1
|
Sims-Rhodes N, Cornwell HE, Barena E, Dubre V, Elliott KS, Nabulsi EH, Yuen N, Sass SM, Miller A, Tiruneh YM, Singh KP. Perceived Barriers and Facilitators of Behavioral-Health Modality Change Adoption During the COVID-19 Pandemic: A Systematic Review. J Multidiscip Healthc 2024; 17:5695-5713. [PMID: 39649371 PMCID: PMC11624676 DOI: 10.2147/jmdh.s472060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2024] [Accepted: 10/07/2024] [Indexed: 12/10/2024] Open
Abstract
Introduction During the Coronavirus Disease 2019 pandemic, there was a surge in demand for mental health services worldwide, presenting challenges for healthcare institutions as they navigated changes in policy and safety regulations. In the United States, this resulted in many behavioral health modality changes to remain in compliance with the Center for Disease Control guidelines. A growing body of literature has documented these, yet few explored barriers and facilitators affecting the adoption of these modality delivery changes. The researchers conducted a systematic review using the PRISMA method, focusing on service delivery changes across healthcare systems in the United States from March 2020 to May 2022. Objective The study objective was to identify barriers and facilitators affecting the adoption of changes to modality delivery of behavioral health services due to pandemic restrictions. Methods This was a systematic review that utilized the PRISMA method. The researchers identified 445 initial articles from eight databases using predetermined keywords and implemented a three-round screening process to select the most pertinent articles for this review. The researchers used a thematic analysis focused on user-related, program-related, technology, and environment-related constructs relevant to engagement with digital mental health interventions, and also addressed provider and administrative-related barriers and facilitators of virtual behavioral health modality changes. Barriers and facilitators were operationalized using the Borghouts Model. Results This systematic review revealed several common barriers and facilitators, including underdeveloped technology infrastructure, privacy and confidentiality concerns, poor technology literacy, availability of diverse technology options, provider technology training, and ease of integration into everyday life. Conclusion This review provides insights into barriers and facilitators of modality change adoption, which could inform the development and implementation of virtual mental healthcare services and may help optimize the application of these services by improving our understanding and ability to overcome barriers influencing their adoption.
Collapse
Affiliation(s)
- Nicholas Sims-Rhodes
- Department of Epidemiology and Biostatistics, University of Texas at Tyler Health Science Center, Tyler, TX, USA
- Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX, USA
| | - Hannah E Cornwell
- Department of Epidemiology and Biostatistics, University of Texas at Tyler Health Science Center, Tyler, TX, USA
| | - Emily Barena
- Department of Psychology and Counseling, The University of Texas at Tyler, Tyler, TX, USA
| | - Vandy Dubre
- Robert R. Muntz Library, The University of Texas at Tyler, Tyler, TX, USA
| | - Kimberly S Elliott
- Department of Healthcare Policy, Economics and Management, University of Texas at Tyler Health Science Center, Tyler, TX, USA
| | - Eman H Nabulsi
- Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX, USA
| | - Nelly Yuen
- Department of Psychology and Counseling, The University of Texas at Tyler, Tyler, TX, USA
| | - Sarah M Sass
- Department of Psychology and Counseling, The University of Texas at Tyler, Tyler, TX, USA
| | - Anastasia Miller
- Department of Educational Leadership, Evaluation and Organizational Development, University of Louisville, Louisville, KY, USA
| | - Yordanos M Tiruneh
- Department of Preventive Medicine, University of Texas at Tyler Health Science Center, Tyler, TX, USA
| | - Karan P Singh
- Department of Epidemiology and Biostatistics, University of Texas at Tyler Health Science Center, Tyler, TX, USA
| |
Collapse
|
2
|
Gittins Stone DI, Elkins RM, Gardner M, Boger K, Sperling J. Examining the Effectiveness of an Intensive Telemental Health Treatment for Pediatric Anxiety and OCD During the COVID-19 Pandemic and Pediatric Mental Health Crisis. Child Psychiatry Hum Dev 2024; 55:1398-1412. [PMID: 36749490 PMCID: PMC9902833 DOI: 10.1007/s10578-023-01500-5] [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] [Accepted: 01/23/2023] [Indexed: 02/08/2023]
Abstract
Despite research supporting the efficacy of weekly outpatient videoconferencing-based cognitive behavioral therapy (VCBT), limited evidence exists about the benefits of leveraging VCBT for brief intensive formats. We examined the effectiveness of an intensive outpatient VCBT targeting pediatric anxiety and OCD. Quasi-experimental design was used to compare outcomes of intensive, in-person, group-based cognitive-behavioral therapy with medication management and caregiver guidance pre-pandemic, to a similar VCBT peri-pandemic (n = 130). Pretreatment and posttreatment assessments included patient- and caregiver-report of anxiety and functional impairment. Analyses of covariance were conducted, examining changes in anxiety and impairment between treatment groups, controlling for admission levels. No significant differences in posttreatment anxiety or impairment were observed between conditions. This study illustrates that intensive, group-based treatment for pediatric anxiety and OCD using VCBT is associated with comparable reductions in anxiety and impairment. It marks a crucial step toward providing broader access to quality care for youth in need.
Collapse
Affiliation(s)
| | - R Meredith Elkins
- McLean Hospital Belmont, Belmont, MA, USA
- Harvard Medical School, Cambridge, MA, USA
| | | | - Kathryn Boger
- McLean Hospital Belmont, Belmont, MA, USA
- Harvard Medical School, Cambridge, MA, USA
| | - Jacqueline Sperling
- McLean Hospital Belmont, Belmont, MA, USA
- Harvard Medical School, Cambridge, MA, USA
| |
Collapse
|
3
|
Al Dweik R, Ajaj R, Kotb R, Halabi DE, Sadier NS, Sarsour H, Elhadi YAM. Opportunities and challenges in leveraging digital technology for mental health system strengthening: a systematic review to inform interventions in the United Arab Emirates. BMC Public Health 2024; 24:2592. [PMID: 39334131 PMCID: PMC11429924 DOI: 10.1186/s12889-024-19980-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2024] [Accepted: 09/04/2024] [Indexed: 09/30/2024] Open
Abstract
Digital technology offers scalable, real-time interventions for mental health promotion and treatment. This systematic review explores the opportunities and challenges associated with the use of digital technology in mental health, with a focus on informing mental health system strengthening interventions in the United Arab Emirates (UAE). Following PRISMA guidelines, a systematic search of databases was conducted up to August 2023 and identified a total of 8479 citations of which 114 studies were included in the qualitative analysis. The included studies encompass diverse digital interventions, platforms, and modalities used across various mental health conditions. The review identifies feasible, acceptable, and efficacious interventions, ranging from telehealth and mobile apps to virtual reality and machine learning models. Opportunities for improving access to care, reducing patients' transfers, and utilizing real-world interaction data for symptom monitoring are highlighted. However, challenges such as digital exclusion, privacy concerns, and potential service replacement caution policymakers. This study serves as a valuable evidence base for policymakers and mental health stakeholders in the UAE to navigate the integration of digital technology in mental health services effectively.
Collapse
Affiliation(s)
- Rania Al Dweik
- Department of Public Health, College of Health Sciences, Abu Dhabi University, Abu Dhabi, United Arab Emirates.
| | - Rahaf Ajaj
- Department of Public Health, College of Health Sciences, Abu Dhabi University, Abu Dhabi, United Arab Emirates
| | - Reham Kotb
- Department of Public Health, College of Health Sciences, Abu Dhabi University, Abu Dhabi, United Arab Emirates
| | - Dima El Halabi
- Department of Public Health, College of Health Sciences, Abu Dhabi University, Abu Dhabi, United Arab Emirates
| | | | | | - Yasir Ahmed Mohammed Elhadi
- Department of Public Health, College of Health Sciences, Abu Dhabi University, Abu Dhabi, United Arab Emirates.
- Institute of Public Health, College of Medicine and Health Sciences, United Arab Emirates University, AL Ain, United Arab Emirates.
| |
Collapse
|
4
|
Ganesh S, Sharma LP, Das B. Hybrid Tele-cognitive Behavioural Therapy (Ht-CBT) for Obsessive-compulsive Disorder: An Innovation Integrating In-person and Online Psychotherapy. Indian J Psychol Med 2024; 46:276-278. [PMID: 38699761 PMCID: PMC11062316 DOI: 10.1177/02537176231219768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/05/2024] Open
Affiliation(s)
- Suhas Ganesh
- Central Institute of Psychiatry, Ranchi, Jharkhand, India
- Schizophrenia Neuropharmacology Research Group, Yale School of Medicine, New Haven, Connecticut, USA
- National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Lavanya P. Sharma
- National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Basudeb Das
- Central Institute of Psychiatry, Ranchi, Jharkhand, India
| |
Collapse
|
5
|
Heyman RE, Daly KA, Slep AMS, Wolff MS. Leveraging technology to increase the disseminability of evidence-based treatment of dental fear: An uncontrolled pilot study. J Public Health Dent 2024; 84:36-42. [PMID: 38114444 PMCID: PMC11173353 DOI: 10.1111/jphd.12598] [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: 03/02/2023] [Revised: 08/14/2023] [Accepted: 11/17/2023] [Indexed: 12/21/2023]
Abstract
OBJECTIVES U.S. and global estimates indicate that over 30% of adults fear receiving dental care, including over 20% who have visited a dentist in the last year, leading to avoidance and degraded oral and systemic health. Although evidence-based cognitive-behavioral treatments for dental fear (CBT-DF) exist, they have little impact on the millions who seek dental care annually because they are not disseminable (6 h of in-chair time, delivered only in person at a few sites). We developed a disseminable CBT-DF stepped-care treatment comprising (Step 1) a mobile-health application and, for those who remain fearful, (Step 2) a 1-h, one-on-one psychological treatment session that allows practice during exposure to the patient's most-feared stimuli. We hypothesized that the treatment would (a) be rated highly on usability and credibility and (b) result in clinically consequential (i.e., lowering fear into the 0-3 "no/low fear" zone) and statistically significant changes in global dental fear. METHOD Racially/ethnically diverse patients (N = 48) with moderate to severe dental fear were recruited; all completed Step 1, and n = 16 completed Step 2. RESULTS As hypothesized, users found the stepped-care treatment highly usable, credible, and helpful. Critically, this stepped-care approach produced reductions in patients' dental fear that were both clinically consequential (with half no longer fearful) and statistically significant (d = 1.11). CONCLUSIONS This usable, credible, stepped-care approach to dental fear treatment holds promise for liberating evidence-based CBT-DF from specialty clinics, allowing broad dissemination.
Collapse
Affiliation(s)
| | | | | | - Mark S. Wolff
- University of Pennsylvania School of Dental Medicine
| |
Collapse
|
6
|
Stepanova E, Thompson A, Yu G, Fu Y. Changes in mental health services in response to the COVID-19 pandemic in high-income countries: a rapid review. BMC Psychiatry 2024; 24:103. [PMID: 38321403 PMCID: PMC10845680 DOI: 10.1186/s12888-024-05497-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 01/03/2024] [Indexed: 02/08/2024] Open
Abstract
BACKGROUND Severe deterioration in mental health and disrupted care provision during the COVID-19 increased unmet needs for mental health. This review aimed to identify changes in mental health services for patients in response to the pandemic and understand the impact of the changes on patients and providers. METHODS Following the Cochrane guidance for rapid reviews, Cochrane CENTRAL, MEDLINE, Embase and PsycInfo were searched for empirical studies that investigated models of care, services, initiatives or programmes developed/evolved for patients receiving mental health care during COVID-19, published in English and undertaken in high-income countries. Thematic analysis was conducted to describe the changes and an effect direction plot was used to show impact on outcomes. RESULTS 33 of 6969 records identified were included reporting on patients' experiences (n = 24), care providers' experiences (n = 7) and mixed of both (n = 2). Changes reported included technology-based care delivery, accessibility, flexibility, remote diagnostics and evaluation, privacy, safety and operating hours of service provision. These changes had impacts on: (1) care access; (2) satisfaction with telehealth; (3) comparability of telehealth with face-to-face care; (4) treatment effectiveness; (5) continuity of care; (6) relationships between patients and care providers; (7) remote detection and diagnostics in patients; (8) privacy; (9) treatment length and (10) work-life balance. CONCLUSIONS A shift to telecommunication technologies had a significant impact on patients and care providers' experiences of mental health care. Improvements to care access, flexibility, remote forms of care delivery and lengths of operating service hours emerged as crucial changes, which supported accessibility to mental health services, increased attendance and reduced dropouts from care. The relationships between patients and care providers were influenced by service changes and were vastly depending on technological literacy and context of patients and availability and care access ranging from regular contact to a loss of in-person contact. The review also identified an increase in care inequality and a feeling of being disconnected among marginalised groups including homeless people, veterans and ethic minority groups. Telehealth in mental care could be a viable alternative to face-to-face service delivery with effective treatment outcomes. Further research is needed to better understand the impact of the changes identified particularly on underserved populations.
Collapse
Affiliation(s)
- Evgenia Stepanova
- Population Health Sciences Institute, Newcastle University, Newcastle, UK.
| | - Alex Thompson
- Population Health Sciences Institute, Newcastle University, Newcastle, UK
| | - Ge Yu
- Health Services and Population Research Department, Institute of Psychiatry, King's Health Economics, King's College London, Psychology & Neuroscience, London, UK
| | - Yu Fu
- Department of Primary Care and Mental Health, Institute of Population Health, University of Liverpool, Liverpool, UK
| |
Collapse
|
7
|
Elliott KS, Nabulsi EH, Sims-Rhodes N, Dubre V, Barena E, Yuen N, Morris M, Sass SM, Kennedy B, Singh KP. Modality and terminology changes for behavioral health service delivery during the COVID-19 pandemic: a systematic review. Front Psychiatry 2024; 14:1265087. [PMID: 38375514 PMCID: PMC10876001 DOI: 10.3389/fpsyt.2023.1265087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 11/27/2023] [Indexed: 02/21/2024] Open
Abstract
Introduction The COVID-19 pandemic prompted healthcare professionals to implement service delivery adaptations to remain in compliance with safety regulations. Though many adaptations in service delivery were reported throughout the literature, a wide variety of terminology and definitions were used. Methods To address this, we conducted a PRISMA review to identify service delivery adaptations across behavioral healthcare services in the United States from March 2020 to May 2022 and to identify variations in terminology used to describe these adaptations. We identified 445 initial articles for our review across eight databases using predetermined keywords. Using a two-round screening process, authors used a team approach to identify the most appropriate articles for this review. Results Our results suggested that a total of 14 different terms were used to describe service modality changes, with the most frequent term being telehealth (63%). Each term found in our review and the frequency of use across identified articles is described in detail. Discussion Implications of this review such as understanding modality changes during the COVID-19 pandemic and beyond are discussed. Our findings illustrate the importance of standardizing terminology to enhance communication and understanding among professionals.
Collapse
Affiliation(s)
- Kimberly S. Elliott
- Department of Healthcare Policy, Economics and Management, University of Texas at Tyler Health Science Center, Tyler, TX, United States
| | - Eman H. Nabulsi
- Department of Epidemiology and Biostatistics, University of Texas at Tyler, Tyler, TX, United States
| | - Nicholas Sims-Rhodes
- Department of Epidemiology and Biostatistics, University of Texas at Tyler, Tyler, TX, United States
| | - Vandy Dubre
- Robert R. Muntz Library, The University of Texas at Tyler, Tyler, TX, United States
| | - Emily Barena
- Department of Psychology and Counseling, The University of Texas at Tyler, Tyler, TX, United States
| | - Nelly Yuen
- Department of Psychology and Counseling, The University of Texas at Tyler, Tyler, TX, United States
| | - Michael Morris
- Department of Healthcare Policy, Economics and Management, University of Texas at Tyler Health Science Center, Tyler, TX, United States
| | - Sarah M. Sass
- Department of Psychology and Counseling, The University of Texas at Tyler, Tyler, TX, United States
| | - Bridget Kennedy
- Department of Psychology and Counseling, The University of Texas at Tyler, Tyler, TX, United States
| | - Karan P. Singh
- Department of Epidemiology and Biostatistics, University of Texas at Tyler, Tyler, TX, United States
| |
Collapse
|
8
|
Miegel F, Jelinek L, Moritz S, Lohse L, Yassari AH, Bücker L. Mixed results for exposure and response prevention therapy in mixed reality for patients with contamination-related obsessive-compulsive disorder: A randomized controlled pilot study. J Clin Psychol 2023; 79:2317-2336. [PMID: 37317567 DOI: 10.1002/jclp.23550] [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: 12/22/2022] [Revised: 03/22/2023] [Accepted: 05/28/2023] [Indexed: 06/16/2023]
Abstract
INTRODUCTION Technology-supported exposure and response prevention (ERP) for patients with obsessive-compulsive disorder (OCD) as tested in clinical research, holds promise but also has limitations. The present study aims to overcome these limitations by using mixed reality for ERP (MERP). The objectives of this pilot study were to evaluate the safety, feasibility, and acceptance of MERP and to identify possible obstacles. METHODS Twenty inpatients with contamination-related OCD were recruited and randomized to two conditions: MERP (six sessions in 3 weeks) and care as usual treatment. Patients were assessed before treatment (baseline), after the 3-week intervention period (post), as well as 3 months after post assessment (follow-up) regarding symptomatology (Y-BOCS). RESULTS Results showed a similar reduction in symptomatology in both groups from baseline to post. Regarding safety, no clinically significant deterioration was detected in the MERP group. Patients' evaluation of the MERP was heterogeneous. The qualitative feedback provided helpful indications for further development of the software. Sense of presence was below the midpoint of the scales. CONCLUSION This is the first study evaluating a MERP for patients with OCD that shows cautious evidence for the acceptance and safety of MERP. The results of the subjective evaluation suggest revisions of the software.
Collapse
Affiliation(s)
- Franziska Miegel
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, Hamburg, 20246, Germany
| | - Lena Jelinek
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, Hamburg, 20246, Germany
| | - Steffen Moritz
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, Hamburg, 20246, Germany
| | - Luzie Lohse
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, Hamburg, 20246, Germany
| | - Amir H Yassari
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, Hamburg, 20246, Germany
| | - Lara Bücker
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, Hamburg, 20246, Germany
| |
Collapse
|
9
|
Lin B, Costakis A, John M, Linder H. Decreased inpatient psychiatric admissions with telepsychiatry use during the COVID-19 pandemic. Front Psychiatry 2023; 14:1172019. [PMID: 37351003 PMCID: PMC10284274 DOI: 10.3389/fpsyt.2023.1172019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 05/17/2023] [Indexed: 06/24/2023] Open
Abstract
Objective This study examines the quality of care provided through telepsychiatry by comparing psychiatric hospitalization rates among patients receiving in-person psychiatric care prior to the COVID-19 pandemic with rates among patients receiving virtual psychiatric care during the COVID-19 pandemic. Methods Mental health-related hospitalization rates among patients enrolled in a large academic hospital's outpatient psychiatry programs between March 1, 2018 and February 28, 2022 were retrospectively analyzed. Four time periods were created, spanning March 1 to February 28 of the following year. Demographic and clinical data were collected from the electronic health record, and descriptive statistics were calculated. Change in hospitalization rate between time periods was evaluated using McNemar's test. Results In the 2018 time period, 7.38% of all enrolled patients were hospitalized, compared to 7.70% hospitalized in the 2019 period, 5.74% in the 2020 period, and 5.38% in the 2021 period. Patients enrolled in both the 2018 and the 2019 periods saw no difference in hospitalization rate between the 2 years (2.93% in 2018, 2.83% in 2019; p = 0.830); patients enrolled in both 2019 and 2020 saw significantly lower hospitalization rates in 2020 (5.47% in 2019, 4.58% in 2020; p = 0.022); and patients enrolled in both 2020 and 2021 saw no difference (3.34% in 2020, 3.23% in 2021; p = 0.777). Conclusion Psychiatric hospitalization rates significantly decreased between the 2019 and the 2020 periods, suggesting a decrease in admissions associated with adoption of telepsychiatry. Future research should differentiate the roles played by telepsychiatry and COVID-19-related factors in reducing hospitalization rates during the pandemic.
Collapse
Affiliation(s)
- Brendon Lin
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States
| | - Anna Costakis
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States
- Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, United States
| | - Majnu John
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States
- Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, United States
- Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, United States
| | - Howard Linder
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States
- Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, United States
| |
Collapse
|
10
|
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.
Collapse
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
| |
Collapse
|
11
|
Hamlett GE, Tyler J, Bredemeier K, Ballentine E, Brown LA. The impact of COVID-19 on treatment seeking and interest in internet-based therapy for anxiety-related disorders: An interrupted time-series analysis. Psychiatry Res 2023; 320:115044. [PMID: 36638695 PMCID: PMC9798668 DOI: 10.1016/j.psychres.2022.115044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 12/26/2022] [Accepted: 12/27/2022] [Indexed: 12/30/2022]
Abstract
AIMS To examine whether the onset of the COVID-19 pandemic led to a change in demand for psychiatric treatment, interest in internet-based therapy, and differences in treatment requests by self-reported diagnoses (e.g., Posttraumatic Stress Disorder, Obsessive Compulsive Disorder, Generalized Anxiety Disorder, and Social Anxiety Disorder). METHODS Using an interrupted time series design, we analyzed intake questionnaires of treatment-seeking patients (N = 1,954) at an anxiety treatment center between June 6, 2019 through September 13, 2021. RESULTS The change in general treatment-seeking from before to immediately after the global pandemic declaration was not statistically significant. However, there was a steady increase in treatment seeking, with a more pronounced increase from 2020 into 2021. Interest in internet-based therapy increased significantly after the onset of COVID-19. The number of treatment-seeking individuals who self-reported "concerns or diagnoses" of PTSD increased significantly. CONCLUSION The study supports anecdotal reports from clinics across the country about unprecedented demand for services. It highlights that many patients experienced an immediate impact of the pandemic on their self-reported concerns about trauma and PTSD symptoms, which has important clinical implications. It also highlights a shifting openness to internet-based services during the pandemic.
Collapse
Affiliation(s)
- Gabriella E. Hamlett
- University of Pennsylvania Perelman School of Medicine, Department of Psychiatry, Philadelphia, PA, USA,Harvard University, Department of Psychology, Cambridge, MA, USA
| | - Jeremy Tyler
- University of Pennsylvania Perelman School of Medicine, Department of Psychiatry, Philadelphia, PA, USA
| | - Keith Bredemeier
- University of Pennsylvania Perelman School of Medicine, Department of Psychiatry, Philadelphia, PA, USA
| | - Emily Ballentine
- University of Pennsylvania Perelman School of Medicine, Department of Psychiatry, Philadelphia, PA, USA
| | - Lily A. Brown
- University of Pennsylvania Perelman School of Medicine, Department of Psychiatry, Philadelphia, PA, USA,Corresponding author
| |
Collapse
|
12
|
Wiese AD, Drummond KN, Fuselier MN, Sheu JC, Liu G, Guzick AG, Goodman WK, Storch EA. Provider perceptions of telehealth and in-person exposure and response prevention for obsessive-compulsive disorder. Psychiatry Res 2022; 313:114610. [PMID: 35567851 PMCID: PMC9910090 DOI: 10.1016/j.psychres.2022.114610] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 05/04/2022] [Accepted: 05/06/2022] [Indexed: 01/27/2023]
Abstract
Until recently, psychotherapies, including exposure and response prevention (ERP) for obsessive-compulsive disorder (OCD), have primarily been delivered in-person. The COVID-19 pandemic required OCD providers delivering ERP to quickly transition to telehealth services. While evidence supports telehealth ERP delivery, limited research has examined OCD provider perceptions about patient characteristics that are most appropriate for this modality, as well as provider abilities to identify and address factors interfering with effective telehealth ERP. In the present study, OCD therapists (N = 113) rated the feasibility of delivering telehealth ERP relative to in-person for different (1) patient age-groups, (2) levels of OCD severity, and (3) provider ability to identify and address factors interfering with ERP during in-person and telehealth ERP (e.g., cognitive avoidance, reassurance seeking, etc.). Providers reported significantly greater feasibility of delivering telehealth ERP to individuals ages 13-to-65-years relative to other age groups assessed. Greater perceived feasibility for telehealth relative to in-person ERP was reported for lower versus higher symptom severity levels. Lastly, providers felt better able to identify and address problematic factors in-person. These findings suggest that providers should practice appropriate caution when offering telehealth ERP for certain patients with OCD. Future research may examine how to address these potential limitations of telehealth ERP delivery.
Collapse
Affiliation(s)
- Andrew D Wiese
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, United States
| | - Kendall N Drummond
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, United States; Department of Psychology, Texas Christian University, Fort Worth, TX, United States
| | - Madeleine N Fuselier
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, United States
| | - Jessica C Sheu
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, United States
| | - Gary Liu
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Andrew G Guzick
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, United States
| | - Wayne K Goodman
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, United States
| | - Eric A Storch
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, United States.
| |
Collapse
|