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Voderholzer U, Meule A, Koch S, Pfeuffer S, Netter AL, Lehr D, Zisler EM. Effectiveness of One Videoconference-Based Exposure and Response Prevention Session at Home in Adjunction to Inpatient Treatment in Persons With Obsessive-Compulsive Disorder: Nonrandomized Study. JMIR Ment Health 2024; 11:e52790. [PMID: 38477970 DOI: 10.2196/52790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 11/24/2023] [Accepted: 12/19/2023] [Indexed: 03/14/2024] Open
Abstract
BACKGROUND Therapist-guided exposure and response prevention (ERP) for the treatment of obsessive-compulsive disorder (OCD) is frequently conducted within clinical settings but rarely at places where patients are usually confronted with OCD symptom-provoking situations in daily life (eg, at home). OBJECTIVE This study aimed to investigate patients' views on 1 ERP session at home via videoconference and its impact on treatment outcome. METHODS A total of 64 inpatients with OCD received 1 session of therapist-guided videoconference-based ERP at home in adjunction to a multimodal inpatient treatment between 2015 and 2020. RESULTS Compared with 64 age- and sex-matched controls who received a multimodal inpatient treatment without 1 session of videoconference-based ERP at home, patients who received 1 session of videoconference-based ERP in adjunction to a multimodal inpatient treatment showed stronger reductions in OCD symptom severity from admission to discharge. Before the videoconference-based ERP session, patients reported high rationale credibility and treatment expectancy. After the videoconference-based ERP session, patients reported medium-to-high positive mood as well as depth and smoothness of the session, and they perceived the working alliance as high. CONCLUSIONS Results highlight the importance of administering therapist-guided ERP sessions in patients' natural environment to enhance treatment response in OCD. Videoconference-based ERP as add-on to treatment as usual is, therefore, a promising approach to facilitate the application of ERP in patients' natural environment and foster the generalization of ERP conducted in clinical settings.
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Affiliation(s)
- Ulrich Voderholzer
- Schoen Clinic Roseneck, Prien am Chiemsee, Germany
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
- Medical Center, Department of Psychiatry and Psychotherapy, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Adrian Meule
- Schoen Clinic Roseneck, Prien am Chiemsee, Germany
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
- Institute of Medical Psychology, Faculty of Medicine, LMU Munich, Munich, Germany
| | - Stefan Koch
- Schoen Clinic Roseneck, Prien am Chiemsee, Germany
| | | | | | - Dirk Lehr
- Leuphana Universität Lüneburg, Lüneburg, Germany
| | - Eva Maria Zisler
- Schoen Clinic Roseneck, Prien am Chiemsee, Germany
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
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Freund J, Piotrowski A, Bührmann L, Oehler C, Titzler I, Netter AL, Potthoff S, Ebert DD, Finch T, Köberlein-Neu J, Etzelmüller A. Validation of the German Normalisation Process Theory Measure G-NoMAD: translation, adaptation, and pilot testing. Implement Sci Commun 2023; 4:126. [PMID: 37845776 PMCID: PMC10578017 DOI: 10.1186/s43058-023-00505-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 09/23/2023] [Indexed: 10/18/2023] Open
Abstract
BACKGROUND Implementing evidence-based healthcare practices (EBPs) is a complex endeavour and often lags behind research-informed decision processes. Understanding and systematically improving implementation using implementation theory can help bridge the gap between research findings and practice. This study aims to translate, pilot, and validate a German version of the English NoMAD questionnaire (G-NoMAD), an instrument derived from the Normalisation Process Theory, to explore the implementation of EBPs. METHODS Survey data has been collected in four German research projects and subsequently combined into a validation data set. Two versions of the G-NoMAD existed, independently translated from the original English version by two research groups. A measurement invariance analysis was conducted, comparing latent scale structures between groups of respondents to both versions. After determining the baseline model, the questionnaire was tested for different degrees of invariance (configural, metric, scalar, and uniqueness) across samples. A confirmatory factor analysis for three models (a four-factor, a unidimensional, and a hierarchical model) was used to examine the theoretical structure of the G-NoMAD. Finally, psychometric results were discussed in a consensus meeting, and the final instructions, items, and scale format were consented to. RESULTS A total of 539 health care professionals completed the questionnaire. The results of the measurement invariance analysis showed configural, partial metric, and partial scalar invariance indicating that the questionnaire versions are comparable. Internal consistency ranged from acceptable to good (0.79 ≤ α ≤ 0.85) per subscale. Both the four factor and the hierarchical model achieved a better fit than the unidimensional model, with indices from acceptable (SRMR = 0.08) to good (CFI = 0.97; TLI = 0.96). However, the RMSEA values were only close to acceptable (four-factor model: χ2164 = 1029.84, RMSEA = 0.10; hierarchical model: χ2166 = 1073.43, RMSEA = 0.10). CONCLUSIONS The G-NoMAD provides a reliable and promising tool to measure the degree of normalisation among individuals involved in implementation activities. Since the fit was similar in the four-factor and the hierarchical model, priority should be given to the practical relevance of the hierarchical model, including a total score and four subscale scores. The findings of this study support the further usage of the G-NoMAD in German implementation settings. TRIAL REGISTRATION Both the AdAM project (No. NCT03430336, 06/02/2018) and the EU-project ImpleMentAll (No. NCT03652883, 29/08/2018) were registered on ClinicalTrials.gov. The ImplementIT study was registered at the German Clinical Trial Registration (No. DRKS00017078, 18/04/2019). The G-NoMAD validation study was registered at the Open Science Framework (No7u9ab, 17/04/2023).
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Affiliation(s)
- Johanna Freund
- Professorship Psychology & Digital Mental Health Care, Department of Sport and Health Sciences, Technical University of Munich, Georg-Brauchle-Ring 60/62, Munich, 80992, Germany.
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany.
| | - Alexandra Piotrowski
- Center for Health Economics and Health Services Research, Schumpeter School of Business and Economics, University of Wuppertal, Wuppertal, Germany
- Chair of General Practice II and Patient Centredness in Primary Care, Institute of General Practice and Primary Care (IAMAG), Faculty of Health, Witten/Herdecke University, Witten, Germany
| | - Leah Bührmann
- Department of Social Work, Education and Community Wellbeing, Northumbria University, Newcastle Upon Tyne, UK
| | - Caroline Oehler
- German Depression Foundation, Leipzig, Germany
- Department of Psychiatry and Psychotherapy, University of Leipzig Medical Center, Leipzig, Germany
| | - Ingrid Titzler
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Anna-Lena Netter
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Philipps University of Marburg, Marburg, Germany
| | - Sebastian Potthoff
- Department of Social Work, Education and Community Wellbeing, Northumbria University, Newcastle Upon Tyne, UK
| | - David Daniel Ebert
- Professorship Psychology & Digital Mental Health Care, Department of Sport and Health Sciences, Technical University of Munich, Georg-Brauchle-Ring 60/62, Munich, 80992, Germany
| | - Tracy Finch
- Department of Nursing, Midwifery and Health, Northumbria University, Newcastle Upon Tyne, UK
| | - Juliane Köberlein-Neu
- Center for Health Economics and Health Services Research, Schumpeter School of Business and Economics, University of Wuppertal, Wuppertal, Germany
| | - Anne Etzelmüller
- Professorship Psychology & Digital Mental Health Care, Department of Sport and Health Sciences, Technical University of Munich, Georg-Brauchle-Ring 60/62, Munich, 80992, Germany
- HelloBetter, GET.ON Institut für Online Gesundheitstrainings GmbH, Berlin, Germany
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Netter AL, Beintner I, Brakemeier EL. Adding an app-based intervention to the Cognitive Behavioral Analysis System of Psychotherapy (CBASP): Proof-of-Concept in Routine Outpatient Psychotherapy Treatment (Preprint). JMIR Form Res 2021; 6:e35482. [PMID: 35943764 PMCID: PMC9399836 DOI: 10.2196/35482] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 02/03/2022] [Accepted: 02/03/2022] [Indexed: 01/12/2023] Open
Abstract
Background The Cognitive Behavioral Analysis System of Psychotherapy (CBASP) is an empirically supported psychotherapeutic treatment developed specifically for persistent depressive disorder. However, given the high rates of nonresponse and relapse, there is a need for optimization. Studies suggest that outcomes can be improved by increasing the treatment dose via, for example, the continuous web-based application of therapy strategies between sessions. The strong emphasis in CBASP on the therapeutic relationship, combined with limited therapeutic availabilities, encourages the addition of web-based interventions to face-to-face therapy in terms of blended therapy. Objective The aim of this study was to test an app-based intervention called CBASPath, which was designed to be used as a blended therapy tool. CBASPath offers 8 sequential modules with app-based exercises to facilitate additional engagement with the therapy content and a separate exercise to conduct situational analyses within the app at any time. Methods CBASPath was tested in an open pilot study as part of routine outpatient CBASP treatment. Participating patients were asked to report their use patterns and blended use (integrated use of the app as part of therapy sessions) at 3 assessment points over the 6-month test period and rate the usability and quality of and their satisfaction with CBASPath. Results The results of the pilot trial showed that 93% (12/13) of participants used CBASPath as a blended tool during their therapy and maintained this throughout the study period. Overall, they reported good usability and quality ratings along with high user satisfaction. All participants showed favorable engagement with CBASPath; however, the frequency of use differed widely among the participants and assessment points. Situational analysis was used by all participants, and the number of completed modules ranged from 1 to 7. All participants reported blended use, although the frequency of integration in the face-to-face sessions varied widely. Conclusions Our findings suggest that the digital augmentation of complex and highly interactive CBASP therapy in the form of blended therapy with CBASPath is feasible in routine outpatient care. Therapeutic guidance might contribute to high adherence and increase patient self-management. A few adjustments, such as saving entries directly in the app, could facilitate higher user engagement. A randomized controlled trial is now needed to investigate the efficacy and added value of this blended approach. In the long term, CBASPath could help optimize persistent depressive disorder treatment and reduce relapse by intensifying therapy and providing long-term patient support through the app.
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Affiliation(s)
- Anna-Lena Netter
- Department of Clinical Psychology and Psychotherapy, Philipps University of Marburg, Marburg, Germany
| | | | - Eva-Lotta Brakemeier
- Department of Clinical Psychology and Psychotherapy, University of Greifswald, Greifswald, Germany
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Netter AL, Hessler JB, Diedrich A, Lehr D, Berking M, Pfeuffer S, Voderholzer U. Usability and Naturalness of Videoconference-Based Exposure and Response Prevention for Obsessive-Compulsive Disorder at the Patients' Homes: A Pilot Study. J Cogn Psychother 2018; 32:303-314. [PMID: 32746409 DOI: 10.1891/0889-8391.32.4.303] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The treatment of choice for obsessive-compulsive disorders is cognitive behavioral therapy, including exposure and response prevention (ERP). Therapist-supervised ERP is more effective than self-controlled ERP, and exposure should take place at the patient's home. This standard might be achieved with ERPs at home via videoconference supervision from the therapist. The aim of this study was to (a) assess the usability and naturalness of videoconference exposure and (b) to compare it with face-to-face exposure at an inpatient clinic and exposure at home alone regarding therapeutic alliance, patients' expectancies, and credibility of the treatment and an overall rating of the exposure session. Mean differences and effect sizes suggested a slight general advantage of videoconference-based ERP and the interaction with the therapist felt natural to the participants. The technical system was rated as medium usable, suggesting a need for better training.
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Affiliation(s)
| | | | | | - Dirk Lehr
- Leuphana University of Lüneburg, Lüneburg, Germany
| | | | | | - Ulrich Voderholzer
- Schoen Clinic Roseneck, Prien am Chiemsee, Germany .,University of Freiburg, Freiburg, Germany
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