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Savell SM, Breeden LV, Emery RE. Partners Now Parents: Supporting Couples During the Journey to Parenthood. FAMILY PROCESS 2025; 64:e13097. [PMID: 39842782 PMCID: PMC11753894 DOI: 10.1111/famp.13097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Revised: 11/09/2024] [Accepted: 12/02/2024] [Indexed: 01/24/2025]
Abstract
Becoming a parent is a highly anticipated milestone for many couples, yet previous research suggests that most couples experience a sharp decline in romantic satisfaction. However, there are few virtual, group-based couples prevention programs for first-time parents. The present study examined the feasibility and effectiveness of a newly developed prevention program for the journey to parenthood, the Partners Now Parents program. Sixty-six racially and socioeconomically diverse expecting parents (33 couples) participated in this small, pilot examination. Seventeen couples were assigned to receive five teletherapy prevention program sessions over the course of the perinatal period, and 16 couples were assigned to an active control group receiving psychoeducation via email. We found a less steep decline in romantic satisfaction for those in the prevention program as compared to the active control group. The findings suggest that the prevention program is feasible, effective, and favorably received by participants. Prevention programs for expecting parents offer entry into mental health support with reduced mental health stigma when couples may be most open to change as they prepare for parenthood.
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Affiliation(s)
- Shannon M. Savell
- Department of PsychologyUniversity of VirginiaCharlottesvilleVirginiaUSA
| | - Lauren V. Breeden
- Department of PsychologyUniversity of VirginiaCharlottesvilleVirginiaUSA
| | - Robert E. Emery
- Department of PsychologyUniversity of VirginiaCharlottesvilleVirginiaUSA
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Gkintoni E, Vassilopoulos SP, Nikolaou G. Next-Generation Cognitive-Behavioral Therapy for Depression: Integrating Digital Tools, Teletherapy, and Personalization for Enhanced Mental Health Outcomes. MEDICINA (KAUNAS, LITHUANIA) 2025; 61:431. [PMID: 40142242 PMCID: PMC11943665 DOI: 10.3390/medicina61030431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/28/2025] [Revised: 02/24/2025] [Accepted: 02/26/2025] [Indexed: 03/28/2025]
Abstract
Background and Objectives: This systematic review aims to present the latest developments in next-generation CBT interventions of digital support tools, teletherapies, and personalized treatment modules in enhancing accessibility, improving treatment adherence, and optimizing therapeutic outcomes for depression. Materials and Methods: This review analyzed 81 PRISMA-guided studies on the efficacy, feasibility, and applicability of NG-CBT approaches. Other important innovations include web-based interventions, AI-operated chatbots, and teletherapy platforms, each of which serves as a critical challenge in delivering mental health care. Key messages have emerged regarding technological readiness, patient engagement, and the changing role of therapists within the digital context of care. Results: Findings indicate that NG-CBT interventions improve treatment accessibility and engagement while maintaining clinical effectiveness. Personalized digital tools enhance adherence, and teletherapy platforms provide scalable and cost-effective alternatives to traditional therapy. Conclusions: Such developments promise great avenues for decreasing the global burden of depression and enhancing the quality of life through novel, accessible, and high-quality therapeutic approaches.
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Affiliation(s)
- Evgenia Gkintoni
- Department of Educational Sciences and Social Work, University of Patras, 26504 Patras, Greece; (S.P.V.); (G.N.)
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Oliveira Machado Cecagno P, Donati Polesello N, Duque-Cartagena T, Machado Luz P, Mundstock E, Bernardina Dalla MD, Kazutoshi Sato D, Mattiello R. Efficacy of Remote Psychological Interventions for Patients with Anxiety and Depression Symptoms: Systematic Review and Meta-Analysis. Telemed J E Health 2025; 31:141-150. [PMID: 39304185 DOI: 10.1089/tmj.2024.0297] [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: 09/22/2024] Open
Abstract
Background: Anxiety and depression are common mental disorders that are highly prevalent worldwide. Clinical trials have found that telehealth interventions result in increased accessibility and improved mental treatment effectiveness. However, a few comprehensive syntheses of evidence from randomized clinical trials that have been conducted to evaluate remote psychological vs face-to-face interventions for anxiety and depression are not conclusive. The objective of this work was to evaluate the efficacy of remote psychological interventions for patients with anxiety and depression symptoms. Methods: Randomized clinical trials with the following criteria were included: participants aged ≥5 years, of both sexes, and who underwent psychological therapy to treat anxiety and or depression symptoms. They were randomized to receive the same psychological treatment remotely or face-to-face. Review studies, animal studies, pilot studies, and studies with patients diagnosed with chronic diseases were excluded. Searches were performed on March 2024 in the following databases: MEDLINE, EMBASE, LILACS, CENTRAL, CINAHL, Web of Science, SciELO, APA PsycINFO, and Scopus. The meta-analysis was conducted using the random-effects model, and the standardized mean difference with the 95% confidence interval (CI) was used to estimate the effect. Results: Six studies were included in this systematic review. The meta-analysis showed no statistically significant difference when comparing remote or face-to-face treatment for depression (SMD of -0.10 [95% CI: -0.57 to 0.37; I2: 77%]) and anxiety (SMD of -0.06 [95% CI: -0.34 to 0.21; I2: 0%]) symptoms. Conclusion: Our meta-analysis indicates that remote psychotherapy demonstrates comparable efficacy to face-to-face care in mitigating symptoms of depression and anxiety. It allows patients to select the best modality for their daily routines, promoting greater engagement and adherence to treatment.
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Affiliation(s)
- Priscila Oliveira Machado Cecagno
- Postgraduate Program in Pediatrics and Child Health, School of Medicine, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Natália Donati Polesello
- School of Medicine, Graduate Program in Medicine, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Tatiana Duque-Cartagena
- Postgraduate Program in Epidemiology, School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Pedro Machado Luz
- School of Medicine, Graduate Program in Medicine, Universidade do Vale do Rio dos Sinos, Porto Alegre, Brazil
| | - Eduardo Mundstock
- Universidade Leonardo da Vinci, Polo Canela, Brazil
- Secretaria da Educação Esporte e Lazer de Canela-Escola Zeferino José Lopes, Canela, Brazil
| | - Marcello Dala Bernardina Dalla
- Cassiano Antônio de Moraes University Hospital, Universidade Federal do Espírito Santo, Vitória, Brazil
- Capixaba Institute for Teaching Research and Innovation of the State Health Department of Espirito Santo, Vitória, Brazil
- Espirito Santense College, Cariacica, Brazil
| | - Douglas Kazutoshi Sato
- Postgraduate Program in Pediatrics and Child Health, School of Medicine, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
- Brain Institute of Rio Grande do Sul, Porto Alegre, Brazil
| | - Rita Mattiello
- Postgraduate Program in Epidemiology, School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
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Lin T, Doorn K, Heckman T, Antebi‐Lerman E, Anderson T. Are Therapists Less Skilful in Teletherapy Than In-Person Therapy Scenarios? A Latent Profile Analysis of Facilitative Interpersonal Skills. Clin Psychol Psychother 2025; 32:e70047. [PMID: 39964346 PMCID: PMC11834988 DOI: 10.1002/cpp.70047] [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: 11/21/2024] [Revised: 01/27/2025] [Accepted: 01/29/2025] [Indexed: 02/20/2025]
Abstract
Emerging research suggests that therapists feel less efficacious administering therapy remotely than in-person. These findings, however, are based almost exclusively on therapist self-reports. The current study compared therapists' self-reported and observer-rated therapeutic skills across simulated in-person and teletherapy scenarios to determine if common factors and therapeutic skills differed between the two treatment settings. A diverse sample of 223 licensed therapists and trainees simulated the provision of psychotherapy using standardised clips of challenging therapeutic scenarios in both tele- and in-person therapy. Common factors and therapeutic skills in tele- and in-person therapy simulations were rated by trained coders and compared. Latent profile analysis identified latent subgroups of therapists based on differences between skills when providing in-person and teletherapy. Both self-report and observer-rated measures indicated that therapists demonstrated reduced common factors and therapeutic skills in teletherapy scenarios than in-person therapy scenarios. Three latent profiles based on differences in skills between teletherapy versus in-person therapy among therapists were identified: developing teletherapists (54.26%), teletherapy experts (34.98%) and teletherapy-challenged therapists (10.76%). No variable assessed in the study differentiated the three groups. Therapists generally demonstrated lower levels of therapeutic skills in teletherapy compared with in-person therapy settings. Considerable variability in the skill difference between the two psychotherapy formats was found among therapists. Trainings targeting skills that are complicated by teletherapy (e.g., emotional expression) are needed.
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Affiliation(s)
- Tao Lin
- Department of PsychiatryUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
- Department of PsychologyOhio UniversityAthensOhioUSA
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Seuling PD, Fendel JC, Spille L, Göritz AS, Schmidt S. Therapeutic alliance in videoconferencing psychotherapy compared to psychotherapy in person: A systematic review and meta-analysis. J Telemed Telecare 2024; 30:1521-1531. [PMID: 36974478 DOI: 10.1177/1357633x231161774] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
Abstract
INTRODUCTION Videoconferencing psychotherapy (VCP) delivers treatment to individuals with limited access to face-to-face mental healthcare. VCP's effectiveness has been demonstrated for various disorders and therapeutic interventions. However, there is contradictory evidence regarding the therapeutic alliance in VCP as compared to psychotherapy in person (PIP). This meta-analysis examines whether therapeutic alliance differs by psychotherapy's delivery format, namely VCP versus PIP. METHODS We searched five databases for trials comparing the therapeutic alliance in VCP and PIP, wherein the therapeutic alliance was rated by either patients or therapists or both. Eighteen publications were included, and the difference between VCP and PIP was assessed. Furthermore, we tested possible moderators of the difference in therapeutic alliance between VCP and PIP by meta-regression, and we assessed the risk of bias of this meta-analysis. RESULTS The meta-analysis revealed no statistically significant difference in the therapeutic alliance between VCP and PIP for alliance ratings by patients (SMD = -0.09; 95% CI = -0.26; 0.07) as well as by therapists (SMD = 0.04; 95% CI = -0.17; 0.25). No significant moderators were found. DISCUSSION In this meta-analysis, VCP and PIP did not differ with respect to the therapeutic alliance as rated by either patients or therapists. Further research is required into mechanisms driving the therapeutic alliance in VCP and PIP.
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Affiliation(s)
- Patrik D Seuling
- Department of Psychosomatic Medicine and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Occupational and Consumer Psychology, Institute of Psychology, University of Freiburg, Freiburg, Germany
| | - Johannes C Fendel
- Department of Psychosomatic Medicine and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Lukas Spille
- Department of Psychosomatic Medicine and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Occupational and Consumer Psychology, Institute of Psychology, University of Freiburg, Freiburg, Germany
| | - Anja S Göritz
- Occupational and Consumer Psychology, Institute of Psychology, University of Freiburg, Freiburg, Germany
- Behavioral Health Technology, University of Augsburg, Augsburg, Germany
| | - Stefan Schmidt
- Department of Psychosomatic Medicine and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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Goetter EM, Yuen EK. Technological Advances in Treating Anxiety Disorders. Psychiatr Clin North Am 2024; 47:813-827. [PMID: 39505456 DOI: 10.1016/j.psc.2024.04.020] [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] [Indexed: 11/08/2024]
Abstract
There has been tremendous interest in utilizing digital interventions to assist in the treatment of anxiety disorders. Anxiety disorders are widely prevalent and often characterized by avoidance, intolerance of uncertainty, interpersonal concerns, and worry. Digital mental health interventions, given their flexibility, may be particularly suited to this population. The authors review the literature on the use of videoconference, virtual reality, website self-help, and mobile applications in the treatment of anxiety disorders. Empirical evidence, advantages, and disadvantages of each format are considered. Additionally, we identify clinical and social challenges unique to the use of these technologies for intervention purposes.
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Affiliation(s)
- Elizabeth M Goetter
- Department of Psychology, La Salle University, 1900 West Olney Avenue, Philadelphia, PA 19141, USA.
| | - Erica K Yuen
- Department of Psychology, University of Tampa, 401 West Kennedy Boulevard, Box Q, Tampa, FL 33606, USA
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Trenoska Basile V, Newton-John T, McDonald S, Wootton BM. Internet videoconferencing delivered cognitive behaviour therapy for generalized anxiety disorder: A randomized controlled trial. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2024; 63:487-506. [PMID: 38860620 DOI: 10.1111/bjc.12482] [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: 03/13/2024] [Revised: 05/23/2024] [Accepted: 05/26/2024] [Indexed: 06/12/2024]
Abstract
OBJECTIVE Generalized anxiety disorder (GAD) is a chronic mental health condition that results in significant individual and societal burden. Cognitive-behaviour therapy (CBT) therapy is an effective treatment for GAD, however, many individuals experience logistical barriers when accessing evidence-based care. Remote treatments may help to reduce these barriers, however, currently, there are few studies examining the efficacy of high-intensity remote methods for GAD treatment. The current study aims to examine the efficacy of CBT delivered via videoconferencing (VCBT) for GAD using a randomized controlled trial design comparing an immediate treatment group to a waitlist control. METHOD Seventy-eight adults (M age = 36.92; SD = 12.92; 84.4% female) with GAD were enrolled in the study. RESULTS Those in the treatment group demonstrated a statistically significant reduction in GAD symptoms from pre-treatment to post-treatment (d = 1.03) and pre-treatment to 3-month follow-up (d = 1.50). Large between-group effect sizes were also observed at post-treatment (d = .80). Twenty-five participants (64.10%) in the VCBT group no longer met diagnostic criteria for GAD at post-treatment, and 26/39 (66.67%) no longer met criteria at 3-month follow-up. Ninety-six per cent of participants were satisfied with the treatment. CONCLUSION The results contribute towards advancing our knowledge on the efficacy and acceptability of VCBT for patients with GAD.
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Affiliation(s)
- Vesna Trenoska Basile
- Discipline of Clinical Psychology, Graduate School of Health, University of Technology Sydney, Ultimo, New South Wales, Australia
| | - Toby Newton-John
- Discipline of Clinical Psychology, Graduate School of Health, University of Technology Sydney, Ultimo, New South Wales, Australia
| | - Sarah McDonald
- Discipline of Clinical Psychology, Graduate School of Health, University of Technology Sydney, Ultimo, New South Wales, Australia
| | - Bethany M Wootton
- Discipline of Clinical Psychology, Graduate School of Health, University of Technology Sydney, Ultimo, New South Wales, Australia
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Argyriou E, Gros DF, Hernandez Tejada MA, Muzzy WA, Acierno R. Optimizing Allocation to Telehealth and In-Person Prolonged Exposure for Women Veterans with Military Sexual Trauma: A Precision Medicine Approach. Behav Sci (Basel) 2024; 14:993. [PMID: 39594293 PMCID: PMC11591394 DOI: 10.3390/bs14110993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2024] [Revised: 10/04/2024] [Accepted: 10/22/2024] [Indexed: 11/28/2024] Open
Abstract
Military sexual trauma-related post-traumatic stress disorder (PTSD) is highly prevalent and costly among women veterans, making the need for effective and accessible treatment of critical importance. Access to care is a key mechanism of mental health disparities and might affect differential response to treatment. The goal of this study was to estimate an individualized treatment rule based on readily available individual characteristics related to access to care to optimize allocation to in-person vs. telehealth delivery of prolonged exposure for PTSD in military sexual trauma survivors. The following variables were used as prescriptive factors: age, race, disability status, socioeconomic status, rural vs. urban status, and baseline PTSD level. The rule was estimated using a machine-learning approach, Outcome Weighted Learning. The estimated optimal rule outperformed a one-size-fits-all rule where everyone is universally assigned to telehealth; it led to markedly lower mean PTSD levels following 6 months from treatment (Vdopt - VTelehealth = -14.55, 95% CI: -27.24, -1.86). However, the rule did not significantly discriminate for in-person therapy (Vdopt - VIn-person = -11.86, 95% CI: -25.83, 2.12). Upon further validation with larger and more diverse samples, such a rule may be applied in practice settings to aid clinical decision-making and personalization of treatment assignment.
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Affiliation(s)
- Evangelia Argyriou
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN 46202, USA;
| | - Daniel F. Gros
- Mental Health Service, Ralph H. Johnson VA Healthcare System, Charleston, SC 29401, USA; (W.A.M.); (R.A.)
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston, SC 29425, USA
| | - Melba A. Hernandez Tejada
- Faillace Department of Psychiatry, University of Texas Health Science Center at Houston, Houston, TX 77030, USA;
| | - Wendy A. Muzzy
- Mental Health Service, Ralph H. Johnson VA Healthcare System, Charleston, SC 29401, USA; (W.A.M.); (R.A.)
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston, SC 29425, USA
| | - Ron Acierno
- Mental Health Service, Ralph H. Johnson VA Healthcare System, Charleston, SC 29401, USA; (W.A.M.); (R.A.)
- Faillace Department of Psychiatry, University of Texas Health Science Center at Houston, Houston, TX 77030, USA;
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McRedmond G, Gafoor R, Ring L, Morant N, Perkins J, Dalrymple N, Dumitru A, David AS, Lewis G, Hunter ECM. Cognitive Behaviour Therapy for Depersonalisation Derealisation Disorder (CBT-f-DDD): Study protocol for a randomised controlled feasibility trial. PLoS One 2024; 19:e0307191. [PMID: 39121060 PMCID: PMC11315339 DOI: 10.1371/journal.pone.0307191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 06/30/2024] [Indexed: 08/11/2024] Open
Abstract
BACKGROUND Depersonalisation-Derealisation Disorder (DDD) is a distressing mental health condition which causes individuals to have a sense of 'unreality' or detachment about themselves and/or the world around them. DDD is chronically under-researched, and as a result, under-diagnosed, with a population prevalence of about 1%. In systematic reviews, Cognitive Behavioural Therapy (CBT) has been found to be the only intervention with significant clinical impact on alleviating the symptoms of DDD. However, previous studies have suffered from small sample sizes, reliance on expert clinicians to provide therapy and narrow population demographics. This feasibility randomised controlled trial aims to provide more robust evidence for the treatment efficacy of CBT in DDD. METHODS The study aims to recruit 40 participants from two NHS trusts, 20 per arm from two community Mental Health NHS services in London. The intervention group will receive 12-24 individual CBT sessions over a 6-month period from CBT therapists following specialist training for DDD. The control group will receive Treatment as Usual. We will assess the feasibility of a future RCT through measuring the acceptability of the intervention, and assessing our ability to recruit, retain and randomise participants. We will calculate the correlation of scores on the Cambridge Depersonalisation Scale, its baseline standard deviation, assess the magnitude/direction of change and characterise the uncertainty in the outcome scores and the probability that the results have been obtained by chance. DISCUSSION The outputs of this trial will guide whether a definite RCT is feasible and acceptable, for both the clinician and participant. TRIAL REGISTRATION The ISRCTN registration number is ISRCTN97686121(https://doi.org/10.1186/ISRCTN97686121).
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Affiliation(s)
- Georgia McRedmond
- Institute of Clinical Trials and Methodology, Comprehensive Clinical Trials Unit, University College London, London, United Kingdom
| | - Rafael Gafoor
- Institute of Clinical Trials and Methodology, Comprehensive Clinical Trials Unit, University College London, London, United Kingdom
| | - Lucy Ring
- Division of Psychiatry, University College London, London, United Kingdom
- Camden & Islington NHS Foundation Trust, St Pancras Hospital, London, United Kingdom
| | - Nicola Morant
- Division of Psychiatry, University College London, London, United Kingdom
| | | | - Nicola Dalrymple
- Division of Psychiatry, University College London, London, United Kingdom
- Camden & Islington NHS Foundation Trust, St Pancras Hospital, London, United Kingdom
| | - Ana Dumitru
- Division of Psychiatry, University College London, London, United Kingdom
- Camden & Islington NHS Foundation Trust, St Pancras Hospital, London, United Kingdom
| | - Anthony S. David
- Division of Psychiatry, University College London, London, United Kingdom
| | - Glyn Lewis
- Division of Psychiatry, University College London, London, United Kingdom
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Aafjes-Van Doorn K, Békés V, Luo X, Hopwood CJ. Therapists' perception of the working alliance, real relationship and therapeutic presence in in-person therapy versus tele-therapy. Psychother Res 2024; 34:574-588. [PMID: 37011405 DOI: 10.1080/10503307.2023.2193299] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 03/14/2023] [Indexed: 04/05/2023] Open
Abstract
Objective: Although teletherapy is increasingly common, very little is known about its impact on therapeutic relationships. We aimed to examine differences between therapists' experiences of teletherapy and in-person therapy post-pandemic with regard to three variables pertinent to the therapeutic relationship: working alliance, real relationship, and therapeutic presence. METHODS In a sample of 826 practicing therapists, we examined these relationship variables, as well as potential moderators of these perceived differences including professional and patient characteristics and covid-related variables. RESULTS Therapists reported feeling significantly less present in teletherapy and their perceptions of the real relationship were somewhat impacted, but there were no average effects on their perceived quality of the working alliance. Perceived differences in the real relationship did not persist with clinical experience controlled. The relative reduction in therapeutic presence in teletherapy was driven by the ratings of process-oriented therapists and therapists conducting mostly individual therapy. Evidence for moderation by covid-related issues was also found, with larger perceived differences in the working alliance reported by therapists who used teletherapy because it was mandated and/or not by choice. CONCLUSION Our findings might have important implications for generating awareness around the therapists' lowered sense of presence in teletherapy compared to in-person teletherapy.
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Affiliation(s)
| | - Vera Békés
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY, USA
| | - Xiaochen Luo
- Department of Counseling Psychology, Santa Clara University, Santa Clara, CA, USA
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Aafjes-van Doorn K, Spina DS, Horne SJ, Békés V. The association between quality of therapeutic alliance and treatment outcomes in teletherapy: A systematic review and meta-analysis. Clin Psychol Rev 2024; 110:102430. [PMID: 38636207 DOI: 10.1016/j.cpr.2024.102430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 11/28/2023] [Accepted: 04/08/2024] [Indexed: 04/20/2024]
Abstract
OBJECTIVE The strength of the therapeutic alliance is widely understood to impact treatment outcomes, however, the alliance-outcome relationship in teletherapy has remained relatively unexamined. The aim of this meta-analysis is to systematically summarize the relationship between therapeutic alliance and treatment outcomes in teletherapy with adult patients conducted via videoconferencing or telephone. METHODS We conducted a systematic search of the databases PsycINFO, PsycARTICLES, ProQuest Dissertation Databases, EMBASE, The Cochrane Library, MEDLINE, Google Scholar, and PubMed for studies published before June 26, 2023. We identified 31 studies with 34 independent samples (4862 participants). RESULTS The average weighted effect size was 0.15, p = .001, 95% CI [0.07, 0.24], k = 34. reflecting a small effect of therapeutic alliance on mental health outcomes. There was significant heterogeneity in the effect sizes, which was driven by between-study differences in the alliance-outcome correlation. The alliance-outcome effect was larger when the alliance was measured late in treatment and when the outcome was measured from the patient's perspective. CONCLUSION Very few teletherapy treatment studies were identified that initially reported on alliance-outcome associations, underlining that this is an under-researched area. The association between alliance-teletherapy outcomes in this meta-analysis was small but significant, and somewhat weaker than the alliance-outcome associations reported for in-person treatments and other online interventions. This might indicate that there are other processes at play in teletherapy that explain variance of treatment outcomes, or that the therapist (and the relationship) has less influence on the treatment outcomes than in in-person therapy.
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Affiliation(s)
| | - Daniel S Spina
- Pennsylvania State University, Psychology Department, PA, USA
| | - Sarah J Horne
- Yeshiva University, Ferkauf Graduate School of Psychology, New York, USA
| | - Vera Békés
- Yeshiva University, Ferkauf Graduate School of Psychology, New York, USA
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Kishimoto T, Kinoshita S, Kitazawa M, Hishimoto A, Asami T, Suda A, Bun S, Kikuchi T, Sado M, Takamiya A, Mimura M, Sato Y, Takemura R, Nagashima K, Nakamae T, Abe Y, Kanazawa T, Kawabata Y, Tomita H, Abe K, Hongo S, Kimura H, Sato A, Kida H, Sakuma K, Funayama M, Sugiyama N, Hino K, Amagai T, Takamiya M, Kodama H, Goto K, Fujiwara S, Kaiya H, Nagao K. Live two-way video versus face-to-face treatment for depression, anxiety, and obsessive-compulsive disorder: A 24-week randomized controlled trial. Psychiatry Clin Neurosci 2024; 78:220-228. [PMID: 38102849 DOI: 10.1111/pcn.13618] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 11/08/2023] [Accepted: 11/09/2023] [Indexed: 12/17/2023]
Abstract
AIM Live two-way video, easily accessible from home via smartphones and other devices, is becoming a new way of providing psychiatric treatment. However, lack of evidence for real-world clinical setting effectiveness hampers its approval by medical insurance in some countries. Here, we conducted the first large-scale pragmatic, randomized controlled trial to determine the effectiveness of long-term treatment for multiple psychiatric disorders via two-way video using smartphones and other devices, which are currently the primary means of telecommunication. METHODS This randomized controlled trial compared two-way video versus face-to-face treatment for depressive disorder, anxiety disorder, and obsessive-compulsive disorder in the subacute/maintenance phase during a 24-week period. Adult patients with the above-mentioned disorders were allocated to either a two-way video group (≥50% video sessions) or a face-to-face group (100% in-person sessions) and received standard treatment covered by public medical insurance. The primary outcome was the 36-Item Short-Form Health Survey Mental Component Summary (SF-36 MCS) score. Secondary outcomes included all-cause discontinuation, working alliance, adverse events, and the severity rating scales for each disorder. RESULTS A total of 199 patients participated in this study. After 24 weeks of treatment, two-way video treatment was found to be noninferior to face-to-face treatment regarding SF-36 MCS score (48.50 vs 46.68, respectively; p < 0.001). There were no significant differences between the groups regarding most secondary end points, including all-cause discontinuation, treatment efficacy, and satisfaction. CONCLUSION Two-way video treatment using smartphones and other devices, was noninferior to face-to-face treatment in real-world clinical settings. Modern telemedicine, easily accessible from home, can be used as a form of health care.
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Affiliation(s)
- Taishiro Kishimoto
- Hills Joint Research Laboratory for Future Preventive Medicine and Wellness, Keio University School of Medicine, Tokyo, Japan
| | - Shotaro Kinoshita
- Hills Joint Research Laboratory for Future Preventive Medicine and Wellness, Keio University School of Medicine, Tokyo, Japan
- Graduate School of Interdisciplinary Information Studies, The University of Tokyo, Tokyo, Japan
| | - Momoko Kitazawa
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Akitoyo Hishimoto
- Department of Psychiatry, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Takeshi Asami
- Department of Psychiatry, Yokohama City University School of Medicine, Yokohama, Japan
| | - Akira Suda
- Department of Psychiatry, Yokohama City University School of Medicine, Yokohama, Japan
- Psychiatric Center, Yokohama City University Medical Center, Yokohama, Japan
| | - Shogyoku Bun
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
- Sato Hospital, Yamagata, Japan
| | - Toshiaki Kikuchi
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Mitsuhiro Sado
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Akihiro Takamiya
- Hills Joint Research Laboratory for Future Preventive Medicine and Wellness, Keio University School of Medicine, Tokyo, Japan
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
- Akasaka Clinic, Tokyo, Japan
| | - Masaru Mimura
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Yasunori Sato
- Clinical and Translational Research Center, Keio University Hospital, Tokyo, Japan
| | - Ryo Takemura
- Clinical and Translational Research Center, Keio University Hospital, Tokyo, Japan
| | - Kengo Nagashima
- Clinical and Translational Research Center, Keio University Hospital, Tokyo, Japan
| | - Takashi Nakamae
- Department of Psychiatry, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yoshinari Abe
- Department of Psychiatry, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Tetsufumi Kanazawa
- Department of Neuropsychiatry, Osaka Medical and Pharmaceutical University, Osaka, Japan
| | - Yasuo Kawabata
- Department of Neuropsychiatry, Osaka Medical and Pharmaceutical University, Osaka, Japan
| | - Hiroaki Tomita
- Department of Psychiatry, Tohoku University Hospital, Sendai, Japan
- Department of Psychiatry, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Koichi Abe
- Department of Psychiatry, Tohoku University Hospital, Sendai, Japan
| | - Seiji Hongo
- Himorogi Psychiatric Institute, Tokyo, Japan
| | - Hiroshi Kimura
- Department of Psychiatry, Gakuji-kai Kimura Hospital, Chiba, Japan
- Department of Psychiatry, School of Medicine, International University of Health and Welfare, Chiba, Japan
| | - Aiko Sato
- Department of Psychiatry, School of Medicine, International University of Health and Welfare, Chiba, Japan
| | - Hisashi Kida
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
- Asaka Hospital, Fukushima, Japan
| | | | - Michitaka Funayama
- Department of Neuropsychiatry, Ashikaga Red Cross Hospital, Tochigi, Japan
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Zandieh S, Abdollahzadeh SM, Sadeghirad B, Wang L, McCabe RE, Yao L, Inness BE, Pathak A, Couban RJ, Crandon H, Torabiardakani K, Bieling P, Busse JW. Therapist-guided remote versus in-person cognitive behavioural therapy: a systematic review and meta-analysis of randomized controlled trials. CMAJ 2024; 196:E327-E340. [PMID: 38499303 PMCID: PMC10948182 DOI: 10.1503/cmaj.230274] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/29/2024] [Indexed: 03/20/2024] Open
Abstract
BACKGROUND Cognitive behavioural therapy (CBT) has been shown to be effective for several psychiatric and somatic conditions; however, most randomized controlled trials (RCTs) have administered treatment in person and whether remote delivery is similarly effective remains uncertain. We sought to compare the effectiveness of therapist-guided remote CBT and in-person CBT. METHODS We systematically searched MEDLINE, Embase, PsycINFO, CINAHL, and the Cochrane Central Register of Controlled Trials from inception to July 4, 2023, for RCTs that enrolled adults (aged ≥ 18 yr) presenting with any clinical condition and that randomized participants to either therapist-guided remote CBT (e.g., teleconference, videoconference) or in-person CBT. Paired reviewers assessed risk of bias and extracted data independently and in duplicate. We performed random-effects model meta-analyses to pool patient-important primary outcomes across eligible RCTs as standardized mean differences (SMDs). We used Grading of Recommendations Assessment, Development and Evaluation (GRADE) guidance to assess the certainty of evidence and used the Instrument to Assess the Credibility of Effect Modification Analyses (ICEMAN) to rate the credibility of subgroup effects. RESULTS We included 54 RCTs that enrolled a total of 5463 patients. Seventeen studies focused on treatment of anxiety and related disorders, 14 on depressive symptoms, 7 on insomnia, 6 on chronic pain or fatigue syndromes, 5 on body image or eating disorders, 3 on tinnitus, 1 on alcohol use disorder, and 1 on mood and anxiety disorders. Moderate-certainty evidence showed little to no difference in the effectiveness of therapist-guided remote and in-person CBT on primary outcomes (SMD -0.02, 95% confidence interval -0.12 to 0.07). INTERPRETATION Moderate-certainty evidence showed little to no difference in the effectiveness of in-person and therapist-guided remote CBT across a range of mental health and somatic disorders, suggesting potential for the use of therapist-guided remote CBT to facilitate greater access to evidence-based care. Systematic review registration: Open Science Framework (https://osf.io/7asrc).
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Affiliation(s)
- Sara Zandieh
- Department of Health Research Methods, Evidence, and Impact (Zandieh, Sadeghirad, Wang, Yao, Pathak, Busse), McMaster University, Hamilton, Ont.; Canadian Agency for Drugs and Technology in Health (Zandieh), Toronto, Ont.; Nutrition Research Center, School of Nutrition and Food Sciences (Abdollahzadeh), Shiraz University of Medical Sciences, Shiraz, Iran; Department of Anesthesia (Sadeghirad, Wang, Busse), McMaster University; The Michael G. DeGroote National Pain Centre (Wang, Torabiardakani, Busse), McMaster University; St. Joseph's Healthcare (McCabe, Bieling); Department of Psychiatry and Behavioural Neurosciences (McCabe, Inness, Bieling), McMaster University, Hamilton, Ont.; Institute for Management and Innovation (Crandon), University of Toronto, Mississauga, Ont
| | - Seyedeh Maryam Abdollahzadeh
- Department of Health Research Methods, Evidence, and Impact (Zandieh, Sadeghirad, Wang, Yao, Pathak, Busse), McMaster University, Hamilton, Ont.; Canadian Agency for Drugs and Technology in Health (Zandieh), Toronto, Ont.; Nutrition Research Center, School of Nutrition and Food Sciences (Abdollahzadeh), Shiraz University of Medical Sciences, Shiraz, Iran; Department of Anesthesia (Sadeghirad, Wang, Busse), McMaster University; The Michael G. DeGroote National Pain Centre (Wang, Torabiardakani, Busse), McMaster University; St. Joseph's Healthcare (McCabe, Bieling); Department of Psychiatry and Behavioural Neurosciences (McCabe, Inness, Bieling), McMaster University, Hamilton, Ont.; Institute for Management and Innovation (Crandon), University of Toronto, Mississauga, Ont
| | - Behnam Sadeghirad
- Department of Health Research Methods, Evidence, and Impact (Zandieh, Sadeghirad, Wang, Yao, Pathak, Busse), McMaster University, Hamilton, Ont.; Canadian Agency for Drugs and Technology in Health (Zandieh), Toronto, Ont.; Nutrition Research Center, School of Nutrition and Food Sciences (Abdollahzadeh), Shiraz University of Medical Sciences, Shiraz, Iran; Department of Anesthesia (Sadeghirad, Wang, Busse), McMaster University; The Michael G. DeGroote National Pain Centre (Wang, Torabiardakani, Busse), McMaster University; St. Joseph's Healthcare (McCabe, Bieling); Department of Psychiatry and Behavioural Neurosciences (McCabe, Inness, Bieling), McMaster University, Hamilton, Ont.; Institute for Management and Innovation (Crandon), University of Toronto, Mississauga, Ont
| | - Li Wang
- Department of Health Research Methods, Evidence, and Impact (Zandieh, Sadeghirad, Wang, Yao, Pathak, Busse), McMaster University, Hamilton, Ont.; Canadian Agency for Drugs and Technology in Health (Zandieh), Toronto, Ont.; Nutrition Research Center, School of Nutrition and Food Sciences (Abdollahzadeh), Shiraz University of Medical Sciences, Shiraz, Iran; Department of Anesthesia (Sadeghirad, Wang, Busse), McMaster University; The Michael G. DeGroote National Pain Centre (Wang, Torabiardakani, Busse), McMaster University; St. Joseph's Healthcare (McCabe, Bieling); Department of Psychiatry and Behavioural Neurosciences (McCabe, Inness, Bieling), McMaster University, Hamilton, Ont.; Institute for Management and Innovation (Crandon), University of Toronto, Mississauga, Ont
| | - Randi E McCabe
- Department of Health Research Methods, Evidence, and Impact (Zandieh, Sadeghirad, Wang, Yao, Pathak, Busse), McMaster University, Hamilton, Ont.; Canadian Agency for Drugs and Technology in Health (Zandieh), Toronto, Ont.; Nutrition Research Center, School of Nutrition and Food Sciences (Abdollahzadeh), Shiraz University of Medical Sciences, Shiraz, Iran; Department of Anesthesia (Sadeghirad, Wang, Busse), McMaster University; The Michael G. DeGroote National Pain Centre (Wang, Torabiardakani, Busse), McMaster University; St. Joseph's Healthcare (McCabe, Bieling); Department of Psychiatry and Behavioural Neurosciences (McCabe, Inness, Bieling), McMaster University, Hamilton, Ont.; Institute for Management and Innovation (Crandon), University of Toronto, Mississauga, Ont
| | - Liam Yao
- Department of Health Research Methods, Evidence, and Impact (Zandieh, Sadeghirad, Wang, Yao, Pathak, Busse), McMaster University, Hamilton, Ont.; Canadian Agency for Drugs and Technology in Health (Zandieh), Toronto, Ont.; Nutrition Research Center, School of Nutrition and Food Sciences (Abdollahzadeh), Shiraz University of Medical Sciences, Shiraz, Iran; Department of Anesthesia (Sadeghirad, Wang, Busse), McMaster University; The Michael G. DeGroote National Pain Centre (Wang, Torabiardakani, Busse), McMaster University; St. Joseph's Healthcare (McCabe, Bieling); Department of Psychiatry and Behavioural Neurosciences (McCabe, Inness, Bieling), McMaster University, Hamilton, Ont.; Institute for Management and Innovation (Crandon), University of Toronto, Mississauga, Ont
| | - Briar E Inness
- Department of Health Research Methods, Evidence, and Impact (Zandieh, Sadeghirad, Wang, Yao, Pathak, Busse), McMaster University, Hamilton, Ont.; Canadian Agency for Drugs and Technology in Health (Zandieh), Toronto, Ont.; Nutrition Research Center, School of Nutrition and Food Sciences (Abdollahzadeh), Shiraz University of Medical Sciences, Shiraz, Iran; Department of Anesthesia (Sadeghirad, Wang, Busse), McMaster University; The Michael G. DeGroote National Pain Centre (Wang, Torabiardakani, Busse), McMaster University; St. Joseph's Healthcare (McCabe, Bieling); Department of Psychiatry and Behavioural Neurosciences (McCabe, Inness, Bieling), McMaster University, Hamilton, Ont.; Institute for Management and Innovation (Crandon), University of Toronto, Mississauga, Ont
| | - Ananya Pathak
- Department of Health Research Methods, Evidence, and Impact (Zandieh, Sadeghirad, Wang, Yao, Pathak, Busse), McMaster University, Hamilton, Ont.; Canadian Agency for Drugs and Technology in Health (Zandieh), Toronto, Ont.; Nutrition Research Center, School of Nutrition and Food Sciences (Abdollahzadeh), Shiraz University of Medical Sciences, Shiraz, Iran; Department of Anesthesia (Sadeghirad, Wang, Busse), McMaster University; The Michael G. DeGroote National Pain Centre (Wang, Torabiardakani, Busse), McMaster University; St. Joseph's Healthcare (McCabe, Bieling); Department of Psychiatry and Behavioural Neurosciences (McCabe, Inness, Bieling), McMaster University, Hamilton, Ont.; Institute for Management and Innovation (Crandon), University of Toronto, Mississauga, Ont
| | - Rachel J Couban
- Department of Health Research Methods, Evidence, and Impact (Zandieh, Sadeghirad, Wang, Yao, Pathak, Busse), McMaster University, Hamilton, Ont.; Canadian Agency for Drugs and Technology in Health (Zandieh), Toronto, Ont.; Nutrition Research Center, School of Nutrition and Food Sciences (Abdollahzadeh), Shiraz University of Medical Sciences, Shiraz, Iran; Department of Anesthesia (Sadeghirad, Wang, Busse), McMaster University; The Michael G. DeGroote National Pain Centre (Wang, Torabiardakani, Busse), McMaster University; St. Joseph's Healthcare (McCabe, Bieling); Department of Psychiatry and Behavioural Neurosciences (McCabe, Inness, Bieling), McMaster University, Hamilton, Ont.; Institute for Management and Innovation (Crandon), University of Toronto, Mississauga, Ont
| | - Holly Crandon
- Department of Health Research Methods, Evidence, and Impact (Zandieh, Sadeghirad, Wang, Yao, Pathak, Busse), McMaster University, Hamilton, Ont.; Canadian Agency for Drugs and Technology in Health (Zandieh), Toronto, Ont.; Nutrition Research Center, School of Nutrition and Food Sciences (Abdollahzadeh), Shiraz University of Medical Sciences, Shiraz, Iran; Department of Anesthesia (Sadeghirad, Wang, Busse), McMaster University; The Michael G. DeGroote National Pain Centre (Wang, Torabiardakani, Busse), McMaster University; St. Joseph's Healthcare (McCabe, Bieling); Department of Psychiatry and Behavioural Neurosciences (McCabe, Inness, Bieling), McMaster University, Hamilton, Ont.; Institute for Management and Innovation (Crandon), University of Toronto, Mississauga, Ont
| | - Kian Torabiardakani
- Department of Health Research Methods, Evidence, and Impact (Zandieh, Sadeghirad, Wang, Yao, Pathak, Busse), McMaster University, Hamilton, Ont.; Canadian Agency for Drugs and Technology in Health (Zandieh), Toronto, Ont.; Nutrition Research Center, School of Nutrition and Food Sciences (Abdollahzadeh), Shiraz University of Medical Sciences, Shiraz, Iran; Department of Anesthesia (Sadeghirad, Wang, Busse), McMaster University; The Michael G. DeGroote National Pain Centre (Wang, Torabiardakani, Busse), McMaster University; St. Joseph's Healthcare (McCabe, Bieling); Department of Psychiatry and Behavioural Neurosciences (McCabe, Inness, Bieling), McMaster University, Hamilton, Ont.; Institute for Management and Innovation (Crandon), University of Toronto, Mississauga, Ont
| | - Peter Bieling
- Department of Health Research Methods, Evidence, and Impact (Zandieh, Sadeghirad, Wang, Yao, Pathak, Busse), McMaster University, Hamilton, Ont.; Canadian Agency for Drugs and Technology in Health (Zandieh), Toronto, Ont.; Nutrition Research Center, School of Nutrition and Food Sciences (Abdollahzadeh), Shiraz University of Medical Sciences, Shiraz, Iran; Department of Anesthesia (Sadeghirad, Wang, Busse), McMaster University; The Michael G. DeGroote National Pain Centre (Wang, Torabiardakani, Busse), McMaster University; St. Joseph's Healthcare (McCabe, Bieling); Department of Psychiatry and Behavioural Neurosciences (McCabe, Inness, Bieling), McMaster University, Hamilton, Ont.; Institute for Management and Innovation (Crandon), University of Toronto, Mississauga, Ont
| | - Jason W Busse
- Department of Health Research Methods, Evidence, and Impact (Zandieh, Sadeghirad, Wang, Yao, Pathak, Busse), McMaster University, Hamilton, Ont.; Canadian Agency for Drugs and Technology in Health (Zandieh), Toronto, Ont.; Nutrition Research Center, School of Nutrition and Food Sciences (Abdollahzadeh), Shiraz University of Medical Sciences, Shiraz, Iran; Department of Anesthesia (Sadeghirad, Wang, Busse), McMaster University; The Michael G. DeGroote National Pain Centre (Wang, Torabiardakani, Busse), McMaster University; St. Joseph's Healthcare (McCabe, Bieling); Department of Psychiatry and Behavioural Neurosciences (McCabe, Inness, Bieling), McMaster University, Hamilton, Ont.; Institute for Management and Innovation (Crandon), University of Toronto, Mississauga, Ont.
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14
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Krzyzaniak N, Greenwood H, Scott AM, Peiris R, Cardona M, Clark J, Glasziou P. The effectiveness of telehealth versus face-to face interventions for anxiety disorders: A systematic review and meta-analysis. J Telemed Telecare 2024; 30:250-261. [PMID: 34860613 DOI: 10.1177/1357633x211053738] [Citation(s) in RCA: 37] [Impact Index Per Article: 37.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Worldwide, it is estimated that 264 million people meet the diagnostic criteria for anxiety conditions. Effective treatment regimens consist of cognitive and behavioural therapies. During the COVID-19 pandemic, treatment delivery relied heavily on telemedicine technologies which enabled remote consultation with patients via phone or video platforms. We aim to identify, appraise and synthesise randomised controlled trials comparing telehealth to face-to-face delivery of care to individuals of any age or gender, diagnosed with anxiety disorders, and disorders with anxiety features. METHODS To conduct this systematic review and meta-analysis, we searched three electronic databases, clinical trial registries and citing-cited references of included studies. RESULTS A total of five small randomised controlled trials were includable; telehealth was conducted by video in three studies, and by telephone in two. The risk of bias for the 5 studies was low to moderate for most domains. Outcomes related to anxiety, depression symptom severity, obsessive-compulsive disorder, function, working alliance, and satisfaction were comparable between the two modes of delivery at each follow-up time point (immediately post-intervention, 3 months, 6 months and 12 months), with no significant differences reported (p > 0.05). None of the trials reported on the costs of telehealth compared to face-to-face care. DISCUSSION For effectively treating anxiety and related conditions, interventions delivered by telehealth appear to be as effective as the same therapy delivered in-person. However, further high-quality trials are warranted to determine the effectiveness, acceptability, feasibility, and cost-effectiveness of telehealth interventions for the management of a wider range of anxiety disorders and treatments.
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Affiliation(s)
| | - Hannah Greenwood
- Institute for Evidence-Based Healthcare, Bond University, Australia
| | - Anna M Scott
- Institute for Evidence-Based Healthcare, Bond University, Australia
| | - Ruwani Peiris
- Institute for Evidence-Based Healthcare, Bond University, Australia
| | - Magnolia Cardona
- Institute for Evidence-Based Healthcare, Bond University, Australia
| | - Justin Clark
- Institute for Evidence-Based Healthcare, Bond University, Australia
| | - Paul Glasziou
- Institute for Evidence-Based Healthcare, Bond University, Australia
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15
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Winter HR, Norton AR, Burley JL, Wootton BM. Remote cognitive behaviour therapy for social anxiety disorder: A meta-analysis. J Anxiety Disord 2023; 100:102787. [PMID: 37890219 DOI: 10.1016/j.janxdis.2023.102787] [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: 12/14/2022] [Revised: 05/03/2023] [Accepted: 10/12/2023] [Indexed: 10/29/2023]
Abstract
Remote cognitive behaviour therapy (CBT) for social anxiety disorder (SAD) has the potential to improve access to treatment by reducing economic, geographic, and psychological barriers. The aim of this study was to use a meta-analytic approach to examine the efficacy of the different remote CBT methods for treating SAD. A systematic electronic database search was used to identify 31 studies (n = 2905; mean age range: 24.73-41.65 years; mean female representation = 60.2 %). Pooled within-group analyses indicated large effect sizes from pre-treatment to post-treatment (Hedges' g = 1.06; 95 % CI: 0.96-1.16) and pre-treatment to follow up (g = 1.18; 95 % CI: 1.03-1.33) for remote CBT. Internet-delivered CBT (g = 1.08; 95 % CI: 0.98-1.19) and application-delivered CBT (g = 1.19; 95 % CI: 0.75-1.64) produced large within-group effect sizes. Bibliotherapy-delivered CBT (g = 0.79; 95 % CI: 0.45-1.13) produced medium within-group effect sizes. Pooled between-group findings indicate that remote CBT treatments were more effective than passive control (g = 0.87; 95 % CI: 0.70-1.03) and non-CBT remote treatments (g = 0.41; 95 % CI: 0.17-0.66), and were at least as effective, or slightly more effective, than face-to-face CBT treatments (g = 0.34; 95 % CI: 0.14-0.54). These findings have important implications for the dissemination of remote and stepped-care treatments for SAD.
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Affiliation(s)
- Halaina R Winter
- Discipline of Clinical Psychology, Graduate School of Health, University of Technology Sydney, Ultimo, NSW 2007, Australia
| | - Alice R Norton
- Discipline of Clinical Psychology, Graduate School of Health, University of Technology Sydney, Ultimo, NSW 2007, Australia; Clinical Psychology Unit, School of Psychology, The University of Sydney, Camperdown, NSW 2006, Australia
| | - Jade L Burley
- Discipline of Clinical Psychology, Graduate School of Health, University of Technology Sydney, Ultimo, NSW 2007, Australia
| | - Bethany M Wootton
- Discipline of Clinical Psychology, Graduate School of Health, University of Technology Sydney, Ultimo, NSW 2007, Australia.
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16
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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.
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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
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17
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Dhaliwal R, Yap S, Talarico F, Al-Shamali H, Mcweeny R, Reeson M, Shalaby R, Chen T, Spronk E, Snodgrass R, Tu E, Erick T, Marshall T, Kennedy M, Greenshaw AJ, Winkler O, Burback L. Synchronous Web-Based Psychotherapy for Mental Disorders From a Health Quality Perspective: Scoping Review. J Med Internet Res 2023; 25:e40710. [PMID: 37921863 PMCID: PMC10656669 DOI: 10.2196/40710] [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: 07/01/2022] [Revised: 09/12/2023] [Accepted: 10/11/2023] [Indexed: 11/04/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic necessitated rapid changes to health care delivery, including a shift from in-person to digitally delivered psychotherapy. While these changes helped ensure timely psychotherapy provision, many concerns exist, including clinical, cultural, practical, privacy, and security issues. OBJECTIVE This scoping review systematically mapped existing peer-reviewed research on synchronous, therapist-delivered web-based psychotherapy for individuals with a diagnosed mental illness. Data were analyzed through the lens of the Alberta Quality Matrix for Health (AQMH) to assess to what degree this literature addresses key indicators of health care quality. This analysis aided in the identification and organization of knowledge gaps with regard to web-based psychotherapies, highlighting potential disparities between previously prioritized dimensions of care and those requiring further attention. METHODS This review adhered to the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines. We included peer-reviewed primary research studies in the English language investigating synchronous, therapist-delivered remote psychotherapy delivered to adults (aged 18 years and older) with a Diagnostic and Statistical Manual of Mental Disorders or International Statistical Classification of Diseases diagnosed mental illness. All other citations were excluded. Relevant studies were identified through MEDLINE, APA PsycINFO, Embase (OVID), Web of Science: Core Collection (Clarivate), Cochrane Library (Wiley), and Scopus (Elsevier) databases. Databases were searched on March 18, 2021. For every publication that was taken into consideration, the data were charted independently by 2 reviewers, and in the event of a discrepancy, the principal investigator validated the choice of either extractor. Results were thematically described according to the 6 AQMH dimensions: acceptability, accessibility, appropriateness, effectiveness, efficiency, and safety. RESULTS From 13,209 publications, 48 articles were included, largely from North American studies. Most studies measured treatment effectiveness (n=48, 100%) and acceptability (n=29, 60%) health quality dimensions. Over 80% (40/48) of studies investigated either a cognitive or exposure intervention for either posttraumatic stress disorder or a mood or anxiety disorder, generally indicating comparable results to in-person therapy. Safety (n=5, 10%) was measured in fewer studies, while treatment accessibility, appropriateness, and efficiency were not explicitly measured in any study, although these dimensions were mentioned as a future direction, hypothesis, or potential outcome. CONCLUSIONS In relation to web-based therapist-delivered psychotherapies for those with a diagnosed mental illness, important aspects of health care quality (accessibility, appropriateness, efficiency, and safety) have received little scientific examination, underscoring a need to address these gaps. There are also significant issues related to the generalizability of this literature, including the underrepresentation of many geographic regions, cultures, populations, clinical contexts, and psychotherapy modalities. Qualitative research in underrepresented populations and settings may uncover important patient and contextual factors important for the future implementation of quality web-based psychotherapy.
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Affiliation(s)
- Raman Dhaliwal
- Department of Psychiatry, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Sidney Yap
- Department of Psychiatry, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Fernanda Talarico
- Department of Psychiatry, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Huda Al-Shamali
- Department of Psychiatry, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Robert Mcweeny
- Department of Psychiatry, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Matthew Reeson
- Department of Psychiatry, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Reham Shalaby
- Department of Psychiatry, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Teresa Chen
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Elena Spronk
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Rayven Snodgrass
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Eileen Tu
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Taylor Erick
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Tyler Marshall
- Department of Psychiatry, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Megan Kennedy
- Geoffrey and Robyn Sperber Health Sciences Library, University of Alberta, Edmonton, AB, Canada
| | - Andrew J Greenshaw
- Department of Psychiatry, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Olga Winkler
- Department of Psychiatry, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Lisa Burback
- Department of Psychiatry, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
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Lisi DM, Hawley LL, McCabe RE, Rowa K, Cameron DH, Richter MA, Rector NA. Online versus in-person delivery of cognitive behaviour therapy for obsessive compulsive disorder: An examination of effectiveness. Clin Psychol Psychother 2023. [PMID: 37699581 DOI: 10.1002/cpp.2908] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 06/13/2023] [Accepted: 08/28/2023] [Indexed: 09/14/2023]
Abstract
Cognitive behavioural therapy (CBT) including exposure and response prevention is the first-line psychological treatment for obsessive compulsive disorder (OCD). Given changes in the clinical landscape, there are increasing efforts to evaluate its effectiveness in online contexts. Mirroring the traditional in-person delivery, few studies have assessed the role of therapist-guided, manual-based CBT for OCD delivered in real-time via videoconferencing methods. The present study sought to fill this gap by comparing in-person and online delivery of group-based CBT for the treatment of OCD. A convenience sample of participants with moderate to severe OCD (n = 144) were recruited from a naturalistic database from two large OCD specialty assessment and treatment centres. Patients received group-based CBT that was provided in-person (pre-COVID-19 pandemic; March 2018 to March 2020) or online via videoconferencing (during the COVID-19 pandemic; March 2020 to April 2021). In both delivery methods, treatment consisted of 2-h weekly sessions led by trained clinicians. Analyses revealed that, regardless of treatment modality, both in-person and online groups demonstrated significant, reliable, and statistically equivalent improvements in OCD symptoms post-treatment. Videoconferenced, clinician-led CBT may be a promising alternative to in-person delivery for those with moderate to severe OCD symptoms.
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Affiliation(s)
- Diana M Lisi
- Frederick W. Thompson Anxiety Disorders Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Lance L Hawley
- Frederick W. Thompson Anxiety Disorders Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Randi E McCabe
- Anxiety Treatment and Research Clinic, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Karen Rowa
- Anxiety Treatment and Research Clinic, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Duncan H Cameron
- Anxiety Treatment and Research Clinic, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Margaret A Richter
- Frederick W. Thompson Anxiety Disorders Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Neil A Rector
- Frederick W. Thompson Anxiety Disorders Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
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19
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Winter HR, Norton A, Wootton BM. Internet videoconferencing delivered cognitive behavioral therapy for social anxiety disoder: Protocol for a randomized controlled trial. Contemp Clin Trials 2023; 132:107298. [PMID: 37482329 DOI: 10.1016/j.cct.2023.107298] [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: 05/04/2023] [Revised: 07/04/2023] [Accepted: 07/15/2023] [Indexed: 07/25/2023]
Abstract
BACKGROUND Social anxiety disorder (SAD) is characterized by a fear of scrutiny in social or performance situations. Due to a number of barriers, many individuals do not seek treatment for SAD, resulting in a chronic and debilitating course. Cognitive behaviour therapy (CBT), and more recently Imagery Rescripting (ImR), have been found to be efficacious in the treatment of SAD when delivered face-to-face. However, the efficacy of these treatment approaches when delivered remotely, have not yet been examined in controlled trials. METHODS The authors propose a two-group randomized controlled trial comparing the efficacy of videoconferencing delivered CBT (vCBT) for SAD against a waitlist control group. The study will recruit 78 adults in total with a primary diagnosis of SAD of at least moderate severity. The manualised high-intensity vCBT intervention will be delivered weekly over an 8-week period. After treatment completion, the waitlist participants will receive a high-intensity videoconferencing delivered ImR (vImR) intervention also delivered weekly over an 8-week period. Treatment for both groups will be delivered in real time via an online videoconferencing platform. Outcome measures will be administered at baseline, mid-treatment, post-treatment, and 3-month follow-up. CONCLUSION This trial will report findings on the efficacy of a remote synchronous high-intensity vCBT and vImR intervention for SAD and benchmark the two different treatment methodologies against standard face-to-face CBT. The results have the potential to inform best-practice remote psychological treatment for SAD. TRIAL REGISTRATION The trial was registered on the Australian New Zealand Clinical Trials Registry; ACTRN12623000313639 (5 April 2023).
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Affiliation(s)
- Halaina R Winter
- Discipline of Clinical Psychology, Graduate School of Health, University of Technology Sydney, NSW, Australia
| | - Alice Norton
- Clinical Psychology Unit, School of Psychology, The University of Sydney, Camperdown, NSW, Australia
| | - Bethany M Wootton
- Discipline of Clinical Psychology, Graduate School of Health, University of Technology Sydney, NSW, Australia..
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20
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Cavallini MC, Caravita SCS, Fandrem H. Feasibility and Early Outcomes of a Parent Training Intervention to Engage Parents in Children's Media Education. Healthcare (Basel) 2023; 11:2130. [PMID: 37570371 PMCID: PMC10418340 DOI: 10.3390/healthcare11152130] [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: 04/20/2023] [Revised: 07/20/2023] [Accepted: 07/24/2023] [Indexed: 08/13/2023] Open
Abstract
The importance of parents in mediating adolescents' Internet use is documented by many studies in the literature. Very few, however, regard interventions to support parents in this role. We wanted to assess the feasibility and the early outcomes of an Internet-based parent educational group course aimed to support parents in adolescents' media education. The intervention was conducted with two different groups of parents (N = 20, 75% women; mean age = 46.9 y; SD = 6.3) at different time-points. The intervention included five sessions, during which information about parental mediation strategies was provided and practical exercises based on the Acceptance and Commitment Therapy (ACT) approach were proposed. The intervention generated greater awareness, openness and flexibility and increased parental familiarity with technological devices. Overall, the proposed web-based and group-based parent training model has shown good feasibility and promising early outcomes in supporting parents as Internet mediators.
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Affiliation(s)
| | - Simona Carla Silvia Caravita
- Norwegian Centre for Learning Environment, University of Stavanger, P.O. Box 8600, 4036 Stavanger, Norway; (S.C.S.C.); (H.F.)
| | - Hildegunn Fandrem
- Norwegian Centre for Learning Environment, University of Stavanger, P.O. Box 8600, 4036 Stavanger, Norway; (S.C.S.C.); (H.F.)
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21
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Shaker AA, Austin SF, Storebø OJ, Schaug JP, Ayad A, Sørensen JA, Tarp K, Bechmann H, Simonsen E. Psychiatric Treatment Conducted via Telemedicine Versus In-Person Modality in Posttraumatic Stress Disorder, Mood Disorders, and Anxiety Disorders: Systematic Review and Meta-Analysis. JMIR Ment Health 2023; 10:e44790. [PMID: 37277113 PMCID: PMC10357375 DOI: 10.2196/44790] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 04/28/2023] [Accepted: 05/22/2023] [Indexed: 06/07/2023] Open
Abstract
BACKGROUND Telemedicine has played a vital role in providing psychiatric treatment to patients during the rapid transition of services during the COVID-19 pandemic. Furthermore, the use of telemedicine is expected to expand within the psychiatric field. The efficacy of telemedicine is well described in scientific literature. However, there is a need for a comprehensive quantitative review that analyzes and considers the different clinical outcomes and psychiatric diagnoses. OBJECTIVE This paper aimed to assess whether individual psychiatric outpatient treatment for posttraumatic stress disorder, mood disorders, and anxiety disorders in adults using telemedicine is equivalent to in-person treatment. METHODS A systematic search of randomized controlled trials was conducted using recognized databases for this review. Overall, 4 outcomes were assessed: treatment efficacy, levels of patient satisfaction, working alliance, and attrition rate. The inverse-variance method was used to summarize the effect size for each outcome. RESULTS A total of 7414 records were identified, and 20 trials were included in the systematic review and meta-analysis. The trials included posttraumatic stress disorder (9 trials), depressive disorder (6 trials), a mix of different disorders (4 trials), and general anxiety disorder (1 trial). Overall, the analyses yielded evidence that telemedicine is comparable with in-person treatment regarding treatment efficacy (standardized mean difference -0.01, 95% CI -0.12 to 0.09; P=.84; I2=19%, 17 trials, n=1814), patient satisfaction mean difference (-0.66, 95% CI -1.60 to 0.28; P=.17; I2=44%, 6 trials, n=591), and attrition rates (risk ratio 1.07, 95% CI 0.94-1.21; P=.32; I2=0%, 20 trials, n=2804). The results also indicated that the working alliance between telemedicine and in-person modalities was comparable, but the heterogeneity was substantial to considerable (mean difference 0.95, 95% CI -0.47 to 2.38; P=.19; I2=75%, 6 trials, n=539). CONCLUSIONS This meta-analysis provided new knowledge on individual telemedicine interventions that were considered equivalent to in-person treatment regarding efficacy, patient satisfaction, working alliance, and attrition rates across diagnoses. The certainty of the evidence regarding efficacy was rated as moderate. Furthermore, high-quality randomized controlled trials are needed to strengthen the evidence base for treatment provided via telemedicine in psychiatry, particularly for personality disorders and a range of anxiety disorders where there is a lack of studies. Individual patient data meta-analysis is suggested for future studies to personalize telemedicine. TRIAL REGISTRATION PROSPERO International Prospective Register of Systematic Reviews CRD42021256357; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=256357.
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Affiliation(s)
- Ali Abbas Shaker
- Psychiatric Department, Region Zealand Psychiatry, Psychiatric Research Unit, Slagelse, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Stephen F Austin
- Psychiatric Department, Region Zealand Psychiatry, Psychiatric Research Unit, Slagelse, Denmark
- Department of Psychology, University of Southern Denmark Faculty of Health Sciences, Odense, Denmark
| | - Ole Jakob Storebø
- Psychiatric Department, Region Zealand Psychiatry, Psychiatric Research Unit, Slagelse, Denmark
- Department of Psychology, University of Southern Denmark Faculty of Health Sciences, Odense, Denmark
| | - Julie Perrine Schaug
- Psychiatric Department, Region Zealand Psychiatry, Psychiatric Research Unit, Slagelse, Denmark
| | - Alaa Ayad
- Psychiatric Department, Region Zealand Psychiatry, Psychiatric Research Unit, Slagelse, Denmark
| | - John Aasted Sørensen
- Department of Engineering Technology and Didactics, Research unit: AI, Mathematics and Software, Technical University of Denmark, Ballerup, Denmark
| | - Kristine Tarp
- Research Unit for Digital Psychiatry, Mental Health Services in the Region of Southern Denmark, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Henrik Bechmann
- Department of Engineering Technology and Didactics, Research unit: AI, Mathematics and Software, Technical University of Denmark, Ballerup, Denmark
| | - Erik Simonsen
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Mental Health Services East, Copenhagen University Hospital - Psychiatry Region Zealand, Roskilde, Denmark
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22
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Crowe M, Inder M, Manuel J, Carlyle D. Characteristics of effective teletherapy for major depression: A systematic review. J Affect Disord 2023; 327:175-182. [PMID: 36758869 DOI: 10.1016/j.jad.2023.02.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 01/19/2023] [Accepted: 02/03/2023] [Indexed: 02/11/2023]
Abstract
BACKGROUND People would prefer to have psychotherapy as treatment over medication for major depression. There is evidence that psychotherapy does not require in-person delivery to be effective. Other modes of delivery, such as videoconferencing teletherapy, may make it a more accessible treatment. METHOD The aim of this review was to identify the characteristics of effective psychotherapy delivered by videoconference for adults in primary care with a primary diagnosis of depression. A quantitative systematic review was conducted and reported according to PRISMA guidelines. RESULTS There were 8 studies included in the review. The therapies studied were tele problem-solving therapy, behavioural activation and cognitive behavioural therapy. All studies had a medium to high risk of bias. Six were randomized controlled trials, one was a pragmatic retrospective cohort study and one was an open-label design. Four studies found similar outcomes to the in-person comparators, one study found tele problem-solving therapy was more effective than behavioural activation, and one study found cognitive behavioural therapy to be similar to usual care. LIMITATIONS The search identified only 8 studies. Due to the heterogeneity of outcome measures and comparators, a meta-analysis could not be conducted. CONCLUSIONS No definitive conclusions can be drawn about the effectiveness of teletherapy in primary care based on this review, however, there is emerging evidence to suggest it has similar outcomes to in-person therapy for people with a primary diagnosis of depression. There is no evidence regarding the superiority of one model of therapy over the others.
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Affiliation(s)
- Marie Crowe
- University of Otago, Christchurch, New Zealand.
| | - Maree Inder
- University of Otago, Christchurch, New Zealand
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23
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Kathiravan S, Chakrabarti S. Development of a protocol for videoconferencing-based exposure and response prevention treatment of obsessive-compulsive disorder during the COVID-19 pandemic. World J Psychiatry 2023; 13:60-74. [PMID: 36925949 PMCID: PMC10011942 DOI: 10.5498/wjp.v13.i2.60] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Revised: 11/01/2022] [Accepted: 12/06/2022] [Indexed: 02/17/2023] Open
Abstract
BACKGROUND The existing literature indicates that psychotherapeutic treatment, especially exposure and response prevention (ERP) is efficacious in treating obsessive-compulsive disorder (OCD). The coronavirus disease 2019 pandemic adversely impacted many patients with OCD and disrupted their usual treatment. Moreover, the pandemic forced a global switch to telemental health (TMH) services to maintain the standards and continuity of care. Consequently, clinicians are increasingly using TMH-based psychotherapeutic treatments to treat OCD. However, several challenges have made it difficult for them to implement these treatments in the changed circumstances imposed by the pandemic. AIM To describe the formulation, implementation, feasibility, and usefulness of videoconferencing-based ERP (VC-ERP) treatment for OCD during the coronavirus disease 2019 pandemic. METHODS This prospective, observational study was conducted in the psychiatric unit of a multi-specialty hospital in north India over 12 mo (July 2020-June 2021). All patients with OCD were assessed using the home-based TMH services of the department. The VC-ERP protocol for OCD was the outcome of weekly Zoom meetings with a group of clinicians involved in administering the treatment. After a systematic evaluation of the available treatment options, an initial protocol for delivering VC-ERP was developed. Guidelines for clinicians and educational materials for patients and their families were prepared. The protocol was implemented among patients with OCD attending the TMH services, and their progress was monitored. The weekly meetings were used to upgrade the protocol to meet the needs of all stakeholders. Feasibility and efficacy outcomes were examined. RESULTS All patients were diagnosed with OCD as a primary or a comorbid condition according to the International Classification of Diseases, 10th version criteria. Out of 115 patients who attended the services during the study period, 37 were excluded from the final analysis. Of the remaining 78 patients, VC-ERP was initiated in 43 patients. Six patients dropped out, and three were hospitalized for inpatient ERP. Eleven patients have completed the full VC-ERP treatment. One patient completed the psychoeducation part of the protocol. VC-ERP is ongoing in 22 patients. The protocol for VC-ERP treatment was developed and upgraded online. A large proportion of the eligible patients (n = 34/43; 79%) actively engaged in the VC-ERP treatment. Drop-out rates were low (n = 6/43; 14%). Satisfaction with the treatment was adequate among patients, caregivers, and clinicians. Apart from hospitalization in 3 patients, there were no other adverse events. Hybrid care and stepped care approaches could be incorporated into the VC-ERP protocol. Therefore, the feasibility of VC-ERP treatment in terms of operational viability, service utilization, service engagement, need for additional in-person services, frequency of adverse events, and user satisfaction was adequate. The VC-ERP treatment was found to be efficacious in the 11 patients who had completed the full treatment. Significant reductions in symptoms and maintenance of treatment gains on follow-up were observed. CONCLUSION This study provided preliminary evidence for the feasibility and usefulness of VC-ERP in the treatment of OCD. The results suggest that VC-ERP can be a useful option in resource-constrained settings.
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Affiliation(s)
- Sanjana Kathiravan
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh 160012, India
| | - Subho Chakrabarti
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh 160012, India
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24
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Papola D, Ostuzzi G, Tedeschi F, Gastaldon C, Purgato M, Del Giovane C, Pompoli A, Pauley D, Karyotaki E, Sijbrandij M, Furukawa TA, Cuijpers P, Barbui C. CBT treatment delivery formats for panic disorder: a systematic review and network meta-analysis of randomised controlled trials. Psychol Med 2023; 53:614-624. [PMID: 37132646 PMCID: PMC9975966 DOI: 10.1017/s0033291722003683] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 11/03/2022] [Accepted: 11/10/2022] [Indexed: 12/13/2022]
Abstract
Several in-person and remote delivery formats of cognitive-behavioural therapy (CBT) for panic disorder are available, but up-to-date and comprehensive evidence on their comparative efficacy and acceptability is lacking. Our aim was to evaluate the comparative efficacy and acceptability of all CBT delivery formats to treat panic disorder. To answer our question we performed a systematic review and network meta-analysis of randomised controlled trials. We searched MEDLINE, Embase, PsycINFO, and CENTRAL, from inception to 1st January 2022. Pairwise and network meta-analyses were conducted using a random-effects model. Confidence in the evidence was assessed using Confidence in Network Meta-Analysis (CINeMA). The protocol was published in a peer-reviewed journal and in PROSPERO. We found a total of 74 trials with 6699 participants. Evidence suggests that face-to-face group [standardised mean differences (s.m.d.) -0.47, 95% confidence interval (CI) -0.87 to -0.07; CINeMA = moderate], face-to-face individual (s.m.d. -0.43, 95% CI -0.70 to -0.15; CINeMA = Moderate), and guided self-help (SMD -0.42, 95% CI -0.77 to -0.07; CINeMA = low), are superior to treatment as usual in terms of efficacy, whilst unguided self-help is not (SMD -0.21, 95% CI -0.58 to -0.16; CINeMA = low). In terms of acceptability (i.e. all-cause discontinuation from the trial) CBT delivery formats did not differ significantly from each other. Our findings are clear in that there are no efficacy differences between CBT delivered as guided self-help, or in the face-to-face individual or group format in the treatment of panic disorder. No CBT delivery format provided high confidence in the evidence at the CINeMA evaluation.
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Affiliation(s)
- Davide Papola
- Department of Neuroscience, Biomedicine and Movement Science, Section of Psychiatry, WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, University of Verona, Verona, Italy
| | - Giovanni Ostuzzi
- Department of Neuroscience, Biomedicine and Movement Science, Section of Psychiatry, WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, University of Verona, Verona, Italy
| | - Federico Tedeschi
- Department of Neuroscience, Biomedicine and Movement Science, Section of Psychiatry, WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, University of Verona, Verona, Italy
| | - Chiara Gastaldon
- Department of Neuroscience, Biomedicine and Movement Science, Section of Psychiatry, WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, University of Verona, Verona, Italy
| | - Marianna Purgato
- Department of Neuroscience, Biomedicine and Movement Science, Section of Psychiatry, WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, University of Verona, Verona, Italy
| | - Cinzia Del Giovane
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | | | - Darin Pauley
- Department of Clinical, Neuro and Developmental Psychology, WHO Collaborating Centre for Research and Dissemination of Psychological Interventions, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Eirini Karyotaki
- Department of Clinical, Neuro and Developmental Psychology, WHO Collaborating Centre for Research and Dissemination of Psychological Interventions, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Marit Sijbrandij
- Department of Clinical, Neuro and Developmental Psychology, WHO Collaborating Centre for Research and Dissemination of Psychological Interventions, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Toshi A. Furukawa
- Departments of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, Japan
| | - Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, WHO Collaborating Centre for Research and Dissemination of Psychological Interventions, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Corrado Barbui
- Department of Neuroscience, Biomedicine and Movement Science, Section of Psychiatry, WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, University of Verona, Verona, Italy
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25
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Dambi JM, Mavhu W, Beji-Chauke R, Kaiyo-Utete M, Mills R, Shumba R, Muchemwa S, Musesengwa R, Verhey R, Abas M, Hirsch CR, Chibanda D. The impact of working alliance in managing youth anxiety and depression: a scoping review. NPJ MENTAL HEALTH RESEARCH 2023; 2:1. [PMID: 37520938 PMCID: PMC9885927 DOI: 10.1038/s44184-023-00021-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 01/17/2023] [Indexed: 01/31/2023]
Abstract
A working alliance (WA) is a multidimensional construct signifying a collaborative relationship between a client and a therapist. Systematic reviews of therapies to treat depression and anxiety, almost exclusively in adults, show WA is essential across psychotherapies. However, there are critical gaps in our understanding of the importance of WA in low-intensity therapies for young people with depression and anxiety. Here, we describe an initiative to explore the effect of WA on anxiety and depression outcomes in youth aged 14-24 years through a scoping review and stakeholders' consultations (N = 32). We analysed 27 studies; most were done in high-income countries and evaluated one-on-one in-person therapies (18/27). The review shows that optimal WA is associated with improvements in: relationships, self-esteem, positive coping strategies, optimism, treatment adherence, and emotional regulation. Young people with lived experience expressed that: a favourable therapy environment, regular meetings, collaborative goal setting and confidentiality were vital in forming and maintaining a functional WA. For a clinician, setting boundaries, maintaining confidentiality, excellent communication skills, being non-judgmental, and empathy were considered essential for facilitating a functional WA. Overall, a functional WA was recognised as an active ingredient in psychotherapies targeting anxiety and depression in young people aged 14-24. Although more research is needed to understand WA's influence in managing anxiety and depression in young people, we recommend routine evaluation of WA. Furthermore, there is an urgent need to identify strategies that promote WA in psychotherapies to optimise the treatment of anxiety and depression in young people.
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Affiliation(s)
- Jermaine M. Dambi
- Rehabilitation Sciences Unit, Faculty of Medicine and Health Sciences, University of Zimbabwe, PO Box AV178, Avondale, Harare, Zimbabwe
- Friendship Bench, 4 Weale Road, Harare, Zimbabwe
| | - Webster Mavhu
- Centre for Sexual Health and HIV/AIDS Research (CeSHHAR), 4 Bath Road, Harare, Zimbabwe
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, L3 5QA UK
| | | | - Malinda Kaiyo-Utete
- Mental Health Unit, Faculty of Medicine and Health Sciences, University of Zimbabwe, PO Box A178, Avondale, Harare, Zimbabwe
| | - Rhiana Mills
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, SE5 8AF UK
| | | | - Sidney Muchemwa
- Rehabilitation Sciences Unit, Faculty of Medicine and Health Sciences, University of Zimbabwe, PO Box AV178, Avondale, Harare, Zimbabwe
- Friendship Bench, 4 Weale Road, Harare, Zimbabwe
| | | | - Ruth Verhey
- Friendship Bench, 4 Weale Road, Harare, Zimbabwe
| | - Melanie Abas
- Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, SE5 8AF UK
| | - Colette R. Hirsch
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, SE5 8AF UK
| | - Dixon Chibanda
- Friendship Bench, 4 Weale Road, Harare, Zimbabwe
- Mental Health Unit, Faculty of Medicine and Health Sciences, University of Zimbabwe, PO Box A178, Avondale, Harare, Zimbabwe
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT UK
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Stadler M, Jesser A, Humer E, Haid B, Stippl P, Schimböck W, Maaß E, Schwanzar H, Leithner D, Pieh C, Probst T. Remote Psychotherapy during the COVID-19 Pandemic: A Mixed-Methods Study on the Changes Experienced by Austrian Psychotherapists. Life (Basel) 2023; 13:life13020360. [PMID: 36836720 PMCID: PMC9961677 DOI: 10.3390/life13020360] [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: 12/28/2022] [Revised: 01/23/2023] [Accepted: 01/25/2023] [Indexed: 01/31/2023] Open
Abstract
The outbreak of the COVID-19 pandemic and associated measures to contain the SARS-CoV-2 coronavirus required a change in treatment format from face-to-face to remote psychotherapy. This study investigated the changes experienced by Austrian therapists when switching to psychotherapy at a distance. A total of 217 therapists participated in an online survey on changes experienced when switching settings. The survey was open from 26 June until 3 September 2020. Several open questions were evaluated using qualitative content analysis. The results show that the setting at a distance was appreciated by the therapists as a possibility to continue therapy even during an exceptional situation. Moreover, remote therapy offered the respondents more flexibility in terms of space and time. Nevertheless, the therapists also reported challenges of remote therapy, such as limited sensory perceptions, technical problems and signs of fatigue. They also described differences in terms of the therapeutic interventions used. There was a great deal of ambivalence in the data regarding the intensity of sessions and the establishment and/or maintenance of a psychotherapeutic relationship. Overall, the study shows that remote psychotherapy seems to have been well accepted by Austrian psychotherapists in many settings and can offer benefits. Clinical studies are also necessary to investigate in which contexts and for which patient groups the remote setting is suitable and where it is potentially contraindicated.
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Affiliation(s)
- Michael Stadler
- Department for Psychosomatic Medicine and Psychotherapy, University for Continuing Education Krems, 3500 Krems, Austria
| | - Andrea Jesser
- Department for Psychosomatic Medicine and Psychotherapy, University for Continuing Education Krems, 3500 Krems, Austria
- Correspondence:
| | - Elke Humer
- Department for Psychosomatic Medicine and Psychotherapy, University for Continuing Education Krems, 3500 Krems, Austria
| | - Barbara Haid
- Austrian Federal Association for Psychotherapy, 1030 Vienna, Austria
| | - Peter Stippl
- Austrian Federal Association for Psychotherapy, 1030 Vienna, Austria
| | | | - Elisabeth Maaß
- Österreichische Gesellschaft Für Wissenschaftliche, Klientenzentrierte Psychotherapie und Personorientierte Gesprächsführung (ÖGWG), 4020 Linz, Austria
| | - Helmut Schwanzar
- Österreichische Gesellschaft Für Wissenschaftliche, Klientenzentrierte Psychotherapie und Personorientierte Gesprächsführung (ÖGWG), 4020 Linz, Austria
| | - Daniela Leithner
- Österreichische Gesellschaft Für Wissenschaftliche, Klientenzentrierte Psychotherapie und Personorientierte Gesprächsführung (ÖGWG), 4020 Linz, Austria
| | - Christoph Pieh
- Department for Psychosomatic Medicine and Psychotherapy, University for Continuing Education Krems, 3500 Krems, Austria
| | - Thomas Probst
- Department for Psychosomatic Medicine and Psychotherapy, University for Continuing Education Krems, 3500 Krems, Austria
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Finazzi E, MacLeod E, MacBeth A. Exploring service users experiences of remotely delivered CBT interventions in primary care during COVID-19: An interpretative phenomenological analysis. PLoS One 2023; 18:e0279263. [PMID: 36607988 PMCID: PMC9821471 DOI: 10.1371/journal.pone.0279263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 12/04/2022] [Indexed: 01/07/2023] Open
Abstract
Primary Care Mental Health Services (PMHCS) aim to provide accessible and effective psychological interventions. However, there is a scarcity of qualitative research focused on patients' experiences. Service users' experience can inform development of accessible, high-quality mental health services. Nine semi-structured interviews were analysed from Primary Care Mental Health users in Northern Scotland using Interpretative Phenomenological Analysis (IPA). Four superordinate themes were generated: Orientating to treatment, Intervention features, Change enablers, and Impact. The results identified both facilitators and barriers associated with access and psychological change; and narratives around CBT acceptability, outcomes and remote delivery. The role of GPs emerged as a key determinant of access to PMHCS. The therapeutic relationship contributed to person-centred care provision, idiosyncratic change processes and self-empowerment. A personal commitment to engage with homework was described as a crucial change enabler. Findings are discussed in relation to existing literature, practical implications and suggestions for future research.
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Affiliation(s)
- Emilia Finazzi
- School of Health and Social Sciences, University of Edinburgh, Edinburgh, United Kingdom
- Department of Clinical and Counselling Psychology, NHS Grampian, Aberdeen, United Kingdom
| | - Eilidh MacLeod
- Primary Care Therapies Service, Aberdeen City Health and Social Care Partnership, NHS Grampian, Aberdeen, United Kingdom
| | - Angus MacBeth
- School of Health and Social Sciences, University of Edinburgh, Edinburgh, United Kingdom
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Colón Llamas T, Escobar Altare A, Ramírez Castro MF, Bermúdez Jaimes ME, López Sánchez MC, Castellanos Urrego SG. Telepsicología en un centro de atención psicológica universitario durante el COVID-19: Experiencias de consultantes y estudiantes. UNIVERSITAS PSYCHOLOGICA 2022. [DOI: 10.11144/javeriana.upsy21.tcap] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
El uso de la telepsicología como herramienta para la atención en salud mental ha presentado en las últimas décadas un importante incremento a nivel mundial. En Colombia, a pesar de existir servicios de teleconsulta, la publicación de estudios es limitada. A raíz de la crisis de salud generada por la pandemia por COVID-19 se implementó el servicio de atención por telepsicología en un centro de atención psicológica universitario. El presente trabajo se propuso caracterizar las experiencias de la atención en la modalidad de telepsicología de consultantes y estudiantes en práctica clínica, con el fin de ampliar el conocimiento en el área y aportar a la evaluación de la viabilidad de estos servicios. Se realizó un estudio descriptivo de caracterización con un diseño transversal. Se aplicó un cuestionario a 253 consultantes y 77 estudiantes, construido por el equipo investigador. La información obtenida mostró que la atención por telepsicología logró altos niveles de satisfacción con el tratamiento recibido, la posibilidad de establecer vínculo terapéutico y el desarrollo de habilidades clínicas en los estudiantes, siendo esta modalidad de atención una alternativa útil para deponer barreras de atención en salud. Se sugiere realizar estudios de seguimiento en diferentes momentos para mayor fiabilidad de los resultados.
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Bean CAL, Aurora P, Maddox CJ, Mekota R, Updegraff A. A comparison of telehealth versus in-person group therapy: Results from a DBT-based dual diagnosis IOP. J Clin Psychol 2022; 78:2073-2086. [PMID: 35531794 PMCID: PMC9790325 DOI: 10.1002/jclp.23374] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 04/20/2022] [Accepted: 04/27/2022] [Indexed: 12/30/2022]
Abstract
OBJECTIVE The effectiveness of remotely delivered group interventions and treatments for individuals with more complex psychiatric presentations is understudied. Nevertheless, the emergence of the COVID-19 pandemic shifted such treatments from in-person to remote service delivery without the establishment of comparable effectiveness between in-person and remote delivery. The current study presents the results of a private practice's transition from in-person treatment delivery to a videoconference-delivered Dialectical Behavior Therapy (DBT)-based intensive outpatient program (IOP) for individuals with comorbid mental health and substance use disorder diagnoses in response to the pandemic. METHODS Change in symptoms of depression, anxiety, and stress following completion of the IOP was compared between the in-person and videoconference groups. RESULTS Large reductions in symptoms were found following completion of the IOP for both the in-person and videoconference groups. Furthermore, no significant differences in symptom reduction were found between the groups. CONCLUSION Although large-scale replication is needed, these results suggest that IOPs and other intensive group therapies delivered via videoconference may be as effective as in-person therapies, even among individuals with more complex psychiatric presentations. Providers who have transitioned group therapies to videoconference formats or are considering creating remote groups can be more confident that they are not sacrificing treatment efficacy.
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Affiliation(s)
| | - Pallavi Aurora
- Department of Psychological SciencesKent State UniversityKentOhioUSA
| | | | | | - Alanna Updegraff
- Department of Psychological SciencesKent State UniversityKentOhioUSA
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Peláez T, López-Carrillero R, Ferrer-Quintero M, Ochoa S, Osma J. Application of the unified protocol for the transdiagnostic treatment of comorbid emotional disorders in patients with ultra-high risk of developing psychosis: A randomized trial study protocol. Front Psychol 2022; 13:976661. [PMID: 36118431 PMCID: PMC9477005 DOI: 10.3389/fpsyg.2022.976661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 07/27/2022] [Indexed: 11/16/2022] Open
Abstract
Background Cognitive Behavioral Therapy is delivered in most of the early intervention services for psychosis in different countries around the world. This approach has been demonstrated to be effective in decreasing or at least delaying the onset of psychosis. However, none of them directly affect the comorbidity of these types of patients that is often the main cause of distress and dysfunctionality. The Unified Protocol for the Transdiagnostic Treatment of Emotional Disorders (UP) is a psychological intervention that combines cognitive-behavioral and third-generation techniques that address emotional dysregulation as an underlying mechanism that these disorders have in common. The application of this intervention could improve the comorbid emotional symptoms of these patients. Materials and methods The study is a randomized controlled trial in which one group receives immediate UP plus standard intervention and the other is placed on a waiting list to receive UP 7 months later, in addition to standard care in one of our early psychosis programs. The sample will be 42 patients with UHR for psychosis with comorbid emotional symptoms. The assessment is performed at baseline, at the end of treatment, and at 3-months’ follow-up, and includes: general psychopathology, anxiety and depression, positive and negative emotions, emotional dysregulation, personality, functionality, quality of life, cognitive distortions, insight, and satisfaction with the UP intervention. Discussion This will be the first study of the efficacy, acceptability, and viability of the UP in a sample of young adults with UHR. The results of this study may have clinical implications, contributing to improving the model of care for young people who consult for underlying psychotic, anxiety, and/or depressive symptoms that can lead to high distress and dysfunctionality. Clinical trial registration [https://clinicaltrials.gov/], identifier [NCT04929938].
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Affiliation(s)
- Trinidad Peláez
- Parc Sanitari Sant Joan de Déu, Barcelona, Spain
- Investigación Biomédica en Red de Salud Mental (CIBERSAM) Instituto de Salud Carlos III, Madrid, Spain
- *Correspondence: Trinidad Peláez,
| | - Raquel López-Carrillero
- Parc Sanitari Sant Joan de Déu, Barcelona, Spain
- Investigación Biomédica en Red de Salud Mental (CIBERSAM) Instituto de Salud Carlos III, Madrid, Spain
| | - Marta Ferrer-Quintero
- Parc Sanitari Sant Joan de Déu, Barcelona, Spain
- Investigación Biomédica en Red de Salud Mental (CIBERSAM) Instituto de Salud Carlos III, Madrid, Spain
| | - Susana Ochoa
- Parc Sanitari Sant Joan de Déu, Barcelona, Spain
- Investigación Biomédica en Red de Salud Mental (CIBERSAM) Instituto de Salud Carlos III, Madrid, Spain
| | - Jorge Osma
- Departamento de Psicología y Sociología, Universidad de Zaragoza, Zaragoza, Spain
- Instituto de Investigación Sanitaria de Aragón, Zaragoza, Spain
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31
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Pfender E, Caplan S. Nonverbal immediacy cues and impression formation in video therapy. COUNSELLING PSYCHOLOGY QUARTERLY 2022. [DOI: 10.1080/09515070.2022.2105816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Affiliation(s)
- Emily Pfender
- Department of Communication, University of Delaware, Newark, DE, USA
| | - Scott Caplan
- Department of Communication, University of Delaware, Newark, DE, USA
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Patients' experiences of home-based psychotherapy via videoconference: A qualitative study. Arch Psychiatr Nurs 2022; 39:91-96. [PMID: 35688550 DOI: 10.1016/j.apnu.2022.03.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 01/09/2022] [Accepted: 03/08/2022] [Indexed: 11/21/2022]
Abstract
The aim of this study is to explore adult outpatients' experiences with home-based psychotherapy via videoconferencing in a Danish mental health service. Participants found videoconferencing-based psychotherapy for preventive relapse sessions very useful, and they believed that it was possible to maintain a good therapeutic relationship via videoconferencing when they knew their therapist in advance. However, experiences with more in-depth psychotherapy are more unclear as some felt alienated and preferred other ways to communicate. In general, participants found videoconferencing-based psychotherapy to be less personal but worth considering when travel hassles outweigh the need for meeting in person.
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Leuchtenberg S, Gromer D, Käthner I. Videoconferencing versus
face‐to‐face
psychotherapy: Insights from patients and psychotherapists about comparability of therapeutic alliance, empathy and treatment characteristics. COUNSELLING & PSYCHOTHERAPY RESEARCH 2022. [DOI: 10.1002/capr.12538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Sophie Leuchtenberg
- Department of Psychology I, Biological Psychology, Clinical Psychology and Psychotherapy University of Würzburg Würzburg Germany
| | - Daniel Gromer
- Department of Psychology I, Biological Psychology, Clinical Psychology and Psychotherapy University of Würzburg Würzburg Germany
| | - Ivo Käthner
- Department of Psychology I, Biological Psychology, Clinical Psychology and Psychotherapy University of Würzburg Würzburg Germany
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Better than expected: client and clinician experiences of videoconferencing therapy (VT) during the COVID-19 pandemic. COGNITIVE BEHAVIOUR THERAPIST 2022. [DOI: 10.1017/s1754470x22000125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Abstract
Videoconferencing therapy (VT) has been an emerging medium of psychological therapy, and during the COVID-19 pandemic there has been substantial growth in its usage as a result of home working. However, there is a paucity of research into client and clinician perceptions of VT. This study sought to assess client and staff experiences of VT. This mixed methods study produced both quantitative and qualitative data. Seven clients who had previously received VT and 11 psychotherapists who had previously delivered VT were recruited from two NHS sites. Clients and psychotherapists took part in qualitative interviews which were analysed using thematic analysis. Quantitative surveys were developed based on themes generated from the interviews and were completed by 172 clients and 117 psychotherapists. These were analysed using simple percentages. VT often exceeded client and psychotherapist expectations and overall experiences of VT were generally positive, although there were mixed findings regarding the therapeutic alliance. Several barriers to VT were cited, such as IT issues, and challenges identified in conducting behavioural experiments, and potential exclusion of certain populations were also cited. The medium of VT was received well by both clients and clinicians, with advantages around convenience seemingly outweighing losses in quality of therapeutic relationship. Future research should focus on overcoming barriers to accessing VT in populations prone to digital exclusion. NHS services not currently employing VT may wish to reconsider their stance, expanding choice of therapy delivery and improving accessibility.
Key learning aims
(1)
To gain insight into client and clinician experiences of VT during the COVID-19 pandemic.
(2)
To assess the acceptability and feasibility of VT within two NHS short-term psychological support services.
(3)
To identify barriers and facilitators to the implementation of VT within two NHS short-term psychological support services.
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Nogami W, Nakagawa A, Kato N, Sasaki Y, Kishimoto T, Horikoshi M, Mimura M. Efficacy and Acceptability of Remote Cognitive Behavioral Therapy for Patients With Major Depressive Disorder in Japanese Clinical Settings: A Case Series. COGNITIVE AND BEHAVIORAL PRACTICE 2022; 30:S1077-7229(22)00080-3. [PMID: 36059862 PMCID: PMC9417319 DOI: 10.1016/j.cbpra.2022.04.002] [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] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Accepted: 04/14/2022] [Indexed: 11/26/2022]
Abstract
Remote cognitive and behavioral therapy (CBT) via videoconference has been garnering attention as a means of improving access to CBT for depression, in particular during the coronavirus disease 2019 pandemic. However, there is a lack of evidence supporting its implementation in Japanese clinical settings. This case series aimed to establish preliminary evidence of whether remote CBT can be an effective therapy for major depression in Japanese clinical settings. Five patients who met the diagnostic criteria for major depressive disorder were enrolled and underwent remote CBT via videoconference and face-to-face assessment interviews. The results showed that remote CBT via videoconference improved depressive symptoms, enabling a relatively high level of patient satisfaction and working alliance. Moreover, detailed feedback from our patients showed that continuous monitoring was preferable for increasing treatment engagement. Further research is warranted to test the efficacy and acceptability of remote CBT via videoconference for treating major depression.
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Affiliation(s)
- Waka Nogami
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo
| | - Atsuo Nakagawa
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo
- Department of Neuropsychiatry, St. Marianna University School of Medicine, Kawasaki
| | - Noriko Kato
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo
- National Center for Cognitive Behavioral Therapy and Research, National Center of Neurology and Psychiatry, Kodaira, Tokyo
| | - Yohei Sasaki
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo
| | - Taishiro Kishimoto
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo
- Hills Joint Research Laboratory for Future Preventive Medicine and Wellness, Keio University School of Medicine, Tokyo
| | - Masaru Horikoshi
- National Center for Cognitive Behavioral Therapy and Research, National Center of Neurology and Psychiatry, Kodaira, Tokyo
| | - Masaru Mimura
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo
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36
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Milosevic I, Cameron DH, Milanovic M, McCabe RE, Rowa K. Face-to-face versus Video Teleconference Group Cognitive Behavioural Therapy for Anxiety and Related Disorders: A Preliminary Comparison. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2022; 67:391-402. [PMID: 34159838 PMCID: PMC9065489 DOI: 10.1177/07067437211027319] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Telehealth is being increasingly incorporated into the delivery of mental health care and has received widespread attention during the COVID-19 pandemic for its ability to facilitate care during physical distancing restrictions. Videoconferencing is a common telehealth modality for delivering psychotherapy and has demonstrated similar outcomes to those of face-to-face therapy. Cognitive behavioural therapy (CBT) is the most common psychotherapy evaluated across various telehealth modalities; however, studies on CBT delivered via videoconference, particularly in a group therapy format, are lacking. Further, little research exists on videoconference group CBT for anxiety disorders. Accordingly, the present study compared the outcomes of group CBT for anxiety and related disorders delivered via videoconference versus face-to-face. METHOD Using a non-randomized design, data on attendance, dropout, clinical outcomes, and functional impairment were collected from 413 adult outpatients of a tertiary care anxiety disorders clinic who attended a CBT group for panic disorder/agoraphobia, social anxiety disorder, generalized anxiety disorder (GAD), or obsessive-compulsive disorder delivered either face-to-face (pre-COVID-19 pandemic) or via videoconference (since the onset of COVID-19 pandemic). Outcomes were assessed using well-validated self-report measures. Data were collected pre-treatment, across 12 weekly sessions, and post-treatment. Intent-to-treat analyses were applied to symptom outcome measures. RESULTS Face-to-face CBT conferred only a slight benefit over videoconference CBT for symptom outcomes across all groups, but when assessed individually, only the GAD group showed greater symptom improvement in the face-to-face format. Effect sizes for significant differences between the delivery formats were small. Participants in videoconference groups tended to have slightly higher attendance rates in some instances, whereas functional improvement and treatment dropout were comparable across the delivery formats. CONCLUSIONS Results provide preliminary evidence that videoconference group CBT for anxiety and related disorders may be a promising and effective alternative to face-to-face CBT. Additional research is needed to establish equivalence between these delivery formats.
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Affiliation(s)
- Irena Milosevic
- Anxiety Treatment and Research Clinic, 25479St. Joseph's Healthcare, Hamilton, Ontario, Canada.,Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Duncan H Cameron
- Anxiety Treatment and Research Clinic, 25479St. Joseph's Healthcare, Hamilton, Ontario, Canada
| | - Melissa Milanovic
- Anxiety Treatment and Research Clinic, 25479St. Joseph's Healthcare, Hamilton, Ontario, Canada.,Department of Psychology, Queen's University, Kingston, Ontario, Canada
| | - Randi E McCabe
- Anxiety Treatment and Research Clinic, 25479St. Joseph's Healthcare, Hamilton, Ontario, Canada.,Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Karen Rowa
- Anxiety Treatment and Research Clinic, 25479St. Joseph's Healthcare, Hamilton, Ontario, Canada.,Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
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Kaphzan H, Sarfati Noiman M, Negev M. The Attitudes and Perceptions of Israeli Psychiatrists Toward Telepsychiatry and Their Behavioral Intention to Use Telepsychiatry. Front Psychiatry 2022; 13:829965. [PMID: 35386519 PMCID: PMC8977602 DOI: 10.3389/fpsyt.2022.829965] [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: 12/06/2021] [Accepted: 02/24/2022] [Indexed: 11/13/2022] Open
Abstract
Background Although telemedicine care has grown in recent years, telepsychiatry is growing at a slower pace than expected, because service providers often hamper the assimilation and expansion of telepsychiatry due their attitudes and perceptions. The unified theory of acceptance and use of technology (UTAUT) is a model that was developed to assess the factors influencing the assimilation of a new technology. We used the UTAUT model to examine the associations between the attitudes and perceptions of psychiatrists in Israel toward telepsychiatry and their intention to use it. Methods An online, close-ended questionnaire based on a modified UTAUT model was distributed among psychiatrists in Israel. Seventy-six questionnaires were completed and statistically analyzed. Results The behavioral intention of Israeli psychiatrists to use telepsychiatry was relatively low, despite their perceptions of themselves as capable of high performance with low effort. Nonetheless, they were interested in using telepsychiatry voluntarily. Experience in telepsychiatry, and to a lesser extent, facilitating conditions, were found to be positively correlated with the intention to use telepsychiatry. Psychiatrists have a positive attitude toward treating patients by telepsychiatry and perceive its risk as moderate. Discussion Despite high performance expectancy, low effort expectancy, low perceived risk, largely positive attitudes, high voluntariness, and the expectancy for facilitating conditions, the intention to use telepsychiatry was rather low. This result is explained by the low level of experience, which plays a pivotal role. We recommend promoting the facilitating conditions that affect the continued use of telepsychiatry when initiating its implementation, and conclude that it is critical to create a sense of success during the initial stages of experience.
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Affiliation(s)
- Hanoch Kaphzan
- Department of Neurobiology, Faculty of Natural Sciences, University of Haifa, Haifa, Israel
| | | | - Maya Negev
- Division of Health Systems Policy and Administration, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
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38
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Patients’ and therapists’ experiences of CBT videoconferencing in anxiety disorders. COGNITIVE BEHAVIOUR THERAPIST 2022. [DOI: 10.1017/s1754470x22000083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Abstract
Cognitive behavioural therapy (CBT) videoconferencing has been demonstrated to be an effective treatment for anxiety disorders and an equal alternative to face-to-face CBT. However, qualitative patient and therapist experiences of CBT videoconferencing have been less researched. Due to COVID-19, mental health services have shifted to remote therapy methods; thus, understanding patient and therapist experiences are crucial to better inform service policies and best practices. The current study focused on patient and therapist experiences of CBT videoconferencing at the Centre for Anxiety Disorders and Trauma (CADAT). Researchers used qualitative content analysis to explore patients’ (n = 54) and therapists’ (n = 15) responses to an online survey. Results yielded four themes: behavioural experiments work well if the problem lends itself to videoconferencing, overall practicalities but some home environment implications, privacy and technical issues, high telepresence and the negative impact on the therapeutic alliance, and COVID-19 influences attitude positively. The findings have clinical implications for CBT videoconferencing, including a need for specific training in assessment and intervention for therapists using videoconferencing.
Key learning aims
Readers of this paper will be able to:
(1)
Describe patient and therapist qualitative experiences of CBT videoconferencing.
(2)
Identify areas to consider when delivering CBT videoconferencing in anxiety disorders.
(3)
Understand therapist training needs for CBT videoconferencing in anxiety disorders.
(4)
Inform own service protocols and best practices for the delivery of CBT videoconferencing.
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Schriger SH, Klein MR, Last BS, Fernandez-Marcote S, Dallard N, Jones B, Beidas RS. Community Mental Health Clinicians' Perspectives on Telehealth During the COVID-19 Pandemic: Mixed Methods Study. JMIR Pediatr Parent 2022; 5:e29250. [PMID: 35023839 PMCID: PMC8989386 DOI: 10.2196/29250] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 12/19/2021] [Accepted: 01/04/2022] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND In March 2020, a rapid shift to telehealth occurred in community mental health settings in response to the need for physical distancing to decrease transmission of the virus causing COVID-19. Whereas treatment delivered over telehealth was previously utilized sparingly in community settings, it quickly became the primary mode of treatment delivery for the vast majority of clinicians, many of whom had little time to prepare for this shift and limited to no experience using telehealth. Little is known about community mental health clinicians' experiences using telehealth. Although telehealth may make mental health treatment more accessible for some clients, it may create additional barriers for others given the high rates of poverty among individuals seeking treatment from community mental health centers. OBJECTIVE We examined community mental health clinicians' perspectives on using telehealth to deliver trauma-focused cognitive behavioral therapy to youth. We sought to better understand the acceptability of using telehealth, as well as barriers and facilitators to usage. METHODS We surveyed 45 clinicians across 15 community clinics in Philadelphia. Clinicians rated their satisfaction with telehealth using a quantitative scale and shared their perspectives on telehealth in response to open-ended questions. Therapists' responses were coded using an open-coding approach wherein coders generated domains, themes, and subthemes. RESULTS Clinicians rated telehealth relatively positively on the quantitative survey, expressing overall satisfaction with their current use of telehealth during the pandemic, and endorsing telehealth as a helpful mode of connecting with clients. Responses to open-ended questions fell into five domains. Clinicians noted that (1) telehealth affects the content (ie, what is discussed) and process (ie, how it is discussed) of therapy; (2) telehealth alters engagement, retention, and attendance; (3) technology is a crucial component of utilizing telehealth; (4) training, resources, and support are needed to facilitate telehealth usage; and (5) the barriers, facilitators, and level of acceptability of telehealth differ across individual clinicians and clients. CONCLUSIONS First, telehealth is likely a better fit for some clients and clinicians than others, and attention should be given to better understanding who is most likely to succeed using this modality. Second, although telehealth increased convenience and accessibility of treatment, clinicians noted that across the board, it was difficult to engage clients (eg, young clients were easily distracted), and further work is needed to identify better telehealth engagement strategies. Third, for many clients, the telehealth modality may actually create an additional barrier to care, as children from families living in poverty may not have the requisite devices or quality broadband connection to make telehealth workable. Better strategies to address disparities in access to and quality of digital technologies are needed to render telehealth an equitable option for all youth seeking mental health services.
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Affiliation(s)
- Simone H Schriger
- Department of Psychology, University of Pennsylvania, Philadelphia, PA, United States
| | - Melanie R Klein
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, United States
| | - Briana S Last
- Department of Psychology, University of Pennsylvania, Philadelphia, PA, United States
| | | | - Natalie Dallard
- Community Behavioral Health, Philadelphia, PA, United States
| | - Bryanna Jones
- Community Behavioral Health, Philadelphia, PA, United States
| | - Rinad S Beidas
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, United States
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
- Penn Implementation Science Center at the Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, United States
- Penn Medicine Nudge Unit, University of Pennsylvania Health System, Philadelphia, PA, United States
- Center for Health Incentives and Behavioral Economics, University of Pennsylvania, Philadelphia, PA, United States
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40
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Carrier JD, Gallagher F, Vanasse A, Roberge P. Strategies to improve access to cognitive behavioral therapies for anxiety disorders: A scoping review. PLoS One 2022; 17:e0264368. [PMID: 35231039 PMCID: PMC8887746 DOI: 10.1371/journal.pone.0264368] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 02/09/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Strategies to improve access to evidence-based psychological treatments (EBPTs) include but are not limited to implementation strategies. No currently available framework accounts for the full scope of strategies available to allow stakeholders to improve access to EBPTs. Anxiety disorders are common and impactful mental conditions for which EBPTs, especially cognitive-behavioral therapies (CBT), are well-established yet often hard to access. OBJECTIVE Describe and classify the various strategies reported to improve access to CBT for anxiety disorders. METHODS Scoping review with a keyword search of several databases + additional grey literature documents reporting on strategies to improve access to CBT for anxiety disorders. A thematic and inductive analysis of data based on grounded theory principles was conducted using NVivo. RESULTS We propose to classify strategies to improve access to CBT for anxiety disorders as either "Contributing to the evidence base," "Identifying CBT delivery modalities to adopt in practice," "Building capacity for CBT delivery," "Attuning the process of access to local needs," "Engaging potential service users," or "Improving programs and policies." Each of these strategies is defined, and critical information for their operationalization is provided, including the actors that could be involved in their implementation. IMPLICATIONS This scoping review highlights gaps in implementation research regarding improving access to EBPTs that should be accounted for in future studies.
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Affiliation(s)
- Jean-Daniel Carrier
- Department of family medicine and emergency medicine, PRIMUS research group, Université de Sherbrooke, Sherbrooke, Canada
- Department of psychiatry, Université de Sherbrooke, Sherbrooke, Canada
| | - Frances Gallagher
- School of nursing, Université de Sherbrooke, Sherbrooke, Canada
- Centre de recherche du CHUS, Sherbrooke, Canada
| | - Alain Vanasse
- Department of family medicine and emergency medicine, PRIMUS research group, Université de Sherbrooke, Sherbrooke, Canada
- Centre de recherche du CHUS, Sherbrooke, Canada
| | - Pasquale Roberge
- Department of family medicine and emergency medicine, PRIMUS research group, Université de Sherbrooke, Sherbrooke, Canada
- Department of psychiatry, Université de Sherbrooke, Sherbrooke, Canada
- Centre de recherche du CHUS, Sherbrooke, Canada
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41
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Kysely A, Bishop B, Kane RT, McDevitt M, De Palma M, Rooney R. Couples Therapy Delivered Through Videoconferencing: Effects on Relationship Outcomes, Mental Health and the Therapeutic Alliance. Front Psychol 2022; 12:773030. [PMID: 35185681 PMCID: PMC8855148 DOI: 10.3389/fpsyg.2021.773030] [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: 09/09/2021] [Accepted: 12/22/2021] [Indexed: 11/18/2022] Open
Abstract
Changing technology, and the pervasive demand created by a greater need in the population for access to mental health interventions, has led to the development of technologies that are shifting the traditional way in which therapy is provided. This study investigated the efficacy of a behavioral couples therapy program conducted via videoconferencing, as compared to face-to-face. There were 60 participants, in couples, ranging in age from 21 to 69 years old. Couples had been in a relationship for between 1 to 49 years. The 30 couples were randomly allocated to the face-to-face or videoconferencing group. They all took part in Couple CARE—a couples behavioral education program which promotes self-change in order to increase relationship satisfaction. The six session manualized intervention was offered in an identical manner to all clients, in each condition. Data analysis was based on several questionnaires completed by each couple at pre, post and 3-months follow-up. Results showed that therapeutic alliance ratings did not differ between groups, but increased significantly over time for both groups. Additionally, the results indicated improvements in relationship satisfaction, mental health, and all other outcome scores over time, which did not differ based on condition. This study uniquely contributes to the literature exploring the use of technology to provide therapy. Specifically, the study provides evidence for couples therapy via videoconferencing as a viable alternative to face-to-face interventions, especially for those couples who may not have access to the treatment they require. It is anticipated that the results of this study will contribute to the field of online therapy, and add to fostering confidence in agencies to allow expansion of services conducted via videoconferencing.
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Giovanetti AK, Punt SEW, Nelson EL, Ilardi SS. Teletherapy Versus In-Person Psychotherapy for Depression: A Meta-Analysis of Randomized Controlled Trials. Telemed J E Health 2022; 28:1077-1089. [PMID: 35007437 DOI: 10.1089/tmj.2021.0294] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Introduction: The recent surge in telehealth service delivery represents a promising development in the field's ability to address access gaps in health care across underserved populations. Telehealth also carries the potential to help reduce the societal burden of mental illnesses such as major depression, which often go untreated. There is now a sufficiently large corpus of randomized controlled trials to examine the comparative effectiveness of teletherapy and in-person services meta-analytically. Methods: We searched the PubMed, PsycINFO, and Cochrane Central Register of Controlled Trials (CENTRAL) databases for articles from January 1, 2000 to February 1, 2021 to identify randomized head-to-head trials of video-based versus in-person delivery of psychotherapy to reduce depressive symptoms. We conducted a random-effects meta-analysis to evaluate potential differences in efficacy rates. We calculated and meta-analyzed odds ratios to examine differential attrition rates between video and in-person conditions. Finally, we conducted subgroup analyses based on the primary treatment focus (depression or another condition) of each trial. Results: Primary study analyses yielded evidence that video-based psychotherapy is roughly comparable in efficacy with in-person psychotherapy for reducing depressive symptoms (g = 0.04, 95% confidence interval [CI = -0.12 to 0.20], p = 0.60, I2 = 5%). Likewise, attrition rates between the two conditions were not significantly different (odds ratio = 1.07, 95% CI = [0.78 to 1.49], p = 0.63, I2 = 25%). Finally, we did not observe significant subgroup differences in either efficacy (p = 0.38) or attrition (p = 0.94). Conclusions: The present findings suggest that video-based teletherapy may be a feasible and effective alternative to in-person services for reducing depressive symptoms. Continued research on the effectiveness of telehealth in clinically depressed samples, and further elucidation of the access barriers entailed by each delivery modality, can help the field better determine which patients will derive the greatest benefit from each mode of intervention.
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Affiliation(s)
| | | | - Eve-Lynn Nelson
- Department of Pediatrics and Kansas Center for Telemedicine and Telehealth, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Stephen S Ilardi
- Department of Psychology, University of Kansas, Lawrence, Kansas, USA
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A qualitative exploration of adolescents’ experiences of digital Dialectical Behaviour Therapy during the COVID-19 pandemic. COGNITIVE BEHAVIOUR THERAPIST 2022. [DOI: 10.1017/s1754470x22000460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Abstract
The UK government implemented national social-distancing measures in response to the global COVID19 pandemic. As a result, many appointments in the National Health Service (NHS) took place virtually, including psychological interventions in out-patient settings. This study explored the experiences of adolescents participating in a dialectical behaviour therapy (DBT-A) programme via teletherapy (i.e. via video or telephone call) in a Children and Adolescent Mental Health Service (CAMHS). Thirteen adolescents with emotion dysregulation and related problems completed an online qualitative survey about their experience and acceptance of DBT-A delivered virtually. Thematic analysis was conducted on the survey data and generated three over-arching themes: (1) sense of loss; (2) feeling uncontained; and (3) benefits of virtual DBT. These over-arching themes were composed of eight subthemes (‘loss of connection with group and therapist’; ‘loss of skills-building opportunities’; ‘limited privacy’; ‘lack of safe therapy space’; ‘difficult endings’; ‘home comforts’; ‘convenience and accessibility’; and ‘easier to participate with others’). This study suggests that adolescents doing virtual DBT-A need approaches that acknowledge and address the additional relational, emotional and practical challenges of online therapy while maintaining fidelity to the evidence-based treatment model. Suggestions for further research and preliminary practice guidelines are discussed.
Key learning aims
(1)
To learn about the experiences of adolescents participating in a DBT programme for adolescents (DBT-A) conducted virtually, including the challenges and benefits they identified.
(2)
To learn about implications for clinical practice and future research directions.
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Jadhakhan F, Blake H, Hett D, Marwaha S. Efficacy of digital technologies aimed at enhancing emotion regulation skills: Literature review. Front Psychiatry 2022; 13:809332. [PMID: 36159937 PMCID: PMC9489858 DOI: 10.3389/fpsyt.2022.809332] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 08/19/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The impact of emotion regulation (ER) interventions on mental health and wellbeing has been extensively documented in the literature, although only recently have digital technologies been incorporated in intervention design. The aim of this review is to explore available published literature relating to the efficacy, barriers and facilitators of digital technologies in enhancing emotion/mood regulation skills. METHODS A review of the literature was performed to explore the effectiveness of digital technology in enhancing ER skills. MEDLINE, CINAHL, PsycINFO and Web of Science databases were searched from inception to 31st August 2020. In addition, the first 10 pages of Google Scholar were examined for relevant articles. The following MeSH term and key words were used to identify relevant articles: "emotion regulation OR mood regulation" AND "intervention OR treatment OR program$ OR therap$" AND "digital technologies OR web-based OR mobile application OR App." Reference lists of retrieved papers were hand searched to identify additional publications. Findings were summarized narratively. RESULTS Titles and abstracts were reviewed by one reviewer in two phases, and confirmed by a second reviewer; discrepancies were resolved through discussion. First, the retrieved titles and abstracts were reviewed to identify relevant studies. Full texts of retrieved studies were then read to determine eligibility. The search resulted in 209 studies of which 191 citations were identified as potentially meeting the inclusion criteria. After reviewing the title and abstract of the 191 papers, 33 studies were identified as potentially meeting the inclusion criteria. Following full-text review, 10 studies met the inclusion criteria. Findings indicated the potential effectiveness of online, text-messaging, and smartphone interventions for enhancing ER skills. CONCLUSION There is encouraging evidence that digital technologies may be beneficial for enhancing ER skills and providing personalized care remotely. Digital technologies, particularly the use of smartphones, were instrumental in facilitating assessments and delivering online self-help interventions such as cognitive behavioral therapy. Continued research is required to rigorously evaluate the effectiveness of digital technologies in ER skills and carefully consider risks/benefits while determining how emerging technologies might support the scale-up of ER skills and mental health treatment.
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Affiliation(s)
- Ferozkhan Jadhakhan
- Institute for Mental Health, School of Psychology, College of Life and Environmental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Holly Blake
- School of Health Sciences, University of Nottingham, Nottingham, United Kingdom.,NIHR Nottingham Biomedical Research Centre, Nottingham, United Kingdom
| | - Danielle Hett
- Institute for Mental Health, School of Psychology, College of Life and Environmental Sciences, University of Birmingham, Birmingham, United Kingdom.,Birmingham and Solihull Mental Health NHS Foundation Trust, Birmingham, United Kingdom
| | - Steven Marwaha
- Institute for Mental Health, School of Psychology, College of Life and Environmental Sciences, University of Birmingham, Birmingham, United Kingdom.,Birmingham and Solihull Mental Health NHS Foundation Trust, Birmingham, United Kingdom
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45
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Goyal S. Can telepsychiatry bridge the treatment gap? JOURNAL OF MENTAL HEALTH AND HUMAN BEHAVIOUR 2022. [DOI: 10.4103/jmhhb.jmhhb_157_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
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46
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Matsumoto K, Hamatani S, Shimizu E. Effectiveness of Videoconference-Delivered Cognitive Behavioral Therapy for Adults With Psychiatric Disorders: Systematic and Meta-Analytic Review. J Med Internet Res 2021; 23:e31293. [PMID: 34898445 PMCID: PMC8713091 DOI: 10.2196/31293] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 09/14/2021] [Accepted: 10/29/2021] [Indexed: 12/23/2022] Open
Abstract
Background Cognitive behavioral therapy (CBT) is the gold standard of psychotherapy for psychiatric disorders. However, the format of delivering CBT in person limits access to the intervention. The advancements in information and communication technology, especially the internet, present an opportunity for cognitive behavioral therapists to service patients or clients in remote areas through videoconferencing. Although many randomized controlled trials of videoconference-delivered cognitive behavioral therapy (VCBT) have already been conducted, the overall estimated effect size of VCBT for psychiatric disorders has not been examined by systematic reviews and meta-analyses. Objective This study attempts to evaluate the effectiveness of VCBT for psychiatric disorders through a systematic and meta-analytic review. Methods A systematic review and meta-analysis of studies in which VCBT was directly compared to control groups (such as treatment as usual, attention control, wait-list control, and other minimal supports) was carried out. To identify previous studies that meet our study objective, 2 independent reviewers undertook a systematic search through seven databases: MEDLINE (via PubMed), Web of Science, Science Direct, PsycINFO, CINAHL, LILACS, and SciELO. Other databases (ClinicalTrials.gov and Cochrane Central Resister of Controlled Trials) were also checked. All studies included in the review were assessed using the quality criteria of the Cochrane Collaboration. Statistical analysis was performed by using Cochrane Review Manager (RevMan, version 5.4.0). Standardized mean difference was used in major meta-analyses where a P value of .05 or less was the threshold for statistical significance. A heterogeneity test and the chi-square test were performed to assess the presence and extent of statistical heterogeneity with significance set at P<.10. Funnel plots were visually inspected to assess the risk of bias. Subgroup analyses were conducted for each disorder to estimate intervention effects. Results The systematic search resulted in 16 studies (total N=1745) that met the criteria for this study and were included in the review. There were 10 studies on depressive symptoms, 3 on chronic pain, 1 on generalized anxiety disorder, 1 on obsessive-compulsive disorder, and 1 on hypochondriasis. The quality and risk of bias was also assessed. Results showed a pooled effect size (Hedge g) post treatment of −0.49 (95% CI –0.68 to –0.29), indicating that VCBT is effective for clients with psychiatric disorders. Study quality did not affect outcomes. Conclusions While the overall results indicate the effectiveness of VCBT, there are still only a limited number of studies on specific psychiatric and somatic conditions. Therefore, more randomized controlled trials are needed to establish the effectiveness of VCBT for different disorders. Trial Registration International Prospective Register of Systematic Reviews (PROSPERO) CRD42021224832; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=224832
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Affiliation(s)
- Kazuki Matsumoto
- Research Center for Child Mental Development, Chiba University, Chiba, Japan.,Laboratory of Neuropsychology, Institute of Liberal Arts and Science, Kanazawa University, Kanazawa, Japan
| | - Sayo Hamatani
- Research Center for Child Mental Development, Chiba University, Chiba, Japan.,Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden.,Research Center for Child Mental Development, University of Fukui, Fukui, Japan
| | - Eiji Shimizu
- Research Center for Child Mental Development, Chiba University, Chiba, Japan.,Department of Cognitive Behavioral Physiology, Graduate School of Medicine, Chiba University, Chiba, Japan.,Cognitive Behavioral Therapy Center, Chiba University Hospital, Chiba, Japan
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Buckman JEJ, Saunders R, Leibowitz J, Minton R. The barriers, benefits and training needs of clinicians delivering psychological therapy via video. Behav Cogn Psychother 2021; 49:696-720. [PMID: 33966666 DOI: 10.1017/s1352465821000187] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Due to the COVID-19 pandemic, mental health services have had to offer psychological therapy via video with little time to prepare or mitigate potential problems. Identifying the barriers, benefits and training needs highlighted by clinicians may support the effective delivery of care. METHOD Changes in the mode therapy sessions were delivered in during 2020 were assessed in two high-volume psychological therapies services. Sixty-six therapists completed a survey about their experiences of delivering therapy via video. RESULTS The lockdown in March 2020 precipitated a dramatic shift from face-to-face to telephone and video-delivered sessions. Most clinicians (89%) found video-based sessions acceptable. Barriers to effective delivery included technological issues, problems with online platforms, and feeling more tired after sessions. Benefits included generalised learning from behavioural work, improvements in efficiency and in the therapeutic relationship, particularly in comparison with telephone-based sessions. Tutorials and support guides were recommended to maximise use of sessions via video. CONCLUSIONS Video-delivered therapy was liked by clinicians and preferred to telephone-based sessions. Issues with platforms, internet connections and access for patients need addressing, local troubleshooting guides, video-based tutorials and greater support for low-intensity therapists to maximise uptake of video sessions where appropriate, may be beneficial.
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Affiliation(s)
- Joshua E J Buckman
- Centre for Outcomes Research and Effectiveness (CORE), Research Department of Clinical, Educational & Health Psychology, University College London, 1-19 Torrington Place, LondonWC1E 7HB, UK
- iCope - Camden & Islington Psychological Therapies Services - Camden & Islington NHS Foundation Trust, St Pancras Hospital, LondonNW1 0PE, UK
| | - Rob Saunders
- Centre for Outcomes Research and Effectiveness (CORE), Research Department of Clinical, Educational & Health Psychology, University College London, 1-19 Torrington Place, LondonWC1E 7HB, UK
| | - Judy Leibowitz
- iCope - Camden & Islington Psychological Therapies Services - Camden & Islington NHS Foundation Trust, St Pancras Hospital, LondonNW1 0PE, UK
| | - Rebecca Minton
- iCope - Camden & Islington Psychological Therapies Services - Camden & Islington NHS Foundation Trust, St Pancras Hospital, LondonNW1 0PE, UK
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Peros OM, Webb L, Fox S, Bernstein A, Hoffman L. Conducting Exposure-Based Groups via Telehealth for Adolescents and Young Adults With Social Anxiety Disorder. COGNITIVE AND BEHAVIORAL PRACTICE 2021; 28:679-689. [PMID: 34690482 PMCID: PMC8523107 DOI: 10.1016/j.cbpra.2021.04.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 04/03/2021] [Indexed: 11/30/2022]
Abstract
The rapid spread of COVID-19 and subsequent social distancing measures posed unprecedented challenges in providing mental health care and a swift transition of services to telehealth platforms. Social distancing measures create unique concerns for young people with social anxiety disorder who already struggle with social connection and isolation; therefore, the continuation of care via telehealth platforms is especially important for this population. To date, there is little literature regarding use of telehealth groups for this population and the current commentary aims to fill in this gap in the literature while also providing general guidelines for telehealth groups. The commentary discusses the delivery of an exposure-based cognitive behavioral therapy group for adolescents and young adults via telehealth and provides considerations, challenges, and benefits of conducting a group through a telehealth platform. In conjunction with clinically relevant examples and in-depth exposure discussions, we aim to provide guidance for youth-focused practitioners who are considering conducting groups in a telehealth format for a range of presentations.
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Affiliation(s)
- Olivia M Peros
- The Columbia University Clinic for Anxiety and Related Disorders and Hofstra University
| | - Lauren Webb
- The Columbia University Clinic for Anxiety and Related Disorders and Hofstra University
| | - Schuyler Fox
- The Columbia University Clinic for Anxiety and Related Disorders
| | - Alyssa Bernstein
- The Columbia University Clinic for Anxiety and Related Disorders
| | - Lauren Hoffman
- The Columbia University Clinic for Anxiety and Related Disorders
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Thomas N, McDonald C, de Boer K, Brand RM, Nedeljkovic M, Seabrook L. Review of the current empirical literature on using videoconferencing to deliver individual psychotherapies to adults with mental health problems. Psychol Psychother 2021; 94:854-883. [PMID: 33620133 PMCID: PMC8451850 DOI: 10.1111/papt.12332] [Citation(s) in RCA: 60] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 01/02/2021] [Indexed: 02/06/2023]
Abstract
PURPOSE The COVID-19 pandemic has resulted in a widespread adoption of videoconferencing as a communication medium in mental health service delivery. This review considers the empirical literature to date on using videoconferencing to deliver psychological therapy to adults presenting with mental health problems. METHOD Papers were identified via search of relevant databases. Quantitative and qualitative data were extracted and synthesized on uptake, feasibility, outcomes, and participant and therapist experiences. RESULTS Videoconferencing has an established evidence base in the delivery of cognitive behavioural therapies for post-traumatic stress disorder and depression, with prolonged exposure, cognitive processing therapy, and behavioural activation non-inferior to in-person delivery. There are large trials reporting efficacy for health anxiety and bulimia nervosa compared with treatment-as-usual. Initial studies show applicability of cognitive behavioural therapies for other anxiety and eating disorders and obsessive-compulsive spectrum disorders, but there has yet to be study of use in severe and complex mental health problems. Therapists may find it more difficult to judge non-verbal behaviour, and there may be initial discomfort while adapting to videoconferencing, but client ratings of the therapeutic alliance are similar to in-person therapy, and videoconferencing may have advantages such as being less confronting. There may be useful opportunities for videoconferencing in embedding therapy delivery within the client's own environment. CONCLUSIONS Videoconferencing is an accessible and effective modality for therapy delivery. Future research needs to extend beyond testing whether videoconferencing can replicate in-person therapy delivery to consider unique therapeutic affordances of the videoconferencing modality. PRACTITIONER POINTS Videoconferencing is an efficacious means of delivering behavioural and cognitive therapies to adults with mental health problems. Trial evidence has established it is no less efficacious than in-person therapy for prolonged exposure, cognitive processing therapy, and behavioural activation. While therapists report nonverbal feedback being harder to judge, and clients can take time to adapt to videoconferencing, clients rate the therapeutic alliance and satisfaction similarly to therapy in-person. Videoconferencing provides opportunities to integrate therapeutic exercises within the person's day-to-day environment.
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Affiliation(s)
- Neil Thomas
- National eTherapy CentreSwinburne University of TechnologyMelbourneVictoriaAustralia
- Centre for Mental HealthSwinburne University of TechnologyMelbourneVictoriaAustralia
- Alfred HospitalMelbourneVictoriaAustralia
| | - Caity McDonald
- Centre for Mental HealthSwinburne University of TechnologyMelbourneVictoriaAustralia
| | - Kathleen de Boer
- Centre for Mental HealthSwinburne University of TechnologyMelbourneVictoriaAustralia
| | - Rachel M. Brand
- Centre for Mental HealthSwinburne University of TechnologyMelbourneVictoriaAustralia
- School of Health and Behavioural SciencesUniversity of the Sunshine CoastSippy DownsQldAustralia
| | - Maja Nedeljkovic
- National eTherapy CentreSwinburne University of TechnologyMelbourneVictoriaAustralia
- Centre for Mental HealthSwinburne University of TechnologyMelbourneVictoriaAustralia
| | - Liz Seabrook
- National eTherapy CentreSwinburne University of TechnologyMelbourneVictoriaAustralia
- Centre for Mental HealthSwinburne University of TechnologyMelbourneVictoriaAustralia
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50
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Bertuzzi V, Fratini G, Tarquinio C, Cannistrà F, Granese V, Giusti EM, Castelnuovo G, Pietrabissa G. Single-Session Therapy by Appointment for the Treatment of Anxiety Disorders in Youth and Adults: A Systematic Review of the Literature. Front Psychol 2021; 12:721382. [PMID: 34539523 PMCID: PMC8440994 DOI: 10.3389/fpsyg.2021.721382] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Accepted: 07/31/2021] [Indexed: 12/29/2022] Open
Abstract
Purpose: This systematic review provides a summary of the available evidence of the efficacy of single-session therapy (SST) on anxiety disorders in both youth and adults. Methods: PubMed, Scopus, Medline, and Google Scholar databases were search for relevant articles, and the Cochrane Collaboration's tool for assessing the risk of bias in randomized trials was used for transparent reporting of the methodological quality of each selected study. Results: The search of electronic databases identified 18 reports based on rigorous inclusion criteria. Single-session therapy was found superior to no treatment in reducing anxiety symptoms, and similar results were observed while comparing SST to multi-treatment sessions. Discussion: The findings support the benefits of SST in enhancing cognitive, behavioral, and psychological outcomes in both youth and adults suffering from anxiety disorders across treatment conditions and approaches, SST thus appears to be a promising way of providing access to both private and public therapeutic services efficiently and cost-effectively. Conclusions: Single-session therapy is effective in treating anxiety disorders. Further research is required to quantify its cost-effectiveness and deepen the knowledge of effective treatment ingredients for both young people and the adult population suffering from diverse anxiety disorders. Systematic Review Registration: PROSPERO, identifier [CRD42021232024].
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Affiliation(s)
- Vanessa Bertuzzi
- Department of Psychology, Catholic University of Milan, Milan, Italy
| | - Giulia Fratini
- Department of Psychology, Catholic University of Milan, Milan, Italy
| | - Claudia Tarquinio
- Department of Psychology, Catholic University of Milan, Milan, Italy
| | | | - Valentina Granese
- Department of Psychology, Catholic University of Milan, Milan, Italy
| | - Emanuele Maria Giusti
- Department of Psychology, Catholic University of Milan, Milan, Italy
- Psychology Research Laboratory, Istituto Auxologico Italiano IRCCS, Milan, Italy
| | - Gianluca Castelnuovo
- Department of Psychology, Catholic University of Milan, Milan, Italy
- Psychology Research Laboratory, Istituto Auxologico Italiano IRCCS, Milan, Italy
| | - Giada Pietrabissa
- Department of Psychology, Catholic University of Milan, Milan, Italy
- Psychology Research Laboratory, Istituto Auxologico Italiano IRCCS, Milan, Italy
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