| | - Sharon M Nelson
- Department of Veterans Affairs, Serious Mental Illness Treatment Resource and Evaluation Center, Office of Mental Health Operations, Washington, District of Columbia, USA
| | - Chandler McDaniel
- Department of Psychology, Mississippi State University, Starkville, Mississippi State, USA
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Lakeman R, King P, Hurley J, Tranter R, Leggett A, Campbell K, Herrera C. Towards online delivery of Dialectical Behaviour Therapy: A scoping review. Int J Ment Health Nurs 2022; 31:843-856. [PMID: 35048482 PMCID: PMC9305106 DOI: 10.1111/inm.12976] [Citation(s) in RCA: 10] [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: 10/26/2021] [Revised: 12/24/2021] [Accepted: 01/03/2022] [Indexed: 12/31/2022]
Abstract
Dialectical Behaviour Therapy (DBT) programmes are often the only available treatment for people diagnosed with borderline personality disorder and were rapidly converted to online delivery during the COVID-19 pandemic. Limited research exists surrounding how the major elements of DBT are delivered in an online environment. This scoping review considered the operationalization of online delivery of DBT and its effectiveness. EBSCO host databases were searched using free text. Of 127 papers, 11 studies from 2010 to 2021 investigating online DBT for any clinical population were included in the review. A narrative synthesis of papers selected was undertaken. Seven articles reported results from five clinical trials (n = 437). Most adaptations mirrored face-to-face programmes although there was considerable variation in how therapy was facilitated. Attendance was reported to be greater online with comparable clinical improvements to face-to-face for those who remained in therapy. Additional challenges included managing risk, therapist preparedness and technology difficulties. Online delivery of DBT programmes is feasible and may be more accessible, acceptable and as safe and effective as face-to-face delivery. However, mirroring face to face delivery in an online environment may not be the most effective and efficient way to adapt DBT to online provision. Research is needed to identify areas which require further adaptation.
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Affiliation(s)
- Richard Lakeman
- Faculty of Health, Southern Cross University, Bilinga, Queensland, Australia
| | - Peter King
- Australian DBT Institute, Southport, Queensland, Australia
| | - John Hurley
- Faculty of Health, Southern Cross University, Bilinga, Queensland, Australia
| | - Richard Tranter
- Mid North Coast Local Health District, Port Macquarie Base Hospital, Port Macquarie, New South Wales, Australia
| | - Andrew Leggett
- Mid North Coast Local Health District, Port Macquarie Base Hospital, Port Macquarie, New South Wales, Australia
| | - Katrina Campbell
- Faculty of Health, Southern Cross University, Bilinga, Queensland, Australia
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Shernoff ES, Ruork AK, Nadeem E, Rizvi SL. The feasibility and promise of Dialectical Behavior Therapy Skills Training with teachers and school personnel in high‐poverty schools. PSYCHOLOGY IN THE SCHOOLS 2022. [DOI: 10.1002/pits.22695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Elisa S. Shernoff
- School Psychology Department Rutgers University Piscataway New Jersey USA
| | - Allison K. Ruork
- School Psychology Department Rutgers University Piscataway New Jersey USA
| | - Erum Nadeem
- School Psychology Department Rutgers University Piscataway New Jersey USA
| | - Shireen L. Rizvi
- School Psychology Department Rutgers University Piscataway New Jersey USA
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van Leeuwen H, Sinnaeve R, Witteveen U, Van Daele T, Ossewaarde L, Egger JIM, van den Bosch LMC. Reviewing the availability, efficacy and clinical utility of Telepsychology in dialectical behavior therapy (Tele-DBT). Borderline Personal Disord Emot Dysregul 2021; 8:26. [PMID: 34717772 PMCID: PMC8556811 DOI: 10.1186/s40479-021-00165-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 09/14/2021] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Telepsychology is increasingly being implemented in mental health care. We conducted a scoping review on the best available research evidence regarding availability, efficacy and clinical utility of telepsychology in DBT. The review was performed using PRISMA-ScR guidelines. Our aim was to help DBT-therapists make empirically supported decisions about the use of telepsychology during and after the current pandemic and to anticipate the changing digital needs of patients and clinicians. METHODS A search was conducted in PubMed, Embase, PsycARTICLES and Web of Science. Search terms for telepsychology were included and combined with search terms that relate to DBT. RESULTS Our search and selection procedures resulted in 41 articles containing information on phone consultation, smartphone applications, internet delivered skills training, videoconferencing, virtual reality and computer- or video-assisted interventions in DBT. CONCLUSIONS The majority of research about telepsychology in DBT has focused on the treatment mode of between-session contact. However, more trials using sophisticated empirical methodologies are needed. Quantitative data on the efficacy and utility of online and blended alternatives to standard (i.e. face-to-face) individual therapy, skills training and therapist consultation team were scarce. The studies that we found were designed to evaluate feasibility and usability. A permanent shift to videoconferencing or online training is therefore not warranted as long as face-to-face is an option. In all, there is an urgent need to compare standard DBT to online or blended DBT. Smartphone apps and virtual reality (VR) are experienced as an acceptable facilitator in access and implantation of DBT skills. In addition, we have to move forward on telepsychology applications by consulting our patients, younger peers and experts in adjacent fields if we want DBT to remain effective and relevant in the digital age.
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Affiliation(s)
- Hanneke van Leeuwen
- Vincent van Gogh Centre of Excellence for Neuropsychiatry, Vincent van Gogh Institute for Psychiatry, Stationsweg 46, 5803, AC, Venray, the Netherlands. .,Cognition and Behaviour, Donders Institute for Brain, Radboud University, Nijmegen, the Netherlands. .,Dialexis, Training institute for Dialectical Behavior Therapy, Nijmegen, The Netherlands.
| | - Roland Sinnaeve
- Dialexis, Training institute for Dialectical Behavior Therapy, Nijmegen, The Netherlands.,UPC KU Leuven, Kortenberg, Belgium.,Department of Neurosciences, Mind Body Research, KU Leuven, Leuven, Belgium
| | - Ursula Witteveen
- Dialexis, Training institute for Dialectical Behavior Therapy, Nijmegen, The Netherlands.,GGNet for Psychiatry, Apeldoorn, the Netherlands.,Dutch Centre for treatment in DBT (NB-DBT), Harderwijk, the Netherlands
| | - Tom Van Daele
- Expertise Unit Psychology, Technology & Society, Thomas More University of Applied Sciences, Antwerp, Belgium
| | - Lindsey Ossewaarde
- Centre for Anxiety and Obsessive-Compulsive Disorders, Vincent van Gogh Institute for Psychiatry, Venray, the Netherlands
| | - Jos I M Egger
- Vincent van Gogh Centre of Excellence for Neuropsychiatry, Vincent van Gogh Institute for Psychiatry, Stationsweg 46, 5803, AC, Venray, the Netherlands.,Cognition and Behaviour, Donders Institute for Brain, Radboud University, Nijmegen, the Netherlands.,Stevig Specialized and Forensic Care for People with Intellectual Disabilities, Dichterbij, Oostrum, The Netherlands
| | - Louisa M C van den Bosch
- Dialexis, Training institute for Dialectical Behavior Therapy, Nijmegen, The Netherlands.,Dutch Centre for treatment in DBT (NB-DBT), Harderwijk, the Netherlands
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Norman-Nott N, Wilks CR, Hesam-Shariati N, Schroeder J, Suh J, Czerwinski M, Briggs NE, Quidé Y, McAuley J, Gustin SM. The No Worries Trial: Efficacy of Online Dialectical Behaviour Therapy Skills Training for Chronic Pain (iDBT-Pain) Using A Single Case Experimental Design. THE JOURNAL OF PAIN 2021; 23:558-576. [PMID: 34678466 DOI: 10.1016/j.jpain.2021.10.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 09/29/2021] [Accepted: 10/05/2021] [Indexed: 12/25/2022]
Abstract
Emotion dysregulation frequently co-occurs with chronic pain, which in turn leads to heightened emotional and physical suffering. This cycle of association has prompted a recommendation for psychological treatment of chronic pain to target mechanisms for emotion regulation. The current trial addressed this need by investigating a new internet-delivered treatment incorporating emotional skills training from dialectical behavioural therapy (DBT). Using a single-case experimental design that is suited to heterogeneous populations and can demonstrate efficacy with a small sample, three participants with chronic pain were recruited. Participants received four weeks of online DBT skills training (iDBT-Pain intervention) which incorporated one-on-one sessions over Zoom and a web app. Results revealed compelling evidence for the intervention on the primary outcome of emotion dysregulation and were promising for the secondary outcome of pain intensity. Improvement was also identified on pre-and post-measures of depression, coping behaviours, sleep problems, wellbeing, and harm avoidance, indicating that the intervention may positively influence other factors related to chronic pain. Overall, the trial provides preliminary efficacy for the intervention to improve chronic pain. However, we recommend further investigation of the iDBT-Pain intervention, either in single case trials, which when conducted with scientific rigour may be aggregated to derive nomothetic conclusions, or in a group-comparison trial to compare with usual modes of treatment. Perspective: This trial advances understanding of emotion-focused treatment for chronic pain and provides evidence for a viable new technological treatment. Importantly, as an internet-delivered approach, the iDBT-Pain intervention is accessible to those with restricted mobility and remote communities where there are often limited psychological services for people with chronic pain. Trial registration: The trial was registered on the Australian and New Zealand Clinical Trials Registry (ACTRN12620000604909).
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Affiliation(s)
- Nell Norman-Nott
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia; School of Psychology, University of New South Wales, Sydney, Australia
| | - Chelsey R Wilks
- Department of Psychological Science, University of Missouri-St Louis, United States
| | - Negin Hesam-Shariati
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia; School of Psychology, University of New South Wales, Sydney, Australia
| | - Jessica Schroeder
- School of Computer Science and Engineering, University of Washington, United States
| | - Jina Suh
- School of Computer Science and Engineering, University of Washington, United States; Microsoft Research, Redmond, United States
| | | | - Nancy E Briggs
- Stats Central, Mark Wainwright Analytical Centre, University of New South Wales, Sydney, Australia
| | - Yann Quidé
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia; School of Psychology, University of New South Wales, Sydney, Australia
| | - James McAuley
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia; School of Health Sciences, University of New South Wales, Sydney, Australia
| | - Sylvia M Gustin
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia; School of Psychology, University of New South Wales, Sydney, Australia.
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Witt K, Chitty KM, Wardhani R, Värnik A, de Leo D, Kõlves K. Effect of alcohol interventions on suicidal ideation and behaviour: A systematic review and meta-analysis. Drug Alcohol Depend 2021; 226:108885. [PMID: 34198137 DOI: 10.1016/j.drugalcdep.2021.108885] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 05/31/2021] [Accepted: 06/03/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Alcohol consumption is related to both suicidal ideation and behaviour, but evidence regarding the effect of psychological interventions to reduce alcohol use on self-harm, suicidal behaviour and ideation is limited. Therefore, the aim of the current study was to conduct a systematic literature review and meta-analysis of the effect of alcohol-related psychological interventions on these outcomes at the individual level. METHODS We searched the Cochrane CENTRAL, Cochrane DARE, EMBASE, Medline, ProQuest, PsycINFO, PubMed, SCOPUS, and Web of Science electronic databases to 5 January 2021. We included all English-language papers worldwide utilising psychological interventions with a focus on harmful alcohol use and suicidal ideation, self-harm, and/or suicidal behaviour. RESULTS We identified 11 studies, nine provided sufficient numerical data for meta-analysis. Although the methods and effect sizes varied substantially in the studies, reducing alcohol may led to a reduction in self-harm and suicide attempt by the final follow-up assessment (Odds ratio [OR] 0.57, 95% confidence interval [CI] 0.33 to 0.97, 6 studies, 491 participants, I2 = 0%). However, there was no apparent effect for these interventions on suicidal ideation or suicide deaths. There was no significant difference in effect by therapeutic approach. Neither intervention dose (in hours) nor duration (in months) significantly explained differences in treatment effectiveness. CONCLUSIONS Interventions targeting harmful alcohol consumption may contribute towards a reduction in self-harm at the individual level. However, there was no apparent effect of these interventions on suicidal ideation (measured either continuously or dichotomously) or suicide deaths.
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Affiliation(s)
- Katrina Witt
- Orygen, Melbourne, Australia; Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia
| | - Kate M Chitty
- Clinical Pharmacology and Toxicology Research Group, Faculty of Medicine and Health, Discipline of Pharmacology, University of Sydney, Sydney, Australia
| | - Rachmania Wardhani
- Australian Institute for Suicide Research and Prevention, WHO Collaborating Centre for Research and Training in Suicide Prevention, School of Applied Psychology, Griffith University, Brisbane, Australia
| | - Airi Värnik
- Tallinn University, Tallinn, Estonia; Estonian-Swedish Mental Health and Suicidology Institute, Tallinn, Estonia
| | - Diego de Leo
- Australian Institute for Suicide Research and Prevention, WHO Collaborating Centre for Research and Training in Suicide Prevention, School of Applied Psychology, Griffith University, Brisbane, Australia
| | - Kairi Kõlves
- Australian Institute for Suicide Research and Prevention, WHO Collaborating Centre for Research and Training in Suicide Prevention, School of Applied Psychology, Griffith University, Brisbane, Australia.
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Chugani CD, Murphy CE, Talis J, Miller E, McAneny C, Condosta D, Kamnikar J, Wehrer E, Mazza JJ. Implementing Dialectical Behavior Therapy Skills Training for Emotional Problem Solving for Adolescents (DBT STEPS-A) in a Low-Income School. SCHOOL MENTAL HEALTH 2021; 14:391-401. [PMID: 34377215 PMCID: PMC8339697 DOI: 10.1007/s12310-021-09472-4] [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] [Subscribe] [Scholar Register] [Accepted: 07/22/2021] [Indexed: 12/30/2022]
Abstract
Adolescents living in low-income areas often have high need for mental health supports due to experiences of poverty and trauma, coupled with limited access and availability of such supports. This study investigated the implementation of a socio-emotional learning curriculum titled, “Dialectical Behavior Therapy Skills Training for Emotional Problem Solving for Adolescents (DBT STEPS-A),” which was integrated into health classes in a low-income high school. While preliminary evidence suggests that DBT STEPS-A can be effective in reducing mental health symptoms in high school students, this study is the first to explore the program’s acceptability, appropriateness, and feasibility when implemented in a low-income school. The implementation presented here also diverged from recommended training protocols due to time and cost limitations. Quantitative and qualitative data were collected from 29 school stakeholders prior to implementation and from 23 school stakeholders post-implementation. Our results indicate that DBT STEPS-A is acceptable and feasible for teachers involved in offering the program and that more work is needed to address appropriateness of the content for racially and socio-economically diverse students, ease of implementing lessons, and support for teachers using DBT STEPS-A skills outside of class. We conclude with a discussion of key implementation challenges and solutions generated.
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Affiliation(s)
- Carla D Chugani
- Department of Pediatrics, Division of Adolescent and Young Adult Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA USA
| | - Courtney E Murphy
- Department of Pediatrics, Division of Adolescent and Young Adult Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA USA
| | - Janine Talis
- Department of Pediatrics, Division of Adolescent and Young Adult Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA USA
| | - Elizabeth Miller
- Department of Pediatrics, Division of Adolescent and Young Adult Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA USA
| | | | | | | | | | - James J Mazza
- University of Washington College of Education, Seattle, WA USA
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Chugani CD, Fuhrman B, Abebe KZ, Talis J, Miller E, Coulter RWS. Wellness and resilience for college and beyond: protocol for a quasi-experimental pilot study investigating a dialectical behaviour therapy skill-infused college course. BMJ Open 2020; 10:e036833. [PMID: 32565475 PMCID: PMC7311003 DOI: 10.1136/bmjopen-2020-036833] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION College students' mental health problems and suicidal behaviour are serious, persistent and prevalent public health issues. With the need for mental health support greatly exceeding the availability of on-campus treatment, a recent trend on college campuses is to offer courses designed to teach students strategies for developing mental health or resilience. While these courses are exceptionally popular among students, a paucity of research investigates the health outcomes associated with participation. The purpose of this study is to investigate the acceptability, appropriateness, feasibility and preliminary effectiveness of a college course grounded in skills from dialectical behaviour therapy (DBT) titled, 'Wellness and Resilience for College and Beyond'. METHODS AND ANALYSIS During the spring and fall 2020 semesters, the course will be offered on five campuses in Southwestern Pennsylvania and West Virginia. The course consists of 15 weekly 2.5-hour lessons, weekly homework assignments and a final examination with content drawn from DBT, acceptance and commitment therapy and positive psychology. Undergraduate students aged 18-24 will self-select into the course and control subjects receiving 'university as usual' will be recruited to serve as a comparison group. Students who receive the course will complete measures of course acceptability, appropriateness and feasibility. All study participants will complete measures of adaptive coping skills use, emotion dysregulation and suicidality. ETHICS AND DISSEMINATION All of the study procedures were approved as an exempt protocol for evaluation of educational curricula by the University of Pittsburgh Human Research Protections Office (HRPO); the study was approved as a research study by the institutional review board (IRB) of the fifth study site. The University of Pittsburgh HRPO served as the IRB of record for all except one study site, which required standard IRB review. Data from this study will be disseminated via conference presentations, peer-reviewed publications and via our online stakeholder learning collaborative. TRIAL REGISTRATION NUMBER NCT04338256.
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Affiliation(s)
- Carla D Chugani
- School of Medicine, Department of Pediatrics, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
| | - Barbara Fuhrman
- School of Medicine, Department of Pediatrics, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
| | - Kaleab Z Abebe
- School of Medicine, Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, PA, United States
| | - Janine Talis
- School of Medicine, Department of Pediatrics, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
| | - Elizabeth Miller
- School of Medicine, Department of Pediatrics, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
| | - Robert W S Coulter
- School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States
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Larsen CA, McKay AK, Van Steinburg PJ. Creating a Flexible Outpatient Mental Health Transitions Program. Issues Ment Health Nurs 2020; 41:500-505. [PMID: 32275459 DOI: 10.1080/01612840.2019.1681566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Limited resources to support persons with mental illness create a crisis in our health care system. There is a shortage of inpatient beds, and emergency departments are overwhelmed by the number of persons experiencing a mental illness crisis. This article describes the design of a program to address the gaps in treatment. The goal of the program was to decrease the length of stay for inpatient mental health care and to divert emergency department patients. We describe the multidisciplinary brainstorming session that envisioned this program, how it differs from previous programs, the staffing model, curriculum, outcomes, and future plans.
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Affiliation(s)
- Clare A Larsen
- Department of Nursing, Mayo Clinic, Rochester, Minnesota, USA
| | - Ann K McKay
- Department of Nursing, Mayo Clinic, Rochester, Minnesota, USA
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12
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Büscher R, Torok M, Terhorst Y, Sander L. Internet-Based Cognitive Behavioral Therapy to Reduce Suicidal Ideation: A Systematic Review and Meta-analysis. JAMA Netw Open 2020; 3:e203933. [PMID: 32343354 PMCID: PMC7189224 DOI: 10.1001/jamanetworkopen.2020.3933] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
IMPORTANCE Suicidal ideation is a widespread phenomenon. However, many individuals at risk for suicide do not seek treatment, which might be addressed by providing low-threshold, internet-based self-help interventions. OBJECTIVE To investigate whether internet-based self-help interventions directly targeting suicidal ideation or behavior are associated with reductions in suicidal ideation. DATA SOURCES A systematic search of PsycINFO, MEDLINE, Cochrane Central Register of Controlled Trials (CENTRAL), and the Centre for Research Excellence of Suicide Prevention (CRESP) databases for trials from inception to April 6, 2019, was performed, supplemented by reference searches. Search strings consisted of various search terms related to the concepts of internet, suicide, and randomized clinical trials. STUDY SELECTION Two independent researchers reviewed titles, abstracts, and full texts. Randomized clinical trials evaluating the effectiveness of internet-based self-help interventions to reduce suicidal ideation were included. Interventions were eligible if they were based on psychotherapeutic elements. Trials had to report a quantitative measure of a suicide-specific outcome. Mobile-based and gatekeeper interventions were excluded; no further restrictions were placed on participant characteristics or date of publication. DATA EXTRACTION AND SYNTHESIS This study followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guidelines. Risk of bias was evaluated using the Cochrane Risk of Bias Tool. Standardized mean differences were calculated using a random-effects model. MAIN OUTCOMES AND MEASURES Suicidal ideation was the a priori primary outcome. RESULTS Six unique eligible trials (1567 unique participants; 1046 [66.8%] female; pooled mean [SD] age, 36.2 [12.5] years) were included in the systematic review and meta-analysis. All identified interventions were internet-based cognitive behavioral therapy (iCBT). Participants assigned to the iCBT condition experienced a significantly reduced suicidal ideation compared with controls following intervention in all 6 trials (standardized mean difference, -0.29; 95% CI, -0.40 to -0.19; P < .001). Heterogeneity was low (I2 = 0%). The effect appeared to be maintained at follow-up in 4 trials (standardized mean difference, -0.18; 95% CI, -0.34 to -0.02; P = .03; I2 = 36%). Studies did not report sufficient data on completed suicides and suicide attempts to assess potential associations. CONCLUSIONS AND RELEVANCE These results show that iCBT interventions are associated with significant reductions in suicidal ideation compared with control conditions. Considering their high scalability, iCBT interventions have the potential to reduce suicide mortality. Future research should assess the effect of these digital health interventions on suicidal behavior and identify moderators and mediators to advance understanding of the mechanisms of effectiveness of these interventions.
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Affiliation(s)
- Rebekka Büscher
- Department of Rehabilitation Psychology and Psychotherapy, University of Freiburg, Freiburg, Germany
| | - Michelle Torok
- Black Dog Institute, University of New South Wales, Sydney, Australia
| | - Yannik Terhorst
- Department of Research Methods, Institute of Psychology and Education, University of Ulm, Ulm, Germany
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, University of Ulm, Ulm, Germany
| | - Lasse Sander
- Department of Rehabilitation Psychology and Psychotherapy, University of Freiburg, Freiburg, Germany
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Padmanathan P, Hall K, Moran P, Jones HE, Gunnell D, Carlisle V, Lingford-Hughes A, Hickman M. Prevention of suicide and reduction of self-harm among people with substance use disorder: A systematic review and meta-analysis of randomised controlled trials. Compr Psychiatry 2020; 96:152135. [PMID: 31810026 DOI: 10.1016/j.comppsych.2019.152135] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 09/19/2019] [Accepted: 10/01/2019] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND People with substance use disorder (SUD) are at significantly greater risk of suicide compared with the general population. In recent years the number of suicides resulting from drug poisoning in England and Wales has increased. We sought to identify and evaluate the effect of interventions to prevent suicide or reduce self-harm among people with SUD. METHODS We conducted a systematic review of randomised controlled trials (RCTs) of interventions for people with SUD that included suicide or self-harm-related primary outcomes. We searched Cochrane Central Register of Controlled Trials (CENTRAL), PsycINFO, PubMed, Embase and Web of Science from inception until 13th January 2019. Studies were assessed for bias using the Cochrane Risk of Bias 2 tool. A random effects meta-analysis of standardised mean differences (SMD) was conducted. RESULTS We identified six RCTs from four countries (Australia, Iran, the United States of America and the United Kingdom) comprising 468 participants in total. All but one study investigated psychosocial interventions. On average across studies there was weak evidence of a small positive effect of interventions on suicide or self-harm outcomes (d=-0.20, 95% CI=-0.39-0.00). LIMITATIONS Studies were heterogeneous in terms of population, intervention, controls and outcome. There were some concerns regarding bias for all trials. All trials were liable to type II error. CONCLUSIONS Evidence is currently lacking regarding the effectiveness of interventions to prevent suicide and reduce self-harm amongst people with SUD.
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Affiliation(s)
- Prianka Padmanathan
- Population Health Sciences, Bristol Medical School, University of Bristol, United Kingdom.
| | - Katherine Hall
- Avon & Wiltshire Mental Health Partnership NHS Trust, United Kingdom
| | - Paul Moran
- Population Health Sciences, Bristol Medical School, University of Bristol, United Kingdom; National Institute for Health Research, Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol, Bristol, UK
| | - Hayley E Jones
- Population Health Sciences, Bristol Medical School, University of Bristol, United Kingdom
| | - David Gunnell
- Population Health Sciences, Bristol Medical School, University of Bristol, United Kingdom; National Institute for Health Research, Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol, Bristol, UK
| | - Victoria Carlisle
- School of Psychological Science, University of Bristol, United Kingdom
| | | | - Matthew Hickman
- Population Health Sciences, Bristol Medical School, University of Bristol, United Kingdom; National Institute for Health Research, Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol, Bristol, UK
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Klein JP, Hauer A, Berger T, Fassbinder E, Schweiger U, Jacob G. Protocol for the REVISIT-BPD Trial, a Randomized Controlled Trial Testing the Effectiveness of an Internet-Based Self-Management Intervention in the Treatment of Borderline Personality Disorder (BPD). Front Psychiatry 2018; 9:439. [PMID: 30298024 PMCID: PMC6160537 DOI: 10.3389/fpsyt.2018.00439] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Accepted: 08/24/2018] [Indexed: 11/13/2022] Open
Abstract
Introduction: Borderline Personality Disorder (BPD) is a prevalent condition that is often under-treated. This is partly because very few psychotherapists offer treatment for this disabling disorder. Internet-based self-management interventions could contribute to reducing the treatment gap but-mainly due to safety concerns-these have never been tested for BPD in controlled trials. Methods: Patients with BPD will be recruited primarily via the internet and randomized to two groups: care as usual (CAU) alone) or the self-management intervention priovi® in addition to CAU. At the end of the diagnostic interview, all participants will discuss an emergency plan. The main outcome measure is the clinician-rated symptom severity using the BPD Severity Index (BPDSI). Secondary outcome measures include a range of self-reported scales, an SCID-diagnosis of BPD and several safety parameters including serious adverse events (e.g., a life-threatening event, hospitalization or suicide attempt). Discussion: This trial will evaluate the effectiveness of the self-management intervention, priovi, in reducing symptoms of BPD. It will also assess the safety of its use in this target population. If successful, this intervention would be the first comprehensive internet intervention for the treatment of BPD and complement the wide range of internet interventions effective in treating other mental disorders, particularly depression and anxiety disorders. Trial Registration: NCT03418142 (clinicaltrials.gov) on January 23rd 2018. Trial status: recruiting, currently N = 108 (July 2018).
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Affiliation(s)
- Jan Philipp Klein
- Department of Psychiatry and Psychotherapy, Lübeck University, Lübeck, Germany
| | | | - Thomas Berger
- Department of Clinical Psychology and Psychotherapy, Bern University, Bern, Switzerland
| | - Eva Fassbinder
- Department of Psychiatry and Psychotherapy, Lübeck University, Lübeck, Germany
| | - Ulrich Schweiger
- Department of Psychiatry and Psychotherapy, Lübeck University, Lübeck, Germany
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Wilks CR, Lungu A, Ang SY, Matsumiya B, Yin Q, Linehan MM. A randomized controlled trial of an Internet delivered dialectical behavior therapy skills training for suicidal and heavy episodic drinkers. J Affect Disord 2018; 232:219-228. [PMID: 29499504 PMCID: PMC5859943 DOI: 10.1016/j.jad.2018.02.053] [Citation(s) in RCA: 64] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Revised: 01/25/2018] [Accepted: 02/16/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND Given that alcohol misuse elevates risk of suicide death among ideators, the paucity of treatment outcome research for individuals presenting with both suicide ideation and problem drinking is particularly troubling. Dialectical behavior therapy (DBT) skills training, which effectively targets behaviors associated with emotion dysregulation including addictive and suicidal behaviors, provides a fitting model amenable to computerization. As stigma and scarcity stand as potential barriers to treatment, online dissemination platforms provide means for efficient treatment delivery that can augment the utility of suitable interventions. This pilot RCT sought to evaluate the feasibility, acceptability, and preliminary efficacy of an Internet-delivered DBT skills training intervention (iDBT-ST) for suicidal individuals who engage in heavy episodic drinking METHODS: Participants (N = 59) were randomized to receive iDBT-ST immediately or after an 8-week waiting period. Clinical outcomes were suicide ideation, alcohol use, and emotion dysregulation. RESULTS Participants on average saw a significant reduction in all outcomes over the four-month study period. Compared to waitlist controls, individuals who received iDBT-ST immediately showed faster reductions in alcohol consumption. CONCLUSIONS Preliminary results suggest that iDBT-ST may be a viable resource for the high-risk and underserved group represented in this study, and pathways for future development are suggested. LIMITATIONS There was difficulty retaining and engaging participants due to technological barriers.
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Affiliation(s)
- Chelsey R. Wilks
- University of Washington, 3539 University Way, Seattle, WA
98195
| | - Anita Lungu
- Lyra Health, 205 Park Rd, Burlingame, CA 98010, USA.
| | - Sin Yee Ang
- University of Washington, 3917 University Way, Seattle, WA 98195, USA.
| | - Brandon Matsumiya
- University of Central Florida, 4111 Pictor Ln, Orlando, FL 32816, USA.
| | - Qingqing Yin
- University of Washington, 3917 University Way, Seattle, WA 98195, USA.
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