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Magill M, Martino S, Wampold BE. Defining the therapeutic relationship in the context of alcohol use, other drug use, and behavior change: Principles and practices. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2024; 163:209398. [PMID: 38754554 PMCID: PMC11180559 DOI: 10.1016/j.josat.2024.209398] [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: 12/06/2023] [Revised: 03/21/2024] [Accepted: 05/06/2024] [Indexed: 05/18/2024]
Abstract
OVERVIEW This article contributes to knowledge and practice of core processes that are shared by evidence-based alcohol or other drug (AOD) therapies. It is the fourth in a series with this aim, and here we discuss perhaps the most universally acknowledged ingredient of effective therapy - the therapeutic relationship. We consider various related terms and definitions in the literature, but in the present review, we offer a definition that underscores the context of behavior change. METHOD This study conducted a literature review and qualitative content analysis to derive a set of principles and practices for facilitating and maintaining the therapeutic relationship. The sources for this review included government-issued practice guidelines, therapy manuals or books, demonstration videos, and peer-reviewed articles (61 sources). The content analysis was performed in NVIVO, and reliability analysis showed moderate agreement between raters (kappa = 0.60). RESULTS Six principles and 16 practices were identified. The distribution of principles and practices could be broken into three categories: 1) the facilitation of client behavior change mechanisms (i.e., self-determination, motivation, self-efficacy), 2) partnership considerations (e.g., goal and task alignment), and 3) therapist interpersonal skills (e.g., empathy). CONCLUSIONS The therapeutic relationship is foundational to the behavior change process. We frame it as a combination of broader interpersonal considerations and attention to key mechanisms of client behavior change. The present work provides a novel resource for trainees, clinicians, and clinical supervisors interested in fostering therapy relationships with clients in AOD or other behavior change settings.
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Affiliation(s)
- Molly Magill
- Brown University, Providence, RI, United States of America.
| | - Steve Martino
- Yale University, New Haven, CT, United States of America
| | - Bruce E Wampold
- University of Wisconsin, Madison, WI, United States of America
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2
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Hignett R, Curran R, Fisher HL, Riches S. Psychologists' experience of working with people who hear voices and their views on the idea of voice simulation training: A qualitative study. Psychol Psychother 2024. [PMID: 38970412 DOI: 10.1111/papt.12540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 06/19/2024] [Indexed: 07/08/2024]
Abstract
OBJECTIVES Research indicates psychologists typically lack subjective understanding of voice hearing. Voice hearing simulation training has potential to improve understanding, empathy and confidence among clinicians, but psychologists have had limited input into its development. This study investigated psychologists' and a psychotherapist's clinical experience of working with people who hear voices and their views and recommendations for voice hearing simulation training. DESIGN This was a qualitative study. METHODS Clinical psychologists and one psychotherapist (N = 17) participated in semi-structured interviews. Thematic analysis was used to analyse transcribed data. RESULTS The Clinical Experience theme comprised of subthemes Barriers to engagement, Diversity of voice hearing experiences, Lack of subjective understanding, Curiosity about voice hearing, Empathy for voice hearers, Using personal experiences to relate to voices, Clinical experience increases knowledge, Importance of supervision and colleague's support, Benefits of experiential training, Limited training in non-psychosis settings and Clinical experience increases confidence. The Views on Voice Hearing Simulation Training theme comprised of subthemes Improves subjective understanding, Concern about distress, Discomfort as a strength of voice hearing simulations, Artificiality of simulation, Increases empathy and Over-estimation of understanding. The Recommendations theme comprised of subthemes Discuss artificiality, Co-production, Promote voice diversity, Support staff and Maximise inclusivity. CONCLUSIONS Findings indicate that clinical experience improves psychologists' confidence and knowledge, yet participants reported a lack of subjective understanding of voice hearing. Co-produced simulation training between individuals who hear voices and clinicians was anticipated to improve subjective understanding, empathy and therapeutic relationships, which could support a range of staff and improve quality of care delivered.
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Affiliation(s)
- Rebecca Hignett
- Department of Psychosis Studies, King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - Rebecca Curran
- Department of Psychosis Studies, King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - Helen L Fisher
- Social, Genetic & Developmental Psychiatry Centre, King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, UK
- ESRC Centre for Society and Mental Health, King's College London, London, UK
| | - Simon Riches
- Social, Genetic & Developmental Psychiatry Centre, King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, UK
- Department of Psychology, King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, UK
- South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Kent, UK
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3
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Ferrario A, Sedlakova J, Trachsel M. The Role of Humanization and Robustness of Large Language Models in Conversational Artificial Intelligence for Individuals With Depression: A Critical Analysis. JMIR Ment Health 2024; 11:e56569. [PMID: 38958218 PMCID: PMC11231450 DOI: 10.2196/56569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 04/27/2024] [Accepted: 04/27/2024] [Indexed: 07/04/2024] Open
Abstract
Unlabelled Large language model (LLM)-powered services are gaining popularity in various applications due to their exceptional performance in many tasks, such as sentiment analysis and answering questions. Recently, research has been exploring their potential use in digital health contexts, particularly in the mental health domain. However, implementing LLM-enhanced conversational artificial intelligence (CAI) presents significant ethical, technical, and clinical challenges. In this viewpoint paper, we discuss 2 challenges that affect the use of LLM-enhanced CAI for individuals with mental health issues, focusing on the use case of patients with depression: the tendency to humanize LLM-enhanced CAI and their lack of contextualized robustness. Our approach is interdisciplinary, relying on considerations from philosophy, psychology, and computer science. We argue that the humanization of LLM-enhanced CAI hinges on the reflection of what it means to simulate "human-like" features with LLMs and what role these systems should play in interactions with humans. Further, ensuring the contextualization of the robustness of LLMs requires considering the specificities of language production in individuals with depression, as well as its evolution over time. Finally, we provide a series of recommendations to foster the responsible design and deployment of LLM-enhanced CAI for the therapeutic support of individuals with depression.
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Affiliation(s)
- Andrea Ferrario
- Institute Biomedical Ethics and History of Medicine, University of Zurich, Zurich, Switzerland
- Mobiliar Lab for Analytics at ETH, ETH Zurich, Zurich, Switzerland
| | - Jana Sedlakova
- Institute Biomedical Ethics and History of Medicine, University of Zurich, Zurich, Switzerland
- Digital Society Initiative, University of Zurich, Zurich, Switzerland
- Institute for Implementation Science in Health Care, University of Zurich, Zurich, Switzerland
| | - Manuel Trachsel
- University of Basel, Basel, Switzerland
- University Hospital Basel, Basel, Switzerland
- University Psychiatric Clinics Basel, Basel, Switzerland
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4
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Hoffman SN, Stein MB, Taylor CT. The relationship between expressive suppression, therapeutic bond, and treatment outcomes of a positive affect intervention for adults with anxiety and/or depression. Cogn Behav Ther 2024; 53:394-408. [PMID: 38483053 DOI: 10.1080/16506073.2024.2321891] [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: 09/25/2023] [Accepted: 02/15/2024] [Indexed: 03/23/2024]
Abstract
Expressive suppression (ES; reducing emotional expression) is linked with reduced social connectedness in individuals with anxiety or depression. One implication is that people who use ES may have difficulty establishing a bond with their therapist which may impede clinical improvement. We examined this hypothesis in 33 adults with clinically elevated anxiety or depression receiving treatment focused on enhancing positive thoughts, emotions, and behaviors. At baseline, participants rated ES for positive and negative emotions during a standardized conversation task designed to generate connectedness. They also rated measures of early (session 3) perceived therapeutic bond and treatment outcomes (i.e. positive affect and social connectedness). ES of positive (r = -.39, p = .018), but not negative (r = .06, p = .747), emotions was negatively associated with therapeutic bond. Therapeutic bond mediated the relationship between greater ES of positive emotions during affiliation and lower post-treatment positive affect, 95% bias-corrected bootstrap confidence interval [-0.021, -0.000], adjusted for pre-treatment positive affect, as well as lower post-treatment social connectedness [-0.397, -0.015]; however, the indirect effect was not significant when accounting for pre-treatment social connectedness (p > .05). ES of positive emotions may be an important factor in the development of therapeutic bond and therefore treatment outcomes for individuals with anxiety or depression.
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Affiliation(s)
- Samantha N Hoffman
- Joint Doctoral Program in Clinical Psychology SDSU Department of Psychology, San Diego State University/University of California San Diego (UCSD), San Diego, USA
- Department of Psychiatry, University of California San Diego, La Jolla, USA
| | - Murray B Stein
- Joint Doctoral Program in Clinical Psychology SDSU Department of Psychology, San Diego State University/University of California San Diego (UCSD), San Diego, USA
- Department of Psychiatry, University of California San Diego, La Jolla, USA
| | - Charles T Taylor
- Joint Doctoral Program in Clinical Psychology SDSU Department of Psychology, San Diego State University/University of California San Diego (UCSD), San Diego, USA
- Department of Psychiatry, University of California San Diego, La Jolla, USA
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Lee GC, Platow MJ, Cruwys T. Listening quality leads to greater working alliance and well-being: Testing a social identity model of working alliance. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2024. [PMID: 38946045 DOI: 10.1111/bjc.12489] [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: 05/04/2024] [Accepted: 06/19/2024] [Indexed: 07/02/2024]
Abstract
OBJECTIVES Characterization of psychotherapy as the "talking cure" de-emphasizes the importance of an active listener on the curative effect of talking. We test whether the working alliance and its benefits emerge from expression of voice, per se, or whether active listening is needed. We examine the role of listening in a social identity model of working alliance. METHODS University student participants in a laboratory experiment spoke about stress management to another person (a confederate student) who either did or did not engage in active listening. Participants reported their perceptions of alliance, key social-psychological variables, and well-being. RESULTS Active listening led to significantly higher ratings of alliance, procedural justice, social identification, and identity leadership, compared to no active listening. Active listening also led to greater positive affect and satisfaction. Ultimately, an explanatory path model was supported in which active listening predicted working alliance through social identification, identity leadership, and procedural justice. CONCLUSIONS Listening quality enhances alliance and well-being in a manner consistent with a social identity model of working alliance, and is a strategy for facilitating alliance in therapy.
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Affiliation(s)
- Georgina C Lee
- School of Medicine and Psychology, The Australian National University, Canberra, Australian Capital Territory, Australia
| | - Michael J Platow
- School of Medicine and Psychology, The Australian National University, Canberra, Australian Capital Territory, Australia
| | - Tegan Cruwys
- School of Medicine and Psychology, The Australian National University, Canberra, Australian Capital Territory, Australia
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Burback L, Forner C, Winkler OK, Al-Shamali HF, Ayoub Y, Paquet J, Verghese M. Survival, Attachment, and Healing: An Evolutionary Lens on Interventions for Trauma-Related Dissociation. Psychol Res Behav Manag 2024; 17:2403-2431. [PMID: 38912158 PMCID: PMC11193433 DOI: 10.2147/prbm.s402456] [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: 01/30/2024] [Accepted: 05/21/2024] [Indexed: 06/25/2024] Open
Abstract
Purpose Dissociation is a necessary part of our threat response system, common to all animal species, normally temporarily activated under conditions of extreme or inescapable threat. Pathological dissociation, however, continues to occur after the initial threat has passed, in response to reminders or inaccessibility of safety and security. Present across the spectrum of psychiatric diagnoses, recurrent dissociative symptoms are linked to severe trauma exposure, insecure attachment, treatment non-response, and maladaptive coping behaviors such as substance use, suicidality, and self-harm. However, empirical studies testing treatments specific to dissociative processes remain scarce. This narrative review summarizes existing studies and provides theoretical, neurobiological, and evolutionary perspectives on dissociative processes and treatments for pathological dissociation. Methods A systematic search of five databases (MEDLINE, EMBASE, APA PsycINFO, CINAHL plus, Scopus) was conducted on April 13, 2023. Peer-reviewed clinical studies with adult participants, assessing intervention effects on dissociative symptoms, were included. Results were thematically analyzed and summarized. Results Sixty-nine studies were identified, mainly focused on posttraumatic stress disorder, trauma-exposed populations, and borderline personality disorder. Psychotherapy was studied in 72.5% of studies; other interventions included medications and neurostimulation. The majority reported positive outcomes, despite the heterogeneous spectrum of interventions. However, treatment of dissociative symptoms was the primary objective in only a minority. Conclusion Pathological dissociation is a complex phenomenon involving brain and body systems designed for perceiving and responding to severe threats, requiring an individualized approach. A literature is emerging regarding potentially evidence-based treatments to help those impacted by recurrent dissociative symptoms. When contextualized within a neurobiological and evolutionary perspective, these treatments can be understood as facilitating an internal and/or relational sense of safety, resulting in symptom reduction. Further studies are needed to explore effective treatments for dissociative symptoms.
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Affiliation(s)
- Lisa Burback
- Department of Psychiatry, University of Alberta, Edmonton, Alberta, Canada
- Neuroscience and Mental Health Institute (NMHI), University of Alberta, Edmonton, Alberta, Canada
| | | | | | - Huda F Al-Shamali
- Department of Psychiatry, University of Alberta, Edmonton, Alberta, Canada
| | - Yahya Ayoub
- Department of Psychiatry, University of Alberta, Edmonton, Alberta, Canada
| | - Jacquelyn Paquet
- Department of Psychiatry, University of Alberta, Edmonton, Alberta, Canada
| | - Myah Verghese
- Department of Neuroscience, University of Alberta, Edmonton, Alberta, Canada
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Boschann A, Staats H, Wiegand-Grefe S. Older patients' perspectives on the therapeutic relationship with young psychotherapists. PLoS One 2024; 19:e0295834. [PMID: 38743763 PMCID: PMC11093373 DOI: 10.1371/journal.pone.0295834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 11/30/2023] [Indexed: 05/16/2024] Open
Abstract
The current demographic change means that young psychotherapists and older patients will increasingly come into contact. Unique for this constellation is the intergenerational therapeutic relationship, which forms the basis of psychotherapy, but has not yet been the focus of empirical research. This qualitative study provides preliminary insights into how older patients (aged over 65) experience and perceive the therapeutic relationship with young psychotherapists (aged in their mid-20s to mid-30s). We conducted semi-structured interviews with twelve older patients (8 women, 4 men) and analysed their data using the grounded theory approach. We found a connection between the type of transference a participant demonstrated and their biographical as well as social experiences, desires, and fantasies. Overall, a tendency to seek harmony was observed among the participants, which was reflected in their behaviour towards young psychotherapists: (a) conflict avoidance, (b) (fantasised) therapy discontinuation, (c) adaption/subordination, and (d) solidarity, support, and protection. Our findings demonstrated that various intergenerational transference phenomena, including the roles in which young therapists are perceived, are associated with certain particularities and challenges, such as the topic of sexuality. It can be valuable for young psychotherapists to become aware of a potential role reversal that may result in older patients trying to support them.
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Affiliation(s)
- Annika Boschann
- Department of Psychiatry and Psychotherapy, UKE Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Psychology, MSB Medical School Berlin, Berlin, Germany
| | - Hermann Staats
- Social and Educational Department, University of Applied Sciences Potsdam FHP, Potsdam, Germany
| | - Silke Wiegand-Grefe
- Department of Psychiatry and Psychotherapy, UKE Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Adrian M, Twohy E, Babeva K, Jenness J, Gurtovenko K, Blossom JB, King S, McCartney L, McCauley E. A unique model of care for youth in crisis: A pilot open trial. Psychol Serv 2024; 21:388-397. [PMID: 37428791 PMCID: PMC10776799 DOI: 10.1037/ser0000778] [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] [Indexed: 07/12/2023]
Abstract
Suicide is the second leading cause of death for those ages 10-24 years in the United States, and emergency department (ED) visits due to youth self-injurious thoughts and behaviors (SITB) and increased substantially between 2016 and 2021. Although ED services are essential for an effective system of care, the ED setting is typically not well-suited for the comprehensive, collaborative, and therapeutic evaluation of SITB; treatment planning; and care coordination that youth in a suicidal crisis need. As a result, an urgent care model for mental health designed to provide comprehensive crisis triage and intervention services is needed within outpatient psychiatry. This pilot trial examined the feasibility, acceptability, and preliminary clinical outcomes of a brief, urgent care model, the Behavioral Health Crisis Care Clinic (CCC), designed to provide comprehensive outpatient triage and intervention services aimed at reducing suicide risk for youth in crisis. Participants were 189 youth (ages 10-20; 62.4% females; 58% Caucasian) who had past-week suicidal ideation or behavior and their caregivers. The results demonstrated the CCC model exceeded feasibility and acceptability benchmarks based on the Service Satisfaction Scale (M score > 3.00). CCC care was associated with significant decreases in self-reported suicide risk based on the Collaborative Assessment and Management of Suicidality Suicide Status Form with low levels of ED usage during CCC care (7.7%) and 1-month posttreatment (11.8%). Over 88% of patients without established outpatient care at the time of referral were connected to care during CCC treatment, almost all of whom (95%) continued with ongoing mental health care 1 month after ending CCC care. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
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Affiliation(s)
- Molly Adrian
- Seattle Children's Child Psychiatry and Behavioral Medicine
| | - Eileen Twohy
- Seattle Children's Child Psychiatry and Behavioral Medicine
| | - Kalina Babeva
- Seattle Children's Child Psychiatry and Behavioral Medicine
| | | | | | | | - Sophie King
- Seattle Children's Child Psychiatry and Behavioral Medicine
| | - Leah McCartney
- Seattle Children's Child Psychiatry and Behavioral Medicine
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Rahmati M, Lee S, Yon DK, Lee SW, Udeh R, McEvoy M, Oh H, Butler L, Keyes H, Barnett Y, Koyanagi A, Shin JI, Smith L. Physical activity and prevention of mental health complications: An umbrella review. Neurosci Biobehav Rev 2024; 160:105641. [PMID: 38527637 DOI: 10.1016/j.neubiorev.2024.105641] [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: 09/24/2023] [Revised: 03/19/2024] [Accepted: 03/22/2024] [Indexed: 03/27/2024]
Abstract
The potential of physical activity in preventing mental health issues has garnered interest among health professionals. We conducted a systematic umbrella review of evidence supporting the relationship between physical activity and the prevention of mental health complications. Our findings revealed a significant association between higher physical activity levels and reduced risk of depression (OR = 0.77, 95% CI 0.72 - 0.82). This association was consistent across various age groups, sex, and geographical regions. Interestingly, low and moderate-intensity physical activity showed the most significant protective effects against depression (low-intensity: OR = 0.81, 95% CI: 0.75-0.56; moderate-intensity: OR = 0.79, 95% CI: 0.72-0.87). Our analysis also showed significant associations between higher physical activity levels and prevention of anxiety disorders (OR = 0.71, 95% CI: 0.61-0.82). However, the evidence regarding the association between physical activity and psychosis/schizophrenia risk was less clear. These findings underscore the physical activity's potential as a preventative measure against mental health complications, highlighting the importance of promoting physical activity in mental health interventions.
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Affiliation(s)
- Masoud Rahmati
- CEReSS-Health Service Research and Quality of Life Center, Aix-Marseille University, Marseille, France; Department of Physical Education and Sport Sciences, Faculty of Literature and Human Sciences, Lorestan University, Khoramabad, Iran; Department of Physical Education and Sport Sciences, Faculty of Literature and Humanities, Vali-E-Asr University of Rafsanjan, Rafsanjan, Iran.
| | - San Lee
- Department of Psychiatry and the Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Dong Keon Yon
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, Republic of Korea; Department of Pediatrics, Kyung Hee University College of Medicine, Seoul, Republic of Korea
| | - Seung Won Lee
- Department of Precision Medicine, Sungkyunkwan University School of Medicine, Suwon, Republic of Korea
| | - Raphael Udeh
- School of Medicine and Public Health, University of Newcastle, NSW, Australia
| | - Mark McEvoy
- School of Medicine and Public Health, University of Newcastle, NSW, Australia; La Trobe Rural Health School, College of Science, Health and Engineering, La Trobe University, VIC, Australia
| | - Hans Oh
- Suzanne Dworak Peck School of Social Work, University of Southern California, Los Angeles, CA, USA
| | - Laurie Butler
- School of Psychology and Sport Science, Anglia Ruskin University, Cambridge, UK
| | - Helen Keyes
- School of Psychology and Sport Science, Anglia Ruskin University, Cambridge, UK
| | - Yvonne Barnett
- Centre for Health, Performance, and Wellbeing, Anglia Ruskin University, Cambridge, UK
| | - Ai Koyanagi
- Research and Development Unit, Parc Sanitari Sant Joan de Deu, Barcelona, Spain
| | - Jae Il Shin
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Republic of Korea; Severance Underwood Meta-Research Center, Institute of Convergence Science, Yonsei University, Seoul, Korea.
| | - Lee Smith
- Centre for Health, Performance, and Wellbeing, Anglia Ruskin University, Cambridge, UK
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Schiller B, Kuska M, Becher-Urbaniak S, Wimmer E, Reisinger M, Mörtl K. Online psychotherapy as a first clinical experience during the Covid-19 pandemic: A new generation of psychotherapists in the digital age. Heliyon 2024; 10:e29464. [PMID: 38638950 PMCID: PMC11024621 DOI: 10.1016/j.heliyon.2024.e29464] [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: 11/14/2023] [Revised: 03/30/2024] [Accepted: 04/08/2024] [Indexed: 04/20/2024] Open
Abstract
The temporary closure of the Outpatient Psychotherapy Clinic at the Sigmund Freud Private University in Vienna during the Covid-19 pandemic demanded an immediate and unexpected reaction to assure further psychotherapeutic services. Both psychotherapists and patients were forced into a rapid transition to online psychotherapy. While Covid-19 research has comprehensively described challenges of online psychotherapies, we were interested in learning specifically how early stage psychotherapists-in-training, who started their clinical work with patients exclusively in the online setting, experienced this unprecedented clinical situation. Sixteen in-depth interviews were conducted with psychotherapists in training. The data were analyzed using a thematic analysis. The analysis revealed how psychotherapists in training were able to cultivate a set of early-training resources and competencies in the online therapy setting without evidence-based guidelines from supervisors and the institution. This study highlighted the necessity of incorporating specific and novel educational input that is necessary for achieving specific online skills in the early training phase. Recognizing that the therapeutic landscape has undergone an irreversible transformation, the data suggest that distinct techniques are necessary to equip early-training psychotherapists for the now commonly practiced alternation between online setting and in-person setting in psychotherapeutic processes.
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Affiliation(s)
- Birgitta Schiller
- Institute for Qualitative Research, Sigmund Freud Private University Vienna, Austria
| | - Martin Kuska
- Faculty of Psychotherapy Science, Sigmund Freud Private University Vienna, Austria
| | - Stella Becher-Urbaniak
- Research Department University Outpatient Clinic for Adults, Sigmund Freud Private University Vienna, Austria
| | - Eva Wimmer
- Institute for Qualitative Research, Sigmund Freud Private University Vienna, Austria
| | - Manfred Reisinger
- Institute for Qualitative Research, Sigmund Freud Private University Vienna, Austria
| | - Kathrin Mörtl
- Institute for Qualitative Research, Sigmund Freud Private University Vienna, Austria
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11
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Sprague C. HIV Inequities, the Therapeutic Alliance, Moral Injury, and Burnout: A Call for Nurse Workforce Participation and Action. J Assoc Nurses AIDS Care 2024:00001782-990000000-00098. [PMID: 38563450 DOI: 10.1097/jnc.0000000000000459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
ABSTRACT Health inequities for those living with HIV have persisted for key populations in the United States and globally. To address these inequities, in accordance with Goals 2 and 3 of the National HIV/AIDS Strategy for the United States, the evidence indicates that the therapeutic alliance could be effective in addressing impediments that undermine HIV outcomes. Nonetheless, the therapeutic alliance relies on health care providers, particularly nurses, reporting burnout and moral injury, further exacerbated by COVID-19. Burnout and moral injury have forced the systemic undervaluing of nurses as a social-cultural norm to the fore-in part a legacy of the economic model that underpins the health care system. Given a looming health workforce shortage and negative effects for key populations with HIV already experiencing health inequities, historic opportunities now exist to advance national institutional reforms to support nurses and other health professionals. This opportunity calls for concerted attention, multisectoral dialogue, and action, with nurses participating in and leading policy and interventions.
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Affiliation(s)
- Courtenay Sprague
- Courtenay Sprague, PhD, MA, is an Associate Professor of Global Health, Department of Conflict Resolution, Human Security & Global Governance, and Department of Nursing, University of Massachusetts Boston, Boston, Massachusetts, USA
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12
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Nishimura H, Kaptchuk RP, Mbabali I, Mulamba J, Nakyanjo N, Anok A, Wawer MJ, Kennedy CE, Nakigozi G, Chang LW, Amico KR, Hutton H. Motivational interviewing experiences from a community health worker-led HIV prevention and care intervention in rural Uganda: a qualitative study. AIDS Care 2024; 36:491-499. [PMID: 37713732 DOI: 10.1080/09540121.2023.2253504] [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: 01/24/2022] [Accepted: 08/25/2023] [Indexed: 09/17/2023]
Abstract
Motivational Interviewing (MI) and Community Health Workers (CHWs) are increasingly utilized in global settings to improve HIV outcomes, yet research exploring implementation strategies using MI and CHWs is lacking. We examined the experiences of CHWs and their clients in a counseling intervention which used MI-informed counseling to increase engagement in HIV prevention and treatment. This study was nested within the mLAKE cluster-randomized trial in a high HIV prevalence fishing community in rural Rakai District, Uganda. We conducted in-depth interviews with purposively-sampled CHWs (n = 8) and clients (n = 51). Transcripts were analyzed thematically to characterize CHWs' implementation of the intervention. Main themes identified included use of specific MI strategies (including evocation, guidance towards positive behavior change, active listening, and open-ended questions), and MI spirit (including collaboration, power-sharing, trust, and non-judgmental relationship building). Through these specific MI mechanisms, CHWs supported client behavior change to facilitate engagement with HIV services. This study provides evidence from a low-resource setting that CHWs with no previous experience in MI can successfully implement MI-informed counseling that is well-received by clients. CHW-led MI-informed counseling appears to be a feasible and effective approach to increase uptake of HIV prevention and care services in low-resource, HIV endemic regions.
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Affiliation(s)
- Holly Nishimura
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Rose Pollard Kaptchuk
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Ismail Mbabali
- Social and Behavioral Sciences Department, Rakai Health Sciences Program, Kalisizo, Uganda
| | - Jeremiah Mulamba
- Social and Behavioral Sciences Department, Rakai Health Sciences Program, Kalisizo, Uganda
| | - Neema Nakyanjo
- Social and Behavioral Sciences Department, Rakai Health Sciences Program, Kalisizo, Uganda
| | - Aggrey Anok
- Social and Behavioral Sciences Department, Rakai Health Sciences Program, Kalisizo, Uganda
| | - Maria J Wawer
- Social and Behavioral Sciences Department, Rakai Health Sciences Program, Kalisizo, Uganda
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Caitlin E Kennedy
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Gertrude Nakigozi
- Social and Behavioral Sciences Department, Rakai Health Sciences Program, Kalisizo, Uganda
| | - Larry W Chang
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
- Social and Behavioral Sciences Department, Rakai Health Sciences Program, Kalisizo, Uganda
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - K Rivet Amico
- Department of Health Behavior Health Education, University of Michigan, Ann Arbor, MI, USA
| | - Heidi Hutton
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA
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13
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Gillespie J, Wright H, Pinkney J, Lloyd H. Blending Behavioural Theory and Narrative Analysis to Explore the Lived Experience of Obesity and Assess Potential Engagement in a UK Weight Management Service: Theory and Narrative Approaches in Weight Management. Healthcare (Basel) 2024; 12:747. [PMID: 38610169 PMCID: PMC11011347 DOI: 10.3390/healthcare12070747] [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: 11/14/2023] [Revised: 03/08/2024] [Accepted: 03/14/2024] [Indexed: 04/14/2024] Open
Abstract
BACKGROUND Current treatments for people with obesity emphasise the need for person-centred approaches that consider complex biopsychosocial factors and value the lived experience of people when attempting to lose weight. METHODS Narrative interviews (n = 20) were conducted with people living with obesity to explore the causes of their weight gain and their expectations and engagement with treatment at a Weight Management Clinic. A mixed inductive and deductive qualitative analysis identified utterances that represented psychological constructs used to understand self-appraisal and health behaviour. A narrative analysis was used to situate these findings in the context of a participant's life story. RESULTS Locus of control was a dominant construct evidenced through a person's attributional style and self-efficacy. Transcripts represented a heightened sense of self-understanding and shifts in control, and styles of attribution and efficacy resulted in either stasis or self-actualisation. The Stages of Change model could be applied to narratives to ascertain a patient's motivation to access treatment. Importantly, narrative interviews also allowed for the consideration of how a person's systemic context influenced their weight. CONCLUSION Narrative interaction supports both self- and shared understandings of the causes and consequences of obesity for individuals, in a non-blaming or shaming manner. It provides an opportunity to enhance engagement through tailored, person-centred treatments.
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Affiliation(s)
- Jessica Gillespie
- School of Psychology, University of Plymouth, Plymouth PL4 8AA, UK; (J.G.); (H.W.)
| | - Hannah Wright
- School of Psychology, University of Plymouth, Plymouth PL4 8AA, UK; (J.G.); (H.W.)
| | - Jonathan Pinkney
- Peninsula Medical School, University of Plymouth, Plymouth PL4 8AA, UK;
| | - Helen Lloyd
- School of Psychology, University of Plymouth, Plymouth PL4 8AA, UK; (J.G.); (H.W.)
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14
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Hare M, Conroy K, Georgiadis C, Shaw AM. Abbreviated Dialectical Behavior Therapy Virtual Skills Group for Caregivers of Adolescents: An Exploratory Study of Service User and Clinical Outcomes. Child Psychiatry Hum Dev 2024:10.1007/s10578-024-01681-7. [PMID: 38530589 DOI: 10.1007/s10578-024-01681-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/10/2024] [Indexed: 03/28/2024]
Abstract
Prior work emphasizes involving caregivers in youth mental health services. To support youth with emotion dysregulation, dialectical behavior therapy for adolescents (DBT-A) includes a multi-family skills group, wherein adolescents and caregivers learn skills together. However, limited work has examined the impact of caregiver involvement within DBT-A. The current study examines outcomes of two caregiver-only DBT-A skills groups adapted for abbreviated telehealth delivery. We report on caregivers' (N = 11, 100% mothers, 55% Hispanic) service user outcomes (e.g. self-efficacy at skill usage, group cohesion, therapeutic alliance) and clinical outcomes (i.e. their own emotion functioning, criticism, responses to their adolescent's negative emotions). Results indicate caregiver-only groups were feasible and acceptable, and suggest preliminary efficacy, including improvements in caregiver emotion functioning, distress during interactions with their adolescents, and adolescent-reported criticism. Caregivers also reported reductions in unsupportive responses with their adolescents. Overall, while we caution interpretation due to a small sample size, findings support the preliminary feasibility and efficacy of modifying caregiver participation in DBT-A to be less time-consuming and administered via telehealth.
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Affiliation(s)
- Megan Hare
- Center for Children and Families, Department of Psychology, Florida International University, Miami, FL, 33199, USA
| | - Kristina Conroy
- Center for Children and Families, Department of Psychology, Florida International University, Miami, FL, 33199, USA
| | - Christopher Georgiadis
- Center for Children and Families, Department of Psychology, Florida International University, Miami, FL, 33199, USA
| | - Ashley M Shaw
- Center for Children and Families, Department of Psychology, Florida International University, Miami, FL, 33199, USA.
- School of Social and Behavioral Sciences, University of New England, Biddeford, ME, 04005, USA.
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15
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Thongsalab J, Yunibhand J, Uthis P. Navigating personal recovery: multinomial logistic regression analysis of schizophrenia outcomes in community-dwelling individuals. Gen Psychiatr 2024; 37:e101325. [PMID: 38510927 PMCID: PMC10952847 DOI: 10.1136/gpsych-2023-101325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 01/31/2024] [Indexed: 03/22/2024] Open
Abstract
Background Schizophrenia is a chronic mental disorder affecting individuals globally, emphasising the significance of personal recovery in mental healthcare. Understanding the recovery stages and the associated factors can provide essential insights for targeted interventions. Aims This study aimed to discern the stages of personal recovery in Thai patients with schizophrenia and elucidate the associated factors with each stage. Methods A multistage sampling technique was employed, selecting 231 patients with schizophrenia from mental health outpatient departments of general and psychiatric hospitals. Data collected from March to May 2023 included screening for psychotic symptoms using the Brief Psychiatric Rating Scale and six self-report questionnaires-Stage of Recovery Scale, Beck Cognitive Insight Scale, Brief Resilience Scale, Family Support, Therapeutic Relationship-Patients Version and Social Support Questionnaire-along with personal data sheets. Pearson correlation and multinomial logistic regression were performed. Results The predominant personal recovery stage among participants was stage 3, 'living with disabilities', comprising 42.4% of the participants. Key factors contributing to personal recovery, explaining approximately 38.4% of the variance, included resilience, family support, therapeutic alliance, hospitalisations since onset and recovery-oriented nursing service utilisation. Logit equations for stages 3 and 4 are as follows: stage 3 (living with disability): logit=-4.44+0.74×resilience+0.07×therapeutic alliance+0.02×recovery-oriented nursing service utilisation; stage 4 (living beyond disability): logit=-11.57-0.05×hospitalisation since onset+1.96×resilience+0.11×family support+0.06×therapeutic alliance. Conclusion The findings emphasise the significance of mental health nursing interventions. In conjunction with recovery-oriented nursing services, strengthening resilience, therapeutic alliances and family support may accelerate personal recovery and reduce hospitalisations among individuals with schizophrenia.
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Affiliation(s)
| | | | - Penpaktr Uthis
- Faculty of Nursing, Chulalongkorn University, Bangkok, Thailand
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16
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Seebacher B, Geimer C, Neu J, Schwarz M, Diermayr G. Identifying central elements of the therapeutic alliance in the setting of telerehabilitation: A qualitative study. PLoS One 2024; 19:e0299909. [PMID: 38457374 PMCID: PMC10923432 DOI: 10.1371/journal.pone.0299909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 02/17/2024] [Indexed: 03/10/2024] Open
Abstract
INTRODUCTION Therapeutic alliance is a relevant aspect of healthcare and may influence patient outcomes. So far, little is known about the therapeutic alliance in telerehabilitation. PURPOSE To identify and describe central elements of therapeutic alliance in the setting of telerehabilitation and compare it to those in conventional rehabilitation. METHODS In this qualitative study, a literature search and in-depth semi-structured interviews with rehabilitation and telerehabilitation experts were conducted from 15.5.-10.8.2020 on elements influencing the therapeutic alliance in rehabilitation and telerehabilitation. Using a combined deductive and inductive approach, qualitative content analysis was used to identify categories and derive central themes. RESULTS The elements bond, communication, agreement on goals and tasks and external factors were identified in the literature search and informed the development of the interview guide. Twelve purposively sampled experts from the fields of physiotherapy, occupational therapy, speech and language therapy, psychology, general medicine, sports science and telerehabilitation software development participated in the interviews. We identified three central themes: building effective communication; nurturing a mutual relationship of trust and respect; and agreement on goals and tasks and drivers of motivation. CONCLUSIONS In this qualitative study, key elements of therapeutic alliance in rehabilitation confirmed those reported in the literature, with additional elements in telerehabilitation comprising support from others for ensuring physical safety and technical connectedness, caregivers acting as co-therapists and applying professional touch, and promoting patient autonomy and motivation using specific strategies.
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Affiliation(s)
- Barbara Seebacher
- Clinical Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
- Department of Rehabilitation Science, Clinic for Rehabilitation Münster, Münster, Austria
| | - Carole Geimer
- School of Therapeutic Sciences, SRH University Heidelberg, Heidelberg, Germany
| | - Julia Neu
- School of Therapeutic Sciences, SRH University Heidelberg, Heidelberg, Germany
| | - Maria Schwarz
- Department of Psychosocial Rehabilitation, Clinic for Rehabilitation Münster, Münster, Österreich
| | - Gudrun Diermayr
- School of Therapeutic Sciences, SRH University Heidelberg, Heidelberg, Germany
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17
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Ellenbogen MA, Cardoso C, Serravalle L, Vadaga K, Joober R. The effects of intranasal oxytocin on the efficacy of psychotherapy for major depressive disorder: a pilot randomized controlled trial. Psychol Med 2024:1-11. [PMID: 38445382 DOI: 10.1017/s0033291724000217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/07/2024]
Abstract
BACKGROUND Although both pharmacotherapy and psychological treatments are considered to be efficacious in the treatment of major depressive disorder (MDD), one third of patients do not respond to treatment and many experience residual symptoms post-treatment. In this double-blind placebo-controlled randomized control trial (RCT), we assessed whether intranasal oxytocin (OT) augments the therapeutic efficacy of psychotherapy for MDD and improves the therapeutic alliance. METHODS Twenty-three volunteers (12 female) with MDD underwent 16 sessions of interpersonal therapy. Prior to each session, volunteers self-administered 24 International Units of intranasal OT (n = 12; Syntocinon) or placebo (n = 11). Depressive symptoms were assessed with the Inventory of Depressive Symptomatology at pre- and post-treatment, and at a six month follow-up. RESULTS Multilevel modeling found a significant effect of OT on the negative slope of depressive symptoms over time (p < 0.05), with medium-large effect sizes at post-treatment (Cohen's d = 0.75) and follow-up (Cohen's d = 0.82). Drug intervention also predicted the intercept when examining the weekly ratings of the therapeutic alliance (p < 0.05), such that volunteers receiving OT, relative to placebo, reported improved therapeutic alliance at session 1. The agreement of goals between therapists and participants, a facet of the therapeutic alliance, mediated the relationship between drug intervention and clinical outcome. CONCLUSION In this pilot study, the administration of intranasal OT, relative to placebo, improved the therapeutic alliance at the beginning of therapy and therapeutic efficacy of psychotherapy in persons with MDD. Future RCTs should attempt to replicate these findings in larger samples with different therapeutic modalities (ClinicalTrials.gov: NCT02405715).
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Affiliation(s)
- Mark A Ellenbogen
- Centre for Research in Human Development, Department of Psychology, Concordia University, Montréal, Canada
| | - Christopher Cardoso
- Centre for Research in Human Development, Department of Psychology, Concordia University, Montréal, Canada
| | - Lisa Serravalle
- Centre for Research in Human Development, Department of Psychology, Concordia University, Montréal, Canada
| | - Kiran Vadaga
- Centre for Research in Human Development, Department of Psychology, Concordia University, Montréal, Canada
| | - Ridha Joober
- The Douglas Research Centre, Department of Psychiatry, McGill University, Montréal, Canada
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18
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Fuhr DC, Wolf-Ostermann K, Hoel V, Zeeb H. [Digital technologies to improve mental health]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2024; 67:332-338. [PMID: 38294700 DOI: 10.1007/s00103-024-03842-4] [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: 08/23/2023] [Accepted: 01/26/2024] [Indexed: 02/01/2024]
Abstract
The burden of mental diseases is enormous and constantly growing worldwide. The resulting increase in demand for psychosocial help is also having a negative impact on waiting times for psychotherapy in Germany. Digital interventions for mental health, such as interventions delivered through or with the help of a website (e.g. "telehealth"), smartphone, or tablet app-based interventions and interventions that use text messages or virtual reality, can help. This article begins with an overview of the functions and range of applications of digital technologies for mental health. The evidence for individual digital forms of interventions is addressed. Overall, it is shown that digital interventions for mental health are likely to be cost-effective compared to no therapy or a non-therapeutic control group. Newer approaches such as "digital phenotyping" are explained in the article. Finally, individual papers from the "Leibniz ScienceCampus Digital Public Health" are presented, and limitations and challenges of technologies for mental health are discussed.
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Affiliation(s)
- Daniela C Fuhr
- Abteilung für Evaluation und Prävention, Leibniz Institut für Präventionsforschung und Epidemiologie, Achterstr. 30, 28359, Bremen, Deutschland.
- Gesundheitswissenschaften, Universität Bremen, Bremen, Deutschland.
| | - Karin Wolf-Ostermann
- Institut für Public Health und Pflegeforschung, Universität Bremen, Bremen, Deutschland
| | - Viktoria Hoel
- Institut für Public Health und Pflegeforschung, Universität Bremen, Bremen, Deutschland
| | - Hajo Zeeb
- Abteilung für Evaluation und Prävention, Leibniz Institut für Präventionsforschung und Epidemiologie, Achterstr. 30, 28359, Bremen, Deutschland
- Gesundheitswissenschaften, Universität Bremen, Bremen, Deutschland
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Soejbjerg A, Rasmussen SE, Christensen KS, Christensen B, Pedersen AF, Maindal HT, Mygind A. Managing mental health in chronic care in general practice: a feasibility study of the Healthy Mind intervention. Scand J Prim Health Care 2024; 42:72-81. [PMID: 38095546 PMCID: PMC10851809 DOI: 10.1080/02813432.2023.2289525] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Accepted: 11/26/2023] [Indexed: 02/08/2024] Open
Abstract
BACKGROUND AND OBJECTIVE Mental health issues are common among patients with chronic physical conditions. This study aims to evaluate the feasibility of the Healthy Mind intervention, a general practice-based programme that provides problem-solving therapy (PST) to patients with poor mental well-being and type 2 diabetes (T2D) and/or ischaemic heart disease (IHD). DESIGN AND SETTING A one-arm feasibility study was conducted in three general practices in the Central Denmark Region. INTERVENTION Eight healthcare providers from the included general practices underwent a two-day course to acquire PST skills. Screening for poor mental health was carried out at the annual chronic care consultation for T2D or IHD, and PST sessions were offered to patients on indication of poor mental health. Nine patients received PST. METHODS Semi-structured interviews with eight healthcare providers and six patients were conducted. Data were analysed deductively focusing on appropriateness, acceptability and fidelity of the intervention. RESULTS The intervention was considered appropriate for the patient group and the general practice setting. The providers acknowledged PST as a valuable tool for managing psychological issues in general practice, and the patients perceived PST as an effective and tangible treatment. Since practice nurses' schedules were generally better suited for longer consultations, they were often the preferred intervention providers. The intervention was largely delivered as intended. However, the GPs generally expected patients to prefer a more directive approach, which sometimes challenged their role as facilitator and guide. CONCLUSION The Healthy Mind intervention was found to be feasible, and the results support proceeding to a full-scale evaluation trial.
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Affiliation(s)
- Anne Soejbjerg
- Research Unit for General Practice, Aarhus University, Aarhus C, Denmark
- Department of Public Health, Aarhus University, Aarhus C, Denmark
| | - Stinne Eika Rasmussen
- Research Unit for General Practice, Aarhus University, Aarhus C, Denmark
- Department of Public Health, Aarhus University, Aarhus C, Denmark
| | - Kaj Sparle Christensen
- Research Unit for General Practice, Aarhus University, Aarhus C, Denmark
- Department of Public Health, Aarhus University, Aarhus C, Denmark
| | - Bo Christensen
- Research Unit for General Practice, Aarhus University, Aarhus C, Denmark
- Department of Public Health, Aarhus University, Aarhus C, Denmark
| | - Anette Fischer Pedersen
- Research Unit for General Practice, Aarhus University, Aarhus C, Denmark
- Department of Public Health, Aarhus University, Aarhus C, Denmark
| | | | - Anna Mygind
- Research Unit for General Practice, Aarhus University, Aarhus C, Denmark
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20
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Broadbridge E, Roter DL, Persky S, Erby LH. Measuring the therapeutic bond in genetic counseling: Testing measurement error in the bond subscale of the Working Alliance Inventory. J Genet Couns 2024. [PMID: 38308411 DOI: 10.1002/jgc4.1844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 12/18/2023] [Accepted: 12/22/2023] [Indexed: 02/04/2024]
Abstract
The therapeutic relationship is a key component of successful genetic counseling. In psychotherapy, a strong therapeutic relationship can improve patient health outcomes and a poor relationship can worsen psychological functioning. Investigation of the therapeutic relationship in genetic counseling has shown evidence for a similar pattern. Reliable measurement of the therapeutic relationship is necessary for consistency across studies in the genetic counseling context. One measure that has been adapted for use in genetic counseling is the Working Alliance Inventory (WAI). However, there have been no studies of the factor structure or item-level method bias analyses for the genetic counseling-adapted version of the WAI. The goal of this study was to test the factor structure of the WAI observer version (WAI-O) bond subscale and assess method bias in a genetic counseling context. We hypothesized that differences in factor structures would exist for items that were positively (n = 9) versus negatively (n = 3) worded (reverse coded). Secondary data analysis was performed on two data sets that utilized the WAI-O in genetic counseling contexts. Data set 1 used simulated genetic counseling sessions that were judged by analog clients recruited through crowdsourcing platforms (N = 861). Data set 2 was conducted with genetic counseling clients, and sessions were evaluated by a research team (N = 120). Principal axis factor analysis with oblique oblimin rotation supported a two-factor solution for the WAI-O bond subscale across data sets. Items factored based on wording, with the positively worded items loading together and the negatively worded items loading on the second factor. Confirmatory factor analyses supported the removal of all negatively worded items from the instrument across data sets. Results suggest that the negatively worded items on the WAI-O may be capturing a construct inconsistent with the positively worded items and support rewording and/or excluding them from use for a more reliable measure of the therapeutic bond.
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Affiliation(s)
- Elizabeth Broadbridge
- Department of Communication, Rutgers University, New Brunswick, New Jersey, USA
- Medical Genomics and Metabolic Genetics Branch, National Human Genome Research Institute, NIH, Bethesda, Maryland, USA
- Department of Health Behavior and Society, Johns Hopkins University, Baltimore, Maryland, USA
| | - Debra L Roter
- Department of Health Behavior and Society, Johns Hopkins University, Baltimore, Maryland, USA
| | - Susan Persky
- Social and Behavioral Research Branch, National Human Genome Research Institute, NIH, Bethesda, Maryland, USA
| | - Lori H Erby
- Medical Genomics and Metabolic Genetics Branch, National Human Genome Research Institute, NIH, Bethesda, Maryland, USA
- Department of Health Behavior and Society, Johns Hopkins University, Baltimore, Maryland, USA
- Center for Precision Health Research, National Human Genome Research Institute, NIH, Bethesda, Maryland, USA
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21
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Kabatnik S. "Because he was disgusting": transforming relations through positioning in messenger-supported group psychotherapy. Front Psychol 2024; 14:1268989. [PMID: 38250109 PMCID: PMC10798039 DOI: 10.3389/fpsyg.2023.1268989] [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: 07/28/2023] [Accepted: 11/07/2023] [Indexed: 01/23/2024] Open
Abstract
Introduction This article deals with positioning in messenger-supported group psychotherapy in terms of transforming relations. The aim of the messenger-supported therapy format is to work through conflicts that have arisen with people via messenger services. This is achieved in different phases of conversation, such as describing the situation, analysing one's own behaviour and defining wishes, by collaboratively drafting a message to the person from the conflict. Methods The data basis is a corpus of 14 video-recorded group psychotherapy sessions. Methodologically, the study is guided by interactional linguistics, a linguistic research field that focuses on interpersonal interaction. Results Using a case study, I show how the interactants work through a conflict through positioning, constitute group identity and relationships, and thus also transform their stance concerning the issue. Moreover, positioning serves the collaborative formulation of a message and thus also the change of the relationship to the person from the messenger communication. Discussion Relationship management in eSA group psychotherapy can be observed on different levels: (1) among the interactants in the room, (2) with the persons from the chat messages, and (3) between the patient(s) and the therapist.
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Affiliation(s)
- Susanne Kabatnik
- Digital Humanities, Faculty II, University of Trier, Trier, Germany
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22
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Barr BL, McIntosh VVW, Britt EF, Jordan J, Carter JD. Clinical factors and early life experiences associated with therapeutic alliance development in treatment for depression or binge eating. Psychother Res 2024; 34:4-16. [PMID: 37079925 DOI: 10.1080/10503307.2023.2191800] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 03/10/2023] [Indexed: 04/22/2023] Open
Abstract
OBJECTIVE This study examines childhood and clinical factors theorized to impact therapeutic alliance development over the course of psychotherapy. METHOD Raters assessed the therapeutic alliance of 212 client-therapist dyads, participating in two randomized controlled trials of schema therapy and cognitive behavioural therapy for binge eating or major depression, at three time points. Linear mixed models were used to characterize therapeutic alliance development over time and assess the influence of childhood trauma, perceived parental bonding, diagnosis and therapy type on scores. RESULTS Participants differed in initial alliance ratings for all subscales but had similar growth trajectories in all but the patient hostility subscale. A diagnosis of bulimia nervosa or binge eating disorder predicted greater initial levels of client distress, client dependency and overall client contribution to a strong therapeutic alliance, compared with a diagnosis of depression. Therapy type, childhood trauma and perceived parental bonds did not predict alliance scores. CONCLUSION Findings highlight the potential influence of clinical and personal characteristics on alliance strength and development, with implications for maximizing treatment outcomes through anticipating and responding to these challenges.
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Affiliation(s)
- Brogan L Barr
- School of Psychology, Speech and Hearing, University of Canterbury, Christchurch, New Zealand
| | - Virginia V W McIntosh
- School of Psychology, Speech and Hearing, University of Canterbury, Christchurch, New Zealand
| | - Eileen F Britt
- School of Psychology, Speech and Hearing, University of Canterbury, Christchurch, New Zealand
| | - Jennifer Jordan
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
- Te Whatu Ora Health New Zealand - Waitaha, Canterbury, New Zealand
| | - Janet D Carter
- School of Psychology, Speech and Hearing, University of Canterbury, Christchurch, New Zealand
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23
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McEvoy PM, Bendlin M, Johnson AR, Kazantzis N, Campbell BNC, Bank SR, Egan SJ. The relationships among working alliance, group cohesion and homework engagement in group cognitive behaviour therapy for social anxiety disorder. Psychother Res 2024; 34:54-67. [PMID: 36630684 DOI: 10.1080/10503307.2022.2161966] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 12/19/2022] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVE Few studies have investigated the role of generic relational factors, such as group cohesion and working alliance, in group cognitive behaviour therapy (CBT) for social anxiety disorder (SAD). The aim of this study was to examine the temporal associations among working alliance, group cohesion, and an index of a CBT-specific factor, homework engagement, as correlates of fear of negative evaluation and symptoms of social anxiety in group CBT for SAD. METHOD There were 105 participants with a diagnosis of social anxiety disorder who were randomly assigned to 12 sessions of group imagery-enhanced or standard CBT. Participants completed measures at various time points during the 12-session interventions, and the relationship among variables was examined through random-intercept cross-lagged panel models. RESULTS Group cohesion was significantly associated with social anxiety symptoms at the end of treatment, however there was no significant relationship with working alliance. Greater homework engagement predicted lower social interaction anxiety, but only during mid-treatment. CONCLUSION The results highlight the importance of supporting group cohesion and maximising homework engagement during core components of social anxiety treatment such as behavioural experiments.
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Affiliation(s)
- Peter M McEvoy
- Curtin enAble Institute, Curtin University, Perth, Australia
- Discipline of Psychology, School of Population Health, Curtin University, Perth, Australia
- Centre for Clinical Interventions, Perth, Australia
| | - Martyna Bendlin
- Curtin enAble Institute, Curtin University, Perth, Australia
- Discipline of Psychology, School of Population Health, Curtin University, Perth, Australia
| | - Andrew R Johnson
- Discipline of Psychology, School of Population Health, Curtin University, Perth, Australia
| | - Nikolaos Kazantzis
- Cognitive Behaviour Therapy Research Unit, Melbourne, Australia
- Beck Institute for Cognitive Behaviour Therapy and Research, Philadelphia, PA, USA
| | | | | | - Sarah J Egan
- Curtin enAble Institute, Curtin University, Perth, Australia
- Discipline of Psychology, School of Population Health, Curtin University, Perth, Australia
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24
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Thal SB, Baker P, Marinis J, Wieberneit M, Sharbanee JM, Bruno R, Skeffington PM, Bright SJ. Therapeutic frameworks in integration sessions in substance-assisted psychotherapy: A systematised review. Clin Psychol Psychother 2023. [PMID: 38148518 DOI: 10.1002/cpp.2945] [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: 06/30/2023] [Revised: 11/07/2023] [Accepted: 11/24/2023] [Indexed: 12/28/2023]
Abstract
Serotonergic psychedelics and related substances have been explored as potential adjuncts in substance-assisted psychotherapy (SAPT) for treating various disorders. SAPT can be divided into three phases: preparation, administration and integration. Integration is commonly defined as the comprehension and effective application of insights from psychedelic experiences into everyday life. However, there is limited research regarding the most appropriate therapeutic approach during SAPT. In this article, we discuss the current evidence for different therapeutic frameworks for integration sessions when serotonergic psychedelics and entactogens are used as adjuncts to psychotherapy. We conducted a systematised review of the literature following PRISMA guidelines and searched PsycINFO, MEDLINE and Cochrane Library databases. The final synthesis included 75 clinical trials, mixed-methods investigations, treatment manuals, study protocols, quasi-experiments, qualitative investigations, descriptive studies, opinion papers, reviews, books and book chapters, published until 11 November 2022. The effects that various therapeutic approaches for integration sessions have on therapeutic outcomes have not been investigated by means of rigorous research. Most of the available evidence we retrieved was not supported by empirical data, thus limiting any conclusive statements regarding appropriate therapeutic frameworks for integration sessions for SAPT. Current clinical studies have used a range of therapeutic frameworks with the majority drawing from the humanistic-experiential tradition. While integration is regarded as crucial for the safe application of SAPT, there is currently an insufficient evidence base to suggest that any type of therapy is effective for guiding integration sessions. A systematic investigation of different therapeutic frameworks for integration and additional therapy-related factors is needed.
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Affiliation(s)
- Sascha B Thal
- Curtin School of Population Health, Curtin University, Bentley, Western Australia, Australia
- School of Psychology, College of Health & Education, Murdoch University, Murdoch, Western Australia, Australia
| | - Paris Baker
- School of Medicine (Psychology), University of Tasmania, Hobart, Tasmania, Australia
| | - Jonathon Marinis
- Orygen Youth Health, University of Melbourne, Parkville, Victoria, Australia
| | - Michelle Wieberneit
- Law School, University of Western Australia, Crawley, Western Australia, Australia
| | - Jason M Sharbanee
- Enable Institute, Discipline of Psychology, Curtin School of Population Health, Curtin University, Bentley, Western Australia, Australia
| | - Raimundo Bruno
- School of Medicine (Psychology), University of Tasmania, Hobart, Tasmania, Australia
| | - Petra M Skeffington
- School of Psychology, College of Health & Education, Murdoch University, Murdoch, Western Australia, Australia
| | - Stephen J Bright
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
- Psychedelic Research in Science and Medicine (PRISM), Balwyn North, Victoria, Australia
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Subhan BA, Johnson VE. The Strong Black Woman Archetype and Therapeutic Outcomes: Examining Relationships Among Women with Childhood Sexual Abuse Histories. J Racial Ethn Health Disparities 2023; 10:2957-2969. [PMID: 36469287 DOI: 10.1007/s40615-022-01472-7] [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: 08/25/2022] [Revised: 10/31/2022] [Accepted: 11/21/2022] [Indexed: 12/12/2022]
Abstract
The Strong Black Woman archetype (SBWA) describes a cultural pattern where Black women are expected to and present as physically and mentally strong, regardless of past and ongoing stressors. The SBWA has served the historical purpose of aiding survival for Black women throughout years of racial and gender oppression. However, the practice has also been associated with adverse mental health and with behaviors, such as self-silencing, that could impede therapeutic process. The purpose of this empirical study was to investigate the relationships between adherence to the SBWA and therapeutic outcomes (i.e., satisfaction with therapy, satisfaction with therapist, perceptions of one's global improvement in therapy) among Black women with childhood sexual abuse histories-a subpopulation at increased need for mental health treatment and who may be susceptible to high levels of adherence to the SBWA. Black adult female participants (N = 103) completed an online survey including a demographic questionnaire, an assessment of SBWA endorsement, and treatment outcomes from their current or most recent therapy experience. Three hierarchical linear regressions were conducted with SBWA as the independent variable and (i) satisfaction with therapist, (ii) satisfaction with therapy, and (iii) global improvement as the dependent variables. Consistent with our hypotheses, we found that SBWA inversely predicted satisfaction with therapy and the therapist. While the relationship between SBWA and global improvement was statistically significant, the finding was not practically significant. Still, our study findings suggest that higher levels of SBWA predict less favorable therapy outcomes. Future research directions and clinical implications are discussed.
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Affiliation(s)
- Bibi Aneesa Subhan
- John Jay College of Criminal Justice, City University of New York, 524 West 59Th Street, 10.65.19 NB, New York, NY, 10019, USA.
| | - Veronica Elaine Johnson
- John Jay College of Criminal Justice, City University of New York, 524 West 59Th Street, 10.65.19 NB, New York, NY, 10019, USA
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Elwood WN. Trust as a dyadic mechanism of action: a call to explore patient-provider relationships in the twenty-first century. JOURNAL OF COMMUNICATION IN HEALTHCARE 2023; 16:370-374. [PMID: 37846861 PMCID: PMC10842970 DOI: 10.1080/17538068.2023.2267830] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2023]
Abstract
Background: There is general agreement that trust between patients and providers influences patient knowledge, behaviors, and adherence to provider-recommendations--with subsequent impacts on patient health-related outcomes and provider practices. There is less academic agreement on the processes by which trust is formulated and changed over time and how trust with ongoing healthcare providers can influence health-related outcomes over time.Methods: This opinion draws on social constructionism and symbolic interactionism to posit the possibility that trust can emanate through the communication process, during which a patient and provider transmit and attend to words, images, and paralanguage to convey their states of being and to induce responses, usually acknowledgement, suasion, or physical behaviors, from one another.Results: Theoretical bases for this construct are provided as are qualitative, quantitative, and mixed measurement approaches for multiple healthcare settings.Conclusions: A mechanistic approach to understand how trust is established through patient-provider communication and how trust informs patient health-related outcomes can contribute over time to improve communication in healthcare encounters.
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Affiliation(s)
- William N Elwood
- Office of Behavioral and Social Sciences Research (OBSSR), Division of Program Coordination, Planning, and Strategic Initiatives, Office of the Director, National Institutes of Health (NIH), Bethesda, MD, USA
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Jubenville-Wood T, Nicholas DB, Weiss J, Cairns S. Facilitators and barriers in psychotherapy from the perspective of autistic adults: an enhanced critical incident study. Int J Qual Stud Health Well-being 2023; 18:2278858. [PMID: 37979185 PMCID: PMC11000678 DOI: 10.1080/17482631.2023.2278858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 10/30/2023] [Indexed: 11/20/2023] Open
Abstract
PURPOSE A significant portion of autistic adults experience mental health challenges. Currently, the literature is incomplete when it comes to understanding the needs and preferences of autistic adults who receive therapy. This study elicited the perspectives of autistic adults, focusing on the facilitators, barriers and ways to enhance psychotherapy based on receiving this care for mental health problems. METHODS Using the qualitative, exploratory approach of the Enhanced Critical Incident Technique, eight autistic adults took part in interviews. RESULTS A total of 147 critical incidents were extracted from participant interviews and categories salient to therapeutic practice. The study identified key factors influencing therapy, such as trust and respect, practical approaches, client factors, structure of sessions, knowledge about autism, support for individualized needs, access to mental health services, and involvement of family/advocate. These factors were categorized into eight main areas relevant to therapeutic practice. CONCLUSIONS Findings from this research reveal that psychotherapy with autistic adults is analogous to performing this work with non-autistic adults, in the sense that this work too entails elements of individually tailored treatment and the reliance on common therapeutic factors. There are also differences in this work that necessitate providers having foundational knowledge about autism. Learning directly from autistic adults' insights may help to improve upon the delivery of mental health care for autistic adults.
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Affiliation(s)
| | - David B. Nicholas
- Faculty of Social Work, University of Calgary, Calgary, Alberta, Canada
| | - Jonathan Weiss
- Faculty of Health, York University, Toronto, Ontario, Canada
| | - Sharon Cairns
- Werklund School of Education, University of Calgary, Calgary, Alberta, Canada
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28
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Shaker AA, Austin SF, Jørgensen MS, Sørensen JA, Bechmann H, Kinnerup HE, Petersen CJ, Olsen RK, Simonsen E. Facilitating In-House Mobile App Development Within Psychiatric Outpatient Services for Patients Diagnosed With Borderline Personality Disorder: Rapid Application Development Approach. JMIR Hum Factors 2023; 10:e46928. [PMID: 38032709 PMCID: PMC10722361 DOI: 10.2196/46928] [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: 03/02/2023] [Revised: 07/31/2023] [Accepted: 09/23/2023] [Indexed: 12/01/2023] Open
Abstract
BACKGROUND Mobile app development within mental health is often time- and resource-consuming, challenging the development of mobile apps for psychiatry. There is a continuum of software development methods ranging from linear (waterfall model) to continuous adaption (Scrum). Rapid application development (RAD) is a model that so far has not been applied to psychiatric settings and may have some advantages over other models. OBJECTIVE This study aims to explore the utility of the RAD model in developing a mobile app for patients with borderline personality disorder (BPD) in a psychiatric outpatient setting. METHODS The 4 phases of the RAD model: (1) requirements planning, (2) user design, (3) construction, and (4) cutover, were applied to develop a mobile app within psychiatric outpatient services for patients diagnosed with BPD. RESULTS For the requirements planning phase, a short time frame was selected to minimize the time between product conceptualization and access within a clinical setting. Evidenced-based interactive content already developed was provided by current staff to enhance usability and trustworthiness. For the user design phase, activity with video themes and a discrete number of functions were used to improve the app functionality and graphical user interface. For the construction phase, close collaboration between clinicians, researchers, and software developers yielded a fully functional, in-house-developed app ready to be tested in clinical practice. For the cutover phase, the mobile app was tested successfully with a small number (n=5) of patients with a BPD. CONCLUSIONS The RAD model could be meaningfully applied in a psychiatric setting to develop an app for BPD within a relatively short time period from conceptualization to implementation in the clinic. Short time frames and identifying a limited number of stakeholders with relevant skills in-house facilitated the use of this model. Despite some limitations, RAD could be a useful model in the development of apps for clinical populations to enable development and access to evidence-based technology.
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Affiliation(s)
- Ali Abbas Shaker
- Psychiatric Research Unit, Psychiatric Department, Region Zealand Psychiatry, Slagelse, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Stephen F Austin
- Psychiatric Research Unit, Psychiatric Department, Region Zealand Psychiatry, Slagelse, Denmark
- Department of Psychology, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Mie Sedoc Jørgensen
- Psychiatric Research Unit, Psychiatric Department, Region Zealand Psychiatry, Slagelse, Denmark
| | - John Aasted Sørensen
- Research Unit: AI, Mathematics and Software, Department of Engineering Technology and Didactics, Technical University of Denmark, Ballerup, Denmark
| | - Henrik Bechmann
- Research Unit: AI, Mathematics and Software, Department of Engineering Technology and Didactics, Technical University of Denmark, Ballerup, Denmark
| | | | - Charlotte Juul Petersen
- Mental Health Services South, Copenhagen University Hospital, Psychiatry Region Zealand, Vordingborg, Denmark
| | - Ragnar Klein Olsen
- Psychiatric Research Unit, Psychiatric Department, Region Zealand Psychiatry, Slagelse, Denmark
| | - Erik Simonsen
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Mental Health Services East, Copenhagen University Hospital, Psychiatry Region Zealand, Roskilde, Denmark
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Fernandes JB, Ferreira N, Domingos J, Ferreira R, Amador C, Pardal N, Castro C, Simões A, Fernandes S, Bernardes C, Vareta DA, Peças D, Ladislau D, Sousa N, Duarte A, Godinho C. Health Professionals' Motivational Strategies to Enhance Adherence in the Rehabilitation of People with Lower Limb Fractures: Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:7050. [PMID: 37998282 PMCID: PMC10671680 DOI: 10.3390/ijerph20227050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 10/28/2023] [Accepted: 11/09/2023] [Indexed: 11/25/2023]
Abstract
Patients with lower limb fractures require rehabilitation but often struggle with adherence to interventions. Adding motivational strategies to rehabilitation programs can increase patient adherence and enhance outcomes. This review aims to identify the motivational strategies used by health professionals in the rehabilitation of people with lower limb fractures. We used Arksey and O'Malley's methodological framework to structure and conduct this scoping review. The literature search was performed using the Scopus, CINAHL, MEDLINE, Nursing & Allied Health, and Cochrane Central Register of Controlled Trials databases. The final search was conducted in February 2023. A total of 1339 articles were identified. After selecting and analyzing the articles, twelve studies were included in this review. Health professionals use several strategies to motivate patients with lower limb fractures to adhere to rehabilitation programs. These strategies include building a therapeutic alliance, increasing patients' health literacy, setting achievable goals, personalizing the rehabilitation program, managing unpleasant sensations of exercise, using persuasion, providing positive reinforcement, avoiding negative emotional stimulation, and helping to seek support. The motivational strategies identified may help professionals to increase patient adherence to rehabilitation for lower limb fractures. This knowledge will allow these professionals to help patients overcome barriers to rehabilitation, enhance their motivation, and ultimately improve their recovery outcomes.
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Affiliation(s)
- Júlio Belo Fernandes
- Egas Moniz Center for Interdisciplinary Research (CiiEM), Egas Moniz School of Health & Science, 2829-511 Almada, Portugal; (N.F.); (J.D.); (C.B.); (D.A.V.); (D.P.); (C.G.)
- Nurs* Lab, 2829-511 Almada, Portugal
| | - Noélia Ferreira
- Egas Moniz Center for Interdisciplinary Research (CiiEM), Egas Moniz School of Health & Science, 2829-511 Almada, Portugal; (N.F.); (J.D.); (C.B.); (D.A.V.); (D.P.); (C.G.)
- Nurs* Lab, 2829-511 Almada, Portugal
| | - Josefa Domingos
- Egas Moniz Center for Interdisciplinary Research (CiiEM), Egas Moniz School of Health & Science, 2829-511 Almada, Portugal; (N.F.); (J.D.); (C.B.); (D.A.V.); (D.P.); (C.G.)
| | - Rui Ferreira
- Department of Nursing, Hospital Garcia de Orta, 2805-267 Almada, Portugal (C.A.)
| | - Catarina Amador
- Department of Nursing, Hospital Garcia de Orta, 2805-267 Almada, Portugal (C.A.)
| | - Nelson Pardal
- Department of Nursing, Hospital Garcia de Orta, 2805-267 Almada, Portugal (C.A.)
| | - Cidália Castro
- Egas Moniz Center for Interdisciplinary Research (CiiEM), Egas Moniz School of Health & Science, 2829-511 Almada, Portugal; (N.F.); (J.D.); (C.B.); (D.A.V.); (D.P.); (C.G.)
- Nurs* Lab, 2829-511 Almada, Portugal
| | - Aida Simões
- Egas Moniz Center for Interdisciplinary Research (CiiEM), Egas Moniz School of Health & Science, 2829-511 Almada, Portugal; (N.F.); (J.D.); (C.B.); (D.A.V.); (D.P.); (C.G.)
- Nurs* Lab, 2829-511 Almada, Portugal
| | - Sónia Fernandes
- Egas Moniz Center for Interdisciplinary Research (CiiEM), Egas Moniz School of Health & Science, 2829-511 Almada, Portugal; (N.F.); (J.D.); (C.B.); (D.A.V.); (D.P.); (C.G.)
- Nurs* Lab, 2829-511 Almada, Portugal
| | - Catarina Bernardes
- Egas Moniz Center for Interdisciplinary Research (CiiEM), Egas Moniz School of Health & Science, 2829-511 Almada, Portugal; (N.F.); (J.D.); (C.B.); (D.A.V.); (D.P.); (C.G.)
- Nurs* Lab, 2829-511 Almada, Portugal
| | - Diana Alves Vareta
- Egas Moniz Center for Interdisciplinary Research (CiiEM), Egas Moniz School of Health & Science, 2829-511 Almada, Portugal; (N.F.); (J.D.); (C.B.); (D.A.V.); (D.P.); (C.G.)
- Nurs* Lab, 2829-511 Almada, Portugal
| | - Dina Peças
- Egas Moniz Center for Interdisciplinary Research (CiiEM), Egas Moniz School of Health & Science, 2829-511 Almada, Portugal; (N.F.); (J.D.); (C.B.); (D.A.V.); (D.P.); (C.G.)
- Nurs* Lab, 2829-511 Almada, Portugal
| | - Dora Ladislau
- Egas Moniz Center for Interdisciplinary Research (CiiEM), Egas Moniz School of Health & Science, 2829-511 Almada, Portugal; (N.F.); (J.D.); (C.B.); (D.A.V.); (D.P.); (C.G.)
- Nurs* Lab, 2829-511 Almada, Portugal
| | - Natacha Sousa
- Regional Health Administration of Lisbon and Tagus Valley, Community Care Unit-Integrating Health, 1500-534 Lisbon, Portugal
| | - Andreia Duarte
- Department of Nursing, Setúbal Hospital Centre, 2900-182 Setúbal, Portugal
| | - Catarina Godinho
- Egas Moniz Center for Interdisciplinary Research (CiiEM), Egas Moniz School of Health & Science, 2829-511 Almada, Portugal; (N.F.); (J.D.); (C.B.); (D.A.V.); (D.P.); (C.G.)
- Nurs* Lab, 2829-511 Almada, Portugal
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Parpottas P, Christofi Y, Ioannou I. Adaptation, Academic Performance and Support: Students with and without Disabilities and Future Considerations for Counselling Psychology. Behav Sci (Basel) 2023; 13:862. [PMID: 37887512 PMCID: PMC10604788 DOI: 10.3390/bs13100862] [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: 09/21/2023] [Revised: 10/14/2023] [Accepted: 10/19/2023] [Indexed: 10/28/2023] Open
Abstract
The transition to university is a process that presents young adults with several challenges in adaptation, especially students with disabilities. The current study investigated the differences in adaptation and academic performance between students with and without disabilities and further examined these differences among students with disabilities. Additionally, we explored the role of academic support for students with disabilities' adaptation and academic performance, as well as their perceptions of a proposed specialised package of counselling psychology interventions. The sample consisted of 127 students with disabilities and 127 without disabilities, aged 18-24 years. Results revealed that students with disabilities reported a lower GPA and adaptation than students without disabilities. Additionally, differences among students with disabilities were observed only in terms of GPA, according to their disability type, existence of comorbidity and type of exam accommodations. Interestingly, no differences were found in GPA or adaptation between students with disabilities who utilised psychological therapy and those who did not. Finally, adaptation scores, but not GPA, were higher for students with disabilities who were positive in receiving a specialised package of counselling psychology interventions. The findings are discussed in relation to the existing literature and future considerations of counselling psychology's role in support of students with disabilities.
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Affiliation(s)
- Panagiotis Parpottas
- Department of Social and Behavioral Sciences, School of Humanities, Social and Education Sciences, European University Cyprus, 2404 Engomi, Cyprus
| | - Yianna Christofi
- Committee for Students with Special Educational Needs, European University Cyprus, 2404 Engomi, Cyprus; (Y.C.); (I.I.)
| | - Ioanna Ioannou
- Committee for Students with Special Educational Needs, European University Cyprus, 2404 Engomi, Cyprus; (Y.C.); (I.I.)
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Ho A, Perry J. What We Owe Those Who Chat Woe: A Relational Lens for Mental Health Apps. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2023; 23:77-80. [PMID: 37812122 DOI: 10.1080/15265161.2023.2250306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/10/2023]
Affiliation(s)
- Anita Ho
- University of British Columbia
- University of California, San Francisco
- CommonSpirit Health
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32
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Romm MJ, Cahalin LP. The development of the Therapeutic Group Context Questionnaire: Reliability and validity measures based on telehealth Group-based Pain Management Programs. J Telemed Telecare 2023; 29:685-697. [PMID: 34160313 DOI: 10.1177/1357633x211027410] [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] [Indexed: 11/16/2022]
Abstract
INTRODUCTION In 2016, the Centers for Disease Control and Prevention analyzed the National Health Interview Survey data and found that the occurrence of chronic pain and high-impact chronic pain in the USA was 20.4% and 8%, respectively. Group-based Pain Management Programs have been viewed as significant treatments aiding patients with self-management of chronic pain. The onset of coronavirus disease 2019 (COVID-19) at the beginning of 2020, widely eliminated the in-person Group-based Pain Management Programs. The exploration of therapeutic contextual factors such as the therapeutic alliance and group dynamics in telehealth Group-based Pain Management Programs appears warranted for which reason the Therapeutic Group Context Questionnaire was developed. METHODS The therapeutic alliance and group dynamics items in the Therapeutic Group Context Questionnaire were developed from an extensive literature review and underwent examination of content validity, internal consistency, reliability, and validity through telehealth Group-based Pain Management Programs. RESULTS Content validity of the Therapeutic Group Context Questionnaire was established in five separate stages and the psychometrics of the Therapeutic Group Context Questionnaire was found to be very good with high internal consistency and reliability (r = 0.85-0.97) and the ability of the Therapeutic Group Context Questionnaire to differentiate between high and low scorers on the SF-36 emotional well-being measure. DISCUSSION The examination of therapeutic contextual factors via telehealth Group-based Pain Management Programs using the Therapeutic Group Context Questionnaire appears possible in view of the very good psychometric properties described above. Investigation of therapeutic contextual factors through the Therapeutic Group Context Questionnaire may provide greater insight into the role that these factors may have in telehealth programs and their impact on pain outcomes. Future investigation of the Therapeutic Group Context Questionnaire in non-telehealth Group-based Pain Management Programs, as well as, other disorders being addressed via telehealth appears warranted.
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Affiliation(s)
- Marnin J Romm
- Physical Therapy Department, University of Miami, USA
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Miller DC, Schoen SA, Schmitt CM, Porter LM. Adolescents' and Adults' Perceptions of Sensory-Based Interventions: A Qualitative Analysis. Am J Occup Ther 2023; 77:7705205160. [PMID: 37768991 DOI: 10.5014/ajot.2023.050198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/30/2023] Open
Abstract
IMPORTANCE Adolescents and adults report that their sensory integration and processing differences affect their occupational performance and quality of life, thus requiring effective sensory-focused interventions. Researchers have yet to investigate this population's experience of occupational therapy interventions designed to remediate these challenges. OBJECTIVE To explore the perceived experience of adolescents and adults with respect to (1) response to intervention, (2) strategies offered to manage sensory differences, and (3) need for services on completion of an intervention. DESIGN Retrospective, qualitative study. SETTING Zoom or phone call. PARTICIPANTS Eleven adolescents and adults with sensory integration and processing differences who had previously completed occupational therapy interventions. INTERVENTION Sensory-based intervention based on the principles of Ayres Sensory Integration® (ASI) and the Sensory Therapies and Research Frame of Reference. OUTCOMES AND MEASURES A semistructured interview to obtain data, followed by an in-depth analysis using an inductive coding process to group initial open codes into themes and common subthemes Results: Open codes were grouped into three core themes: (1) therapist-related factors (what the therapist did in treatment); (2) client-related factors (what the client experienced); and (3) follow-up (future needs of the clients). Four main subthemes of the client-therapist relationship emerged: (1) therapeutic alliance; (2) education and knowledge; (3) strategies, tools, and resources; and (4) future needs. CONCLUSIONS AND RELEVANCE This study provides a perspective on the experience of adolescents and adults specific to the impact of a sensory-focused occupational therapy intervention on their daily lives. This will help occupational therapists when designing interventions for current and future clients. What This Article Adds: This study highlights the need for further research addressing effective sensory-based interventions for adolescents and adults. It also captures which components of intervention clients deemed helpful and identifies potential targets for future intervention.
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Affiliation(s)
- Dana C Miller
- Dana C. Miller, OTD, OTR/L, is Occupational Therapist, Atrium Health, Charlotte, NC. At the time of this study, she was Doctoral Student, Occupational Therapy Department, Wingate University, Wingate, NC
| | - Sarah A Schoen
- Sarah A. Schoen, PhD, OTR/L, is Director of Research, STAR Institute, Centennial, CO, and Associate Professor, Occupational Therapy, Rocky Mountain University of Health Professions, Provo, UT;
| | - Carolyn M Schmitt
- Carolyn M. Schmitt, OTD, OTR/L, is Occupational Therapist, Greenwood, CO. At the time of this study, she was Lead Occupational Therapist, STAR Institute, Centennial, CO
| | - Lisa M Porter
- Lisa M. Porter, PhD, OTD, OTR/L, is Assistant Professor, School of Occupational Therapy, Pacific University, Hillsboro, OR. At the time of this study, she was Assistant Professor, Department of Occupational Therapy, Tennessee State University, Nashville
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Boekeloo B, Fish J, Turpin R, Aparicio EM, Shin R, Vigorito MA, Lare SM, McGraw JS, King-Marshall E. LGBTQ+ cultural-competence training effectiveness: Mental health organization and therapist survey outcome results from a pilot randomized controlled trial. Clin Psychol Psychother 2023. [PMID: 37622344 DOI: 10.1002/cpp.2893] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 07/25/2023] [Accepted: 07/26/2023] [Indexed: 08/26/2023]
Abstract
Lesbian, gay, bisexual, transgender, queer/questioning and other sexual and gender diverse (LGBTQ+) persons frequently lack access to mental health service organizations (MHOs) and therapists who are competent with LGBTQ+ clients. Existing continuing education programmes to better equip therapists to work with LGBTQ+ clients are often not widely accessible or skills focused, evaluated for effectiveness and inclusive of MHO administrators who can address the organizational climate needed for therapist effectiveness. A virtual, face-to-face, multi-level (administrators and therapists) and multi-strategy (technical assistance, workshop and clinical consultations) LGBTQ+ cultural competence training-the Sexual and Gender Diversity Learning Community (SGDLC)-was tested in a pilot randomized controlled trial. Ten organizations were randomly assigned to the intervention (SGDLC plus free online videos) or control (free online videos only) group. Pretest/posttest Organization LGBTQ+ Climate Surveys (n = 10 MHOs) and pretest/posttest Therapist LGBTQ+ Competence Self-Assessments (n = 48 therapists) were administered. Results showed that at pretest, average ratings across organization LGBTQ+ climate survey items were low; twice as many items improved on average in the intervention (10/18 items) than control (5/18 items) group organizations. At pretest, therapist average scores (range 0-1) were highest for knowledge (0.88), followed by affirmative attitudes (0.81), practice self-efficacy (0.81), affirmative practices (0.75) and commitment to continued learning (0.69). Pretest/posttest change scores were higher for the intervention relative to the control group regarding therapist self-reported affirmative attitudes (cumulative ordinal ratio [OR] = 3.29; 95% confidence interval [CI] = 1.73, 6.26), practice self-efficacy (OR = 5.28, 95% CI = 2.00, 13.93) and affirmative practices (OR = 3.12, 95% CI = 1.18, 8.25). Average therapist and administrator satisfaction scores were high for the SGDLC. These findings suggest the SGDLC training can affect organizational- and therapist-level changes that may benefit LGBTQ+ clients.
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Affiliation(s)
- Bradley Boekeloo
- Department of Behavioral and Community Health, School of Public Health, University of Maryland, College Park, Maryland, USA
| | - Jessica Fish
- Department of Family Science, School of Public Health, University of Maryland, College Park, Maryland, USA
| | - Rodman Turpin
- College of Public Health, Department of Global and Community Health, George Mason University, Fairfax, Virginia, USA
| | - Elizabeth M Aparicio
- Department of Behavioral and Community Health, School of Public Health, University of Maryland, College Park, Maryland, USA
| | - Richard Shin
- Department of Counseling, Higher Education, and Special Education, University of Maryland, College Park, Maryland, USA
| | - Michael A Vigorito
- Vigorito Counseling and Consulting, LLC, Washington, District of Columbia, USA
| | - Sean M Lare
- Vigorito Counseling and Consulting, LLC, Washington, District of Columbia, USA
| | - James S McGraw
- Department of Psychology, Bowling Green State University, Bowling Green, Ohio, USA
| | - Evelyn King-Marshall
- Department of Behavioral and Community Health, School of Public Health, University of Maryland, College Park, Maryland, USA
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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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Wei S, Freeman D, Rovira A. A randomised controlled test of emotional attributes of a virtual coach within a virtual reality (VR) mental health treatment. Sci Rep 2023; 13:11517. [PMID: 37460586 PMCID: PMC10352334 DOI: 10.1038/s41598-023-38499-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 07/10/2023] [Indexed: 07/20/2023] Open
Abstract
We set out to test whether positive non-verbal behaviours of a virtual coach can enhance people's engagement in automated virtual reality therapy. 120 individuals scoring highly for fear of heights participated. In a two-by-two factor, between-groups, randomised design, participants met a virtual coach that varied in warmth of facial expression (with/without) and affirmative nods (with/without). The virtual coach provided a consultation about treating fear of heights. Participants rated the therapeutic alliance, treatment credibility, and treatment expectancy. Both warm facial expressions (group difference = 7.44 [3.25, 11.62], p = 0.001, [Formula: see text]=0.10) and affirmative nods (group difference = 4.36 [0.21, 8.58], p = 0.040, [Formula: see text] = 0.04) by the virtual coach independently increased therapeutic alliance. Affirmative nods increased the treatment credibility (group difference = 1.76 [0.34, 3.11], p = 0.015, [Formula: see text] = 0.05) and expectancy (group difference = 2.28 [0.45, 4.12], p = 0.015, [Formula: see text] = 0.05) but warm facial expressions did not increase treatment credibility (group difference = 0.64 [- 0.75, 2.02], p = 0.363, [Formula: see text] = 0.01) or expectancy (group difference = 0.36 [- 1.48, 2.20], p = 0.700, [Formula: see text] = 0.001). There were no significant interactions between head nods and facial expressions in the occurrence of therapeutic alliance (p = 0.403, [Formula: see text] = 0.01), credibility (p = 0.072, [Formula: see text] = 0.03), or expectancy (p = 0.275, [Formula: see text] = 0.01). Our results demonstrate that in the development of automated VR therapies there is likely to be therapeutic value in detailed consideration of the animations of virtual coaches.
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Affiliation(s)
- Shu Wei
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, OX3 7JX, UK.
| | - Daniel Freeman
- Department of Experimental Psychology, University of Oxford, Oxford, UK
- Oxford Health NHS Foundation Trust, Oxford, UK
| | - Aitor Rovira
- Department of Experimental Psychology, University of Oxford, Oxford, UK
- Oxford Health NHS Foundation Trust, Oxford, UK
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Eilertsen SEH, Eilertsen TH. Why is it so hard to identify (consistent) predictors of treatment outcome in psychotherapy? - clinical and research perspectives. BMC Psychol 2023; 11:198. [PMID: 37408027 DOI: 10.1186/s40359-023-01238-8] [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: 01/13/2023] [Accepted: 06/26/2023] [Indexed: 07/07/2023] Open
Abstract
BACKGROUND Anxiety and depression are two of the most debilitating psychological disorders worldwide today. Fortunately, effective treatments exist. However, a large proportion of patients do not recover from treatment, and many still have symptoms after completing treatment. Numerous studies have tried to identify predictors of treatment outcome. So far, researchers have found few or no consistent predictors applicable to allocate patients to relevant treatment. METHODS We set out to investigate why it is so hard to identify (consistent) predictors of treatment outcome for psychotherapy in anxiety and depression by reviewing relevant literature. RESULTS Four challenges stand out; a) the complexity of human lives, b) sample size and statistical power, c) the complexity of therapist-patient relationships, and d) the lack of consistency in study designs. Together these challenges imply there are a countless number of possible predictors. We also consider ethical implications of predictor research in psychotherapy. Finally, we consider possible solutions, including the use of machine learning, larger samples and more realistic complex predictor models. CONCLUSIONS Our paper sheds light on why it is so hard to identify consistent predictors of treatment outcome in psychotherapy and suggest ethical implications as well as possible solutions to this problem.
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Affiliation(s)
- Silje Elisabeth Hasmo Eilertsen
- Haugaland DPS/Department of Research and Innovation, Helse Fonna HF, Haugaland DPS v/ Silje Eilertsen, Postboks 2052, Haugesund, Norway.
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Ghosh A, Mahintamani T, Aswathy PV, Basu D, Mattoo SK, Subodh BN, Pillai RR, Kaur M. Service users' perception and attitude toward telemedicine-based treatment for substance use disorders: A qualitative study from India. Indian J Psychiatry 2023; 65:774-784. [PMID: 37645352 PMCID: PMC10461579 DOI: 10.4103/indianjpsychiatry.indianjpsychiatry_167_23] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 04/14/2023] [Accepted: 06/28/2023] [Indexed: 08/31/2023] Open
Abstract
Aim We aimed to assess the service user's acceptability, feasibility, and attitude toward telemedicine practice and compare it with in-person consultation in substance use disorder (SUD). Materials and Methods We recruited 15 adult patients with SUD who accessed both telemedicine and in-person care. We conducted in-depth interviews on awareness and access, facilitators and barriers, treatment satisfaction, and therapeutic relationship in the telemedicine context. We performed a conventional content analysis of the interview excerpts and used inductive and deductive coding. We assumed that social, personal, and logistic contexts influence patients' perceptions and experiences with telemedicine-based addiction care (TAC). Results Most participants were middle-aged men (40.5 years, 86.7%), dependent on two or more substances (86.7%), and had a history of chronic, heavy substance use (use ~16 years, dependence ~11.5 years). Patients' perspectives on TAC could broadly be divided into three phases: pre-consultation, consultation, and post-consultation. Patients felt that TAC improved treatment access with adequate autonomy and control; however, there were technical challenges. Patients expressed privacy concerns and feared experiencing stigma during teleconsultation. They reported missing the elaborate inquiry, physical examination, and ritual of visiting their doctors in person. Additionally, personal comfort and technical difficulties determine the satisfaction level with TAC. Overall perception and suitability of TAC and the decision to continue it developed in the post-consultation phase. Conclusion Our study provides an in-depth insight into the barriers and facilitators of telemedicine-based SUD treatment access, use, and retention; it also helps to understand better the choices and preferences for telehealth care vis-à-vis standard in-person care for SUDs.
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Affiliation(s)
- Abhishek Ghosh
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Tathagata Mahintamani
- Department of Addiction Medicine,Psychiatry, Lokopriya Gopinath Bordoloi Regional Institute of Mental Health, Tezpur, Assam, India
| | - P. V. Aswathy
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Debasish Basu
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | | | - B. N. Subodh
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Renjith R. Pillai
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Manpreet Kaur
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Howieson JA. A framework for the evidence-based practice of therapeutic jurisprudence: A legal therapeutic alliance. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2023; 89:101906. [PMID: 37451069 DOI: 10.1016/j.ijlp.2023.101906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 06/29/2023] [Accepted: 07/02/2023] [Indexed: 07/18/2023]
Abstract
This paper provides a theoretical rationale for using the constructs of procedural justice, trust and self-determination as a framework to guide the evidence-based practice of therapeutic jurisprudence (TJ). The overarching purpose of TJ is to provide therapeutic outcomes to all participants in the legal system. This paper proposes that in legal decision-making, running a procedurally just process that generates trust amongst participants and allows the parties to experience self-determination, creates a dynamic akin to the therapeutic alliance, which, in therapy, is a reliable predictor of therapeutic outcomes. The paper argues that when a legal therapeutic alliance forms in a legal decision-making process then positive therapeutic outcomes are possible, and the process can be classified as one that accords with the philosophy of TJ. A subsequent argument is that a therapeutic court can be defined as one that enacts such a process. The paper concludes by explaining how the framework can provide both a guide to courts in designing TJ processes and an assessment framework to analyse legal decision-making processes for their therapeutic value.
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Affiliation(s)
- Jill A Howieson
- Law School, University of Western Australia, 35 Stirling Highway, Perth, WA 6009, Australia.
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Hilton CE. Behaviour change, the itchy spot of healthcare quality improvement: How can psychology theory and skills help to scratch the itch? Health Psychol Open 2023; 10:20551029231198938. [PMID: 37746584 PMCID: PMC10517624 DOI: 10.1177/20551029231198938] [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] [Indexed: 09/26/2023] Open
Abstract
Despite the clear utility and transferability, National Health Service (NHS) quality improvement initiatives have yet to benefit fully from what is already known within health psychology. Thus far, evidence from established, seminal behaviour change theory and practice have been ignored in favour of newly developed models and frameworks. Further, whilst there is a growing interest in what is commonly referred to as 'human factors' of change and improvement, there is scant transferability of known psychologically informed implementation skills into routine NHS Improvement practice. The science and practice of healthcare improvement is growing, and the behaviour change aspect is critical to sustainable outcomes. Therefore, this paper offers practical guidance on how seminal psychological behaviour change theory and motivational interviewing (a person-centred skills-based approach specifically developed to support people through change) can be combined to better address individual and organisational change within a healthcare improvement context.
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Heredia-Callejón A, García-Pérez P, Armenta-Peinado JA, Infantes-Rosales MÁ, Rodríguez-Martínez MC. Influence of the Therapeutic Alliance on the Rehabilitation of Stroke: A Systematic Review of Qualitative Studies. J Clin Med 2023; 12:4266. [PMID: 37445301 DOI: 10.3390/jcm12134266] [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: 05/27/2023] [Revised: 06/13/2023] [Accepted: 06/20/2023] [Indexed: 07/15/2023] Open
Abstract
The therapeutic alliance is a fundamental component of rehabilitation in order to achieve effective outcomes. However, what develops, maintains or hinders this relationship has not been sufficiently explored. The aim of this systematic review is to recognize the role of the therapeutic alliance in the neurological rehabilitation process. A search for articles was carried out in the databases PubMed, Web of Science, SCOPUS, CINAHL, APA PsycInfo, OTseeker and Dialnet. They were selected according to the eligibility criteria. Internal quality assessment of the articles was measured with the Consolidated Criteria for Reporting Qualitative Research (COREQ). The systematic review was registered in PROSPERO (ID 346523). The search in the databases identified 1596 articles, from which 9 different studies were finally included in the systematic review, reflecting the limitations of studies in this field. All studies are qualitative, from the point of view of the patients themselves, their relatives and healthcare professionals. The total sample of the included studies is 182 participants (96 health professionals, 76 users and 10 relatives). Semi-structured interviews, focus group discussions and written reflections were mainly used to collect the data. In conclusion, the therapeutic alliance can be an active component in the post-stroke rehabilitation process. Being recognized as a person, collaboration with the therapeutic team, empathy, empowerment, confidence, professional skills, maintenance of hope and the role of the family have been identified as aspects that can have an influence on the therapeutic alliance.
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Affiliation(s)
| | - Patricia García-Pérez
- Occupational Therapy Department, Hospital Marítimo, Servicio Andaluz de Salud (SAS), 29620 Malaga, Spain
| | - Juan Antonio Armenta-Peinado
- Department of Physiotherapy, Faculty of Health Sciences, University of Malaga, 29071 Malaga, Spain
- Biomedical Research Institute (IBIMA), 29590 Malaga, Spain
| | - Miguel Ángel Infantes-Rosales
- Department of Physiotherapy, Faculty of Health Sciences, University of Malaga, 29071 Malaga, Spain
- Biomedical Research Institute (IBIMA), 29590 Malaga, Spain
| | - María Carmen Rodríguez-Martínez
- Department of Physiotherapy, Faculty of Health Sciences, University of Malaga, 29071 Malaga, Spain
- Biomedical Research Institute (IBIMA), 29590 Malaga, Spain
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Reatto LL, Werbart A, Oasi O, De Salve F, Ierardi E, Giordano M, Riva Crugnola C. Understanding psychoanalytic work online and back to the couch in the wake of the COVID-19 pandemic: an investigation among Italian psychoanalysts. Front Psychol 2023; 14:1167582. [PMID: 37425145 PMCID: PMC10324410 DOI: 10.3389/fpsyg.2023.1167582] [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: 02/16/2023] [Accepted: 06/06/2023] [Indexed: 07/11/2023] Open
Abstract
Background Worldwide, psychotherapists' clinical experience went through rapid developments with transition to teletherapy during the COVID-19 pandemic. Literature on the use of remote psychoanalysis was not conclusive, leaving the issue of the consequences of the necessary setting alternation open. This study aimed to investigate the psychoanalysts' experiences of shifting to remote work and then returning to in-person setting, considering the effect of the patients' attachment styles and personality configurations. Method Seventy-one analysts of the Italian Psychoanalytic Society were asked to fill out an online survey about patients who found the transition easier and patients who found it more difficult. General questions on therapeutic work, ISTS (Interpretive and Supportive Technique Scale) for interpretive and supportive aspects of technique, WAI-S-TR (Working Alliance Inventory-Short Revised-Therapist) for therapeutic alliance, RQ (Relationship Questionnaire) for attachment style, and PMAI (Prototype Matching of Anaclitic-Introjective Personality Configuration) for personality configurations were administered. Results All of the analysts chose to continue the treatment using audio-visual tools. Patients with difficult transitions had a significantly higher frequency of insecure attachment and a higher score on RQ Dismissing scale than patients with easy transitions. No significant differences were found between the two groups in personality configurations, psychotherapeutic alliance, and psychotherapeutic technique. Moreover, a higher level of therapeutic alliance was positively correlated to RQ Secure scale and was negatively correlated to RQ Dismissing scale. Patients with easy transition both to remote work and back to in-person setting had higher scores of therapeutic alliances than those with difficult transition both to remote work and back to in-person setting. Conclusion Online psychoanalytic therapy was widely used during the COVID-19 pandemic. Patients with insecure attachment styles had greater difficulties in adapting to setting alternations, thus confirming that insecure attachment is a vulnerability factor not only for psychopathological problems but also for a well-functioning therapeutic collaboration. Patient's personality configuration did not influence their adaptation to the setting alternation. The supportive and interpretive styles did not undergo significant changes in the transition from in-person setting to remote setting and vice versa, thus suggesting a continuity in the analysts' "internal setting."
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Affiliation(s)
| | - Andrzej Werbart
- Department of Psychology, Stockholm University, Stockholm, Sweden
| | - Osmano Oasi
- Department of Psychology, Catholic University of the Sacred Heart, Milan, Italy
| | - Francesca De Salve
- Department of Psychology, Catholic University of the Sacred Heart, Milan, Italy
| | - Elena Ierardi
- Department of Psychology, University of Milano-Bicocca, Milan, Italy
| | - Mattia Giordano
- Department of Psychology, Catholic University of the Sacred Heart, Milan, Italy
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Park SH, Cheng CP, Buehler NJ, Sanford T, Torrey W. A sentiment analysis on online psychiatrist reviews to identify clinical attributes of psychiatrists that shape the therapeutic alliance. Front Psychiatry 2023; 14:1174154. [PMID: 37398580 PMCID: PMC10313228 DOI: 10.3389/fpsyt.2023.1174154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Accepted: 05/29/2023] [Indexed: 07/04/2023] Open
Abstract
Background While online reviews from physician rating websites are increasingly utilized by healthcare providers to better understand patient needs, it remains difficult to objectively identify areas for improvement in providing psychiatric care. Objectives To quantitatively characterize the sentiment of online written reviews of psychiatrists to determine clinical attributes that can be strengthened to improve psychiatrists' therapeutic alliance with their patients. Materials and methods Sentiment scores of 6,400 written reviews of 400 US-based psychiatrists on a US-based online physician rating website were obtained through a natural-language-processing-based sentiment analysis. Relationships among sentiment scores, average star ratings, and demographics were examined. Linguistic analyses determined words and bigrams that were highly associated with reviews with the most positive and negative sentiment. Findings Sentiment scores were significantly correlated with average star ratings of the psychiatrists (R = 0.737, p < 0.001). Psychiatrists who were younger (< 56 years old) and/or practiced in the Northeast had significantly higher average star ratings than those older and/or practicing in the Southwest. Frequency analysis showed that positive reviews most frequently contained "time" (N = 1,138) and "caring" (N = 784) while negative reviews most frequently contained "medication" (N = 495) and "time" (N = 379). Logistic regression analysis revealed that reviews were more likely to be considered positive when they included "great listener" (OR = 16.89) and "comfortable" (OR = 10.72) and more likely to be negative when they included "meds" (OR = 0.55) and "side effect" (OR = 0.59). Conclusion Psychiatrists who are younger and located in the Northeast receive more positive reviews; there may be potential for demographic bias among patient reviewers. Patients positively rate psychiatrists who make them feel heard and comfortable but negatively rate encounters centered around medications and their side effects. Our study lends quantitative evidence to support the importance of thorough and empathetic communication of psychiatrists in building a strong therapeutic alliance.
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Affiliation(s)
- Soo Hwan Park
- Geisel School of Medicine at Dartmouth, Hanover, NH, United States
- Department of Psychiatry, Dartmouth Health, Lebanon, NH, United States
| | | | | | - Timothy Sanford
- Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - William Torrey
- Geisel School of Medicine at Dartmouth, Hanover, NH, United States
- Department of Psychiatry, Dartmouth Health, Lebanon, NH, United States
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Hudon A, Lammatteo V, Rodrigues-Coutlée S, Dellazizzo L, Giguère S, Phraxayavong K, Potvin S, Dumais A. Exploration of the role of emotional expression of treatment-resistant schizophrenia patients having followed virtual reality therapy: a content analysis. BMC Psychiatry 2023; 23:420. [PMID: 37308864 DOI: 10.1186/s12888-023-04861-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Accepted: 05/10/2023] [Indexed: 06/14/2023] Open
Abstract
BACKGROUND Emotional responses are an important component of psychotherapeutic processes. Avatar therapy (AT) is a virtual reality-based therapy currently being developed and studied for patients suffering from treatment resistant schizophrenia. Considering the importance of identifying emotions in therapeutical processes and their impact on the therapeutic outcome, an exploration of such emotions is needed. METHODS The aim of this study is to identify the underlying emotions at the core of the patient-Avatar interaction during AT by content analysis of immersive sessions transcripts and audio recordings. A content analysis of AT transcripts and audio recordings using iterative categorization was conducted for 16 patients suffering from TRS who underwent AT between 2017 and 2022 (128 transcripts and 128 audio recordings). An iterative categorization technique was conducted to identify the different emotions expressed by the patient and the Avatar during the immersive sessions. RESULTS The following emotions were identified in this study: Anger, Contempt/ Disgust, Fear, Sadness, Shame/ Embarrassment, Interest, Surprise, Joy and Neutral. Patients expressed mostly neutral, joy and anger emotions whereas the Avatar expressed predominantly interest, disgust/contempt, and neutral emotions. CONCLUSIONS This study portrays a first qualitative insight on the emotions that are expressed in AT and serves as a steppingstone for further investigation in the role of emotions in the therapeutic outcomes of AT.
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Affiliation(s)
- Alexandre Hudon
- Centre de recherche de l'Institut Universitaire en Santé Mentale de Montréal, Montreal, Canada
- Department of Psychiatry and Addictology, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
| | | | | | - Laura Dellazizzo
- Centre de recherche de l'Institut Universitaire en Santé Mentale de Montréal, Montreal, Canada
- Department of Psychiatry and Addictology, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
| | - Sabrina Giguère
- Centre de recherche de l'Institut Universitaire en Santé Mentale de Montréal, Montreal, Canada
- Department of Psychiatry and Addictology, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
| | | | - Stéphane Potvin
- Centre de recherche de l'Institut Universitaire en Santé Mentale de Montréal, Montreal, Canada
- Department of Psychiatry and Addictology, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
| | - Alexandre Dumais
- Centre de recherche de l'Institut Universitaire en Santé Mentale de Montréal, Montreal, Canada.
- Services et Recherches Psychiatriques AD, Montreal, QC, Canada.
- Department of Psychiatry and Addictology, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada.
- Institut national de psychiatrie légale Philippe-Pinel, Montreal, Canada.
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Sigmarsdóttir M, Rodríguez MMD, Gewirtz A, Rains L, Tjaden J, Forgatch MS. Five-year fidelity assessment of an evidence-based parenting program (GenerationPMTO): inter-rater reliability following international implementation. BMC Health Serv Res 2023; 23:576. [PMID: 37277856 DOI: 10.1186/s12913-023-09611-4] [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: 10/21/2022] [Accepted: 05/24/2023] [Indexed: 06/07/2023] Open
Abstract
BACKGROUND Implementing evidence-based programs in community service settings introduces the challenge of ensuring sustained fidelity to the original program. We employ a fidelity measure based on direct observation of practitioners' competence and adherence to the evidence-based parenting program (EBPP) GenerationPMTO following installation in national and international sites. Fidelity monitoring is crucial, especially when the program purveyor transfers administration of the program to the community as was done in this case. In previous studies, the Fidelity of Implementation rating system (FIMP) was used to evaluate practitioners' fidelity to the GenerationPMTO intervention in six countries following implementation showing high levels of adherence up to 17 years post certification. Other studies showed FIMP to have predictive validity. The present study provides inter-rater reliability data for this fidelity tool across teams of the purveyor, Implementation Sciences International, Inc./ISII, and national and international sites over a five-year period. METHODS Data assess inter-rater reliability in terms of percent agreement and intraclass correlation (ICC) for the purveyor's two fidelity teams and the fidelity teams in seven implementation sites. RESULTS Results report stable good to excellent levels of inter-rater reliability and ICCs as well as good attendance at fidelity meetings for all fidelity teams. CONCLUSIONS This observational method of assessing fidelity post implementation is a promising approach to enable EBPPs to be transferred safely from purveyors to communities while maintaining reliable fidelity to the intervention.
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Affiliation(s)
| | | | - Abigail Gewirtz
- Department of Psychology, Arizona State University, Tempe, USA
| | - Laura Rains
- Implementation Sciences International, Inc., Eugene, USA
| | | | - Marion S Forgatch
- Implementation Sciences International, Inc., Eugene, USA
- Oregon Social Learning Center, Eugene, USA
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Gernert CC, Nelson A, Falkai P, Falter‐Wagner CM. Synchrony in psychotherapy: High physiological positive concordance predicts symptom reduction and negative concordance predicts symptom aggravation. Int J Methods Psychiatr Res 2023; 33:e1978. [PMID: 37204940 PMCID: PMC10804325 DOI: 10.1002/mpr.1978] [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: 01/26/2023] [Revised: 04/02/2023] [Accepted: 05/09/2023] [Indexed: 05/21/2023] Open
Abstract
OBJECTIVE Therapeutic alliance is often considered as a predictor for therapeutic success. This study explored dyadic synchrony of skin conductance response (SCR) during naturalistic therapeutic interactions and investigated its potential as an objective biomarker for predicting therapy effectiveness. METHODS In this proof-of-concept study, skin conductance from both dyad members was continuously measured via wristbands during psychotherapy. Patients and therapists completed post-session reports capturing their subjective appraisal of therapeutic alliance. Additionally, patients completed symptom questionnaires. Each therapeutic dyad was recorded twice in a follow-up design. The first session of the follow-up group was assessed for physiological synchrony (Single Session Index (SSI)). Therapy outcome was captured by the difference between symptom severity scores over time. RESULTS SCR synchrony significantly predicted the outcome variable of change in patients' global severity index (GSI). High positive SCR concordance was linked to a reduction in patients' GSI, while negative or small positive SSI values were linked to an increase in patients' GSI. CONCLUSION The results demonstrate the presence of SCR synchrony in clinical interactions. Skin conductance response synchrony was a significant predictor for change in patients' symptom severity index, emphasizing its potential as an objective biomarker in the context of evidence-based psychotherapy.
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Affiliation(s)
- Clara C. Gernert
- Department of Psychiatry, Medical FacultyLMU MunichMunichGermany
| | - Afton Nelson
- Department of Psychiatry, Medical FacultyLMU MunichMunichGermany
| | - Peter Falkai
- Department of Psychiatry, Medical FacultyLMU MunichMunichGermany
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Hanft-Robert S, Lindberg LG, Mösko M, Carlsson J. A balancing act: how interpreters affect the therapeutic alliance in psychotherapy with trauma-affected refugees-a qualitative study with therapists. Front Psychol 2023; 14:1175597. [PMID: 37260954 PMCID: PMC10228651 DOI: 10.3389/fpsyg.2023.1175597] [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: 02/27/2023] [Accepted: 04/24/2023] [Indexed: 06/02/2023] Open
Abstract
Objective The therapeutic alliance (TA) has the highest predictive value concerning the success of psychotherapy. The presented study aimed to explore how the presence of an interpreter affects the TA when working with trauma-affected refugees. Method Semi-structured interviews were conducted with seven psychologists working in an outpatient clinic specialized in mental health care for migrant and refugee patients with trauma-related mental health problems in Denmark. Interviews were transcribed verbatim and analyzed using a structuring content analysis approach. Results TA has been described as a dynamic therapist-interpreter-patient alliance triangle consisting of three distinct but highly intertwined and mutually influential dyadic alliances. Specific factors affecting the quality of the TA were identified, e.g., interpreter being emotionally attuned yet not overly involved; interpreter being barely visible yet present as a human being. Characteristics of trauma-affected refugee patients affecting the TA formation were also identified, e.g., a high level of personal distrust, different understandings of mental disorders and psychotherapy, stigmatization, perceptions of authorities. Conclusion The presence of interpreters was perceived ambivalently and the formation of a good TA seems to be a balancing act. Based on the findings, recommendations for forming and maintaining a good TA in interpreter-mediated psychotherapy are provided.
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Affiliation(s)
- Saskia Hanft-Robert
- Department of Medical Psychology, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Laura Glahder Lindberg
- Mental Health Center Ballerup, Copenhagen University Hospital – Mental Health Services Copenhagen, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Mike Mösko
- Department of Medical Psychology, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Applied Human Sciences, Magdeburg-Stendal University of Applied Sciences, Magdeburg, Germany
| | - Jessica Carlsson
- Mental Health Center Ballerup, Copenhagen University Hospital – Mental Health Services Copenhagen, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Bernard M, Poncin E, Bovet E, Tamches E, Cantin B, Pralong J, Borasio GD. Giving and receiving thanks: a mixed methods pilot study of a gratitude intervention for palliative patients and their carers. BMC Palliat Care 2023; 22:52. [PMID: 37101149 PMCID: PMC10134658 DOI: 10.1186/s12904-023-01172-x] [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: 09/16/2022] [Accepted: 04/12/2023] [Indexed: 04/28/2023] Open
Abstract
BACKGROUND Psychological research examining the nature and workings of gratitude has burgeoned over the past two decades. However, few studies have considered gratitude in the palliative care context. Based on an exploratory study which found that gratitude was correlated with better quality of life and less psychological distress in palliative patients, we designed and piloted a gratitude intervention where palliative patients and a carer of their choice wrote and shared a gratitude letter with each other. The aims of this study are to establish the feasibility and acceptability of our gratitude intervention and provide a preliminary assessment of its effects. METHODS This pilot intervention study adopted a mixed-methods, concurrent nested, pre-post evaluation design. To assess the intervention's effects, we employed quantitative questionnaires on quality of life, quality of relationship, psychological distress, and subjective burden, as well as semi-structured interviews. To assess feasibility, we considered patients and carers' eligibility, participation and attrition rates, reasons for refusal to participate, appropriateness of intervention timeframe, modalities of participation, and barriers and facilitators. Acceptability was assessed through post-intervention satisfaction questionnaires. RESULTS Thirty-nine participants completed the intervention and twenty-nine participated in interviews. We did not find any statistically significant pre/post intervention changes for patients, but found significant decrease in psychological distress for carers in terms of depression (median = 3 at T0, 1.5 at T1, p = .034) and total score (median = 13 at T0, 7.5 at T1, p = .041). Thematic analysis of interviews indicates that overall, the intervention had: (1) multiple positive outcomes for over a third of interviewees, in the form of positive emotional, cognitive, and relational effects; (2) single positive outcomes for nearly half of interviewees, who experienced emotional or cognitive effects; (3) no effect on two patients; and (4) negative emotional effects on two patients. Feasibility and acceptability indicators suggest that the intervention was well received by participants, and that it should adopt flexible modalities (e.g. writing or dictating a gratitude message) to ensure that it is feasible and adapted to individual needs and preferences. CONCLUSIONS Larger scale deployment and evaluation of the gratitude intervention, including a control group, is warranted in order to have a more reliable evaluation of its effectiveness in palliative care.
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Affiliation(s)
- Mathieu Bernard
- Palliative and Supportive Care Service, Lausanne University Hospital and University of Lausanne, Av. Pierre-Decker 5, Lausanne, CH-1011, Switzerland.
| | - Emmanuelle Poncin
- Palliative and Supportive Care Service, Lausanne University Hospital and University of Lausanne, Av. Pierre-Decker 5, Lausanne, CH-1011, Switzerland
| | - Emilie Bovet
- Haute École de Santé Vaud (HESAV), Haute École Spécialisée de Suisse Occidentale (HES-SO), Lausanne, Switzerland
| | - Emmanuel Tamches
- Palliative and Supportive Care Service, Lausanne University Hospital and University of Lausanne, Av. Pierre-Decker 5, Lausanne, CH-1011, Switzerland
| | - Boris Cantin
- Palliative Care Center, Fribourg Hospital, Fribourg, Switzerland
| | | | - Gian Domenico Borasio
- Palliative and Supportive Care Service, Lausanne University Hospital and University of Lausanne, Av. Pierre-Decker 5, Lausanne, CH-1011, Switzerland
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49
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Modlin NL, Miller TM, Rucker JJ, Kirlic N, Lennard-Jones M, Schlosser D, Aaronson ST. Optimizing outcomes in psilocybin therapy: Considerations in participant evaluation and preparation. J Affect Disord 2023; 326:18-25. [PMID: 36707036 DOI: 10.1016/j.jad.2023.01.077] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 01/11/2023] [Accepted: 01/21/2023] [Indexed: 01/26/2023]
Abstract
Recent studies have demonstrated the promise of psilocybin therapies in creating positive changes for those with poor mental health across multiple diagnostic categories, including major depressive disorder (MDD), end-of-life anxiety, and obsessive-compulsive disorder (OCD). While there may be a large population that is eligible to participate in psilocybin therapy based on psychiatric diagnosis and medical clearance, little attention has been given to intrapersonal and interpersonal factors that might influence patient's readiness (i.e., eligibility and capacity) for psychedelic interventions. This paper proposes that readiness assessment includes both intrapersonal and interpersonal factors in order to improve safety, patient care, and treatment outcomes. While at the present time a reliable and valid instrument has not been developed, we propose that three specific areas of focus - patient presentation, therapeutic alliance, and patient safety - may be used to establish a patient's readiness for psilocybin therapy, thus increasing therapy optimization and personalization.
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Affiliation(s)
- Nadav Liam Modlin
- The Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Tammy M Miller
- Institute for Advanced Therapeutics and Diagnostics, Sheppard Pratt, Towson, MD, United States of America
| | - James J Rucker
- Department of Psychological Medicine, King's College London, Institute of Psychiatry, Psychology, and Neuroscience, London, United Kingdom; South London and Maudsley National Health Service Foundation Trust, Bethlem Royal Hospital, Beckenham, United Kingdom
| | | | | | - Danielle Schlosser
- Compass Pathfinder Ltd, London, United Kingdom; Weill Institute for Neurosciences, University of California, San Francisco, United States of America
| | - Scott T Aaronson
- Institute for Advanced Therapeutics and Diagnostics, Sheppard Pratt, Towson, MD, United States of America; University of Maryland School of Medicine, Department of Psychiatry, 701 West Pratt Street, Baltimore, MD 21201, United States of America.
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50
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Hart MJ, Sung JY, McQuillin SD, Schleider JL. Expanding the reach of psychosocial services for youth: Untapped potential of mentor-delivered single session interventions. JOURNAL OF COMMUNITY PSYCHOLOGY 2023; 51:1255-1272. [PMID: 36017616 DOI: 10.1002/jcop.22927] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 07/30/2022] [Accepted: 08/11/2022] [Indexed: 06/15/2023]
Abstract
At present, the mental healthcare system cannot meet the demand for services, and the need-to-access gap is widest among children and adolescents. Single session interventions (SSIs) are brief, intentional, and mechanism-targeted programs that have shown promise in increasing the reach of effective, evidence-based services; yet, a wide gap still remains due to structural barriers (e.g., lack of awareness, workforce shortages). The present paper posits the integration of SSIs and mentor-delivered programs as a promising future step to further overcome the inaccessibility of youth mental health services. Capitalizing on the advantages of mentoring relationships (e.g., the associated interpersonal benefits and mentors' pre-existence in most community settings) has the potential to complement and enhance the value of SSIs, and to expand the acceptability and reach of evidence-based mental health services. In this paper, we discuss the anticipated benefits of mentor-delivered SSIs, as well as cautionary considerations related to the proposed model. To conclude, we highlight the necessary implementation and research implications.
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Affiliation(s)
- Mackenzie J Hart
- Department of Psychology, University of South Carolina, Columbia, South Carolina, USA
| | - Jenna Y Sung
- Department of Psychology, Stony Brook University, Stony Brook, New York, USA
| | - Samuel D McQuillin
- Department of Psychology, University of South Carolina, Columbia, South Carolina, USA
| | - Jessica L Schleider
- Department of Psychology, Stony Brook University, Stony Brook, New York, USA
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