|
1
|
Rajkumar E, Lipsa JM, Harshit S, Gopi A. Effectiveness of psychological interventions for mental health problems among war refugees: A systematic review and meta-analysis. Psychiatry Res 2025; 348:116432. [PMID: 40080994 DOI: 10.1016/j.psychres.2025.116432] [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: 10/15/2024] [Revised: 03/03/2025] [Accepted: 03/04/2025] [Indexed: 03/15/2025]
Abstract
BACKGROUND Globally 117.3 million people are displaced due to war, with one in five refugees experiencing psychological distress. Despite the availability of numerous psychological interventions for war refugees, their overall efficacy is still unexplored. Thus, this review examines the effectiveness of psychological interventions in reducing the mental health issues of war refugees. METHODS A systematic search was conducted in PubMed, Web of Science, APA PsycNET, ScienceDirect and Google Scholar for studies published on the effectiveness of psychological interventions for mental health issues among war refugees in July 2024. JBI and NHLBI checklists were employed to appraise the risk of bias in the included studies. Review Manager version 5.4 was used to run the meta-analysis. RESULTS Out of 22,197 initially identified records, a total of 21 studies were included for systematic review and eight randomized controlled trials (RCTs) for meta-analysis. Random effects meta-analysis showed significant medium effect size for psychological interventions (SMD = -0.69; 95 % CI:0.87, -0.51; p < .00001) in reducing the mental health issues among war refugees. Sub group analysis based on the mode of delivery revealed that interventions delivered through in-person mode reported a significant large effect size (SMD = -1.03; 95 % CI:1.36, -0.71; p < .00001) while, telehealth interventions showed significant small effect size (SMD = -0.44; 95 % CI:0.61, -0.28; p < .00001). CONCLUSION In-person and telehealth based psychological interventions offer promising findings in addressing mental health issues among war refugees. However, given the barriers to accessing face to face treatments and limited evidence on telehealth interventions, future research on digital interventions is recommended.
Collapse
Affiliation(s)
- Eslavath Rajkumar
- Department of Liberal Arts, Indian Institute of Technology Bhilai, Chhattisgarh, 491002, India
| | - Jose Mariya Lipsa
- Department of Liberal Arts, Indian Institute of Technology Bhilai, Chhattisgarh, 491002, India
| | - Shrivastava Harshit
- Department of Liberal Arts, Indian Institute of Technology Bhilai, Chhattisgarh, 491002, India.
| | - Aswathy Gopi
- Department of Psychology, SRM University-AP, Amaravati, Andhra Pradesh, India
| |
Collapse
|
|
2
|
Hofer A, Borse S, Hasenöhrl C, Harrach K, Ehrlich S, Schnebel A, Wunderer E. Professional Digital Counselling for Eating Disorders in Germany: Results of the DigiBEssst Project Survey on the Perspectives and Experiences of Health Professionals, Individuals With Eating Disorders, and Carers. EUROPEAN EATING DISORDERS REVIEW 2025; 33:562-574. [PMID: 39698817 PMCID: PMC11965544 DOI: 10.1002/erv.3164] [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: 05/03/2024] [Revised: 11/29/2024] [Accepted: 12/01/2024] [Indexed: 12/20/2024]
Abstract
OBJECTIVE The research project DigiBEssst examines existing digital counselling services for individuals with eating disorders (ED) and carers in Germany. It highlights their experiences with digital counselling as well as those of the expert counsellors involved, aiming to derive quality criteria for digital counselling in ED. METHOD A mixed-methods design was adopted. Analysing the websites of 181 professional counselling centers, the research team identified 86 counselling centers for ED that offered online counselling. Initially, 29 centres participated in an online survey. Subsequently, in-depth, semi-structured interviews were conducted with professionals (n = 15), individuals with ED (n = 13), and carers (n = 10). The data were analysed using descriptive statistics and structured content analysis. RESULTS Less than half of the German counselling facilities offered online counselling. The participants emphasised the need for a specific concept, counsellors' profound expertise in ED and online counselling, sustainable funding, sufficient personnel and time resources, and secure platforms to ensure data protection and quality management. Access to professional services requires informative, user-friendly websites, and social media presence. CONCLUSIONS The identified prerequisites and quality criteria for professional online counselling developed in this project can provide recommendations for the conceptualisation of digital counselling services.
Collapse
Affiliation(s)
- Anna Hofer
- Faculty of Social WorkLandshut University of Applied SciencesLandshutGermany
- Faculty of Medicine, Technische Universität DresdenDresdenGermany
| | - Sigrid Borse
- Federal Association for Eating Disorders BFEMunichGermany
| | - Cäcilia Hasenöhrl
- Faculty of Social WorkLandshut University of Applied SciencesLandshutGermany
| | - Kathrin Harrach
- Faculty of Social WorkLandshut University of Applied SciencesLandshutGermany
| | - Stefan Ehrlich
- Division of Psychological and Social Medicine and Developmental Neurosciences, Eating Disorders Research and Treatment Center at the Department of Child and Adolescent PsychiatryFaculty of MedicineTechnische Universität DresdenUniversity Hospital C.G. CarusDresdenGermany
| | | | - Eva Wunderer
- Faculty of Social WorkLandshut University of Applied SciencesLandshutGermany
| |
Collapse
|
|
3
|
Traetta I, Gabbatore I, Aimar A, Arduino GM, Bosco FM. Assessing communicative-pragmatic ability in telehealth: e-ABaCo in autistic individuals. Front Psychiatry 2025; 16:1568108. [PMID: 40357514 PMCID: PMC12066485 DOI: 10.3389/fpsyt.2025.1568108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2025] [Accepted: 03/31/2025] [Indexed: 05/15/2025] Open
Abstract
Introduction Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder characterized by difficulties in social communication. Autistic individuals who are verbally fluent, often show difficulties in pragmatic ability, i.e. the capacity to use language and other expressive means, as gestures or the tone of the voice, to convey meaning in a given context. During the COVID-19 pandemic, the use of various technologies such as videoconferencing and internet for the delivery of healthcare services, i.e. telehealth, has proven to be effective, accessible and safe tools for remote healthcare. However, there are few tools to assess pragmatic skills in telehealth. This study investigates the effectiveness of the telehealth-adapted Assessment Battery for Communication (e-ABaCo), a clinical tool previously validated for in-person assessments, to evaluate pragmatic abilities in autistic individuals. We expect a substantial equivalence in performance for the administration of the adapted version of e-ABaCo compared to the face-to-face one. Methods We compared the performance of 30 autistic adolescents, of which 15 assessed via telehealth (ASD TH) and 15 assessed face-to-face (ASD FtF), with that of 15 adolescents with typical development (face-to-face assessment). The groups were matched for age, sex, and intellectual quotient. E-ABaCo was used to assess both comprehension and production of communicative ability realized through different expressive means, i.e. linguistic, extralinguistic and paralinguistic, as well as social appropriateness. Results In line with the expectation, the pragmatic performance of autistic adolescents showed a substantial equivalence when comparing the assessments conducted via telehealth and face-to-face modality. Moreover, in line with the relevant literature, there was a significant difference between the ASD groups' performance (both FtF and TH) and the control group of the adolescents with typical development (CG FtF) in all pragmatic aspects assessed, i.e. the Pragmatic total score, comprehension and production abilities, and all the expressive means investigated. Discussion These results confirm the potential usefulness of telehealth assessment procedures, and demonstrate the sensitivity and validity of e-ABaCo for conducting an effective assessment of pragmatic skills in on-line modality in autistic adolescents.
Collapse
Affiliation(s)
- Ilaria Traetta
- Department of Psychology, Research Group on Inferential Processes in Social Interaction (GIPSI) Research Group, University of Turin, Turin, Italy
| | - Ilaria Gabbatore
- Department of Humanities, Research Group on Inferential Processes in Social Interaction (GIPSI) Research Group, University of Turin, Turin, Italy
| | | | | | - Francesca M. Bosco
- Department of Psychology, Research Group on Inferential Processes in Social Interaction (GIPSI) Research Group, University of Turin, Turin, Italy
| |
Collapse
|
|
4
|
Cataldo F, Chang S, Mendoza A, Buchanan G, Van Dam N. Exploring Technical Features to Enhance Control in Videoconferencing Psychotherapy: Quantitative Study on Clinicians' Perspectives. J Med Internet Res 2025; 27:e66904. [PMID: 40168042 PMCID: PMC12000784 DOI: 10.2196/66904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2024] [Revised: 12/21/2024] [Accepted: 02/19/2025] [Indexed: 04/02/2025] Open
Abstract
BACKGROUND The COVID-19 pandemic required psychologists and other mental health professionals to use videoconferencing platforms. Previous research has highlighted therapists' hesitation toward adopting the medium since they find it hard to establish control over videoconferencing psychotherapy (VCP). An earlier study provided a set of potential features that may help enhance psychologists' control in their videoconference sessions, such as screen control functionality, emergency call functionality, eye contact functionality, zooming in and out functionality, and an interactive interface with other apps and software. OBJECTIVE This study aims to investigate whether introducing technical features might improve clinicians' control over their video sessions. Additionally, it seeks to understand the role of the video in therapists' VCP experience from a technical and relationship point of view. METHODS A total of 121 mental health professionals responded to the survey, but only 86 participants provided complete data. Exploratory Factor Analysis was used to scrutinize the data collected. A total of three factors were identified: (1) "challenges in providing VCP," (2) "features to enhance the therapeutic relationship," and (3) "enhancing control." Path analysis was used to observe the relationship between factors on their own and with adjustment to participants' areas of expertise and year in practice. RESULTS This study highlighted a relationship between the three identified factors. It was found that introducing certain features reduced therapists' challenges in the provision of VCP. Moreover, the additional features provided therapists with enhanced control over their VCP sessions. A path analysis was conducted to investigate the relationships between the factors loaded. The results of the analysis revealed a significant relationship between "challenges in VCP" and "features to enhance the therapeutic relationship" (adjusted beta [Adjβ]=-0.54, 95% CI 0.29-0.79; P<.001) and "features to enhance TR" and "enhancing control" (Adjβ=0.25, 95% CI 0.15-0.35; P<.001). Additionally, a significant positive relationship was found between "features to enhance the therapeutic relationship" and "enhancing control" (Adjβ=0.25, 95% CI 0.15-0.35; P<.001). Furthermore, there was an indirect effect of "challenges in providing VCP" on "enhancing control" (Adjβ=0.13, 95% CI 0.05-0.22; P=.001) mediated by "features to enhance TR." The analysis identified the factor "features to enhance TR" (effect size=0.25) as key for improving clinicians' performance and control. CONCLUSIONS This study demonstrates that technology may help improve therapists' VCP experiences by implementing features that respond to their need for enhanced control. By augmenting therapists' control, clinicians can effectively serve their patients and facilitate successful therapy outcomes. Moreover, this study confirms the video as a third agent that prevents therapists from affecting clients' reality due to technical and relational limits. Additionally, this study supports the general system theory, which allowed for the incorporation of video in our exploration and helped explain its agency in VCP.
Collapse
Affiliation(s)
- Francesco Cataldo
- School of Computing and Information System, University of Melbourne, Melbourne, Australia
| | - Shanton Chang
- School of Computing and Information System, University of Melbourne, Melbourne, Australia
| | - Antonette Mendoza
- School of Computing and Information System, University of Melbourne, Melbourne, Australia
| | - George Buchanan
- School of Computing Technologies, Royal Melbourne Institute of Technology University, Melbourne, Australia
| | - Nicholas Van Dam
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Australia
| |
Collapse
|
|
5
|
Ho TQA, Engel L, Ride J, Le LKD, Melvin G, Le HND, Mihalopoulos C. Young People's Preferences for Web-Based Mental Health Interventions for Managing Anxiety and Depression: A Discrete Choice Experiment. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2025:10.1007/s40258-025-00958-9. [PMID: 40155590 DOI: 10.1007/s40258-025-00958-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/23/2025] [Indexed: 04/01/2025]
Abstract
OBJECTIVE Anxiety and depression are prevalent in young people. Web-based mental health interventions (W-MHIs) have the potential to reduce anxiety and depression, yet the level of engagement remains low. This study aims to elicit young people's preferences towards W-MHIs and the relative importance of intervention attributes in influencing choice. METHODS A discrete choice experiment (DCE) was conducted online among young people aged 18-25 years who lived in Australia, self-reported experiences of anxiety and/or depression in the past 12 months and had an intention to use W-MHIs and/or previous experience with W-MHIs for managing anxiety and/or depression. Participants were recruited via social media and Deakin University notice boards. The DCE design comprised six attributes, including out-of-pocket cost, access to trained instructors (e.g., therapists, coaches) to help users stay engaged with the intervention, total time required to complete the intervention, initial screening, quizzes within the W-MHIs to check user's understanding about the intervention content, and communication with other users. The DCE design consisted of three blocks, each with eight unlabelled choice tasks, each with two alternatives. Data were analysed using a mixed logit model. RESULTS One hundred ninety-nine participants completed the DCE (mean age: 21.43 ± 2.29 years, 64.32% female). Lower cost, access to instructors, and moderate time required to complete the intervention (5 h) were significant facilitators. The W-MHIs including audio- or video-call access to instructors were 23 percentage points more likely to be chosen than those without and W-MHI with a moderate completion time (5 h) was 18 percentage points more likely to be chosen than one with a shorter time (2 h). CONCLUSION Our results highlight that low-cost W-MHIs with access to trained instructors and moderate completion time could increase uptake. More research is required to confirm these findings and examine whether these preferences vary across different population characteristics.
Collapse
Affiliation(s)
- Thi Quynh Anh Ho
- Institute of Health Transformation, Deakin Health Economics, School of Health and Social Development, Deakin University, Melbourne, VIC, Australia.
| | - Lidia Engel
- Monash University Health Economics Group, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Jemimah Ride
- Monash University Health Economics Group, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- Health Economics Unit, School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Long Khanh-Dao Le
- Monash University Health Economics Group, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Glenn Melvin
- School of Psychology, Deakin University, Melbourne, VIC, Australia
| | - Ha N D Le
- Institute of Health Transformation, Deakin Health Economics, School of Health and Social Development, Deakin University, Melbourne, VIC, Australia
| | - Cathrine Mihalopoulos
- Institute of Health Transformation, Deakin Health Economics, School of Health and Social Development, Deakin University, Melbourne, VIC, Australia
- Monash University Health Economics Group, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| |
Collapse
|
|
6
|
Ofem UJ, Anake PM, Abuo CB, Ukatu JO, Etta EO. Artificial intelligence application in counselling practices. A multigroup analysis of acceptance and awareness using gender and professional rank. Front Digit Health 2025; 6:1414178. [PMID: 40176970 PMCID: PMC11962729 DOI: 10.3389/fdgth.2024.1414178] [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: 07/30/2024] [Accepted: 12/23/2024] [Indexed: 04/05/2025] Open
Abstract
Introduction Artificial intelligence (AI) has emerged as a transformative tool in various professional domains, including counselling, where it offers innovative ways to enhance service delivery and client outcomes. Despite its potential, research on AI in counselling practices often focuses on its technical applications, with limited attention to the interplay between awareness, acceptance, and application. This study analyses how professional counsellors apply artificial intelligence in counselling practices using the nexus between awareness and application through acceptance of AI with gender and professional rank as group. Method A total of 5,432 professional counsellors were selected for the study. Data collection was conducted online to ensure a wide reach. The research instruments underwent validity checks, demonstrating high content and factorial validity. Convergent and discriminant validity were confirmed using the Average Variance Extracted (AVE) and Fornel-Larcker criterion. Results The findings revealed that professional counsellors exhibited high levels of awareness, acceptability, and application of AI in their counselling practices. Acceptance played a positive mediating role in the relationship between awareness and application. However, male practitioners and professors displayed stronger awareness, acceptance, and application of AI tools compared to their counterparts. Conclusion The study highlights the significant role of acceptance in bridging awareness and application of AI in counselling practices. It underscores the importance of addressing gender and professional rank disparities to ensure equitable adoption and utilization of AI tools. The findings offer valuable insights for policymakers in promoting the integration of AI in counselling to enhance professional practices.
Collapse
Affiliation(s)
- Usani Joseph Ofem
- Department of Educational Foundations, Alex Ekwueme Federal University Ndufu-Alike, Abakaliki, Ebonyi, Nigeria
| | - Pauline Mbua Anake
- Department of Guidance and Counselling, University of Calabar, Calabar, Nigeria
| | - Cyril Bisong Abuo
- Department of Guidance and Counselling, University of Calabar, Calabar, Nigeria
| | - James Omaji Ukatu
- Department of Criminology, Alex Ekwueme Federal University Ndufu-Alike, Abakaliki, Ebonyi, Nigeria
| | - Eugene Onor Etta
- Department of Public Administration, Federal Polytechnic Ugep, Ugep, Cross River, Nigeria
| |
Collapse
|
|
7
|
Barakat S, Rom S, Kim M, Aouad P, Maguire S. User Experience and Therapeutic Alliance of Treatment Completers of Clinician-Supported Versus Self-Help Online Intervention for Eating Disorders: A Mixed Methods Approach. EUROPEAN EATING DISORDERS REVIEW 2025. [PMID: 39934980 DOI: 10.1002/erv.3176] [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: 06/09/2024] [Revised: 12/19/2024] [Accepted: 01/16/2025] [Indexed: 02/13/2025]
Abstract
BACKGROUND Poor rates of retention associated with digital interventions necessitate understanding of factors influencing engagement. This study presents a secondary analysis of a three-arm, randomised controlled trial of an online self-help treatment for bulimia nervosa (clinician-supported, self-help and waitlist control). AIMS The study aimed to understand the effect of added clinician-support, or lack of support, upon user experience and therapeutic alliance. METHOD At post-treatment, 61 participants completed a battery of self-report questionnaires assessing user experience and therapeutic alliance. Data were analysed using mixed methods (regression and thematic analyses). RESULTS Quantitative analyses indicated clinician-supported participants reported higher levels of treatment satisfaction and therapeutic alliance, however differences were not significant after controlling for covariates. Intervention effectiveness ratings were positively associated with post-treatment reductions in binge episodes and eating disorder psychopathology. Qualitative data were organised into four themes: (1) human support, (2) content, structure and digital set up, (3) process of therapeutic change and (4) positive feedback. CONCLUSIONS Overall, the intervention was found to have positive ratings of user experience and therapeutic alliance in both supported and unsupported versions. The qualitative analyses revealed a strong preference for human support. The findings shed light on the complex interactions between digital and human elements of blended treatment delivery. TRIAL REGISTRATION The trial was pre-registered with the Australia New Zealand Clinical Trials Registry (ACTRN12619000123145p).
Collapse
Affiliation(s)
- Sarah Barakat
- InsideOut Institute for Eating Disorders, University of Sydney and Sydney Local Health District, Sydney, Australia
| | - Sean Rom
- InsideOut Institute for Eating Disorders, University of Sydney and Sydney Local Health District, Sydney, Australia
| | - Marcellinus Kim
- Sydney Local Health District Mental Health Services, Royal Prince Alfred Hospital, Sydney, Australia
| | - Phillip Aouad
- InsideOut Institute for Eating Disorders, University of Sydney and Sydney Local Health District, Sydney, Australia
| | - Sarah Maguire
- InsideOut Institute for Eating Disorders, University of Sydney and Sydney Local Health District, Sydney, Australia
| |
Collapse
|
|
8
|
Mittmann G, Steiner-Hofbauer V, Schrank B. Attitudes of the general population and mental health practitioners towards blended therapy in Austria. Wien Klin Wochenschr 2025; 137:118-125. [PMID: 39037450 PMCID: PMC11794416 DOI: 10.1007/s00508-024-02391-9] [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: 11/08/2023] [Accepted: 06/14/2024] [Indexed: 07/23/2024]
Abstract
INTRODUCTION Mental health problems are steadily increasing worldwide. In Austria, the overall supply of mental health services is low, especially in rural areas. Mobile technology and a blended care approach have the potential to overcome problems with service provision. The aim of this study was to map the attitudes of practitioners and people living in Austria towards blended therapy. METHOD Two individual online questionnaires (including the Unified Theory of Acceptance and Use of Technology, advantages and disadvantages, useful features) were distributed to practitioners and the general population in Austria. RESULTS The questionnaires were answered by 152 members of the general public and 129 practitioners. The general population and practitioners seem to be cautious, but slightly positive about blended therapy. Previous experience of practitioners with blended therapy was low. Practitioners are most worried about the therapeutic process and their work-life balance, while the general population is worried about being overwhelmed by the concept, mainly due to the time investment. Tracking, recording and reminding functions (e.g., for mood, homework) were seen as especially valuable features and accessibility was deemed the biggest advantage by both samples. CONCLUSION Practitioners' attitudes are important for implementation of blended therapy. More awareness might help against the cautiousness as well as implementing digital health applications in Austrian health policies.
Collapse
Affiliation(s)
- Gloria Mittmann
- Research Centre Transitional Psychiatry, Karl Landsteiner University of Health Sciences, Dr. Karl-Dorrek-Straße 30, 3500, Krems, Austria.
| | - Verena Steiner-Hofbauer
- Research Centre Transitional Psychiatry, Karl Landsteiner University of Health Sciences, Dr. Karl-Dorrek-Straße 30, 3500, Krems, Austria
| | - Beate Schrank
- Research Centre Transitional Psychiatry, Karl Landsteiner University of Health Sciences, Dr. Karl-Dorrek-Straße 30, 3500, Krems, Austria
- Department of Psychiatry and Psychotherapeutic Medicine, University Hospital Tulln, Tulln, Austria
| |
Collapse
|
|
9
|
Videtta G, Busilacchi S, Bartoccioni G, Cirella L, Barone Y, Delvecchio G. Effects of therapeutic alliance on patients with major depressive disorder: a literature review. Front Psychol 2025; 15:1465017. [PMID: 39830839 PMCID: PMC11739292 DOI: 10.3389/fpsyg.2024.1465017] [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: 07/15/2024] [Accepted: 11/29/2024] [Indexed: 01/22/2025] Open
Abstract
Therapeutic alliance refers to the collaborative relationship between a therapist and a patient, a concept widely explored in clinical research. It has emerged as a crucial component of effective psychotherapeutic interventions, particularly in the treatment of major depressive disorder (MDD), where its role appears to be multifaceted. In this context, we reviewed the main literature on the role of therapeutic alliance in MDD. The record search was conducted across three databases: PubMed, Web of Science, and PsychInfo. Seven of the reviewed studies highlighted that therapeutic alliance is a strong predictor of clinical outcomes, contributing to symptom improvement, relapse prevention, and more adaptive functioning in patients with MDD. However, three studies supported the hypothesis that clinical improvement itself might influence the therapeutic alliance between a therapist and a patient at different stages of treatment. Overall, the results suggest a bidirectional relationship between therapeutic alliance and symptom improvement, indicating that a stronger alliance often predicts better outcomes and symptom reduction can further enhance the alliance. However, the interpretation of these results must consider certain methodological limitations. These include the use of different approaches, measurements, and clinical outcomes to assess therapeutic alliance, as well as insufficient exploration of the temporal precedence between therapeutic alliance and clinical outcomes. In conclusion, future studies are warranted to address these limitations and further clarify the role of therapeutic alliance in MDD, along with its potential implications for clinical practice.
Collapse
Affiliation(s)
- Giovanni Videtta
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Silvia Busilacchi
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giulia Bartoccioni
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Luisa Cirella
- Healthcare Professionals Department, Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Ylenia Barone
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giuseppe Delvecchio
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| |
Collapse
|
|
10
|
Kohn C, Turner L, Yang Z, Absoud M, Casbard A, Gomes M, Grant G, Hassiotis A, Kennedy E, Levitt S, McNamara R, Randell E, Totsika V. Remotely Delivered Video Interaction Guidance for Families of Children With an Intellectual Disability Referred to Specialist Mental Health Services: Protocol for a Feasibility Randomized Controlled Trial. JMIR Res Protoc 2024; 13:e54619. [PMID: 39636678 DOI: 10.2196/54619] [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: 11/20/2023] [Revised: 05/28/2024] [Accepted: 09/25/2024] [Indexed: 12/07/2024] Open
Abstract
BACKGROUND Children with an intellectual disability (ID) are 3-4 times more likely to present with behaviors that challenge and mental health problems than typically developing children. Parenting and the quality of parent-child relationships are risk factors for these families. The COVID-19 pandemic further exacerbated difficulties, leading to an increase in child mental health problems and behaviors that challenge, a deterioration in parental mental health, and further strain on family relationships. Remote family interventions could be an effective solution for both families and specialist mental health services. Video interaction guidance (VIG) has shown promise for improving child mental health. However, it is unclear whether it is widely acceptable to families and feasible to implement across specialist child mental health services. OBJECTIVE This randomized controlled trial aims to evaluate the feasibility of delivering VIG as a remote intervention for parents of children aged 6-12 years with ID who have been referred to specialist mental health services. METHODS The study will be undertaken across 5-7 National Health Service specialist mental health services in England, involving 50 participants randomly allocated on a 1:1 basis to either the intervention group (receiving remote VIG) or the treatment-as-usual (TAU) group. The intervention group will engage in 3-5 cycles of VIG delivered remotely over 12 weeks. The primary feasibility outcomes include the recruitment rate, retention at 6-month follow-up, and VIG cycle completion rate. The secondary outcomes will assess the acceptability of VIG and the feasibility of remote implementation, including fidelity to the intervention protocol. Data will be gathered through online surveys and telephone interviews at baseline, 3 months, and 6 months. Feasibility outcomes will be summarized using descriptive statistics, while thematic analysis will be applied to qualitative data from semistructured interviews with participants, VIG practitioners, and service managers. An embedded process evaluation will explore barriers and facilitators to engagement with VIG, and a parallel health economics evaluation will assess the feasibility of capturing service use data and intervention costs. RESULTS The trial was open to recruitment between December 2022 and March 2024. The first results should be available in 2025. CONCLUSIONS The study is the first randomized evaluation of VIG as offered to parents of children with ID who have been referred to specialist mental health settings. The outcomes from this feasibility trial will inform the decision to proceed with a definitive trial, using a traffic light system to evaluate recruitment, retention, and VIG completion rates alongside qualitative insights and economic evaluations. TRIAL REGISTRATION ISRCTN Registry ISRCTN13171328; http://www.isrctn.com/ISRCTN13171328. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/54619.
Collapse
Affiliation(s)
- Charmaine Kohn
- The Tavistock and Portman NHS Foundation Trust, London, United Kingdom
| | | | - Zhixing Yang
- University College London, London, United Kingdom
| | - Michael Absoud
- Evelina London Children's Hospital, London, United Kingdom
| | - Angela Casbard
- Centre for Trials Research, Cardiff University, Cardiff, United Kingdom
| | - Manuel Gomes
- University College London, London, United Kingdom
| | - Gemma Grant
- Challenging Behaviour Foundation, Chatham, United Kingdom
| | | | - Eilis Kennedy
- The Tavistock and Portman NHS Foundation Trust, London, United Kingdom
| | - Sophie Levitt
- Brighter Futures for Children, Reading, United Kingdom
| | - Rachel McNamara
- Centre for Trials Research, Cardiff University, Cardiff, United Kingdom
| | - Elizabeth Randell
- Centre for Trials Research, Cardiff University, Cardiff, United Kingdom
| | | |
Collapse
|
|
11
|
Haaf R, Schefft C, Krämer R, Klein JP, Köhler S. Working alliance and its link to guidance in an internet-based intervention for depressive disorders: a secondary analysis of a randomized controlled trial. Front Psychiatry 2024; 15:1448823. [PMID: 39323963 PMCID: PMC11422127 DOI: 10.3389/fpsyt.2024.1448823] [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: 06/13/2024] [Accepted: 08/13/2024] [Indexed: 09/27/2024] Open
Abstract
Background Guided Internet-based interventions (IBIs) are typically found to be more effective than unguided ones, but the reasons behind this are not well understood. The therapist-client working alliance, crucial in face-to-face psychotherapy, is also increasingly recognized as an important factor in IBIs. This study examines trajectories of the working alliance and its relationship to therapeutic guidance through a secondary analysis of a randomized controlled trial (RCT) on Selfapy, a 12-week IBI based on cognitive behavioral therapy for depressive disorders. The trial compared a therapist-guided version (with weekly calls) to an unguided version (n = 301, mean age 37 years, 83% female, mean BDI-II = 30.09). Methods Based on an intention-to-treat approach, this study investigates within- and between-group differences in the quality of the working alliance, assessed with the WAI-SR questionnaire at mid- and post-treatment via repeated measures ANOVA. Furthermore, correlations and mediation analyses were conducted to explore the relationship between the working alliance and outcomes, as well as adherence parameters. Results Findings indicate that the IBI was successful in fostering a robust working alliance in both intervention groups, with similar ratings at mid-treatment but significantly higher ratings in the guided group at post-treatment (Cohen's d = -0.38). Post-treatment working alliance scores were positively linked to symptom reduction at post-treatment (guided: r = .25, unguided r = .15) and follow-up (guided: r = .25, unguided: r = .17). In the unguided group, the association was primarily driven by the subscale task. Serial mediation analysis indicated that the relationship between guidance and outcomes at follow-up was mediated by working alliance (b = 0.59; 95% CI: 0.14, 1.22) and a link between working alliance and adherence (b = 0.15; 95% CI: 0.04, 0.34). Conclusions Considering limitations like using a questionnaire developed for face-to-face therapy, findings support the importance of the working alliance in guided IBIs, while also providing new insights into its role and formation in unguided IBIs. The potential benefits of a strong working alliance, notably by improving adherence, may prove crucial for integrating guided as well as unguided IBIs into routine use, indicating the need for additional research in this context. Clinical Trial Registration https://tinyurl.com/2p9h5hnx, German Clinical Trials Register DRKS00017191.
Collapse
Affiliation(s)
- Raoul Haaf
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt- Universität zu Berlin, Berlin, Germany
| | - Cora Schefft
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt- Universität zu Berlin, Berlin, Germany
| | - Rico Krämer
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt- Universität zu Berlin, Berlin, Germany
| | - Jan Philipp Klein
- Department of Psychiatry, Psychosomatics and Psychotherapy, University of Lübeck, Lübeck, Germany
- Center for Brain, Behavior and Metabolism, University of Lübeck, Lübeck, Germany
| | - Stephan Köhler
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt- Universität zu Berlin, Berlin, Germany
| |
Collapse
|
|
12
|
Adu MK, Eboreime O, Shalaby R, Eboreime E, Agyapong B, da Luz Dias R, Sapara AO, Agyapong VIO. Comparing Email Versus Text Messaging as Delivery Platforms for Supporting Patients With Major Depressive Disorder: Noninferiority Randomized Controlled Trial. JMIR Form Res 2024; 8:e59003. [PMID: 39250182 PMCID: PMC11420606 DOI: 10.2196/59003] [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: 03/30/2024] [Revised: 05/26/2024] [Accepted: 07/01/2024] [Indexed: 09/10/2024] Open
Abstract
BACKGROUND The prevalence of major depressive disorder (MDD) poses significant global health challenges, with available treatments often insufficient in achieving remission for many patients. Digital health technologies, such as SMS text messaging-based cognitive behavioral therapy, offer accessible alternatives but may not reach all individuals. Email communication presents a secure avenue for health communication, yet its effectiveness compared to SMS text messaging in providing mental health support for patients with MDD remains uncertain. OBJECTIVE This study aims to compare the efficacy of email versus SMS text messaging as delivery platforms for supporting patients with MDD, addressing a critical gap in understanding optimal digital interventions for mental health care. METHODS A randomized noninferiority pilot trial was conducted, comparing outcomes for patients receiving 6-week daily supportive messages via email with those receiving messages via SMS text message. This duration corresponds to a minimum of 180 days of message delivery. The supportive messages maintained consistent length and structure across both delivery methods. Participants (N=66) were recruited from the Access 24/7 clinic in Edmonton, Alberta, among those who were diagnosed with MDD. The outcomes were measured at baseline and 6 months after enrollment using the Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), and the World Health Organization Well-Being Index (WHO-5). RESULTS Most of the participants were females (n=43, 65%), aged between 26 and 40 years (n=34, 55%), had high school education (n=35, 58%), employed (n=33, 50%), and single (n=24, 36%). Again, most participants had had no history of any major physical illness (n=56, 85%) and (n=61, 92%) responded "No" to having a history of admission for treatment of mood disorders. There was no statistically significant difference in the mean changes in PHQ-9, GAD-7, and WHO-5 scores between the email and SMS text messaging groups (mean difference, 95% CI: -1.90, 95% CI -6.53 to 2.74; 5.78, 95% CI -1.94 to 13.50; and 11.85, 95% CI -3.81 to 27.51), respectively. Both supportive modalities showed potential in reducing depressive symptoms and improving quality of life. CONCLUSIONS The study's findings suggest that both email and SMS text messaging interventions have equivalent effectiveness in reducing depression symptoms among individuals with MDD. As digital technology continues to evolve, harnessing the power of multiple digital platforms for mental health interventions can significantly contribute to bridging the existing treatment gaps and improving the overall well-being of individuals with depressive conditions. Further research is needed with a larger sample size to confirm and expand upon these findings. TRIAL REGISTRATION ClinicalTrials.gov NCT04638231; https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8552095/.
Collapse
Affiliation(s)
- Medard K Adu
- Department of Psychiatry, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Oghenekome Eboreime
- Reproductive Care Program, Healthy Population & Provincial Initiatives, IWK, Halifax, NS, Canada
| | - Reham Shalaby
- Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Ejemai Eboreime
- Department of Psychiatry, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Belinda Agyapong
- Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Raquel da Luz Dias
- Department of Psychiatry, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Adegboyega O Sapara
- Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Vincent I O Agyapong
- Department of Psychiatry, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
- Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| |
Collapse
|
|
13
|
Doukani A, Quartagno M, Sera F, Free C, Kakuma R, Riper H, Kleiboer A, Cerga-Pashoja A, van Schaik A, Botella C, Berger T, Chevreul K, Matynia M, Krieger T, Hazo JB, Draisma S, Titzler I, Topooco N, Mathiasen K, Vernmark K, Urech A, Maj A, Andersson G, Berking M, Baños RM, Araya R. Comparison of the Working Alliance in Blended Cognitive Behavioral Therapy and Treatment as Usual for Depression in Europe: Secondary Data Analysis of the E-COMPARED Randomized Controlled Trial. J Med Internet Res 2024; 26:e47515. [PMID: 38819882 PMCID: PMC11179025 DOI: 10.2196/47515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 02/09/2024] [Accepted: 02/11/2024] [Indexed: 06/01/2024] Open
Abstract
BACKGROUND Increasing interest has centered on the psychotherapeutic working alliance as a means of understanding clinical change in digital mental health interventions in recent years. However, little is understood about how and to what extent a digital mental health program can have an impact on the working alliance and clinical outcomes in a blended (therapist plus digital program) cognitive behavioral therapy (bCBT) intervention for depression. OBJECTIVE This study aimed to test the difference in working alliance scores between bCBT and treatment as usual (TAU), examine the association between working alliance and depression severity scores in both arms, and test for an interaction between system usability and working alliance with regard to the association between working alliance and depression scores in bCBT at 3-month assessments. METHODS We conducted a secondary data analysis of the E-COMPARED (European Comparative Effectiveness Research on Blended Depression Treatment versus Treatment-as-usual) trial, which compared bCBT with TAU across 9 European countries. Data were collected in primary care and specialized services between April 2015 and December 2017. Eligible participants aged 18 years or older and diagnosed with major depressive disorder were randomized to either bCBT (n=476) or TAU (n=467). bCBT consisted of 6-20 sessions of bCBT (involving face-to-face sessions with a therapist and an internet-based program). TAU consisted of usual care for depression. The main outcomes were scores of the working alliance (Working Alliance Inventory-Short Revised-Client [WAI-SR-C]) and depressive symptoms (Patient Health Questionnaire-9 [PHQ-9]) at 3 months after randomization. Other variables included system usability scores (System Usability Scale-Client [SUS-C]) at 3 months and baseline demographic information. Data from baseline and 3-month assessments were analyzed using linear regression models that adjusted for a set of baseline variables. RESULTS Of the 945 included participants, 644 (68.2%) were female, and the mean age was 38.96 years (IQR 38). bCBT was associated with higher composite WAI-SR-C scores compared to TAU (B=5.67, 95% CI 4.48-6.86). There was an inverse association between WAI-SR-C and PHQ-9 in bCBT (B=-0.12, 95% CI -0.17 to -0.06) and TAU (B=-0.06, 95% CI -0.11 to -0.02), in which as WAI-SR-C scores increased, PHQ-9 scores decreased. Finally, there was a significant interaction between SUS-C and WAI-SR-C with regard to an inverse association between higher WAI-SR-C scores and lower PHQ-9 scores in bCBT (b=-0.030, 95% CI -0.05 to -0.01; P=.005). CONCLUSIONS To our knowledge, this is the first study to show that bCBT may enhance the client working alliance when compared to evidence-based routine care for depression that services reported offering. The working alliance in bCBT was also associated with clinical improvements that appear to be enhanced by good program usability. Our findings add further weight to the view that the addition of internet-delivered CBT to face-to-face CBT may positively augment experiences of the working alliance. TRIAL REGISTRATION ClinicalTrials.gov NCT02542891, https://clinicaltrials.gov/study/NCT02542891; German Clinical Trials Register DRKS00006866, https://drks.de/search/en/trial/DRKS00006866; Netherlands Trials Register NTR4962, https://www.onderzoekmetmensen.nl/en/trial/25452; ClinicalTrials.Gov NCT02389660, https://clinicaltrials.gov/study/NCT02389660; ClinicalTrials.gov NCT02361684, https://clinicaltrials.gov/study/NCT02361684; ClinicalTrials.gov NCT02449447, https://clinicaltrials.gov/study/NCT02449447; ClinicalTrials.gov NCT02410616, https://clinicaltrials.gov/study/NCT02410616; ISRCTN Registry ISRCTN12388725, https://www.isrctn.com/ISRCTN12388725?q=ISRCTN12388725&filters=&sort=&offset=1&totalResults=1&page=1&pageSize=10; ClinicalTrials.gov NCT02796573, https://classic.clinicaltrials.gov/ct2/show/NCT02796573. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.1186/s13063-016-1511-1.
Collapse
Affiliation(s)
- Asmae Doukani
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Matteo Quartagno
- Medical Research Council Clinical Trials Unit, University College London, London, United Kingdom
| | - Francesco Sera
- Department of Statistics, Computer Science and Applications "G. Parenti", University of Florence, Florance, Italy
| | - Caroline Free
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Ritsuko Kakuma
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Heleen Riper
- Department of Psychiatry, Amsterdam University Medial Centre, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Annet Kleiboer
- Department Clinical, Neuro, and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- Amsterdam Public Health Institute, Amsterdam, Netherlands
| | - Arlinda Cerga-Pashoja
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Anneke van Schaik
- Department of Psychiatry, Amsterdam University Medial Centre, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- Academic Department for Depressive Disorders, Dutch Mental Health Care, Amsterdam, Netherlands
| | - Cristina Botella
- Department of Basic Psychology, Clinical and Psychobiology, Universitat Jaume I, Castellón de la Plana, Spain
- Centro de Investigación Biomédica en Red Fisiopatología Obesidad y Nutrición, Instituto Carlos III, Madrid, Spain
| | - Thomas Berger
- Department of Clinical Psychology and Psychotherapy, University of Bern, Bern, Switzerland
| | - Karine Chevreul
- Unité de Recherche Clinique in Health Economics, Assistance Publique-Hôpitaux de Paris, Paris, France
- Health Economics Research Unit, Inserm, University of Paris, Paris, France
| | - Maria Matynia
- Faculty of Psychology, SWPS University, Warsaw, Poland
| | - Tobias Krieger
- Department of Clinical Psychology and Psychotherapy, University of Bern, Bern, Switzerland
| | - Jean-Baptiste Hazo
- Unité de Recherche Clinique in Health Economics, Assistance Publique-Hôpitaux de Paris, Paris, France
- Health Economics Research Unit, Inserm, University of Paris, Paris, France
| | - Stasja Draisma
- Department on Aging, Netherlands Institute of Mental Health and Addiction (Trimbos Institute), Utrecht, Netherlands
| | - Ingrid Titzler
- Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Naira Topooco
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
| | - Kim Mathiasen
- Department of Clinical Medicine, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
- Centre for Digital Psychiatry, Mental Health Services of Southern Denmark, Odense, Denmark
| | - Kristofer Vernmark
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
| | - Antoine Urech
- Department of Clinical Psychology and Psychotherapy, University of Bern, Bern, Switzerland
- Department of Neurology, Inselspital Bern, Bern University Hospital, Bern, Switzerland
| | - Anna Maj
- Faculty of Psychology, SWPS University, Warsaw, Poland
| | - Gerhard Andersson
- Department of Behavioral Sciences and Learning, Linköping University, Linköping, Sweden
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Matthias Berking
- Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Rosa María Baños
- Centro de Investigación Biomédica en Red Fisiopatología Obesidad y Nutrición, Instituto Carlos III, Madrid, Spain
- Department of Personality, Evaluation and Psychological Treatments, Universidad de Valencia, Valencia, Spain
| | - Ricardo Araya
- Department of Health Service and Population Research, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| |
Collapse
|
|
14
|
Santillan-Ramos P, Humer E, Schaffler Y, Pieh C, Probst T, Felnhofer A, Kothgassner O, Netzer I, Jesser A. Impact of the COVID-19 pandemic on the work of clinical psychologists in Austria: results of a mixed-methods study. Front Psychol 2024; 15:1302442. [PMID: 38725952 PMCID: PMC11081068 DOI: 10.3389/fpsyg.2024.1302442] [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: 09/27/2023] [Accepted: 04/09/2024] [Indexed: 05/12/2024] Open
Abstract
Introduction Clinical psychologists in Austria shouldered a large part of the massive increase in demand for mental health services caused by the COVID-19 pandemic. This study aimed to find out how the pandemic affected their work and to gather information on how best to support the profession in the event of a crisis. Methods N = 172 Austrian clinical psychologists participated in a cross-sectional online survey between 11 April 2022 and 31 May 2022, including both closed and open-ended questions about their work. Open-ended questions were analyzed using qualitative content analysis. A mixed-methods analysis was conducted to test correlations between the categories derived from the qualitative analysis and professional variables. Results The analyses revealed that clinical psychologists, especially those with more years of experience, perceived an increased need for clinical psychological treatment, especially for children and adolescents, a lack of coverage for clinical psychological treatment by health insurance, a change to remote treatment formats, and a number of burdens associated with complying with COVID-19 measures. Discussion Clinical psychologists reported an urgent need to increase resources in both outpatient and inpatient settings and to promote health insurance coverage. To support the clinical psychology profession in providing high-quality work in times of crisis, there is a need to facilitate more opportunities for team and peer exchange, as well as financial support in the event of loss of income.
Collapse
Affiliation(s)
- Paola Santillan-Ramos
- Department for Psychosomatic Medicine and Psychotherapy, University of Continuing Education Krems, Krems an der Donau, Austria
| | - Elke Humer
- Department for Psychosomatic Medicine and Psychotherapy, University of Continuing Education Krems, Krems an der Donau, Austria
- Faculty of Psychotherapy Science, Sigmund Freud University, Vienna, Austria
| | - Yvonne Schaffler
- Department for Psychosomatic Medicine and Psychotherapy, University of Continuing Education Krems, Krems an der Donau, Austria
| | - Christoph Pieh
- Department for Psychosomatic Medicine and Psychotherapy, University of Continuing Education Krems, Krems an der Donau, Austria
| | - Thomas Probst
- Department for Psychosomatic Medicine and Psychotherapy, University of Continuing Education Krems, Krems an der Donau, Austria
- Division of Psychotherapy, Department of Psychology, Paris Lodron University of Salzburg, Salzburg, Austria
| | - Anna Felnhofer
- Division of Pediatric Pulmonology, Allergology and Endocrinology, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Oswald Kothgassner
- Department of Child and Adolescent Psychiatry, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Ingeborg Netzer
- Österreichischer Arbeitskreis für Gruppentherapie und Gruppendynamik, Fachsektion Integrative Gestalt Therapy Vienna, Vienna, Austria
| | - Andrea Jesser
- Department for Psychosomatic Medicine and Psychotherapy, University of Continuing Education Krems, Krems an der Donau, Austria
- Faculty of Psychotherapy Science, Sigmund Freud University, Vienna, Austria
| |
Collapse
|
|
15
|
Cohen Rodrigues TR, de Buisonjé DR, Reijnders T, Santhanam P, Kowatsch T, Breeman LD, Janssen VR, Kraaijenhagen RA, Atsma DE, Evers AW, the BENEFIT consortium. Human cues in eHealth to promote lifestyle change: An experimental field study to examine adherence to self-help interventions. Internet Interv 2024; 35:100726. [PMID: 38370288 PMCID: PMC10869898 DOI: 10.1016/j.invent.2024.100726] [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: 06/24/2023] [Revised: 01/27/2024] [Accepted: 02/07/2024] [Indexed: 02/20/2024] Open
Abstract
eHealth lifestyle interventions without human support (self-help interventions) are generally less effective, as they suffer from lower adherence levels. To solve this, we investigated whether (1) using a text-based conversational agent (TCA) and applying human cues contribute to a working alliance with the TCA, and whether (2) adding human cues and establishing a positive working alliance increase intervention adherence. Participants (N = 121) followed a TCA-supported app-based physical activity intervention. We manipulated two types of human cues: visual (ie, message appearance) and relational (ie, message content). We employed a 2 (visual cues: yes, no) x 2 (relational cues: yes, no) between-subjects design, resulting in four experimental groups: (1) visual and relational cues, (2) visual cues only, (3) relational cues only, or (4) no human cues. We measured the working alliance with the Working Alliance Inventory Short Revised form and intervention adherence as the number of days participants responded to the TCA's messages. Contrary to expectations, the working alliance was unaffected by using human cues. Working alliance was positively related to adherence (t(78) = 3.606, p = .001). Furthermore, groups who received visual cues showed lower adherence levels compared to those who received relational cues only or no cues (U = 1140.5, z = -3.520, p < .001). We replicated the finding that establishing a working alliance contributes to intervention adherence, independently of the use of human cues in a TCA. However, we were unable to show that adding human cues impacted the working alliance and increased adherence. The results indicate that adding visual cues to a TCA may even negatively affect adherence, possibly because it may create confusion concerning the true nature of the coach, which may prompt unrealistic expectations.
Collapse
Affiliation(s)
| | | | - Thomas Reijnders
- Health, Medical, and Neuropsychology Unit, Leiden University, the Netherlands
| | - Prabhakaran Santhanam
- Centre for Digital Health Interventions, Department of Management, Technology, and Economics, ETH Zurich, Zurich, Switzerland
| | - Tobias Kowatsch
- Centre for Digital Health Interventions, Department of Management, Technology, and Economics, ETH Zurich, Zurich, Switzerland
- Instiute for Implementation Science in Health Care, University of Zurich, Zurich, Switzerland
- School of Medicine, University of St.Gallen, St. Gallen, Switzerland
| | - Linda D. Breeman
- Health, Medical, and Neuropsychology Unit, Leiden University, the Netherlands
| | - Veronica R. Janssen
- Health, Medical, and Neuropsychology Unit, Leiden University, the Netherlands
- Department of Cardiology, Leiden University Medical Center, the Netherlands
| | - Roderik A. Kraaijenhagen
- NDDO Institute for Prevention and Early Diagnostics (NIPED), Amsterdam, the Netherlands
- Vital10, Amsterdam, the Netherlands
| | - Douwe E. Atsma
- Department of Cardiology, Leiden University Medical Center, the Netherlands
| | - Andrea W.M. Evers
- Health, Medical, and Neuropsychology Unit, Leiden University, the Netherlands
- Department of Psychiatry, Leiden University Medical Center, Leiden, the Netherlands
- Medical Delta, Leiden University, Technical University of Delft, Erasmus University Rotterdam, the Netherlands
| | - the BENEFIT consortium
- Health, Medical, and Neuropsychology Unit, Leiden University, the Netherlands
- Centre for Digital Health Interventions, Department of Management, Technology, and Economics, ETH Zurich, Zurich, Switzerland
- Instiute for Implementation Science in Health Care, University of Zurich, Zurich, Switzerland
- School of Medicine, University of St.Gallen, St. Gallen, Switzerland
- Department of Cardiology, Leiden University Medical Center, the Netherlands
- NDDO Institute for Prevention and Early Diagnostics (NIPED), Amsterdam, the Netherlands
- Vital10, Amsterdam, the Netherlands
- Department of Psychiatry, Leiden University Medical Center, Leiden, the Netherlands
- Medical Delta, Leiden University, Technical University of Delft, Erasmus University Rotterdam, the Netherlands
| |
Collapse
|
|
16
|
Wols A, Pingel M, Lichtwarck-Aschoff A, Granic I. Effectiveness of applied and casual games for young people's mental health: A systematic review of randomised controlled studies. Clin Psychol Rev 2024; 108:102396. [PMID: 38320420 DOI: 10.1016/j.cpr.2024.102396] [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: 05/12/2023] [Revised: 01/24/2024] [Accepted: 01/29/2024] [Indexed: 02/08/2024]
Abstract
Many youth experience mental health problems and digital games hold potential as mental health interventions. This systematic review provides an overview of randomised controlled studies assessing the effectiveness of digital applied and casual games for improving mental health in youth aged 6-24 years. A systematic search of PsycINFO, Web of Science and Pubmed yielded 145 eligible studies. Studies on (sub)clinical participant samples (n = 75) most often focused on attention-deficit/hyperactivity disorder (ADHD), autism and anxiety. Applied games were found most effective for improving social skills, verbal memory and anxiety, whereas casual games were found most effective for improving depression, anxiety and ADHD. Studies involving healthy youth (n = 70) were grouped into papers examining anxiety in medical settings, momentary effects on positive and negative affect, and papers employing a longitudinal design measuring mental health trait outcomes. Promising results were found for the use of games as distraction tools in medical settings, and for applied and casual games for improving momentary affect. Overall, our findings demonstrate the potential of digital games for improving mental health. Implications and recommendations for future research are discussed, such as developing evaluation guidelines, clearly defining applied games, harmonising outcome measures, including positive outcomes, and examining nonspecific factors that may influence symptom improvement as well.
Collapse
Affiliation(s)
- Aniek Wols
- Radboud University, Behavioural Science Institute, Nijmegen, the Netherlands.
| | - Michelle Pingel
- Radboud University, Behavioural Science Institute, Nijmegen, the Netherlands
| | - Anna Lichtwarck-Aschoff
- Rijksuniversiteit Groningen, Department of Pedagogical & Educational Sciences, Groningen, the Netherlands
| | - Isabela Granic
- McMaster University, Health, Aging & Society, Hamilton, Ontario, Canada
| |
Collapse
|
|
17
|
Cohen Rodrigues TR, Reijnders T, Breeman LD, Janssen VR, Kraaijenhagen RA, Atsma DE, Evers AW. Use Intention and User Expectations of Human-Supported and Self-Help eHealth Interventions: Internet-Based Randomized Controlled Trial. JMIR Form Res 2024; 8:e38803. [PMID: 38358784 PMCID: PMC10905349 DOI: 10.2196/38803] [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: 04/16/2022] [Revised: 10/28/2023] [Accepted: 11/20/2023] [Indexed: 02/16/2024] Open
Abstract
BACKGROUND Self-help eHealth interventions provide automated support to change health behaviors without any further human assistance. The main advantage of self-help eHealth interventions is that they have the potential to lower the workload of health care professionals. However, one disadvantage is that they generally have a lower uptake. Possibly, the absence of a relationship with a health care professional (referred to as the working alliance) could lead to negative expectations that hinder the uptake of self-help interventions. The Unified Theory of Acceptance and Use of Technology (UTAUT) identifies which expectations predict use intention. As there has been no previous research exploring how expectations affect the adoption of both self-help and human-supported eHealth interventions, this study is the first to investigate the impact of expectations on the uptake of both kinds of eHealth interventions. OBJECTIVE This study investigated the intention to use a self-help eHealth intervention compared to a human-supported eHealth intervention and the expectations that moderate this relationship. METHODS A total of 146 participants were randomly assigned to 1 of 2 conditions (human-supported or self-help eHealth interventions). Participants evaluated screenshots of a human-supported or self-help app-based stress intervention. We measured intention to use the intervention-expected working alliance and the UTAUT constructs: performance expectancy, effort expectancy, and social influence. RESULTS Use intention did not differ significantly between the 2 conditions (t142=-1.133; P=.26). Performance expectancy (F1,140=69.269; P<.001), effort expectancy (F1,140=3.961; P=.049), social influence (F1,140=90.025; P<.001), and expected working alliance (F1,140=26.435; P<.001) were positively related to use intention regardless of condition. The interaction analysis showed that performance expectancy (F1,140=4.363; P=.04) and effort expectancy (F1,140=4.102; P=.045) more strongly influenced use intention in the self-help condition compared to the human-supported condition. CONCLUSIONS As we found no difference in use intention, our results suggest that we could expect an equal uptake of self-help eHealth interventions and human-supported ones. However, attention should be paid to people who have doubts about the intervention's helpfulness or ease of use. For those people, providing additional human support would be beneficial to ensure uptake. Screening user expectations could help health care professionals optimize self-help eHealth intervention uptake in practice. TRIAL REGISTRATION OSF Registries osf.io/n47cz; https://osf.io/n47cz.
Collapse
Affiliation(s)
| | - Thomas Reijnders
- Health, Medical, and Neuropsychology Unit, Leiden University, Leiden, Netherlands
| | - Linda D Breeman
- Health, Medical, and Neuropsychology Unit, Leiden University, Leiden, Netherlands
| | - Veronica R Janssen
- Health, Medical, and Neuropsychology Unit, Leiden University, Leiden, Netherlands
- Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
| | - Roderik A Kraaijenhagen
- NDDO Institute for Prevention and Early Diagnostics (NIPED), Amsterdam, Netherlands
- Vital10, Amsterdam, Netherlands
| | - Douwe E Atsma
- Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
| | - Andrea Wm Evers
- Health, Medical, and Neuropsychology Unit, Leiden University, Leiden, Netherlands
- Department of Psychiatry, Leiden University Medical Center, Leiden, Netherlands
- Medical Delta, Leiden University, Technical University of Delft, Erasmus University Rotterdam, Leiden, Delft, Rotterdam, Netherlands
| |
Collapse
|
|
18
|
Karnik V, Henderson H, Khan UR, Boyd J. Phone-Based Text Therapy for Youth Mental Health: Rapid Review. Interact J Med Res 2023; 12:e47250. [PMID: 38096012 PMCID: PMC10755647 DOI: 10.2196/47250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Revised: 06/14/2023] [Accepted: 07/10/2023] [Indexed: 12/31/2023] Open
Abstract
BACKGROUND Mental illness has become a prevalent issue impacting adolescents worldwide. Many barriers, including stigma and poor health literacy, prevent this population group from accessing reliable mental health care services. Synchronous text-therapy counseling is an underused therapeutic approach in combating adolescent mental illness. Phone-based text therapy is uniquely placed to offer personalized counseling to adolescents through a familiar and engaging treatment modality. OBJECTIVE This rapid review aims to understand the clinical effectiveness, usability, and accessibility of phone-based text therapy for youth mental health. METHODS Cochrane CENTRAL, Embase, PubMed, and PsycINFO were used to search for suitable literature. Five groups of keywords were used: those related to (1) "therapy," (2) "text," (3) "phone," (4) "youth," and (5) "mental health." Eligibility criteria were formed through the PICO (Population, Intervention, Control, and Outcome) framework. Studies were included if a synchronous phone-based text therapy intervention was used in an adolescent population, with an age range of 12-24 years. Only literature available in full-text, English, and a peer-reviewed journal was considered. Furthermore, a date limit of 5 years was set to reflect the recent development of digital interventions for mental health. Pertinent information from each study was tabulated, and a narrative synthesis was used to assess, describe, and organize the included studies comprehensively and concisely. RESULTS Of the 771 studies dual screened, 7 studies were included in this rapid review. Most of the exclusions occurred due to the use of the wrong intervention, such as asynchronous messaging. The selected studies had a low risk of bias and were suitable for the review. All interventional trials demonstrated reductions in mental health symptoms, primarily depression and anxiety. Most studies displayed high usability among participants, while data were unclear regarding accessibility. CONCLUSIONS This review reveals the high potential of phone-based text therapy as an intervention for adolescents experiencing mental illness. We hope that this review promotes further refinement of text-based phone therapies and encourages future research on this subject matter.
Collapse
Affiliation(s)
- Varun Karnik
- La Trobe University, Melbourne, Australia
- Griffith University, Gold Coast, Australia
| | | | | | - James Boyd
- La Trobe University, Melbourne, Australia
| |
Collapse
|
|
19
|
Alder G, Taylor D, Rashid U, Olsen S, Brooks T, Terry G, Niazi IK, Signal N. A Brain Computer Interface Neuromodulatory Device for Stroke Rehabilitation: Iterative User-Centered Design Approach. JMIR Rehabil Assist Technol 2023; 10:e49702. [PMID: 38079202 PMCID: PMC10750233 DOI: 10.2196/49702] [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: 06/07/2023] [Revised: 09/03/2023] [Accepted: 09/27/2023] [Indexed: 12/28/2023] Open
Abstract
BACKGROUND Rehabilitation technologies for people with stroke are rapidly evolving. These technologies have the potential to support higher volumes of rehabilitation to improve outcomes for people with stroke. Despite growing evidence of their efficacy, there is a lack of uptake and sustained use in stroke rehabilitation and a call for user-centered design approaches during technology design and development. This study focuses on a novel rehabilitation technology called exciteBCI, a complex neuromodulatory wearable technology in the prototype stage that augments locomotor rehabilitation for people with stroke. The exciteBCI consists of a brain computer interface, a muscle electrical stimulator, and a mobile app. OBJECTIVE This study presents the evaluation phase of an iterative user-centered design approach supported by a qualitative descriptive methodology that sought to (1) explore users' perspectives and experiences of exciteBCI and how well it fits with rehabilitation, and (2) facilitate modifications to exciteBCI design features. METHODS The iterative usability evaluation of exciteBCI was conducted in 2 phases. Phase 1 consisted of 3 sprint cycles consisting of single usability sessions with people with stroke (n=4) and physiotherapists (n=4). During their interactions with exciteBCI, participants used a "think-aloud" approach, followed by a semistructured interview. At the end of each sprint cycle, device requirements were gathered and the device was modified in preparation for the next cycle. Phase 2 focused on a "near-live" approach in which 2 people with stroke and 1 physiotherapist participated in a 3-week program of rehabilitation augmented by exciteBCI (n=3). Participants completed a semistructured interview at the end of the program. Data were analyzed from both phases using conventional content analysis. RESULTS Overall, participants perceived and experienced exciteBCI positively, while providing guidance for iterative changes. Five interrelated themes were identified from the data: (1) "This is rehab" illustrated that participants viewed exciteBCI as having a good fit with rehabilitation practice; (2) "Getting the most out of rehab" highlighted that exciteBCI was perceived as a means to enhance rehabilitation through increased engagement and challenge; (3) "It is a tool not a therapist," revealed views that the technology could either enhance or disrupt the therapeutic relationship; and (4) "Weighing up the benefits versus the burden" and (5) "Don't make me look different" emphasized important design considerations related to device set-up, use, and social acceptability. CONCLUSIONS This study offers several important findings that can inform the design and implementation of rehabilitation technologies. These include (1) the design of rehabilitation technology should support the therapeutic relationship between the patient and therapist, (2) social acceptability is a design priority in rehabilitation technology but its importance varies depending on the use context, and (3) there is value in using design research methods that support understanding usability in the context of sustained use.
Collapse
Affiliation(s)
- Gemma Alder
- Rehabilitation Innovation Centre, Health and Rehabilitation Research Institute, Auckland University of Technology, Auckland, New Zealand
| | - Denise Taylor
- Rehabilitation Innovation Centre, Health and Rehabilitation Research Institute, Auckland University of Technology, Auckland, New Zealand
| | - Usman Rashid
- Rehabilitation Innovation Centre, Health and Rehabilitation Research Institute, Auckland University of Technology, Auckland, New Zealand
| | - Sharon Olsen
- Rehabilitation Innovation Centre, Health and Rehabilitation Research Institute, Auckland University of Technology, Auckland, New Zealand
| | - Thonia Brooks
- Rehabilitation Innovation Centre, Health and Rehabilitation Research Institute, Auckland University of Technology, Auckland, New Zealand
| | - Gareth Terry
- Rehabilitation Innovation Centre, Health and Rehabilitation Research Institute, Auckland University of Technology, Auckland, New Zealand
| | - Imran Khan Niazi
- Rehabilitation Innovation Centre, Health and Rehabilitation Research Institute, Auckland University of Technology, Auckland, New Zealand
- Centre for Chiropractic Research, New Zealand College of Chiropractic, Auckland, New Zealand
- Sensory Motor Integration, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Nada Signal
- Rehabilitation Innovation Centre, Health and Rehabilitation Research Institute, Auckland University of Technology, Auckland, New Zealand
| |
Collapse
|
|
20
|
Pearson C, Sham R, Gardner S, Klapman S, Altschuler A. Perceived Quality of Online Music Therapy Sessions by Older Adults Aging at Home. Can J Aging 2023; 42:607-620. [PMID: 37492881 DOI: 10.1017/s0714980823000260] [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: 07/27/2023] Open
Abstract
Online delivery is new to the field of music therapy (MT). This research investigated older adults' perceived quality of MT online by certified music therapists. In this feasibility study, applying both process and outcome assessments, nine older adults volunteered to participate. Zoom was used, and a virtual music therapy (VMT) kit was developed as a resource. Surveys and observed technical difficulties revealed that perceived quality varied slightly by level of technical difficulty experienced; however, overall mean perceived quality was 7.2 out of 9. Post-study interviews revealed three main themes: (a) individual experiences with VMT, (b) individuals' suggestions for further development of VMT sessions, and (c) individuals' personal outcomes from VMT sessions. Participants reported overall positive experiences with VMT. Despite a slight decline in perceived quality when more technical difficulties were present, each participant reported a desire for more sessions, and they would recommend it to others.
Collapse
Affiliation(s)
- Chrissy Pearson
- Culture and Arts, Baycrest Health Sciences, Toronto, ON, Canada
| | - Rosalind Sham
- Kunin-Lunenfeld Centre for Applied Research and Evaluation, Baycrest Health Sciences, Toronto, ON, Canada
| | - Sandra Gardner
- Kunin-Lunenfeld Centre for Applied Research and Evaluation, Baycrest Health Sciences, Toronto, ON, Canada
| | - Sarah Klapman
- Kunin-Lunenfeld Centre for Applied Research and Evaluation, Baycrest Health Sciences, Toronto, ON, Canada
| | | |
Collapse
|
|
21
|
Dol A, van Strien T, Velthuijsen H, van Gemert-Pijnen L, Bode C. Preferences for coaching strategies in a personalized virtual coach for emotional eaters: an explorative study. Front Psychol 2023; 14:1260229. [PMID: 38034311 PMCID: PMC10687361 DOI: 10.3389/fpsyg.2023.1260229] [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: 07/17/2023] [Accepted: 11/01/2023] [Indexed: 12/02/2023] Open
Abstract
Objectives Emotional eating is recognized as a potential contributor to weight gain. Emotional eaters often hide their problems because of feelings of shame about their behavior, making it challenging to provide them with the necessary support. The introduction of a virtual coach might offer a potential solution in assisting them. To find out whether emotional eaters are receptive to online personalized coaching, we presented emotional eaters with two essential proto-typical problem situations for emotional eaters: "experiencing cravings" and "after giving in to cravings," and asked them whether they preferred one of the three coaching strategies presented: Validating, Focus-on-Change and Dialectical. Methods An experimental vignette study (2 × 3 design) was carried out. The vignettes featured two distinct personas, each representing one of the two common problem scenarios experienced by emotional eaters, along with three distinct coaching strategies for each scenario. To identify potential predictors for recognition of problem situations, questionnaires on emotional eating (DEBQ), personality traits (Big-5), well-being (PANAS), and BMI were administrated. Results A total of 62% of the respondents identified themselves with "after giving in to cravings" and 47% with "experiencing cravings." BMI, emotional eating and emotional stability appeared to be predictors in recognizing both the problem situations. In "experiencing cravings," the participating women preferred Dialectical and the Validation coaching strategies. In the "after giving in to cravings" condition, they revealed a preference for the Dialectical and the Focus-on-Change coaching strategies. Conclusion Using vignettes allowed a less threatening way of bringing up sensitive topics for emotional eaters. The personas representing the problem situations were reasonably well recognized. To further enhance this recognition, it is important for the design and content of the personas to be even more closely related to the typical problem scenarios of emotional eaters, rather than focusing on physical characteristics or social backgrounds. This way, users may be less distracted by these factors. With the knowledge gained about the predictors that may influence recognition of the problem situations, design for coaching can be more customized. The participants represented individuals with high emotional eating levels, enhancing external validity.
Collapse
Affiliation(s)
- Aranka Dol
- Department of Psychology, Health and Technology, University of Twente, Enschede, Netherlands
- Institute for Communication, Media & IT, Hanze University, Groningen, Netherlands
| | - Tatjana van Strien
- Behavioural Science Institute, Radboud University, Nijmegen, Netherlands
| | - Hugo Velthuijsen
- Institute for Communication, Media & IT, Hanze University, Groningen, Netherlands
| | | | - Christina Bode
- Department of Psychology, Health and Technology, University of Twente, Enschede, Netherlands
| |
Collapse
|
|
22
|
Reliford A, Zhang E, Lanina O, Williams SZ, Sanichar N, Khan S, Dapkins I, Frankle WG. Patient and Clinician Satisfaction with the Early Implementation of Telemental Health Services in an Urban Behavioral Health Clinic During the COVID-19 Pandemic. Telemed J E Health 2023; 29:1713-1722. [PMID: 36912813 DOI: 10.1089/tmj.2022.0480] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2023] Open
Abstract
Objective: The COVID-19 pandemic served as an impetus for the rapid expansion of telehealth. In this study, we examined the experience of rapid transition to telemental health (TMH) within The Family Health Centers at NYU Langone, a large, urban, Federally Qualified Health Center, in the 3 months after the onset of the COVID-19 pandemic. Methods: We administered surveys to clinicians and patients who utilized TMH between March 16, 2020 and July 16, 2020. Patients were sent a web-based survey via email or received a phone survey (for those without email) with four languages choices: English, Spanish, Traditional Chinese, or Simplified Chinese. Results: The majority (79%) of clinicians (n = 83) rated the experience of TMH as "excellent" or "good," and felt that they could establish and maintain the patient relationship through TMH. Four thousand seven hundred seventy-two survey invitations were sent out to patients, and 654 (13.7%) responded. Ninety percent reported that they were satisfied with the service they received and rated TMH as better or the same as in-person care (81.6%) with a high mean satisfaction score (4.5 out of 5). Patients were more likely to rate TMH as better or the same as in-person care relative to the clinicians. Conclusions: These results are consistent with several recent studies that have explored patient satisfaction with TMH during the COVID-19 pandemic and demonstrate that both clinicians and patients experienced a high degree of satisfaction with mental health care delivered virtually compared with face-to-face encounters.
Collapse
Affiliation(s)
- Aaron Reliford
- Department of Child and Adolescent Psychiatry, NYU Grossman School of Medicine, New York, New York, USA
| | - Emily Zhang
- Department of Psychiatry, and NYU Grossman School of Medicine, New York, New York, USA
| | - Olga Lanina
- Department of Psychiatry, and NYU Grossman School of Medicine, New York, New York, USA
| | - Sharifa Z Williams
- Center for Research on Cultural and Structural Equity in Behavioral Health, Division of Social Solutions and Services Research, Nathan S. Kline Institute for Psychiatric Research, Orangeburg, New York, USA
| | - Navin Sanichar
- Center for Research on Cultural and Structural Equity in Behavioral Health, Division of Social Solutions and Services Research, Nathan S. Kline Institute for Psychiatric Research, Orangeburg, New York, USA
| | - Shabana Khan
- Department of Child and Adolescent Psychiatry, NYU Grossman School of Medicine, New York, New York, USA
| | - Isaac Dapkins
- Department of Population Health, NYU Grossman School of Medicine, New York, New York, USA
| | - W Gordon Frankle
- Department of Psychiatry, and NYU Grossman School of Medicine, New York, New York, USA
| |
Collapse
|
|
23
|
Joubert AE, Grierson AB, Li I, Sharrock MJ, Moulds ML, Werner-Seidler A, Stech EP, Mahoney AEJ, Newby JM. Managing Rumination and worry: A randomised controlled trial of an internet intervention targeting repetitive negative thinking delivered with and without clinician guidance. Behav Res Ther 2023; 168:104378. [PMID: 37595354 DOI: 10.1016/j.brat.2023.104378] [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: 11/14/2021] [Revised: 06/05/2023] [Accepted: 07/23/2023] [Indexed: 08/20/2023]
Abstract
BACKGROUND Rumination and worry, forms of repetitive negative thinking (RNT), are implicated in the onset, maintenance, severity, and relapse risk of depression and anxiety disorders. This randomised controlled trial evaluated an internet intervention targeting both rumination and worry in adults compared to treatment-as-usual (TAU) and compared treatment effects and adherence when delivered with and without clinician guidance. METHODS Adults (N = 137) with elevated RNT were randomly allocated to a 3-lesson clinician guided (n = 45) or self-help (n = 47) online program delivered over 6 weeks, or a TAU control group which waited 18 weeks to receive the program (n = 45). The clinician guided group received semi-structured phone support after each lesson. All three groups continued any pre-trial TAU. RNT, anxiety, depression, and psychological distress were assessed at baseline, post-treatment (week 7), and 3-month follow-up. RESULTS Intention-to-treat linear mixed models showed that participants in the self-help and clinician guided groups had significantly lower RNT, anxiety, depression, and distress at post-treatment and 3-month follow-up compared to TAU. Treatment effects were significantly larger in the clinician guided group compared to self-help (between-group gs = 0.41-0.97). No significant between-group differences were found in adherence/program completion (guided: 76%; self-guided: 79%) or treatment satisfaction (1-5 scale: guided: M = 4.17, SD = 1.20; self-guided: M = 3.89, SD = 0.93). Total time spent on clinician guidance was M = 48.64 min (SD = 21.28). CONCLUSION This brief online intervention for RNT is acceptable and efficacious in reducing RNT, anxiety, depression, and distress in both clinician guided and self-help formats. The program appeared most effective when delivered with clinician guidance. Larger definitive trials comparing guided and self-guided programs are needed. Australian and New Zealand Clinical Trials Registration number: ACTRN12620000959976.
Collapse
Affiliation(s)
- Amy E Joubert
- Clinical Research Unit for Anxiety and Depression (CRUfAD), St. Vincent's Hospital, Level 4 O'Brien Centre, 394- 404 Victoria Street, Darlinghurst, Sydney, New South Wales, 2010, Australia; School of Psychology, University of New South Wales, Sydney, NSW, 2052, Australia
| | - Ashlee B Grierson
- Clinical Research Unit for Anxiety and Depression (CRUfAD), St. Vincent's Hospital, Level 4 O'Brien Centre, 394- 404 Victoria Street, Darlinghurst, Sydney, New South Wales, 2010, Australia; School of Psychiatry, UNSW Medicine, University of New South Wales, Sydney, NSW, 2052, Australia
| | - Ian Li
- Clinical Research Unit for Anxiety and Depression (CRUfAD), St. Vincent's Hospital, Level 4 O'Brien Centre, 394- 404 Victoria Street, Darlinghurst, Sydney, New South Wales, 2010, Australia; School of Psychiatry, UNSW Medicine, University of New South Wales, Sydney, NSW, 2052, Australia
| | - Maria J Sharrock
- Clinical Research Unit for Anxiety and Depression (CRUfAD), St. Vincent's Hospital, Level 4 O'Brien Centre, 394- 404 Victoria Street, Darlinghurst, Sydney, New South Wales, 2010, Australia; School of Psychiatry, UNSW Medicine, University of New South Wales, Sydney, NSW, 2052, Australia
| | - Michelle L Moulds
- School of Psychology, University of New South Wales, Sydney, NSW, 2052, Australia
| | - Aliza Werner-Seidler
- Black Dog Institute, The University of New South Wales, Sydney, NSW, 2052, Australia
| | - Eileen P Stech
- Black Dog Institute, The University of New South Wales, Sydney, NSW, 2052, Australia
| | - Alison E J Mahoney
- Clinical Research Unit for Anxiety and Depression (CRUfAD), St. Vincent's Hospital, Level 4 O'Brien Centre, 394- 404 Victoria Street, Darlinghurst, Sydney, New South Wales, 2010, Australia; School of Psychiatry, UNSW Medicine, University of New South Wales, Sydney, NSW, 2052, Australia
| | - Jill M Newby
- School of Psychology, University of New South Wales, Sydney, NSW, 2052, Australia; Black Dog Institute, The University of New South Wales, Sydney, NSW, 2052, Australia.
| |
Collapse
|
|
24
|
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."
Collapse
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
| | | |
Collapse
|
|
25
|
Zubala A, Kennell N, MacInnes C, MacInnes M, Malcolm M. Online art therapy pilot in the Western Isles of Scotland: a feasibility and acceptability study of a novel service in a rural community. Front Psychiatry 2023; 14:1193445. [PMID: 37283707 PMCID: PMC10241303 DOI: 10.3389/fpsyt.2023.1193445] [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: 03/24/2023] [Accepted: 04/27/2023] [Indexed: 06/08/2023] Open
Abstract
Introduction Art therapy, despite being an evidence-based, safe and acceptable intervention, is not widely available to clients in Scotland. Online delivery has the potential to expand the reach and accessibility, but special considerations need to be given to designing successful online art therapy services, due to the unique emphasis on the role of an image and artmaking alongside the therapeutic relationship. Methods A pilot online art therapy service was developed and delivered in the Western Isles of Scotland to individual adult clients wishing to increase their psychological wellbeing. This research aimed to assess feasibility and acceptability of the novel service, identify enablers and challenges in setting up and delivering the service, explore participants' expectations and experiences of art therapy and identify any impacts of the service. Mixed-method evaluation incorporated questionnaires, focus groups, interviews and Audio Image Recordings (AIRs). Findings were grouped into themes across several key areas: service setup, research procedures, intervention design and impacts and insights. Recommendations were developed for the first three areas and the last section presents indications of change and gives voice to client experience primarily. Results Online art therapy was described by clients as a judgement-free zone which allowed freedom to experiment, express, feel and immerse themselves in the creative flow. Other benefits included readiness to accept emotions, increased understanding of self and others and being able to see things from a new perspective. Clients recognised the unique nature of art therapy in relation to other psychological treatments and valued the freedom of expression it offered, including the non-verbal. Discussion This project demonstrated that online art therapy is not only a feasible an acceptable intervention, but potentially also a powerfully impactful one, capable of instilling a positive change in a surprisingly short period of time. Exploring ways to expand current and introduce new art therapy services is highly recommended. Refinement of an intervention design, tools and research procedures is recommended through further feasibility studies of a larger scale.
Collapse
Affiliation(s)
- Ania Zubala
- Institute of Health Research and Innovation, University of the Highlands and Islands, Inverness, United Kingdom
| | - Nicola Kennell
- Research and Development, Green Tree Arts, Kinbrace, United Kingdom
| | - Catriona MacInnes
- Institute of Health Research and Innovation, University of the Highlands and Islands, Inverness, United Kingdom
| | - Marion MacInnes
- Research and Innovation, NHS Western Isles, Stornoway, United Kingdom
| | - Martin Malcolm
- Research and Innovation, NHS Western Isles, Stornoway, United Kingdom
| |
Collapse
|
|
26
|
Salazar de Pablo G, Pascual-Sánchez A, Panchal U, Clark B, Krebs G. Efficacy of remotely-delivered cognitive behavioural therapy for obsessive-compulsive disorder: An updated meta-analysis of randomised controlled trials. J Affect Disord 2023; 322:289-299. [PMID: 36395988 DOI: 10.1016/j.jad.2022.11.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Revised: 09/12/2022] [Accepted: 11/06/2022] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Despite remotely-delivered cognitive behavioural therapy (CBT) being an emerging field, the evidence of its efficacy in obsessive-compulsive disorder (OCD) is limited. We aimed to estimate the efficacy of remotely-delivered CBT for OCD, compared to face-to-face CBT and non-CBT control conditions. METHODS Randomised clinical trials (RCTs) identified through a systematic literature search of PubMed, Ovid/PsychINFO and Web of Science until 21/06/2021. Eligible studies included individuals with OCD evaluating at least one form of remotely-delivered CBT versus a control condition. Random-effects meta-analyses, sub-analyses, meta-regressions, heterogeneity analyses, publication bias assessment and quality assessment. RESULTS Twenty-two RCTs were included (n = 1796, mean age = 27.7 years, females = 59.1 %). Remotely-delivered CBT was more efficacious than non-CBT control conditions for OCD symptoms (g = 0.936 95 % CI = 0.597-1.275, p < .001), depressive symptoms (g = 0.358, 95 % CI = 0.125-0.590, p = .003) and anxiety symptoms (g = 0.468, 95 % CI = 0.135-0.800, p = .006). There were no significant differences in efficacy between remotely-delivered CBT and face-to-face CBT for OCD symptoms (g = -0.104 95 % CI = -0.391-0.184, p = .479), depressive symptoms (g = 0.138, 95 % CI = -0.044-0.320, p = .138), anxiety symptoms (g = 0.166, 95 % CI = -0.456-0.780, p = .601) or quality of life (g = 0.057, 95 % CI = -0.178-0.292, p = .489). Higher baseline severity of OCD symptoms was associated with a lower efficacy of remotely-delivered CBT compared to face-to-face CBT (β = -0.092, p = .036). The quality of the included studies was mostly identified as "low risk of bias" (45.5 %) or "some concerns" (45.5 %). LIMITATIONS Heterogeneity and limited evidence for some outcomes. CONCLUSIONS Remotely-delivered CBT appears efficacious in reducing OCD symptoms and other relevant outcomes and is therefore a viable option for increasing treatment access. Preliminary evidence suggests some individuals with severe OCD may benefit more from face-to-face than remotely-delivered CBT.
Collapse
Affiliation(s)
- Gonzalo Salazar de Pablo
- National & Specialist OCD, BDD and Related Disorder Clinic, South London & Maudsley NHS Trust, UK; Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK; Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK.
| | - Ana Pascual-Sánchez
- Division of Psychiatry, Department of Brain Sciences, Imperial College, London, UK
| | - Urvashi Panchal
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | - Bruce Clark
- National & Specialist OCD, BDD and Related Disorder Clinic, South London & Maudsley NHS Trust, UK
| | - Georgina Krebs
- National & Specialist OCD, BDD and Related Disorder Clinic, South London & Maudsley NHS Trust, UK; Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK; Department of Clinical, Educational and Health Psychology, University College London, UK
| |
Collapse
|
|
27
|
Castle D, Feusner J, Laposa JM, Richter PMA, Hossain R, Lusicic A, Drummond LM. Psychotherapies and digital interventions for OCD in adults: What do we know, what do we need still to explore? Compr Psychiatry 2023; 120:152357. [PMID: 36410261 PMCID: PMC10848818 DOI: 10.1016/j.comppsych.2022.152357] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 08/07/2022] [Accepted: 11/14/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Despite significant advances in the understanding and treatment of obsessive compulsive disorder (OCD), current treatment options are limited in terms of efficacy for symptom remission. Thus, assessing the potential role of iterative or alternate psychotherapies is important. Also, the potential role of digital technologies to enhance the accessibility of these therapies, should not be underestimated. We also need to embrace the idea of a more personalized treatment choice, being cognisant of clinical, genetic and neuroimaging predictors of treatment response. PROCEDURES Non-systematic review of current literature on emerging psychological and digital therapies for OCD, as well as of potential biomarkers of treatment response. FINDINGS A number of 'third wave' therapies (e.g., Acceptance and Commitment Therapy, Mindfulness-Based Cognitive Therapy) have an emerging and encouraging evidence base in OCD. Other approaches entail employment of elements of other psychotherapies such as Dialectical Behaviour Therapy; or trauma-focussed therapies such as Eye Movement Desensitisation and Reprocessing, and Imagery Rescripting and Narrative Therapy. Further strategies include Danger Ideation Reduction Therapy and Habit Reversal. For these latter approaches, large-scale randomised controlled trials are largely lacking, and the precise role of these therapies in treating people with OCD, remains to be clarified. A concentrated 4-day program (the Bergen program) has shown promising short- and long-term results. Exercise, music, and art therapy have not been adequately tested in people with OCD, but may have an adjunctive role. Digital technologies are being actively investigated for enhancing reach and efficacy of psychological therapies for OCD. Biomarkers, including genetic and neuroimaging, are starting to point to a future with more 'personalised medicine informed' treatment strategizing for OCD. CONCLUSIONS There are a number of potential psychological options for the treatment of people with OCD who do not respond adequately to exposure/response prevention or cognitive behaviour therapy. Adjunctive exercise, music, and art therapy might be useful, albeit the evidence base for these is very small. Consideration should be given to different ways of delivering such interventions, including group-based, concentrated, inpatient, or with outreach, where appropriate. Digital technologies are an emerging field with a number of potential applications for aiding the treatment of OCD. Biomarkers for treatment response determination have much potential capacity and deserve further empirical testing.
Collapse
Affiliation(s)
- David Castle
- Centre for Addiction and Mental Health, 60 White Squirrel Way, Toronto, Ontario M6J 1H4, Canada; Department of Psychiatry, University of Toronto, 250 College Street, Toronto, Ontario M5T 1R8, Canada.
| | - Jamie Feusner
- Department of Psychiatry, University of Toronto, 250 College Street, Toronto, Ontario M5T 1R8, Canada; Centre for Addiction and Mental Health, 250 College Street, Toronto, Ontario M5T 1RB, Canada
| | - Judith M Laposa
- Department of Psychiatry, University of Toronto, 250 College Street, Toronto, Ontario M5T 1R8, Canada; Campbell Family Mental Health Research Institute, Center for Addiction and Mental Health, 100 Stokes St., Toronto, Ontario M6J 1H4, Canada
| | - Peggy M A Richter
- Department of Psychiatry, University of Toronto, 250 College Street, Toronto, Ontario M5T 1R8, Canada; Frederick W Thompson Anxiety Disorders Centre, Sunnybrook Health Sciences Centre, 2075 Bayview, Toronto, Ontario M4N 3M5, Canada
| | - Rahat Hossain
- Department of Psychiatry, University of Toronto, 250 College Street, Toronto, Ontario M5T 1R8, Canada
| | - Ana Lusicic
- Centre for Addiction and Mental Health, 60 White Squirrel Way, Toronto, Ontario M6J 1H4, Canada; Department of Psychiatry, University of Toronto, 250 College Street, Toronto, Ontario M5T 1R8, Canada
| | - Lynne M Drummond
- Service for OCD/ BDD, South-West London and St George's NHS Trust, Glenburnie Road, London SW17 7DJ, United Kingdom
| |
Collapse
|
|
28
|
Contreras M, Van Hout E, Farquhar M, McCracken LM, Gould RL, Hornberger M, Richmond E, Kishita N. Internet-delivered guided self-help Acceptance and Commitment Therapy for family carers of people with dementia (iACT4CARERS): a qualitative study of carer views and acceptability. Int J Qual Stud Health Well-being 2022; 17:2066255. [PMID: 35435153 PMCID: PMC9037213 DOI: 10.1080/17482631.2022.2066255] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Affiliation(s)
- Milena Contreras
- School of Health Sciences, University of East Anglia, Norwich, UK
| | - Elien Van Hout
- School of Health Sciences, University of East Anglia, Norwich, UK
| | - Morag Farquhar
- School of Health Sciences, University of East Anglia, Norwich, UK
| | | | - Rebecca L Gould
- Division of Psychiatry, University College London, London, UK
| | | | - Erica Richmond
- Older People’s Community Team, Norfolk and Suffolk NHS Foundation Trust, Norwich, UK
| | - Naoko Kishita
- School of Health Sciences, University of East Anglia, Norwich, UK
| |
Collapse
|
|
29
|
Brown K, Parry S. How do people with first episode psychosis experience therapeutic relationships with mental health practitioners? A narrative review. PSYCHOSIS 2022. [DOI: 10.1080/17522439.2022.2160487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Katrina Brown
- Faculty of Health and Medicine, Lancaster University, Lancaster
| | - Sarah Parry
- Faculty of Health and Medicine, Lancaster University, Lancaster
| |
Collapse
|
|
30
|
Cohen Rodrigues TR, Reijnders T, de Buisonjé DR, Breeman LD, van den Broek I, Janssen VR, Kraaijenhagen RA, Atsma DE, Evers AW, on behalf of the BENEFIT consortium. Lifestyle support preferences of patients with cardiovascular diseases: What lifestyle support might work best for whom? PEC INNOVATION 2022; 1:100071. [PMID: 37213735 PMCID: PMC10194186 DOI: 10.1016/j.pecinn.2022.100071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 03/15/2022] [Accepted: 08/12/2022] [Indexed: 05/23/2023]
Abstract
Background Lifestyle support is essential in preventing and treating cardiovascular diseases (CVD), and eHealth may be an easy and affordable solution to provide this support. However, CVD patients vary in their ability and interest to use eHealth. This study investigates demographic characteristics determining CVD patients' online and offline lifestyle support preferences. Methods We used a cross-sectional study design. 659 CVD patients (Harteraad panel) completed our questionnaire. We assessed demographic characteristics and preferred lifestyle support type (coach, eHealth, family/friends, self-supportive). Results Respondents mostly preferred being self-supportive (n = 179, 27.2%), and a coach in a group or individually (n = 145, 22.0%; n = 139, 21.1%). An app/internet to work independently (n = 89, 13.5%) or being in touch with other CVD patients (n = 44, 6.7%) was least preferred. Men were more likely to prefer being supported by family/friends (p = .016) or self-supportive (p < .001), while women preferred a coach individually or via an app/internet (p < .001). Older patients mostly preferred self-support (p = .001). Patients with low social support were more likely to prefer being coached individually (p < .001), but not support from family/friends (p = .002). Conclusion Men and older patients are more interested in being self-supportive, and patients with lower levels of social support could need extra support outside their social network. eHealth could provide a solution, but attention should be paid to spike interest for digital interventions among certain groups.
Collapse
Affiliation(s)
- Talia R. Cohen Rodrigues
- Health, Medical, and Neuropsychology Unit, Leiden University, the Netherlands
- Corresponding author at: Wassenaarseweg 52, 2333 AK Leiden, the Netherlands.
| | - Thomas Reijnders
- Health, Medical, and Neuropsychology Unit, Leiden University, the Netherlands
- Department of Human-Centered Design, Faculty of Industrial Design Engineering, TU Delft, Delft, the Netherlands
| | | | - Linda D. Breeman
- Health, Medical, and Neuropsychology Unit, Leiden University, the Netherlands
| | | | - Veronica R. Janssen
- Health, Medical, and Neuropsychology Unit, Leiden University, the Netherlands
- Department of Cardiology, Leiden University Medical Center, the Netherlands
| | - Roderik A. Kraaijenhagen
- NDDO Institute for Prevention and Early Diagnostics (NIPED), Amsterdam, the Netherlands
- Vital10, Amsterdam, the Netherlands
| | - Douwe E. Atsma
- Department of Cardiology, Leiden University Medical Center, the Netherlands
| | - Andrea W.M. Evers
- Health, Medical, and Neuropsychology Unit, Leiden University, the Netherlands
- Department of Psychiatry, Leiden University Medical Center, Leiden, the Netherlands
- Medical Delta, Leiden University, Technical University of Delft, Erasmus University Rotterdam, the Netherlands
| | | |
Collapse
|
|
31
|
Palmer CS, Brown Levey SM, Kostiuk M, Zisner AR, Tolle LW, Richey RM, Callan S. Virtual Care for Behavioral Health Conditions. Prim Care 2022; 49:641-657. [PMID: 36357068 PMCID: PMC9581698 DOI: 10.1016/j.pop.2022.04.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The COVID-19 pandemic has highlighted the urgent need for behavioral health care services. A substantial portion of mental health care transitioned to virtual care during the COVID-19 pandemic, remains virtual today, and will continue that way in the future. Mental health needs continue to grow, and there has been growing evidence showing the efficacy of virtual health for behavioral health conditions at the system, provider, and patient level. There is also a growing understanding of the barriers and challenges to virtual behavioral health care.
Collapse
Affiliation(s)
- Christina S Palmer
- Department of Family Medicine, University of Colorado School of Medicine.
| | | | | | - Aimee R Zisner
- Department of Family Medicine, University of Colorado School of Medicine
| | | | | | | |
Collapse
|
|
32
|
Theurer C, Wilz G. Opportunities for fostering a positive therapeutic relationship in an Internet‐based cognitive behavioural therapy for dementia caregivers. COUNSELLING & PSYCHOTHERAPY RESEARCH 2022. [DOI: 10.1002/capr.12597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Affiliation(s)
- Christina Theurer
- Institute of Psychology, Department of Counseling and Clinical Psychology Friedrich Schiller University Jena Jena Germany
| | - Gabriele Wilz
- Institute of Psychology, Department of Counseling and Clinical Psychology Friedrich Schiller University Jena Jena Germany
| |
Collapse
|
|
33
|
Eichenberg C, Aranyi G, Rach P, Winter L. Therapeutic alliance in psychotherapy across online and face-to-face settings: A quantitative analysis. Internet Interv 2022; 29:100556. [PMID: 35942217 PMCID: PMC9350857 DOI: 10.1016/j.invent.2022.100556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 06/30/2022] [Accepted: 07/04/2022] [Indexed: 11/23/2022] Open
Abstract
Lockdown enacted by government in response to the Covid-19 pandemic in Austria forced psychotherapy practice into an online-only setting for several months in 2020. Although there is evidence supporting the effectiveness of psychotherapy in remote settings, research investigating therapeutic alliance in online psychotherapy is still limited, with a specific need for research in assessing possible effects of changes in therapeutic setting from face-to-face to online and vice versa. We measured therapeutic alliance in client-therapist dyads using the Helping Alliance Questionnaire (HAQ) at the Adult Outpatient Clinic of Sigmund Freud University, Vienna. Eighty-seven dyads completed HAQ twice, assessing three time-points: after switching from face-to-face to online therapy, providing a retrospective assessment of their alliance before the setting change as well as a concurrent account of their experience during online therapy, then another assessment after switching back to face-to-face setting after lockdown restrictions were lifted. Data were analysed by fitting a multilevel linear model, where the variables person (client/therapist) and time (before online therapy; online therapy; back to face-to-face) were nested within the client-therapist dyad. We found a statistically significant small improvement in the quality of therapeutic alliance over time, but no differences due to change in therapeutic setting. Separate analysis of HAQ sub-scales revealed that clients rated their relationship statistically significantly higher than their therapists with medium effect size, while there were no differences in success ratings over time and settings, nor between clients and therapists. The findings support the feasibility of online therapy in terms of therapeutic alliance in general, and alternating between face-to-face and online therapy settings in particular.
Collapse
Affiliation(s)
- Christiane Eichenberg
- Sigmund Freud Private University, Institute of Psychosomatic, Faculty of Medicine, Vienna, Austria
| | - Gabor Aranyi
- Institute of Education and Psychology at Szombathely, Faculty of Education and Psychology, Eotvos Lorand University, Hungary
- Sigmund Freud Private University, Faculty of Psychotherapy Science, Vienna, Austria
| | - Paul Rach
- Sigmund Freud Private University, Faculty of Psychotherapy Science, Vienna, Austria
| | - Lisa Winter
- Sigmund Freud Private University, Faculty of Psychotherapy Science, Vienna, Austria
| |
Collapse
|
|
34
|
Burke MV, Cha S, Shumaker TM, LaPlante M, McConahey L, Graham AL. Delivery of smoking cessation treatment via live chat: An analysis of client-centered coaching skills and behavior change techniques. PATIENT EDUCATION AND COUNSELING 2022; 105:2183-2189. [PMID: 34887156 DOI: 10.1016/j.pec.2021.11.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 10/14/2021] [Accepted: 11/30/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE This qualitative study explored whether evidence-based tobacco cessation treatment components can be deployed via web-based live chat coaching. METHODS N = 100 randomly selected chats were coded. Researchers used a structured coding guide to note the presence of 3 Motivational Interviewing (MI) skills and 61 behavior change techniques (BCTs). RESULTS MI skills were observed in 86% of chats: 31 chats incorporated one skill, 31 incorporated two, and 24 incorporated all three. Open-ended questions were most common (76%), followed by affirmations (47%) and reflective listening statements (38%). BCTs were observed in 100% of chats: 21% involved one-five BCTs, 69% involved six-10 BCTs, and 10% involved 11 or more BCTs. Mean number of BCTs per chat was 7.25 (SD=2.5; range 2-17). The most common BCTs were Social Support (99%), Reward/Threat (95%), Natural Consequences (82%), Regulation (82%), Goals/Planning (64%), and Self Belief (42%). CONCLUSIONS Tobacco cessation coaching using MI skills and evidence-based BCTs can be delivered via live chat. This synchronous modality allows the delivery of an intervention tailored to the user's motivations and goals. PRACTICE IMPLICATIONS Web-based live chat can broaden the reach of tobacco treatment specialists to deploy evidence-based counseling skills and behavior change techniques in personalized, accessible coaching.
Collapse
Affiliation(s)
- Michael V Burke
- Nicotine Dependence Center, Mayo Clinic, Rochester, MN, USA; Department of Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN, USA.
| | - Sarah Cha
- Innovations Center, Truth Initiative, Washington, DC, USA.
| | | | | | - Laura McConahey
- Nicotine Dependence Center, Mayo Clinic, Rochester, MN, USA.
| | - Amanda L Graham
- Department of Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN, USA; Innovations Center, Truth Initiative, Washington, DC, USA.
| |
Collapse
|
|
35
|
Stoeten C, de Haan HA, Postel MG, Brusse-Keizer M, Ter Huurne ED. Therapeutic Alliance in Web-Based Treatment for Eating Disorders: Secondary Analysis of a Randomized Controlled Trial. JMIR Form Res 2022; 6:e33813. [PMID: 35771608 PMCID: PMC9284349 DOI: 10.2196/33813] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 04/20/2022] [Accepted: 04/24/2022] [Indexed: 11/16/2022] Open
Abstract
Background In face-to-face therapy for eating disorders, therapeutic alliance (TA) is an important predictor of symptom reduction and treatment completion. To date, however, little is known about TA during web-based cognitive behavioral therapy (web-CBT) and its association with symptom reduction, treatment completion, and the perspectives of patients versus therapists. Objective This study aimed to investigate TA ratings measured at interim and after treatment, separately for patients and therapists; the degree of agreement between therapists and patients (treatment completers and noncompleters) for TA ratings; and associations between patient and therapist TA ratings and both eating disorder pathology and treatment completion. Methods A secondary analysis was performed on randomized controlled trial data of a web-CBT intervention for eating disorders. Participants were 170 females with bulimia nervosa (n=33), binge eating disorder (n=68), or eating disorder not otherwise specified (n=69); the mean age was 39.6 (SD 11.5) years. TA was operationalized using the Helping Alliance Questionnaire (HAQ). Paired t tests were conducted to assess the change in TA from interim to after treatment. Intraclass correlations were calculated to determine cross-informant agreement with regard to HAQ scores between patients and therapists. A total of 2 stepwise regressive procedures (at interim and after treatment) were used to examine which HAQ scores predicted eating disorder pathology and therapy completion. Results For treatment completers (128/170, 75.3%), the HAQ-total scores and HAQ-Helpfulness scores for both patients and therapists improved significantly from interim to post treatment. For noncompleters (42/170, 24.7%), all HAQ scores decreased significantly. For all HAQ scales, the agreement between patients and therapists was poor. However, the agreement was slightly better after treatment than at interim. Higher patient scores on the helpfulness subscale of the HAQ at interim and after treatment were associated with less eating disorder psychopathology. A positive association was found between the HAQ-total patient scores at interim and treatment completion. Finally, posttreatment HAQ-total patient scores and posttreatment HAQ-Helpfulness scores of therapists were positively associated with treatment completion. Conclusions Our study showed that TA in web-CBT is predictive of eating disorder pathology and treatment completion. Of particular importance is patients’ confidence in their abilities as measured with the HAQ-Helpfulness subscale when predicting posttreatment eating disorder pathology and treatment completion.
Collapse
Affiliation(s)
- Claudia Stoeten
- Tactus Addiction Care, Deventer, Netherlands
- Mediant, Hengelo, Netherlands
| | - Hein Arnoud de Haan
- Tactus Addiction Care, Deventer, Netherlands
- Nijmegen Institute for Scientist-Practitioners in Addiction (NISPA), Nijmegen, Netherlands
| | | | | | | |
Collapse
|
|
36
|
Luo X, Bugatti M, Molina L, Tilley JL, Mahaffey B, Gonzalez A. Conceptual Invariance, Trajectories, and Outcome Associations of Working Alliance in Unguided and Guided Internet-Based Psychological Interventions: Secondary Analysis of a Randomized Controlled Trial. JMIR Ment Health 2022; 9:e35496. [PMID: 35727626 PMCID: PMC9257617 DOI: 10.2196/35496] [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: 12/07/2021] [Revised: 05/03/2022] [Accepted: 05/06/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The role of working alliance remains unclear for many forms of internet-based interventions (IBIs), a set of effective psychotherapy alternatives that do not require synchronous interactions between patients and therapists. OBJECTIVE This study examined the conceptual invariance, trajectories, and outcome associations of working alliance across an unguided IBI and guided IBIs that incorporated clinician support through asynchronous text messaging or video messaging. METHODS Adults with high education attainment (n=145) with subclinical levels of anxiety, stress, or depressive symptoms were randomized to 1 of 3 treatment conditions for 7 weeks. All participants received treatments from MyCompass, an unguided IBI using cognitive behavior therapy. Participants in condition 2 and 3 received supplemental, asynchronous clinician support through text and video, respectively. Working alliance with the IBIs was measured weekly using select items from the 12-item version of the Agnew Relationship Measure. Symptom and functional outcomes were assessed at baseline, at the end of treatment, and 1-month follow-up. RESULTS Working alliance with the IBIs was conceptually invariant across the 3 conditions. Working alliance followed a quadratic pattern of change over time for all conditions and declined significantly only in the text-support condition. After controlling for baseline symptoms, higher baseline levels of working alliance predicted less depression and less functional impairment at follow-up, whereas faster increases in working alliance predicted less worry at the end of treatment and at follow-up, all of which only occurred in the video-support condition. CONCLUSIONS Working alliance with the IBIs was generally established in the initial sessions. Although working alliance is conceptually invariant across IBIs with or without clinician support, the associations between working alliance and treatment outcomes among IBIs may differ depending on clinician involvement and the modalities of support. TRIAL REGISTRATION ClinicalTrials.gov NCT05122429; https://clinicaltrials.gov/ct2/show/NCT05122429.
Collapse
Affiliation(s)
- Xiaochen Luo
- Department of Counseling Psychology, Santa Clara University, Santa Clara, CA, United States
| | - Matteo Bugatti
- Morgridge College of Education, University of Denver, Denver, CO, United States
| | - Lucero Molina
- Department of Psychiatry, Stony Brook University, Stony Brook, NY, United States
| | - Jacqueline L Tilley
- Psychological and Child & Human Development Area Group, National Institute of Education, Nanyang Technological University, Singapore, Singapore
| | - Brittain Mahaffey
- Department of Psychiatry, Stony Brook University, Stony Brook, NY, United States
| | - Adam Gonzalez
- Department of Psychiatry, Stony Brook University, Stony Brook, NY, United States
| |
Collapse
|
|
37
|
Nooraeen S, Javanbakht M, Malakouti SK. The Challenges of Providing Community Psychiatric Services in the COVID-19 Era: The Probability of Soaring Rehospitalization and Caregivers' Burden of People with Severe Mental Illnesses. Med J Islam Repub Iran 2022; 35:181. [PMID: 35706522 PMCID: PMC9168065 DOI: 10.47176/mjiri.35.181] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Indexed: 11/09/2022] Open
Affiliation(s)
- Sara Nooraeen
- Mental Health Research Center, School of Behavioral Sciences and Mental Health, Iran University of Medical Sciences, Tehran, Iran
| | - Maryam Javanbakht
- Mental Health Research Center, School of Behavioral Sciences and Mental Health, Iran University of Medical Sciences, Tehran, Iran
| | - Seyed Kazem Malakouti
- Mental Health Research Center, School of Behavioral Sciences and Mental Health, Iran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
|
38
|
James-Palmer A, Anderson EZ, Daneault JF. Remote Delivery of Yoga Interventions Through Technology: Scoping Review. J Med Internet Res 2022; 24:e29092. [PMID: 35666562 PMCID: PMC9210204 DOI: 10.2196/29092] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 05/10/2021] [Accepted: 04/26/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The popularity of yoga and the understanding of its potential health benefits have recently increased. Unfortunately, not everyone can easily engage in in-person yoga classes. Over the past decade, the use of remotely delivered yoga has increased in real-world applications. However, the state of the related scientific literature is unclear. OBJECTIVE This scoping review aimed to identify gaps in the literature related to the remote delivery of yoga interventions, including gaps related to the populations studied, the yoga intervention characteristics (delivery methods and intervention components implemented), the safety and feasibility of the interventions, and the preliminary efficacy of the interventions. METHODS This scoping review was conducted in accordance with the PRISMA-ScR (Preferred Reporting Item for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines. Scientific databases were searched throughout April 2021 for experimental studies involving yoga delivered through technology. Eligibility was assessed through abstract and title screening and a subsequent full-article review. The included articles were appraised for quality, and data were extracted from each article. RESULTS A total of 12 studies of weak to moderate quality were included. Populations varied in physical and mental health status. Of the 12 studies, 10 (83%) implemented asynchronous delivery methods (via prerecorded material), 1 (8%) implemented synchronous delivery methods (through videoconferencing), and 1 (8%) did not clearly describe the delivery method. Yoga interventions were heterogeneous in style and prescribed dose but primarily included yoga intervention components of postures, breathing, and relaxation and meditation. Owing to the heterogeneous nature of the included studies, conclusive findings regarding the preliminary efficacy of the interventions could not be ascertained. CONCLUSIONS Several gaps in the literature were identified. Overall, this review showed that more attention needs to be paid to yoga intervention delivery methods while designing studies and developing interventions. Decisions regarding delivery methods should be justified and not made arbitrarily. Studies of high methodological rigor and robust reporting are needed.
Collapse
Affiliation(s)
- Aurora James-Palmer
- Department of Rehabilitation and Movement Sciences, Rutgers University, Newark, NJ, United States
| | - Ellen Zambo Anderson
- Department of Rehabilitation and Movement Sciences, Rutgers University, Newark, NJ, United States
| | - Jean-Francois Daneault
- Department of Rehabilitation and Movement Sciences, Rutgers University, Newark, NJ, United States
| |
Collapse
|
|
39
|
A systematic quality rating of available mobile health apps for borderline personality disorder. Borderline Personal Disord Emot Dysregul 2022; 9:17. [PMID: 35642024 PMCID: PMC9158356 DOI: 10.1186/s40479-022-00186-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 05/08/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Mobile health apps (MHAs) may offer a mean to overcome treatment barriers in Borderline Personality Disorder (BPD) mental health care. However, MHAs for BPD on the market lack transparency and quality assessment. METHODS European app stores were systematically searched, and two independent trained reviewers extracted relevant MHAs. Employed methods and privacy and security details documentation of included MHAs were extracted. MHAs were then assessed and rated using the German version of the standardized Mobile Application Rating Scale (MARS-G). Mean values and standard deviations of all subscales (engagement, functionality, aesthetics, information, and therapeutic gain) and correlations with user ratings were calculated. RESULTS Of 2977 identified MHAs, 16 were included, showing average quality across the four main subscales (M = 3.25, SD = 0.68). Shortcomings were observed with regard to engagement (M = 2.87, SD = 0.99), potential therapeutic gain (M = 2.67, SD = 0.83), existing evidence base (25.0% of included MHAs were tested empirically), and documented privacy and security details. No significant correlations were found between user ratings and the overall total score of the MARS-G or MARS-G main subscales. CONCLUSIONS Available MHAs for BPD vary in quality and evidence on their efficacy, effectiveness, and possible adverse events is scarce. More substantial efforts to ensure the quality of MHAs available for patients and a focus on transparency, particularly regarding privacy and security documentation, are necessary.
Collapse
|
|
40
|
Ganho-Ávila A, Vieira Figueiredo D, Vagos P. Online Cognitive Therapy for Social Anxiety Disorder in Adolescence: A Clinical Case Study Using the CT@TeenSAD. Clin Case Stud 2022. [DOI: 10.1177/15346501221091519] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
SAD is an intense fear or anxiety associated with past, current, or future social situations. The Clark and Wells (1995) cognitive model for SAD has been proved to be clinically effective in adults, and its developmentally sensitive adaptations for adolescents have recently shown promising results. Given this evidence and considering that adolescence is typically the age of onset for the first SAD symptoms and a critical developmental period for the delivery of evidence-based interventions, we adapted CT for adolescents for online intervention (CT@TeenSAD) encompassing 10 weekly, 90 min sessions, extended by two booster sessions. This work presents the first case study of that intervention as applied to Merida (M.; pseudonym; 17-year-old, girl). The estimated Reliable Change Index shows M.’s progress for most of her symptoms, from pre-to post-treatment (RCI-1 range: −.53 to −8.03), and the maintenance of benefits at 3 months follow-up (RCI-2 range: .00 to −2.25). A relapse in the adoption of safety behaviors was seen between post-treatment and follow-up, which might be explained by the life-changing challenges experienced by M. between session 10 and follow-up, concerning her transition from high school to college. M.’s case study offers a first glance on the promising results of CT@TeenSAD related to its efficacy and feasibility. Likewise, it offers the opportunity to critically appraise the limitations of the intervention as well as practical challenges and suggestions thought to be useful for therapists willing to implement CT@TeenSAD in the future.
Collapse
Affiliation(s)
- Ana Ganho-Ávila
- Center for Research in Neuropsychology and Cognitive Behavioral Intervention–CINEICC, Faculty of Psychology and Educational Sciences, University of Coimbra, Coimbra, Portugal
| | - Diana Vieira Figueiredo
- Center for Research in Neuropsychology and Cognitive Behavioral Intervention–CINEICC, Faculty of Psychology and Educational Sciences, University of Coimbra, Coimbra, Portugal
| | - Paula Vagos
- Center for Research in Neuropsychology and Cognitive Behavioral Intervention–CINEICC, Faculty of Psychology and Educational Sciences, University of Coimbra, Coimbra, Portugal
- Institute of Human Development, Portucalense Infante D. Henrique University, Porto, Portugal
| |
Collapse
|
|
41
|
Toh G, Pearce E, Vines J, Ikhtabi S, Birken M, Pitman A, Johnson S. Digital interventions for subjective and objective social isolation among individuals with mental health conditions: a scoping review. BMC Psychiatry 2022; 22:331. [PMID: 35549899 PMCID: PMC9098213 DOI: 10.1186/s12888-022-03889-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 03/24/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Social isolation encompasses subjective and objective concepts. Both are associated with negative health consequences and are more prevalent among people with mental health problems than among the general population. To alleviate social isolation, digital interventions have potential as accessible alternatives or adjuncts to face-to-face interventions. This scoping review aimed to describe the types of digital interventions evaluated for feasibility, acceptability and effectiveness in alleviating social isolation among individuals with mental health problems, and to present an overview of the quantitative evidence yielded to inform future intervention design. METHODS We searched five electronic databases for quantitative and mixed methods studies published between January 2000 and July 2020. Studies were included if they evaluated digital interventions for individuals with mental health conditions, had subjective and/or objective social isolation as their primary outcome, or as one of their outcomes if no primary outcome was specified. Feasibility studies were included if feasibility outcomes were the primary outcomes and social isolation was among their secondary outcomes. A narrative synthesis was conducted to present our findings. The protocol was registered on Open Science Framework (doi: https://doi.org/10.17605/OSF.IO/CNX8A ). RESULTS Thirty-two studies were included for our review: 16 feasibility studies, seven single-group studies and nine effectiveness trials. There was great variation in the interventions, study designs and sample populations. Interventions included web-based programmes, phone-based programmes, blended interventions, socially assistive robots and virtual reality interventions. Many were feasibility studies, or otherwise not fully powered to detect an effect if one were present, thus preventing clear conclusions about clinical effectiveness. Satisfactory feasibility outcomes indicated potential for future trials to assess these interventions. CONCLUSION Our scoping review identified a range of digital approaches utilized to alleviate social isolation among individuals with mental health disorders. Conclusions regarding clinical effectiveness cannot be reached due to variability of approaches and lack of large-scale randomized controlled trials. To make clear recommendations for digital social isolation interventions, future research needs to be based on rigorous methods and larger samples. Future studies should also focus on utilizing theory-driven approaches and improving existing approaches to advance the field.
Collapse
Affiliation(s)
- Gigi Toh
- Division of Psychiatry, Faculty of Brain Sciences, University College London, 149 Tottenham Court Road, London, W1W 7NF, UK.
| | - Eiluned Pearce
- Division of Psychiatry, Faculty of Brain Sciences, University College London, 149 Tottenham Court Road, London, W1W 7NF, UK
| | - John Vines
- School of Informatics, University of Edinburgh, Crichton St, Newington, Edinburgh, UK
| | - Sarah Ikhtabi
- Division of Psychiatry, Faculty of Brain Sciences, University College London, 149 Tottenham Court Road, London, W1W 7NF, UK
| | - Mary Birken
- Division of Psychiatry, Faculty of Brain Sciences, University College London, 149 Tottenham Court Road, London, W1W 7NF, UK
| | - Alexandra Pitman
- Division of Psychiatry, Faculty of Brain Sciences, University College London, 149 Tottenham Court Road, London, W1W 7NF, UK
- Camden and Islington National Health Service Foundation Trust, St Pancras Hospital, St Pancras Way, London, NW1 0PE, UK
| | - Sonia Johnson
- Division of Psychiatry, Faculty of Brain Sciences, University College London, 149 Tottenham Court Road, London, W1W 7NF, UK.
- Camden and Islington National Health Service Foundation Trust, St Pancras Hospital, St Pancras Way, London, NW1 0PE, UK.
| |
Collapse
|
|
42
|
Mercadal Rotger J, Cabré V. Therapeutic Alliance in Online and Face-to-face Psychological Treatment: Comparative Study. JMIR Ment Health 2022; 9:e36775. [PMID: 35499910 PMCID: PMC9112077 DOI: 10.2196/36775] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 03/08/2022] [Accepted: 03/08/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Since the COVID-19 pandemic, the number of online mental health treatments have grown exponentially. Additionally, it seems inevitable that this technical resource is here to stay at health centers. However, there is still very little scholarly literature published on this topic, and therefore, the impact of the changes that have had to be dealt with in this regard has not been studied. OBJECTIVE This study aims to evaluate the differences in the establishment of the therapeutic alliance (TA) based on the intervention modality (online or face-to-face), the type of attachment, and diagnosis. METHODS A total of 291 subjects participated in the study, 149 (51.2%) of whom were men and 142 were (48.8%) women between the ages of 18 and 30 years. The instruments used were sociodemographic data, SOFTA-o (System for Observing Family Therapeutic Alliances-observational), and Relationship Questionnaire. RESULTS The results show that the treatments conducted face-to-face obtain significantly better scores in the creation of the TA than those conducted online (t=-42.045, df=289, P<.001). The same holds true with attachment, in that users with secure attachment show a better TA than those with insecure attachment (t=6.068, P<.001,), although there were no significant differences with the diagnosis (F=4.566, P=.44), age (r=0.02, P=.70), and sex (t=0.217, P=.33). CONCLUSIONS We believe that professionals are not yet prepared to conduct remote treatment with a degree of efficacy similar to that of face-to-face. It is essential for professionals to receive training in this new technical resource and to understand and incorporate the variants it entails into their daily practice.
Collapse
Affiliation(s)
- Josep Mercadal Rotger
- Institut Universitari de Salut Mental Vidal i Barraquer, Universitat Ramon Llull, Barcelona, Spain
| | - Victor Cabré
- Institut Universitari de Salut Mental Vidal i Barraquer, Universitat Ramon Llull, Barcelona, Spain
| |
Collapse
|
|
43
|
Benudis A, Re'em Y, Kanellopoulos D, Moreno A, Zonana J. Patient and provider experiences of telemental health during the COVID-19 pandemic in a New York City academic medical center. Psychiatry Res 2022; 311:114496. [PMID: 35306378 PMCID: PMC8898588 DOI: 10.1016/j.psychres.2022.114496] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Revised: 02/26/2022] [Accepted: 03/05/2022] [Indexed: 12/21/2022]
Abstract
OBJECTIVE We aimed to evaluate patient and provider experiences with telemental health (TMH) at an academic outpatient psychiatry department in New York City during the first wave of the COVID-19 pandemic. METHODS Patients and providers completed online surveys evaluating their experience with TMH during the first wave of the COVID-19 pandemic. Surveys were distributed to 1,178 patients and 287 providers from July 2020 through October 2020. RESULTS 42.5% of providers and 21% of patients responded to the survey. The majority of patient and provider respondents rated the quality of phone and video visits as "equally good" or "somewhat worse" than in-person visits, while the majority of respondents were "somewhat satisfied" or "very satisfied" with video visits. Patients and providers preferred a hybrid model for future care. Common barriers to TMH included privacy, technical difficulties, and wi-fi access. CONCLUSIONS Patients and providers appeared willing to exchange some degree of quality for satisfaction with TMH. This study did not demonstrate with statistical significance any specific patient populations that would benefit more or less from TMH, suggesting that TMH may be a successful model for diverse patient populations. Our results suggest that providers, payors, and regulators should facilitate hybrid care delivery models that incorporate TMH beyond the pandemic.
Collapse
Affiliation(s)
- Abigail Benudis
- NewYork-Presbyterian Hospital/Weill Cornell Medical Center, New York, NY, USA; Weill Cornell Medical College, New York, NY, USA.
| | - Yochai Re'em
- NewYork-Presbyterian Hospital/Weill Cornell Medical Center, New York, NY, USA
| | - Dora Kanellopoulos
- NewYork-Presbyterian Hospital/Westchester Behavioral Health Center, White Plains, NY, USA,Weill Cornell Medical College, New York, NY, USA
| | | | - Jess Zonana
- NewYork-Presbyterian Hospital/Weill Cornell Medical Center, New York, NY, USA,Weill Cornell Medical College, New York, NY, USA
| |
Collapse
|
|
44
|
Al-Mahrouqi T, Al-Alawi K, Al-Alawi M, Al Balushi N, Al Ghailani A, Al Sabti H, Al Sinawi H. A promising future for tele-mental health in Oman: A qualitative exploration of clients and therapists' experiences. SAGE Open Med 2022; 10:20503121221086372. [PMID: 35371483 PMCID: PMC8969011 DOI: 10.1177/20503121221086372] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 02/17/2022] [Indexed: 12/27/2022] Open
Abstract
Objectives Tele-mental health services can play an important role in overcoming barriers in mental health services in the Eastern Mediterranean Region. However, despite its potential, tele-mental health has not been widely adopted in Oman. This study is an exploratory investigation into the experiences of therapists and their clients in utilizing video-based tele-mental health care during the COVID-19 pandemic. Methods A total of 19 semistructured qualitative interviews were individually conducted, it included 13 adult clients with mental health conditions who received video-based tele-mental health care and six clinical psychologists who provided video-based tele-mental health care during the COVID-19 pandemic. Results The clients reported favorable experiences using tele-mental health, with the primary benefits being convenience, easy accessibility to subspecialized care, reduced absenteeism from work with commuting costs, and alleviated mental health stigma. The therapists also expressed experiencing benefits from tele-mental health, such as reduced risk of intrahospital infection, reduced healthcare costs, and the achievement of work-life balance. Primary concerns were related to the lack of public tele-mental health services, lack of specified tele-mental health guidelines, shortage of trained therapists, limited access to high-speed Internet, electronic devices, privacy, and concerns toward the security of telehealth systems in general. Conclusion Clients and therapists report that tele-mental health offers new opportunities to improve the quality of mental healthcare services in Oman, and that the challenges could be resolved by establishing governmental tele-mental health services along with developing tele-mental health guidelines and implementing local postgraduate clinical psychology programs in universities in Oman.
Collapse
Affiliation(s)
- Tamadhir Al-Mahrouqi
- Psychiatry Residency Training Program, Oman Medical Specialty Board, Muscat, Oman
| | | | - Mohammed Al-Alawi
- Behavioral Medicine Department, Sultan Qaboos University Hospital, Muscat, Oman
| | - Naser Al Balushi
- Behavioral Medicine Department, Sultan Qaboos University Hospital, Muscat, Oman
| | - Abdullah Al Ghailani
- Psychiatry Residency Training Program, Oman Medical Specialty Board, Muscat, Oman
| | | | - Hamed Al Sinawi
- Behavioral Medicine Department, Sultan Qaboos University Hospital, Muscat, Oman
| |
Collapse
|
|
45
|
Parker A, Dash S, Bourke M, Patten R, Craike M, Baldwin P, Hosking W, Levinger I, Apostolopoulos V, de Courten M, Sharples J, Naslund M, Stavropoulos V, Woessner M, Sonn C, Stansen C, Pascoe M. A Brief, Daily, Online Mental Health and Well-being Intervention for University Staff During the COVID-19 Pandemic: Program Description and Outcomes Using a Mixed Methods Design. JMIR Form Res 2022; 6:e35776. [PMID: 35044304 PMCID: PMC8887557 DOI: 10.2196/35776] [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: 12/19/2021] [Revised: 01/18/2022] [Accepted: 01/18/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The unprecedented changes and isolation measures to contain COVID-19 have had multiple psychological and social impacts, with implications for professional and personal functioning. Evidence-informed interventions that can be rapidly implemented under pandemic conditions to support mental health during such times are urgently needed. OBJECTIVE The aim of this study was to determine the acceptability and preliminary outcomes of a daily online mental health promotion program for tertiary education staff during the COVID-19 pandemic. METHODS The "Victoria University (VU) Elevenses" program was delivered as an uncontrolled intervention at Victoria University (VU) in the western metropolitan region of Melbourne, Australia. In April 2020, an email invitation was sent to all academic and professional staff inviting them to: (1) participate in the program and (2) opt-in to the research component. The "VU Elevenses" program provided 10-15-minute microinterventions comprising lifestyle and well-being strategies to promote mental health via an online meeting platform at 11 AM each weekday. A mixed methods approach was used to evaluate the program, combining structured questionnaires with semistructured interviews to investigate the experiences of staff who participated in the program. RESULTS Between 16 and 90 participants provided weekly program feedback. A total of 106 university staff opted into the longitudinal research component and 10 staff participated in the interviews. Participants reported high levels of satisfaction with sessions and perceived benefits for mental health. Approximately one quarter of participants reported moderate to severe symptoms of depression, anxiety, and stress at baseline, with significant reductions in these symptoms in the first 7 weeks of the program, corresponding with easing in mandatory isolation ("lockdown") restrictions. Symptoms of depression, anxiety, and stress all increased when lockdown measures were reintroduced, but not to the same levels as found during the initial lockdown period. Overall changes in depression and anxiety from baseline to the end of the program were explained by changes in COVID-19-related distress, whereas changes in self-compassion explained changes in stress. CONCLUSIONS We show that it is feasible and acceptable to develop and deliver a program of brief interventions in a timely manner, using a simple and accessible online platform. Although participation in the program was initially associated with reduced symptoms of depression, anxiety, and stress, participants' mental health worsened with the reintroduction of a "lockdown" period. However, as symptoms of depression, anxiety, and stress did not return to levels observed at the start of the VU Elevenses program, participation in the uncontrolled intervention may have offered a protective benefit against the impact of the second significant lockdown period.
Collapse
Affiliation(s)
- Alexandra Parker
- Institute for Health and Sport, Victoria University, Melbourne, Australia
- Orygen, Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - Sarah Dash
- Institute for Health and Sport, Victoria University, Melbourne, Australia
| | - Matthew Bourke
- Institute for Health and Sport, Victoria University, Melbourne, Australia
| | - Rhiannon Patten
- Institute for Health and Sport, Victoria University, Melbourne, Australia
| | - Melinda Craike
- Institute for Health and Sport, Victoria University, Melbourne, Australia
- Mitchell Institute, Victoria University, Melbourne, Australia
| | - Peter Baldwin
- Institute for Health and Sport, Victoria University, Melbourne, Australia
- Black Dog Institute, Sydney, Australia
| | - Warwick Hosking
- Institute for Health and Sport, Victoria University, Melbourne, Australia
| | - Itamar Levinger
- Institute for Health and Sport, Victoria University, Melbourne, Australia
- Australian Institute for Musculoskeletal Science, Department of Medicine, Western Health, Melbourne Medical School, University of Melbourne, Melbourne, Australia
| | | | | | - Jenny Sharples
- Institute for Health and Sport, Victoria University, Melbourne, Australia
| | - Monika Naslund
- Institute for Health and Sport, Victoria University, Melbourne, Australia
| | | | - Mary Woessner
- Institute for Health and Sport, Victoria University, Melbourne, Australia
| | - Christopher Sonn
- Institute for Health and Sport, Victoria University, Melbourne, Australia
| | - Caroline Stansen
- Institute for Health and Sport, Victoria University, Melbourne, Australia
| | - Michaela Pascoe
- Institute for Health and Sport, Victoria University, Melbourne, Australia
- Peter MacCallum Cancer Centre, Melbourne, Australia
| |
Collapse
|
|
46
|
Abstract
AIM The COVID-19 pandemic has created barriers to the running of group therapies due to the need to maintain social distance. This paper aims to describe modifications of existing therapeutic groups delivered to people diagnosed with serious and enduring mental illnesses (SMIs) to enable the therapies to continue in an online format due to the COVID-19 restrictions. CONCLUSIONS Therapists and consumers were motivated to find a way to continue the therapies described despite the context of the restrictions imposed due to COVID-19. This paper describes what was involved in 'pivoting' to a new mode of practice and modifications that were required over time and as new regulations were put in place. Formal research is required to establish an evidence base if these therapies were required to be regularly delivered in an online mode.
Collapse
Affiliation(s)
- Frances Dark
- Metro South Addiction and Mental Health Service, Woolloongabba, QLD, Australia.,School of Medicine, The University of Queensland, Herston, Australia
| | - Anne Miles
- WISE Ways to Work Occupational Therapy, WISE Employment, North Melbourne, VIC, Australia
| | - Kathy Madson
- Metro South Addiction and Mental Health Service, Woolloongabba, QLD, Australia
| | - Ellen Strochnetter
- WISE Ways to Work Occupational Therapy, WISE Employment, North Melbourne, VIC, Australia
| |
Collapse
|
|
47
|
Digitizing Social Counseling-Insights for Workplace Health Management. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19020917. [PMID: 35055750 PMCID: PMC8775588 DOI: 10.3390/ijerph19020917] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 01/08/2022] [Accepted: 01/11/2022] [Indexed: 02/04/2023]
Abstract
Working digitally can lead to changes in work organization and social interactions, as well as work pace and workload. Online counseling is more and more integrated in social counseling. Research exists on employees' and users' attitudes towards online counseling as well as on the advantages and disadvantages of online counseling. There is a lack of studies on the stressors and strains caused by the increasing digitalization and the associated health consequences in this context. With an interview study, we investigated the general work situation of counselors, with a focus on stressors, strain, and resources caused by online counseling. Consecutively, we discuss the results in relation to their impact on workplace health management. Twenty-two explorative interviews with counselors from a German welfare organization were conducted in 2019 and 2020. Qualitative content analysis according to Mayring was used for analysis. Counselors' use of online devices depends on their own digital affinity and is likely to be used when advantages for clients are seen. Difficulties were mentioned in establishing a relationship of trust with the clients. Good teamwork and regular informal exchanges among colleagues contribute to job satisfaction. Overall, we found only few health-related effects. Results of the study suggest that digitization can have positive effects on the job satisfaction of counselors, if the associated changes are supported by organizational measures.
Collapse
|
|
48
|
Tong F, Lederman R, D'Alfonso S, Berry K, Bucci S. Digital Therapeutic Alliance With Fully Automated Mental Health Smartphone Apps: A Narrative Review. Front Psychiatry 2022; 13:819623. [PMID: 35815030 PMCID: PMC9256980 DOI: 10.3389/fpsyt.2022.819623] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 05/30/2022] [Indexed: 11/29/2022] Open
Abstract
Fully automated mental health smartphone apps show strong promise in increasing access to psychological support. Therefore, it is crucial to understand how to make these apps effective. The therapeutic alliance (TA), or the relationship between healthcare professionals and clients, is considered fundamental to successful treatment outcomes in face-to-face therapy. Thus, understanding the TA in the context of fully automated apps would bring us insights into building effective smartphone apps which engage users. However, the concept of a digital therapeutic alliance (DTA) in the context of fully automated mental health smartphone apps is nascent and under-researched, and only a handful of studies have been published in this area. In particular, no published review paper examined the DTA in the context of fully automated apps. The objective of this review was to integrate the extant literature to identify research gaps and future directions in the investigation of DTA in relation to fully automated mental health smartphone apps. Our findings suggest that the DTA in relation to fully automated smartphone apps needs to be conceptualized differently to traditional face-to-face TA. First, the role of bond in the context of fully automated apps is unclear. Second, human components of face-to-face TA, such as empathy, are hard to achieve in the digital context. Third, some users may perceive apps as more non-judgmental and flexible, which may further influence DTA formation. Subdisciplines of computer science, such as affective computing and positive computing, and some human-computer interaction (HCI) theories, such as those of persuasive technology and human-app attachment, can potentially help to foster a sense of empathy, build tasks and goals and develop bond or an attachment between users and apps, which may further contribute to DTA formation in fully automated smartphone apps. Whilst the review produced a relatively limited quantity of literature, this reflects the novelty of the topic and the need for further research.
Collapse
Affiliation(s)
- Fangziyun Tong
- School of Computing and Information Systems, University of Melbourne, Parkville, VIC, Australia.,Division of Psychology and Mental Health, School of Health Sciences, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, United Kingdom
| | - Reeva Lederman
- School of Computing and Information Systems, University of Melbourne, Parkville, VIC, Australia
| | - Simon D'Alfonso
- School of Computing and Information Systems, University of Melbourne, Parkville, VIC, Australia
| | - Katherine Berry
- Division of Psychology and Mental Health, School of Health Sciences, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, United Kingdom.,Complex Trauma and Resilience Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom
| | - Sandra Bucci
- Division of Psychology and Mental Health, School of Health Sciences, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, United Kingdom.,Complex Trauma and Resilience Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom
| |
Collapse
|
|
49
|
Martinez RG, van Dyk IS, Kroll JL, Emerson ND, Bursch B. Recommendations for building telemental health relationships with youth: A systematic review and resource for clinicians. EVIDENCE-BASED PRACTICE IN CHILD AND ADOLESCENT MENTAL HEALTH 2022; 7:349-362. [PMID: 36248612 PMCID: PMC9562612 DOI: 10.1080/23794925.2021.1970050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Affiliation(s)
- Ruben G. Martinez
- Department of Psychiatry & Biobehavioral Sciences, UCLA Jane & Terry Semel Institute for Neuroscience & Human Behavior, Los Angeles, CA
| | - Ilana Seager van Dyk
- Department of Social & Behavioral Science, Yale School of Public Health, New Haven, CT
| | - Juliet L. Kroll
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TC
| | - Natacha D. Emerson
- Department of Psychiatry & Biobehavioral Sciences, UCLA Jane & Terry Semel Institute for Neuroscience & Human Behavior, Los Angeles, CA
| | - Brenda Bursch
- Department of Psychiatry & Biobehavioral Sciences, UCLA Jane & Terry Semel Institute for Neuroscience & Human Behavior, Los Angeles, CA,Department of Pediatrics, UCLA David Geffen School of Medicine, Los Angeles, CA
| |
Collapse
|
|
50
|
Therapists’ perceptions and acceptability of providing internet-delivered guided self-help acceptance and commitment therapy (ACT) for family carers of people with dementia (iACT4CARERS): a qualitative study. COGNITIVE BEHAVIOUR THERAPIST 2021. [DOI: 10.1017/s1754470x21000337] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Abstract
This study aimed to explore therapists’ perceptions and acceptability of providing internet-delivered, therapist-guided, self-help acceptance and commitment therapy (ACT) for family carers of people with dementia (iACT4CARERS). To achieve this, a qualitative approach with semi-structured interviews was employed with eight novice therapists recruited from primary and secondary care services taking part in a feasibility study of iACT4CARERS. The interviews were audio-recorded, transcribed, and analysed using thematic analysis. Four over-arching themes were identified: (1) positive attitudes towards the intervention, (2) therapists’ workload, (3) therapists’ confidence to perform their role, and (4) connecting with family carers in a virtual context. Theme 1 included seeing their involvement as an opportunity for personal growth and perceiving benefits to the family carers, which contributed to greater acceptability. Theme 2 reflected that while workload and the user-friendliness of the online platform were highly acceptable among the therapists, there were also time-consuming cases that increased therapists’ burden. Theme 3 revealed that practical resources provided during the training, continued supervision, and opportunities to learn from other therapists, increased therapist confidence and facilitated greater acceptability. Finally, Theme 4 highlighted that improving the connection between therapists and carers was critical in a virtual context and strategies to improve the therapist–carer relationship were recommended. The implementation of iACT4CARERS was largely acceptable for the therapists involved in the trial. Ways to strengthen the therapeutic relationship in the virtual context and practical strategies to deal with common problems may enhance therapist experience and delivery in a full-scale effectiveness trial.
Key learning aims
(1)
To understand which factors facilitated therapists’ positive perceptions and acceptability of providing internet-delivered guided self-help ACT (iACT4CARERS).
(2)
To understand what challenges acted as barriers to therapists’ positive perceptions and acceptability of providing iACT4CARERS.
(3)
To learn what aspects of the training and the intervention can be refined to improve the acceptability to therapists in trials involving internet-delivered guided self-help interventions for family carers.
Collapse
|