A Decade in Review: A Systematic Review of Virtual Reality Interventions for Emotional Disorders

Research is increasingly demonstrating the therapeutic benefits of virtual reality interventions for various mental health conditions, though these rarely translate from research to application in clinical settings. This systematic review aims to examine the efficacy of current virtual reality interventions for emotional disorders, with a focus on clinical and technological features that influence translation of treatments from research to clinical practice. A comprehensive systematic literature search was conducted following PRISMA guidelines, for studies including the application of a virtual reality intervention to a clinical population of adults with an emotional disorder. Thirty-seven eligible studies were identified, appraised, and assessed for bias. Treatment effects were typically large across studies, with virtual reality being considered an efficacious treatment modality for various anxiety disorders and post-traumatic stress disorder. Virtual reality interventions were typically used for delivering exposure in cognitive behavioural therapy approaches. Considerable variability was seen in cost, technological specifications, degree of therapist involvement, delivery format, dosage, duration, and frequency of treatment. Suboptimal methodological rigour was identified in some studies. Remote use of virtual reality was rare, despite increasing options for in home use. Virtual reality interventions have the potential to overcome barriers to care and better meet the needs of consumers. Future research should examine the efficacy of virtual reality for treatment of depressive disorders and obsesive compulsive disorder. Improved methodological reporting and development of transdiagnostic and remotely delivered virtual reality interventions, will likely increase the translation of this treatment modality.

Organizational and Policy Barriers to the Use of Digital Mental Health by Mental Health Professionals

Background: Digital mental health (DMH) provides effective methods of overcoming issues of time constraints, accessibility, and availability of mental health care. They can provide a valuable means to deliver mental health care in the present pandemic. However, adoption of these methods has been slow. Mental health professional (MHP) concerns at the organizational and policy level that influence this slow adoption need to be examined. Materials and Methods: A narrative review was conducted to identify the barriers. Searches using the databases Scopus, Embase, and PubMed were conducted to identify research focused on barriers reported by MHPs to use DMH. Results: The search resulted in 356 unique citations, and 21 papers met the inclusion and exclusion criteria. Forward and backward sampling resulted in identifying an additional 19 relevant papers. Discussion: Unmet needs for information, training, and infrastructure, challenges to the workflow and excessive workloads, and ambiguous policies serve as barriers to DMH use. This article recommends strategies for researchers, organizations, DMH designers, and governmental institutions to ensure efficient utilization of DMH. Conclusion: Concerted efforts at individual, organizational, and governmental levels are essential to ensure efficient utilization of DMH.

Stressors and protective factors among regional and metropolitan Australian medical doctors: A mixed methods investigation

OBJECTIVE

This study aimed to compare stress, burnout, stressors, and protective factors among regional- and metropolitan-based Australian medical doctors.

METHOD

A mixed methods design was utilized with 252 Australian medical doctors completing an online questionnaire package. A subsample also completed qualitative interviews.

RESULTS

Stress was significantly higher among doctors compared with population norms. Over half of doctors reported burnout on one or more dimensions. The strongest unique predictors were being female, working late, and work-family conflict. Qualitatively, 12 stressors (e.g., training and competition, workload, and time management) and 9 protective subthemes (e.g., being well resourced, clinical interest) emerged across system-level, clinical environment-level, and individual factor and personal response themes.

CONCLUSIONS

Stress and burnout among doctors are alarmingly high and both system/organization-level (e.g., communication systems, workload, flexible work arrangements) and individual-level (e.g., fostering resilience/coping strategies) predictors are implicated by our results. These may be useful targets for future interventions.

Development of a measure of stigma towards occupational stress for mental health professionals

PURPOSE

Stigma is a common barrier to mental health professionals (MHPs) seeking help for occupational stress and burnout, although there is a lack of psychometrically sound tools to measure this construct. The current study aimed to develop and validate a scale (the Mental Health Professional Stigma Scale; MHPSS) for this purpose.

METHODS

The MHPSS and related measures were completed by 221 Australian MHPs via online survey, with a subsample completing the MHPSS again 2 weeks after initial completion.

RESULTS

Exploratory factor analysis revealed a four-factor solution, comprising of 13 items and accounting for 50.16% of variance. Factors were Perceived Other Stigma, Perceived Structural Stigma, Personal Stigma, and Self stigma. The internal consistency, test-retest reliability, and validity of the scale were supported.

CONCLUSIONS

The MHPSS has utility to capture stigmatising attitudes and beliefs related to occupational stress and burnout among MHPs. It may be used to assist in the development and evaluation of initiatives to reduce stigma and increase help-seeking among MHPs.

Development of the eTAP: A brief measure of attitudes and process in e-interventions for mental health

BACKGROUND

Considerable evidence supports the efficacy of e-interventions for mental health treatment and support. However, client engagement and adherence to these interventions are less than optimal and remain poorly understood.

OBJECTIVE

The aim of the current study was to develop and investigate the psychometric properties of the e-Therapy Attitudes and Process questionnaire (eTAP). Based on the Theory of Planned Behaviour (TPB), the eTAP was designed to measure factors related to client engagement in e-interventions for mental health.

METHODS

Participants were 220 adults who reported current use of an e-intervention for mental health support. Participants completed the eTAP and related measures, with a subsample of 49 participants completing a one-week follow up assessment.

RESULTS

A 16-item version of the eTAP produced a clear four-factor structure, explaining 70.25% of variance. The factors were consistent with the TPB, namely, Intention, Subjective Norm, Attitudes, and Perceived Behavioural Control. Internal consistency of the total and subscales was high, and adequate to good one-week test retest reliability was found. Convergent and divergent validity of the total and subscales was supported, as was the predictive validity. Specifically, eTAP Intentions correctly predicted engagement in e-interventions with 84% accuracy and non-engagement with 74% accuracy.

CONCLUSIONS

The eTAP was developed as a measure of factors related to engagement and adherence with e-interventions for mental health. Psychometric investigation supported the validity and reliability of the eTAP. The eTAP may be a valuable tool to understand, predict, and guide interventions to increase engagement and adherence to e-interventions for mental health.

Development of the eTAP-T: A measure of mental health professionals' attitudes and process towards e-interventions

BACKGROUND

The development of technological applications within psychotherapy has opened up new opportunities for mental health professionals (MHPs) to address client need. Despite the clinical efficacy and utility of evidence-based electronic interventions, MHPs' engagement with these interventions remains poorly understood.

OBJECTIVE

The aim of the current study was to develop and conduct a preliminary psychometric investigation of the measurement properties of the electronic-therapy attitudes and process questionnaire - therapist version (eTAP-T). Based upon the theory of planned behaviour (TPB), the eTAP-T measures factors related to MHPs' engagement with e-interventions for clients' mental health concerns.

METHODS

Participants were 222 practicing MHPs who reported being in direct contact with clients. Participants completed the eTAP-T and related measures with a subsample of 40 participants completing a two-week follow up questionnaire.

RESULTS

Exploratory factor analysis with item reduction resulted in a 12-item eTAP-T, with four factors accounting for 82% of variance. The four factors (subjective norms, perceived behavioural control, attitudes and intentions) were consistent with the four TPB domains. The eTAP-T demonstrated satisfactory validity and reliability as per the consensus-based standards for the selection of health measurement instruments.

CONCLUSIONS

The development and preliminary psychometric investigation supported the validity and reliability of the eTAP-T. Further research is required for confirmatory analyses. The eTAP-T may be useful in identifying the training needs of MHPs and evaluating training programs. Specific areas for intervention, such as attitudes or perceived credibility may be identified and targetted, with the measure then also used to evaluate change across these domains. It is anticipated that the eTAP-T may useful tool in improving uptake of digital interventions by MHPs.

Can the Perceived Barriers to Psychological Treatment Scale be used to investigate treatment barriers among females with disordered and non-disordered eating behaviours?

There is a lack of psychometrically sound instruments to assess treatment barriers among individuals with disordered eating behaviours. This study examined the factor structure and psychometric properties of the Perceived Barriers to Psychological Treatment scale (PBPT; Mohr et al., 2010) among a sample of individuals with disordered eating behaviours. Participants were 708 females aged 14 years and older who completed an online survey. The sample was randomly divided in two for the conduct of exploratory (EFA) and confirmatory (CFA) factor analyses. EFA suggested a seven-factor structure retaining 24 of the original 27 items (variance explained = 60%, α = 0.91). Factors were stigma, participation restrictions, negative evaluation of treatment, lack of motivation, emotional concerns, access restrictions, and time constraints. To assess clinical sensitivity, we conducted a secondary EFA utilising only clinical cases from this sample, which supported the solution but suggested retaining 25 of the original 27 items (variance explained = 58%, α = 0.89). The 25-item, seven-factor solution was further supported by CFA with an independent sample. Construct validity was also supported. The study suggests that the instrument will provide clinicians and researchers with a valid and reliable method of assessing treatment barriers in disordered eating samples.

The Therapy Attitudes and Process Questionnaire: A Brief Measure of Factors Related to Psychotherapy Appointment Attendance

BACKGROUND

Patient non-attendance and dropout remains problematic in mental health settings. The theory of planned behavior (TPB) has proven useful in understanding such challenges in a variety of healthcare settings, but the absence of an adequate measure in mental health has hampered research in this area.

OBJECTIVE

The aim of the current study was to develop and conduct an initial psychometric investigation of a brief measure, the Therapy Attitudes and Process Questionnaire (TAP), utilizing the TPB to understand factors associated with attendance in mental health settings.

METHODS

We used a quantitative survey-based design and administered the TAP to 178 adult participants who were engaged in individual or group psychotherapy. A subsample also provided data to assess validity and reliability.

RESULTS

A four-factor solution was revealed through exploratory factor analysis and accounted for approximately 75 % of the variance in scores. Factors corresponded to those predicted by the TPB. Analyses supported the reliability, validity, and internal consistency of the measure.

CONCLUSIONS

Results suggest that the TAP may be a useful tool for examining patients' attitudes and beliefs about attending psychotherapy appointments. The TAP can be used to better understand patients' intentions, attitudes, perceptions of behavioral control, and subjective norms relating to psychotherapy attendance. This understanding may facilitate improved outcomes for patients and clinicians.

What do help-seeking measures assess? Building a conceptualization framework for help-seeking intentions through a systematic review of measure content

Mental health services are underutilised by people who could benefit from treatment. Research into help-seeking intentions (HSI) is required to support interventions to increase service use. Existing HSI measures are not psychometrically robust and problems with content validity undermine research in this field. Our purpose was to create a clear conceptualization of HSI and systematically review the content of existing measures. Previous researchers had defined help-seeking and intentions separately, so the first step was to create a more comprehensive definition. Seven theoretical perspectives identified in the HSI literature were mapped onto the new definition and aggregated to form a conceptual framework that reflects expert opinion. This framework guided an analysis of item relevance and a comparison of completeness across measures. Most individual items (99.1%) were relevant, lending credibility to the proposed framework. However, no measure provided a complete assessment of the HSI construct. This study used a novel methodology to develop a definition and conceptual framework, both of which reflect sound theoretical perspectives and represent the consensus-view of experts. The current results will guide the development of stronger measures with improved construct validity and will support interventions aimed at improving help-seeking.

Development of the SOSS-D: a scale to measure stigma of occupational stress and burnout in medical doctors

BACKGROUND

Occupational stress and burnout are highly prevalent among doctors, with stigma identified as a barrier to help-seeking in this population. However, there has been a lack of a standardised tool to measure stigma of occupational stress and burnout among doctors.

AIMS

The aim of the current study was to develop and investigate the psychometric properties of the Stigma of Occupational Stress Scale for Doctors (SOSS-D).

METHOD

An online questionnaire package was completed by 200 (38 male, 162 female) doctors. Participants completed measures relating to help-seeking intentions, general stigma, and the SOSS-D.

RESULTS

Exploratory Factor Analysis was used to refine the scale to an 11-item version. The analysis revealed a three-factor structure, which explained 63.4% of variance. Factors related to perceived structural stigma, personal stigma and perceived other stigma. The internal consistency, convergent, discriminant and criterion validity of the scale were supported.

CONCLUSIONS

The SOSS-D may assist educators and mental health professionals in measuring and assessing the efficacy of interventions designed to reduce stigma. As such, it is anticipated that the SOSS-D will be a useful instrument for understanding and addressing stigma of occupational stress and burnout among medical doctors, to improve help-seeking behaviours in this population.

Going global: do consumer preferences, attitudes, and barriers to using e-mental health services differ across countries?

BACKGROUND

e-Mental health services have the capacity to overcome barriers to care and reduce the unmet need for psychological services, particularly in developing countries. However, it is unknown how acceptable e-mental health interventions may be to these populations.

AIMS

The purpose of the current study was to examine consumer attitudes and perceived barriers to e-mental health usage across four countries: Australia, Iran, the Philippines and South Africa.

METHODS

An online survey was completed by 524 adults living in these countries, assessing previous contact with e-mental health services, willingness to use e-mental health services, and perceived barriers and needs for accessing e-mental health services.

RESULTS

Although previous contact with e-mental health services was low, the majority of respondents in each sample reported a willingness to try e-mental health services if offered. Barriers toward e-mental health usage were higher among the developing countries than Australia. The most commonly endorsed barriers concerned needing information and assurances regarding the programmes.

CONCLUSIONS

Across countries, participants indicated a willingness to use e-mental health programmes if offered. With appropriate research and careful implementation, e-mental health has the potential to be a valuable part of mental healthcare in developing countries.

Psychosocial interventions for managing occupational stress and burnout among medical doctors: a systematic review

BACKGROUND

Occupational stress and burnout are highly prevalent among medical doctors and can have adverse effects on patient, doctor, and organisational outcomes. The purpose of the current study was to review and evaluate evidence on psychosocial interventions aimed at reducing occupational stress and burnout among medical doctors.

METHOD

A systematic review was conducted for original research articles reporting on psychosocial interventions targeting occupational stress or burnout among medical doctors, published in the English language, and with data collected at a minimum of two time points. Searches were conducted across five electronic databases, as well as by manual search of Google Scholar. Data was extracted relating to study characteristics and outcomes, quality and rigour, as well as modes of delivery and engagement. Studies were appraised using the Strength of Recommendation Taxonomy (SORT) and Critical Appraisal Skills Programme (CASP).

RESULTS

Twenty-three articles were reviewed, which reported on interventions utilising cognitive-behavioural, relaxation, and supportive discussion strategies. Only 12 studies allowed estimation of pre- to post-intervention effects. Cognitive behavioural interventions demonstrated the strongest evidence, particularly for reducing stress. Some evidence was identified to support the efficacy of relaxation-based approaches, but no such evidence was found for the efficacy of discussion-based interventions, such as Balint groups. There was a lack of quality among reviewed studies, with no studies receiving a quality rating of 1, and the overall body of evidence being rated as level B, according to the SORT. Effect sizes were not pooled due to a lack of quality among the study sample.

CONCLUSION

This review found that despite increased scientific attention, the quality of research examining the benefits of psychosocial/behavioural interventions for occupational stress and burnout in medical doctors remains low. Despite this, interventions focused on cognitive and behavioural principles appear to show promise in reducing doctor stress and burnout. Limitations of the current review include a lack of risk of bias assessment or pooling of analyses. Recommendations for improving the quality of research in this area, as well as implications of the current body of evidence are discussed.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42016032595.

Assessing treatment barriers in eating disorders: A systematic review

This systematic review evaluated methods used to assess treatment barriers among individuals with eating disorders or disordered eating. A total of 11 studies were identified and evaluated according to attributes considered important in the accurate assessment of treatment barriers. The majority of studies used qualitative methods, with five studies utilizing either a checklist or scale-based instrument. Adequate psychometric investigation was lacking. This review highlights the paucity of research examining barriers to accessing and/or receiving treatment in disordered eating populations. There is a need for development of psychometrically sound instruments that assess the range and relative interference of specific barriers experienced in this population.

Therapy on the Move

The present research investigated the use of a Smartphone App as an adjunct in the treatment of a range of anxiety disorders. The primary aim of the App was to increase client adherence to between session therapy tasks, involving homework practice of a range of skills and tasks known to be associated with successful treatment of anxiety disorders. Homework is an important component of many therapeutic approaches, allowing clients to practise therapeutic skills between sessions, as well as providing continuity between sessions (Freeman & Rosenfield, 2002). Greater client adherence to homework tasks has been associated with improved treatment outcomes, and may be particularly important for reducing the risk of relapse (Scheel, Hanson, & Razzhavaikina, 2004). However, despite the benefits of engagement with homework tasks, client adherence to these activities can often be a significant barrier to treatment (Addis & Jacobson, 2000; Burns & Nolenhoeksema, 1991; Detweiler & Whisman, 1999; Detweiler-Bedell & Whisman, 2005). It is also one area in which the use of adjunctive technologies may have the greatest impact. The aim of this paper was to describe the development and pilot testing of a therapeutic Smartphone application, namely, PsychAssist. This application was designed as an adjunct to face-to-face therapy in the treatment of anxiety disorders among adults. The App was developed with the purpose of enhancing client engagement and adherence to between session (homework) tasks to improve maintenance and generalization of therapeutic behaviours.

Comparison of Perceived Barriers and Treatment Preferences Associated with Internet-Based and Face-to-Face Psychological Treatment of Depression

One of the major reasons that internet-based psychological treatments are strongly advocated is the belief that they may enable consumers to overcome many of the barriers to treatment otherwise encountered in seeking face to face treatment. A corollary to this belief is the assumption that many consumers may then be more likely to prefer to receive treatment via the internet because of the reduced barriers to care offered by internet-based treatments. However, there has been no formal examination of the barriers perceived by consumers to internet-based treatments in comparison to face to face treatment to ascertain whether these hypothesized differences impact on treatment preferences. This study compared consumer perceptions of barriers to treatment for both internet and face-to-face psychological treatments for depression. Of interest was whether consumers continue to report a preference for face-to-face treatment over internet-based treatment, even if perceptions of barriers to care were deemed greater for traditional than internet based delivery of services. Potential consumers of a structured online psychological program for workplace depression were targeted. An online survey was accessed by fifty-three employed individuals (female = 35, male = 18) with ages ranging from 18 to 60 (M = 35.57, SD = 12.15). Results indicated that participants perceived that internet-based treatment was associated with fewer barriers than face-to-face treatment for depression. Participants perceived that time constraints and participation restrictions would make it more difficult to access face-to-face treatment than internet-based treatment. However, the participants reported that they would be more likely to access face-to-face treatment for depression than internet-based treatment. These results suggest that there is a need to further investigate ways in which consumers can be encouraged to consider engaging in internet-based treatment.

Protocols for protection of human participants: a comparison of five countries

Research ethics protocols relating to human participants were compared across five countries, namely, Australia, Azerbaijan, Iran, the Philippines, and South Africa. These countries were considered to be geographically and culturally diverse, as well as representing both developed and developing countries. The extent to which the research participant is protected across cultures and countries was investigated, with particular focus on the use of informed consent procedures. It was argued that current ethical guidelines and practices fail to ensure the protection of the most vulnerable participants within these cultures. Informed consent mechanisms also often fail to consider cultural differences in self-concept, understanding of research methods, and power differences between researchers and participants. Discussion of these ethical challenges and recommendations for research ethics development within these cultures and countries are discussed.