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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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2
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Kucer A, Derella OJ, Kilbride A, Zayde A. Therapeutic Alliance and Group Cohesion Across Telehealth Delivery of Mentalizing-focused Parenting Groups. Int J Group Psychother 2024; 74:122-148. [PMID: 38513156 PMCID: PMC11088874 DOI: 10.1080/00207284.2024.2319627] [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] [Indexed: 03/23/2024]
Abstract
This study assessed changes in therapeutic alliance and group cohesion among parents/primary caregivers enrolled in Connecting and Reflecting Experience (CARE), a short-term, group-based, mentalizing-focused parenting program designed to support a diverse community facing socioeconomic and health disparities. Caregivers (N = 44) experiencing parenting stress or parent-child relational challenges were recruited from their children's outpatient psychiatry clinic to participate in one of nine 12-session telehealth CARE groups. Caregivers completed the Working Alliance Inventory-Short Revised and the Therapeutic Factors Inventory Cohesiveness subscale after CARE Sessions 1 and 12. Ratings of group cohesion and therapeutic bond with facilitators increased significantly across treatment. Findings indicate that caregivers from underserved families with high levels of parenting stress experienced an increase in group cohesion and therapeutic alliance throughout a telehealth adaptation of CARE.
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Affiliation(s)
| | - Olivia J. Derella
- Montefiore Medical Center / Albert Einstein College of Medicine, Bronx, NY
| | - Anna Kilbride
- Montefiore Medical Center / Albert Einstein College of Medicine, Bronx, NY
| | - Amanda Zayde
- Montefiore Medical Center / Albert Einstein College of Medicine, Bronx, NY
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Walton CJ, Gonzalez S, Cooney EB, Leigh L, Szwec S. Engagement over telehealth: comparing attendance between dialectical behaviour therapy delivered face-to-face and via telehealth for programs in Australia and New Zealand during the Covid-19 pandemic. Borderline Personal Disord Emot Dysregul 2023; 10:16. [PMID: 37208784 DOI: 10.1186/s40479-023-00221-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 04/24/2023] [Indexed: 05/21/2023] Open
Abstract
BACKGROUND While the COVID-19 crisis has had numerous global negative impacts, it has also presented an imperative for mental health care systems to make digital mental health interventions a part of routine care. Accordingly, through necessity, many Dialectical Behaviour Therapy (DBT) programs transitioned to telehealth, despite little information on clinical outcomes compared with face-to-face treatment delivery. This study examined differences in client engagement (i.e. attendance) of DBT: delivered face-to-face prior to the first COVID-19 lockdown in Australia and New Zealand; delivered via telehealth during the lockdown; and delivered post-lockdown. Our primary outcomes were to compare: [1] client attendance rates of DBT individual therapy delivered face-to-face with delivery via telehealth, and [2] client attendance rates of DBT skills training delivered face-to-face compared with delivery via telehealth. METHODS DBT programs across Australia and New Zealand provided de-identified data for a total of 143 individuals who received DBT treatment provided via telehealth or face-to-face over a six-month period in 2020. Data included attendance rates of DBT individual therapy sessions; attendance rates of DBT skills training sessions as well as drop-out rates and First Nations status of clients. RESULTS A mixed effects logistic regression model revealed no significant differences between attendance rates for clients attending face-to-face sessions or telehealth sessions for either group therapy or individual therapy. This result was found for clients who identified as First Nations persons and those who didn't identify as First Nations persons. CONCLUSIONS Clients were as likely to attend their DBT sessions over telehealth as they were face-to-face during the first year of the Covid-19 pandemic. These findings provide preliminary evidence that providing DBT over telehealth may be a viable option to increase access for clients, particularly in areas where face-to-face treatment is not available. Further, based on the data collected in this study, we can be less concerned that offering telehealth treatment will compromise attendance rates compared to face-to-face treatment. Further research is needed comparing clinical outcomes between treatments delivered face-to-face compared delivery via telehealth.
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Affiliation(s)
- Carla J Walton
- Centre for Psychotherapy, Hunter New England Mental Health Service, 2300, PO Box 833, Newcastle, NSW, Australia
| | - Sharleen Gonzalez
- Centre for Psychotherapy, Hunter New England Mental Health Service, 2300, PO Box 833, Newcastle, NSW, Australia
| | - Emily B Cooney
- Department of Psychological Medicine, Wellington Medical School, University of Otago (Te Whare, Wānanga o Otāgo ki Te Whanga-Nui-a-Tara), Newtown, Wellington, New Zealand
- Yale University, New Haven, Connecticut, United States of America
| | - Lucy Leigh
- Data Sciences Unit, Hunter Medical Research Institute, Lot 1 Kookaburra Circuit, 2305, New Lambton Heights, NSW, Australia
| | - Stuart Szwec
- Data Sciences Unit, Hunter Medical Research Institute, Lot 1 Kookaburra Circuit, 2305, New Lambton Heights, NSW, Australia
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Terrazas-Carrillo E, Garcia E, Rodriguez K, Malagon A, Gonzalez M, Garcia S. Telehealth Psychoeducational Groups With Latinx College Students: Findings From Focus Groups. Int J Group Psychother 2023; 73:75-115. [PMID: 38446566 DOI: 10.1080/00207284.2022.2159414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Abstract
The literatures examining psychoeducational groups and telehealth services have demonstrated positive results but less is known about the efficacy of psychoeducational telehealth groups. This study examines the perspectives of 105 Latinx college students who participated in an 8-session psychoeducational group via a telehealth platform during the COVID-19 pandemic. The research questions included (a) What was the experience of these Latinx college students participating in telehealth psychoeducational groups? and (b) What were the potential perceived advantages and disadvantages of implementing telehealth psychoeducational groups? Postintervention, a total of 16 focus groups were convened with a total of 105 Latinx college students (average number of participants per group = 6). Interviews were coded using conventional qualitative analysis and yielded four main themes: (1) group cohesion, which involved group members feeling that they were connected and that the group was a safe space; (2) group leaders, which involved leaders' preparation and knowledge and their ability to foster a safe environment); (3) cultural issues, which involved cultural values and acculturative and first-generation stress.; and (4) telehealth implementation, wherein participants described advantages and disadvantages of the telehealth approach. We discuss study limitations and directions for future research.
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Joy D, Caddle A. A service evaluation to examine the effectiveness of chronic pain management programmes delivered using video conferencing technology compared to in-person. Br J Pain 2023; 17:142-151. [PMID: 37057256 PMCID: PMC10088418 DOI: 10.1177/20494637221135125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Introduction The Covid-19 pandemic required rapid substitution of in-person Pain Management Programmes (PMP) delivery with delivery via videoconferencing technologies (VCT). No prior published VCT-PMP effectiveness findings were found, so an evaluation was conducted to explore effectiveness of this method and to compare psychometric outcomes with pre-pandemic, in-person- PMPs, delivered in routine clinical settings. Methods Participants were routinely attending PMPs. A consecutive series of six in-person-PMPs (n = 61) immediately prior to the pandemic were compared with the first series of six VCT-PMPs (n = 64) delivered in the same services. A within-subjects comparison of clinical outcomes (pre-post for VCT-PMP and in-person PMP) and a between-subjects comparison of delivery type was conducted (two-way mixed ANOVA). Reliable change indices examined reliable improvements and deteriorations by delivery type. Results Both PMP delivery format groups made significant improvements in anxiety, depression, pain self-efficacy, chronic pain acceptance and pain catastrophising. No significant difference was found between VCT-PMP and in-person-PMP on each of the measures. Reliable change indices indicated similar levels of improvement and deterioration with each delivery format with improvements far outweighing deteriorations. Attrition was greater in the VCT format (33%) versus in-person-PMP (18%). Conclusion This study indicates that meaningful change as measured by standard psychometric questionnaires can occur in PMPs delivered via VCT and appear broadly equivalent to that achieved through in-person delivery. Physical performance outcomes such as quality and amount of movement were not measured or explored.
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The benefits of continuing patient and public involvement as part of a randomised controlled trial during the Covid-19 global pandemic. RESEARCH FOR ALL 2023. [DOI: 10.14324/rfa.07.1.03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/20/2023]
Abstract
Patient and public involvement (PPI) in clinical research strengthens the quality and relevance of research, and has been crucial to ensure that researchers continue to investigate relevant and important topics during the global Covid-19 pandemic. The MICE (Mental Health Intervention for Children with Epilepsy) randomised controlled trial relies upon PPI to steer the direction and delivery of the trial, and the PPI Research Advisory Group (RAG) adapted to remote online meetings during the pandemic. This article first describes how the PPI RAG supported the research trial during the course of the pandemic, particularly with key trial stages of recruitment, retention and follow-up. It considers how the PPI tasks were adapted to ensure that they remained meaningful throughout this period, particularly for children and young people. Second, the article explores the acceptability of PPI in research using teleconferencing methods, via a co-produced survey of the PPI group members. Survey results indicated that, while participants valued face-to-face meetings, having remote PPI meetings was preferable to having nothing. There was some suggestion that teleconferencing platforms make it challenging for reserved members of the group, and for children, to contribute. Our findings emphasise the importance of continuing PPI even when circumstances are sub-optimal. We hope that our findings will contribute to the wider conversation about what makes PPI effective, particularly in a digital world.
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Özdemir MB, Bengisoy A. Effects of an Online Solution-Focused Psychoeducation Programme on Children’s Emotional Resilience and Problem-Solving Skills. Front Psychol 2022; 13:870464. [PMID: 35936282 PMCID: PMC9346442 DOI: 10.3389/fpsyg.2022.870464] [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: 02/06/2022] [Accepted: 05/16/2022] [Indexed: 11/13/2022] Open
Abstract
This study investigates the effects of a solution-oriented and approach-based psychoeducation programme, initiated in December 2019 and conducted online during the worldwide COVID-19 pandemic, on children’s emotional resilience and problem-solving skills. In the world that was closed with the pandemic, children were kept away from the social support system of teachers and friends. Pandemic isolated the children. The negative experiences associated with COVID-19 have placed both traditional approaches and important online learning and support applications on the agenda, since both can help to solve the problems we face. Educators and experts have provided psychological support services, questioning the methods used to reach people during the pandemic and rediscovering alternative ways of connecting with individuals through online media. The online framework of this study emerged in response to the needs caused by the pandemic. The study is designed using a real experimental pattern and is based on a pretest-posttest, experimental/control-group model. The Social Support Evaluation Scale for Children and Teenagers was used to select the participants. In total, 18 participants were equally assigned to research groups (experiment n = 9, control n = 9). The psychoeducation programme consisted of six sessions, each lasting 50–60 min on average. Research carried out online during the pandemic shows that this psychoeducation programme is effective in strengthening students’ problem-solving and emotional resilience skills. These findings are discussed within the framework of the literature, followed by recommendations.
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Affiliation(s)
- Melih Burak Özdemir
- Department of Guidance and Psychological Counseling, Institute of Graduate Studies and Research, European University of Lefke, Mersin, Turkey
- *Correspondence: Melih Burak Özdemir, ;
| | - Ayşe Bengisoy
- Department of Psychological Counseling and Guidance, Faculty of Education, European University of Lefke, Mersin, Turkey
- Ayşe Bengisoy,
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Blending Internet-based and tele group treatment: Acceptability, effects, and mechanisms of change of cognitive behavioral treatment for depression. Internet Interv 2022; 29:100551. [PMID: 35722084 PMCID: PMC9204733 DOI: 10.1016/j.invent.2022.100551] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 05/23/2022] [Accepted: 05/30/2022] [Indexed: 11/20/2022] Open
Abstract
The current COV-19 pandemic increases the need for remote treatment. Among several provision strategies, tele groups have been tested as an efficient option. Still, the number of studies is comparably low, with a clear lack of studies investigating supposed treatment mechanisms. Sixty-one mildly to moderately depressed participants from Salzburg, Bavaria, and Upper Austria were randomized to the intervention or a waiting list control group (RCT). The seven-week treatment comprised preparatory online modules, followed by personalized feedback and a subsequent tele group session. Large treatment effects were observed for depression (CES-D: d = 0.99, p < .001; PHQ-9: d = 0.87, p = .002), together with large effects for cognitive behavioral skills (cognitive style, and behavioral activation, d = 0.88-0.97). Changes in skills mediated treatment outcomes for CES-D and PHQ-9, suggesting comparable mechanisms as in face-to-face therapy. Two typical moderators, therapeutic alliance, and group cohesion, however, failed to predict outcome (p = .289), or only exhibited statistical tendencies (p = .049 to .071). Client satisfaction, system usability, and treatment adherence were high. Blending Internet-based and tele group interventions offers additional options for low-threshold care that is less dependent on population density, commuting distances, or constraints due to the current COV-19 crisis. Results indicate that the blended intervention is clinically effective by fostering core CBT skills. While findings suggest the notion that working alliance and group cohesion can be established online, their relevancy for outcomes of blended treatment needs to be further investigated.
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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: 1.0] [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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Gnanapragasam SN, Hariman K, Ventriglio A. Editorial: To zoom or not to zoom - that is the question. Int J Soc Psychiatry 2021; 67:974-976. [PMID: 33827315 DOI: 10.1177/00207640211004991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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A Preliminary Examination of the Acceptability, Feasibility, and Effectiveness of a Telehealth Cognitive-Behavioral Therapy Group for Social Anxiety Disorder. COGNITIVE AND BEHAVIORAL PRACTICE 2021. [DOI: 10.1016/j.cbpra.2021.04.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Mazziotti R, Rutigliano G. Tele-Mental Health for Reaching Out to Patients in a Time of Pandemic: Provider Survey and Meta-analysis of Patient Satisfaction. JMIR Ment Health 2021; 8:e26187. [PMID: 34114956 PMCID: PMC8323764 DOI: 10.2196/26187] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 02/13/2021] [Accepted: 05/13/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic threatened to impact mental health by disrupting access to care due to physical distance measures and the unexpected pressure on public health services. Tele-mental health was rapidly implemented to deliver health care services. OBJECTIVE The aims of this study were (1) to present state-of-the-art tele-mental health research, (2) to survey mental health providers about care delivery during the pandemic, and (3) to assess patient satisfaction with tele-mental health. METHODS Document clustering was applied to map research topics within tele-mental health research. A survey was circulated among mental health providers. Patient satisfaction was investigated through a meta-analysis of studies that compared satisfaction scores between tele-mental health and face-to-face interventions for mental health disorders, retrieved from Web of Knowledge and Scopus. Hedges g was used as the effect size measure, and effect sizes were pooled using a random-effect model. Sources of heterogeneity and bias were examined. RESULTS Evidence on tele-mental health has been accumulating since 2000, especially regarding service implementation, depressive or anxiety disorders, posttraumatic stress disorder, and special populations. Research was concentrated in a few countries. The survey (n=174 respondents from Italy, n=120 international) confirmed that, after the onset of COVID-19 outbreak, there was a massive shift from face-to-face to tele-mental health delivery of care. However, respondents held skeptical views about tele-mental health and did not feel sufficiently trained and satisfied. Meta-analysis of 29 studies (n=2143) showed that patients would be equally satisfied with tele-mental health as they are with face-to-face interventions (Hedges g=-0.001, 95% CI -0.116 to 0.114, P=.98, Q=43.83, I2=36%, P=.03) if technology-related issues were minimized. CONCLUSIONS Mental health services equipped with tele-mental health will be better able to cope with public health crises. Both providers and patients need to be actively engaged in digitization, to reshape their reciprocal trust around technological innovations.
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Affiliation(s)
- Raffaele Mazziotti
- Institute of Neuroscience, National Research Council (CNR), Pisa, Italy.,Department of Neuroscience, Psychology, Drug Research and Child Health (NEUROFARBA), University of Florence, Florence, Italy
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Barnett P, Goulding L, Casetta C, Jordan H, Sheridan-Rains L, Steare T, Williams J, Wood L, Gaughran F, Johnson S. Implementation of Telemental Health Services Before COVID-19: Rapid Umbrella Review of Systematic Reviews. J Med Internet Res 2021; 23:e26492. [PMID: 34061758 PMCID: PMC8335619 DOI: 10.2196/26492] [Citation(s) in RCA: 61] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 03/30/2021] [Accepted: 04/30/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Telemental health care has been rapidly adopted for maintaining services during the COVID-19 pandemic, and a substantial interest is now being devoted in its future role. Service planning and policy making for recovery from the pandemic and beyond should draw on both COVID-19 experiences and the substantial research evidence accumulated before this pandemic. OBJECTIVE We aim to conduct an umbrella review of systematic reviews available on the literature and evidence-based guidance on telemental health, including both qualitative and quantitative literature. METHODS Three databases were searched between January 2010 and August 2020 for systematic reviews meeting the predefined criteria. The retrieved reviews were independently screened, and those meeting the inclusion criteria were synthesized and assessed for risk of bias. Narrative synthesis was used to report these findings. RESULTS In total, 19 systematic reviews met the inclusion criteria. A total of 15 reviews examined clinical effectiveness, 8 reported on the aspects of telemental health implementation, 10 reported on acceptability to service users and clinicians, 2 reported on cost-effectiveness, and 1 reported on guidance. Most reviews were assessed to be of low quality. The findings suggested that video-based communication could be as effective and acceptable as face-to-face formats, at least in the short term. Evidence on the extent of digital exclusion and how it can be overcome and that on some significant contexts, such as children and young people's services and inpatient settings, was found to be lacking. CONCLUSIONS This umbrella review suggests that telemental health has the potential to be an effective and acceptable form of service delivery. However, we found limited evidence on the impact of its large-scale implementation across catchment areas. Combining previous evidence and COVID-19 experiences may allow realistic planning for the future implementation of telemental health.
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Affiliation(s)
- Phoebe Barnett
- Centre for Outcomes Research and Effectiveness, Division of Psychology and Language Sciences, University College London, London, United Kingdom.,NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, London, United Kingdom
| | - Lucy Goulding
- King's Improvement Science, Centre for Implementation Science, King's College London, London, United Kingdom
| | - Cecilia Casetta
- NIHR Applied Research Collaboration, King's College London, London, United Kingdom
| | - Harriet Jordan
- NIHR Applied Research Collaboration, King's College London, London, United Kingdom.,Institute of Psychiatry, Psychology and Neuroscience, King's College London and South London and Maudsley NHS Trust, London, United Kingdom
| | - Luke Sheridan-Rains
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, London, United Kingdom
| | - Thomas Steare
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, London, United Kingdom
| | - Julie Williams
- Centre for Implementation Science, Health Service and Population Research Department, King's College London, London, United Kingdom
| | - Lisa Wood
- Division of Psychiatry, University College London, London, United Kingdom
| | - Fiona Gaughran
- NIHR Applied Research Collaboration, King's College London, London, United Kingdom.,Institute of Psychiatry, Psychology and Neuroscience, King's College London and South London and Maudsley NHS Trust, London, United Kingdom
| | - Sonia Johnson
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, London, United Kingdom.,Camden and Islington NHS Foundation Trust, London, United Kingdom
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Simpson S, Richardson LK, Pelling N. Introduction to the Special Issue “Telepsychology: Research and Practice”. AUSTRALIAN PSYCHOLOGIST 2020. [DOI: 10.1111/ap.12146] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Affiliation(s)
- Susan Simpson
- School of Psychology, Social Work and Social Policy, University of South Australia,
| | | | - Nadine Pelling
- School of Psychology, Social Work and Social Policy, University of South Australia,
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15
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Frueh BC. Solving Mental Healthcare Access Problems in the Twenty‐first Century. AUSTRALIAN PSYCHOLOGIST 2020. [DOI: 10.1111/ap.12140] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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16
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Simpson S, Richardson L, Pietrabissa G, Castelnuovo G, Reid C. Videotherapy and therapeutic alliance in the age of COVID-19. Clin Psychol Psychother 2020; 28:409-421. [PMID: 33037682 PMCID: PMC7675483 DOI: 10.1002/cpp.2521] [Citation(s) in RCA: 89] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 09/23/2020] [Accepted: 09/26/2020] [Indexed: 12/17/2022]
Abstract
The arrival of the coronavirus (COVID‐19) pandemic has confronted us with a global and unprecedented challenge of community‐wide psychological distress alongside reduced access to therapeutic services in the traditional face‐to‐face format, due to the need to self‐isolate. This previously unimagineable set of circumstances provides a unique opportunity, and indeed an imperative, for videotherapy to fulfil its potential in addressing mental health and well‐being needs from a distance. Historically, the uptake of videotherapy has been hindered by psychotherapist expectations of inferior therapeutic alliance and outcomes, in spite of considerable research evidence to the contrary. Research suggests that videotherapy provides a powerful pathway for clients to experience enhanced opportunities for self‐expression, connection and intimacy. This more neutral therapeutic ‘space’ provides clients with multifarious opportunities for self‐awareness, creative experience and collaboration, with potentially a greater sense of agency over their own experience. This paper explores ways in which videotherapy can lead to a revitalisation of the concept of the therapeutic relationship, in order to meet the challenges associated with COVID‐19. A number of specific considerations for videotherapy adaptations and etiquette in the midst of COVID‐19 are described.
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Affiliation(s)
- Susan Simpson
- NHS Lothian, St. John's Hospital, Livingston, UK.,Department of Justice & Society, University of South Australia, Adelaide, SA, Australia
| | - Lisa Richardson
- North Metropolitan Health Service, MHPHDS, Perth, WA, Australia
| | - Giada Pietrabissa
- Psychology Research Laboratory, I.R.C.C.S. Istituto Auxologico Italiano, Milan, Italy.,Department of Psychology, Catholic University of the Sacred Heart, Milan, Italy
| | - Gianluca Castelnuovo
- Psychology Research Laboratory, I.R.C.C.S. Istituto Auxologico Italiano, Milan, Italy.,Department of Psychology, Catholic University of the Sacred Heart, Milan, Italy
| | - Corinne Reid
- Deputy Vice Chancellor, Research, Victoria University, Melbourne, VIC, Australia
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Payne L, Flannery H, Kambakara Gedara C, Daniilidi X, Hitchcock M, Lambert D, Taylor C, Christie D. Business as usual? Psychological support at a distance. Clin Child Psychol Psychiatry 2020; 25:672-686. [PMID: 32594756 PMCID: PMC7370649 DOI: 10.1177/1359104520937378] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The impact of COVID-19 has challenged the long accepted 'norm' in delivery of psychological therapy. Public policies designed to reduce transmission have made it extremely difficult to meet with service-users safely in the traditional face-to-face context. E-therapies have existed in theory and practice since technological progress has made them possible. They can offer a host of advantages over face-to-face equivalents, including improved access, greater flexibility for service-users and professionals, and cost savings. However, despite the emerging evidence and anticipated positive value, implementation has been slower than anticipated. Concerns have been raised by service-users, clinicians, and public health organisations, identifying significant barriers to the wide spread use of e-therapies. In the current climate, many clinicians are offering e-therapies for the first time, without prior arrangement or training, as the only viable option to continue to support their clients. This paper offers a clinically relevant review of the e-therapies literature, including effectiveness and acceptability dilemmas and challenges that need to be addressed to support the safe use and growth of e-therapies in psychology services. Further research is needed to better understand what might be lost and what gained in comparison to face-to-face therapy, and for which client groups and settings it might be most effective.
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Affiliation(s)
- Lara Payne
- Child and Adolescent Psychology Service, University College London Hospital, London, UK
| | - Halina Flannery
- Child and Adolescent Psychology Service, University College London Hospital, London, UK
| | | | - Xeni Daniilidi
- Child and Adolescent Psychology Service, University College London Hospital, London, UK
| | - Megan Hitchcock
- Child and Adolescent Psychology Service, University College London Hospital, London, UK
| | - Danielle Lambert
- Child and Adolescent Psychology Service, University College London Hospital, London, UK
| | - Charlotte Taylor
- Child and Adolescent Psychology Service, University College London Hospital, London, UK
| | - Deborah Christie
- Child and Adolescent Psychology Service, University College London Hospital, London, UK
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Lopez A, Rothberg B, Reaser E, Schwenk S, Griffin R. Therapeutic groups via video teleconferencing and the impact on group cohesion. Mhealth 2020; 6:13. [PMID: 32270005 PMCID: PMC7136655 DOI: 10.21037/mhealth.2019.11.04] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 11/12/2019] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND The use of synchronous telemental health for therapy group is a relatively new area of exploration. While telegroups have demonstrated they can be helpful in providing psychoeducation, there is less known about whether synchronous remote groups can develop group cohesion and whether patients can receive the benefit of a supportive group setting. METHODS A pilot study was conducted comparing group cohesion between patients who participated in a dialectical behavior therapy (DBT) group via video teleconferencing (VTC) and patients who participated in an in-person group. RESULTS Findings indicate that while both groups felt equally connected to the facilitator, there were significant differences between the online and in-person groups on the group cohesion scale. Those in the online group did not feel as connected to other group members as those in the in-person group. Qualitative statements indicate that while an in-person group may have been preferable, the convenience of the online group outweighed any negative effects. Attendance was significantly better in the online group, suggesting that use of this technology may help to overcome barriers preventing treatment participation. The focus of this study was on group cohesion and changes in psychiatric symptoms were not evaluated. CONCLUSIONS The use of telemental health for group therapy appears to be a viable alternative to traditional in-person groups, especially when no other treatment options are available. However, facilitators may need to take extra steps to build group cohesion when members are participating remotely.
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Affiliation(s)
- Amy Lopez
- Helen and Arthur E. Johnson Depression Center, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Brian Rothberg
- Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Emily Reaser
- Graduate School of Social Work, University of Denver, Denver, CO, USA
| | - Sarah Schwenk
- Helen and Arthur E. Johnson Depression Center, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Rachel Griffin
- Helen and Arthur E. Johnson Depression Center, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
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19
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Newcomb ME, Sarno EL, Bettin E, Carey J, Ciolino JD, Hill R, Garcia CP, Macapagal K, Mustanski B, Swann G, Whitton SW. Relationship Education and HIV Prevention for Young Male Couples Administered Online via Videoconference: Protocol for a National Randomized Controlled Trial of 2GETHER. JMIR Res Protoc 2020; 9:e15883. [PMID: 32012111 PMCID: PMC7011124 DOI: 10.2196/15883] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 10/12/2019] [Accepted: 11/27/2019] [Indexed: 12/11/2022] Open
Abstract
Background Young men who have sex with men have a high HIV incidence, and a substantial proportion of incident infections occur in the context of main partnerships. However, romantic relationships also provide numerous benefits to individual health and wellbeing. 2GETHER is a relationship education and HIV prevention program for young male couples, and the 2GETHER USA randomized controlled trial (RCT) was launched to establish the efficacy of an online version of 2GETHER. Objective The objective of 2GETHER is to optimize relationship functioning in young male couples as a method to improve communication about sexual risk behaviors and reduce HIV transmission. In the 2GETHER USA study, 2GETHER was adapted for online administration to couples across the United States via videoconferencing. The intervention in question aims to address the unique needs of couples from varied racial/ethnic backgrounds and geographic regions. Methods This is a comparative effectiveness RCT of 2GETHER USA relative to existing public health practice (control). 2GETHER USA is a hybrid group- and individual-level intervention that delivers three weekly online group discussion sessions for skills delivery, followed by two individualized couple sessions that focus on skills implementation in each couple. The control condition differs by participant HIV status: (1) the Testing Together protocol for concordant HIV-negative couples; (2) medication adherence and risk reduction counseling for concordant HIV-positive couples; or (3) both protocols for serodiscordant couples. Follow-up assessments are delivered at 3-, 6-, 9-, and 12-months post-intervention in both conditions. Testing for rectal and urethral Chlamydia and Gonorrhea occurs at baseline and 12-month follow-up. The primary behavioral outcome is condomless anal sex with serodiscordant serious partners or any casual partners. The primary biomedical outcome is sexually transmitted infection incidence at a 12-month follow-up. Results As of October 11, 2019, the trial has enrolled and randomized 140 dyads (Individual N=280). Enrollment will continue until we randomize 200 dyads (N=400). Assessment of intervention outcomes at 3-, 6-, 9-, and 12-months is ongoing. Conclusions 2GETHER is innovative in that it integrates relationship education and HIV prevention for optimizing the health and wellbeing of young male couples. The 2GETHER USA online adaptation has the potential to reach couples across the United States and reduce barriers to accessing health care services that are affirming of sexual minority identities for those who live in rural or under-resourced areas. Trial Registration ClinicalTrials.gov NCT03284541; https://clinicaltrials.gov/ct2/show/NCT03284541 International Registered Report Identifier (IRRID) DERR1-10.2196/15883
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Affiliation(s)
- Michael E Newcomb
- Department of Medical Social Sciences, Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL, United States
| | - Elissa L Sarno
- Department of Medical Social Sciences, Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL, United States
| | - Emily Bettin
- Department of Medical Social Sciences, Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL, United States
| | - James Carey
- Department of Medical Social Sciences, Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL, United States
| | - Jody D Ciolino
- Department of Preventive Medicine, Northwestern University, Chicago, IL, United States
| | - Ricky Hill
- Department of Medical Social Sciences, Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL, United States
| | - Christopher P Garcia
- Department of Medical Social Sciences, Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL, United States
| | - Kathryn Macapagal
- Department of Medical Social Sciences, Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL, United States
| | - Brian Mustanski
- Department of Medical Social Sciences, Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL, United States
| | - Gregory Swann
- Department of Medical Social Sciences, Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL, United States
| | - Sarah W Whitton
- Department of Psychology, University of Cincinnati, Cincinnati, OH, United States
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Best P, McConnell T, Davidson G, Badham J, Neill RD. Group based video-conferencing for adults with depression: findings from a user-led qualitative data analysis using participatory theme elicitation. RESEARCH INVOLVEMENT AND ENGAGEMENT 2019; 5:40. [PMID: 31844555 PMCID: PMC6896757 DOI: 10.1186/s40900-019-0173-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 11/21/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Accessing support services for depression has been historically difficult given the societal stigma that exists regarding the condition. Recent advances in digital technologies continue to be postulated as a potential panacea yet the results from research trials have been mixed with a range of effect sizes. METHODS This article offers a different perspective by presenting a panel of end users (co-researchers) with qualitative interview data (n = 8) taken from a feasibility RCT of a group based video-conferencing service for depressed adults. The co-researcher panel were introduced to a new method of participatory data analysis known as Participatory Theme Elicitation (PTE). This method involves using network analysis techniques to create groupings and visual diagrams in order to support the generation of themes and minimise scientific researcher input/influence. RESULTS Co-researchers reported that while VC based interventions appeared convenient, accessible and relatively low cost - additional training and support should be offered to improve uptake and retention. In addition, co-researchers suggested that further exploration is needed regarding the level of self-awareness one feels in a group based VC environment and whether this facilitates disclosure (through disinhibition) or increases anxiety. CONCLUSION The findings presented here appear to support existing (researcher and academic-led) literature in the field as well as suggest new areas for investigation. By presenting data generated solely by co-researchers, this article also adds to the evidence surrounding participatory analysis methods - particularly the growing need for robust approaches that are accessible and less time-consuming than those currently available. TRIAL REGISTRATION NUMBER NCT03288506 (Clinicaltrials.gov) 20th Sept 2017 https://clinicaltrials.gov/ct2/show/NCT03288506.
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Affiliation(s)
- Paul Best
- School of Social Sciences Education and Social Work. 6 College Park, Queen’s University Belfast, Belfast, UK
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Royal Victoria Hospital, Queen’s University Belfast, Belfast, UK
- Centre for Evidence and Social Innovation, Queen’s University Belfast, Belfast, UK
| | - Tracey McConnell
- School of Social Sciences Education and Social Work. 6 College Park, Queen’s University Belfast, Belfast, UK
- Centre for Evidence and Social Innovation, Queen’s University Belfast, Belfast, UK
| | - Gavin Davidson
- School of Social Sciences Education and Social Work. 6 College Park, Queen’s University Belfast, Belfast, UK
- Centre for Evidence and Social Innovation, Queen’s University Belfast, Belfast, UK
| | - Jennifer Badham
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Royal Victoria Hospital, Queen’s University Belfast, Belfast, UK
| | - Ruth D. Neill
- School of Social Sciences Education and Social Work. 6 College Park, Queen’s University Belfast, Belfast, UK
- Centre for Evidence and Social Innovation, Queen’s University Belfast, Belfast, UK
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Cowan KE, McKean AJ, Gentry MT, Hilty DM. Barriers to Use of Telepsychiatry: Clinicians as Gatekeepers. Mayo Clin Proc 2019; 94:2510-2523. [PMID: 31806104 DOI: 10.1016/j.mayocp.2019.04.018] [Citation(s) in RCA: 203] [Impact Index Per Article: 40.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 04/15/2019] [Accepted: 04/24/2019] [Indexed: 12/17/2022]
Abstract
Telepsychiatry is effective and has generated hope and promise for improved access and enhanced quality of care with reasonable cost containment. Clinicians and organizations are informed about clinical, technological, and administrative telepsychiatric barriers via guidelines, but there are many practical patient and clinician factors that have slowed implementation and undermined sustainability. Literature describing barriers to use of telepsychiatry was reviewed. PubMed search terms with date limits from January 1, 1959, to April 25, 2019, included telepsychiatry, telemedicine, telemental health, videoconferencing, video based, Internet, synchronous, real-time, two-way, limitations, restrictions, barriers, obstacles, challenges, issues, implementation, utilization, adoption, perspectives, perceptions, attitudes, beliefs, willingness, acceptability, feasibility, culture/cultural, outcomes, satisfaction, quality, effectiveness, and efficacy. Articles were selected for inclusion on the basis of relevance. Barriers are described from both patient and clinicians' perspectives. Patients and clinicians are largely satisfied with telepsychiatry, but concerns about establishing rapport, privacy, safety, and technology limitations have slowed acceptance of telepsychiatry. Clinicians are also concerned about reimbursement/financial, legal/regulatory, licensure/credentialing, and education/learning issues. These issues point to system and policy concerns, which, in combination with other administrative concerns, raise questions about system design/workflow, efficiency of clinical care, and changing organizational culture. Although telepsychiatry service is convenient for patients, the many barriers from clinicians' perspectives are concerning, because they serve as gatekeepers for implementation and sustainability of telepsychiatry services. This suggests that solutions to overcome barriers must start by addressing the concerns of clinicians and enhancing clinical workflow.
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Affiliation(s)
- Kirsten E Cowan
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN; Essentia Health, Duluth, MN
| | | | - Melanie T Gentry
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN
| | - Donald M Hilty
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento
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Clough BA, Rowland DP, Casey LM. Development of the eTAP-T: A measure of mental health professionals' attitudes and process towards e-interventions. Internet Interv 2019; 18:100288. [PMID: 31890635 PMCID: PMC6926282 DOI: 10.1016/j.invent.2019.100288] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 10/15/2019] [Accepted: 10/16/2019] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND The development of technological applications within psychotherapy has opened up new opportunities for mental health professionals (MHPs) to address client need. Despite the clinical efficacy and utility of evidence-based electronic interventions, MHPs' engagement with these interventions remains poorly understood. OBJECTIVE The aim of the current study was to develop and conduct a preliminary psychometric investigation of the measurement properties of the electronic-therapy attitudes and process questionnaire - therapist version (eTAP-T). Based upon the theory of planned behaviour (TPB), the eTAP-T measures factors related to MHPs' engagement with e-interventions for clients' mental health concerns. METHODS Participants were 222 practicing MHPs who reported being in direct contact with clients. Participants completed the eTAP-T and related measures with a subsample of 40 participants completing a two-week follow up questionnaire. RESULTS Exploratory factor analysis with item reduction resulted in a 12-item eTAP-T, with four factors accounting for 82% of variance. The four factors (subjective norms, perceived behavioural control, attitudes and intentions) were consistent with the four TPB domains. The eTAP-T demonstrated satisfactory validity and reliability as per the consensus-based standards for the selection of health measurement instruments. CONCLUSIONS The development and preliminary psychometric investigation supported the validity and reliability of the eTAP-T. Further research is required for confirmatory analyses. The eTAP-T may be useful in identifying the training needs of MHPs and evaluating training programs. Specific areas for intervention, such as attitudes or perceived credibility may be identified and targetted, with the measure then also used to evaluate change across these domains. It is anticipated that the eTAP-T may useful tool in improving uptake of digital interventions by MHPs.
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Affiliation(s)
- Bonnie A. Clough
- Corresponding author at: School of Applied Psychology, Griffith University, Parklands Drive, Southport 4215, Queensland, Australia.
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23
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Probst G, Berger T, Flückiger C. The Alliance-Outcome Relation in Internet-Based Interventions for Psychological Disorders: A Correlational Meta-Analysis. VERHALTENSTHERAPIE 2019. [DOI: 10.1159/000503432] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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24
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Probst G, Berger T, Flückiger C. Die Allianz als Prädiktor für den Therapieerfolg internetbasierter Interventionen bei psychischen Störungen: Eine korrelative Metaanalyse. VERHALTENSTHERAPIE 2019. [DOI: 10.1159/000501565] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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25
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Schuster R, Kalthoff I, Walther A, Köhldorfer L, Partinger E, Berger T, Laireiter AR. Effects, Adherence, and Therapists' Perceptions of Web- and Mobile-Supported Group Therapy for Depression: Mixed-Methods Study. J Med Internet Res 2019; 21:e11860. [PMID: 31066700 PMCID: PMC6533044 DOI: 10.2196/11860] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 10/10/2018] [Accepted: 10/27/2018] [Indexed: 02/07/2023] Open
Abstract
Background Blended group therapy (bGT) has been investigated a several times for anxiety and depression, but information on patients’ adherence to and therapists’ perception of the novel format is nonexistent. Furthermore, many studies investigated mainly female and highly educated populations, limiting the validity of previous findings. Objective This study aimed to reduce the gaps and limitations of the previous findings by evaluating an integrated internet- and mobile-supported bGT format. Methods A total of 27 patients diagnosed with major depression (14/27, 52% female and 7/27, 25.9% compulsory education) participated in a 7-week treatment at a university outpatient clinic. Furthermore, 8 novice therapists participated in semistructured interviews and a subsequent cross-validation survey. Results Primary symptom reduction was high (d=1.31 to 1.51) and remained stable for the follow-up period. Therapists identified advantages (eg, patient engagement, treatment intensification, and improved therapeutic relation) and disadvantages (eg, increased workload, data issues, and undesired effects) of bGT. The required online guidance time was 10.3 min per patient and week, including guidance on exercises (67% or 6.9 min) and intimate communication (33% or 3.4 min). Concerning patients’ adherence to bGT, tracked completion of all Web-based and mobile tasks was high and comparable with group attendance. Conclusions Results suggest high feasibility of bGT in a gender-balanced, moderately educated sample. bGT provides group therapists with tools for individual care, resulting in an optimization of the therapy process, and high completion rates of the implemented bGT elements. The limited work experience of the involved therapists restricts the study findings, and potential drawbacks need to be regarded in the development of future bGT interventions.
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Affiliation(s)
- Raphael Schuster
- Center for Clinical Psychology, Psychotherapy and Health Psychology, Department of Psychology, University of Salzburg, Salzburg, Austria
| | - Inanna Kalthoff
- Center for Clinical Psychology, Psychotherapy and Health Psychology, Department of Psychology, University of Salzburg, Salzburg, Austria
| | - Alexandra Walther
- Center for Clinical Psychology, Psychotherapy and Health Psychology, Department of Psychology, University of Salzburg, Salzburg, Austria
| | - Lena Köhldorfer
- Department of Applied Psychology: Health, Development and Promotion, Faculty of Psychology, University of Vienna, Vienna, Austria
| | - Edith Partinger
- Department of Applied Psychology: Health, Development and Promotion, Faculty of Psychology, University of Vienna, Vienna, Austria
| | - Thomas Berger
- Department of Clinical Psychology and Psychotherapy, University of Berne, Berne, Switzerland
| | - Anton-Rupert Laireiter
- Center for Clinical Psychology, Psychotherapy and Health Psychology, Department of Psychology, University of Salzburg, Salzburg, Austria.,Department of Applied Psychology: Health, Development and Promotion, Faculty of Psychology, University of Vienna, Vienna, Austria
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26
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Wrape ER, McGinn MM. Clinical and Ethical Considerations for Delivering Couple and Family Therapy via Telehealth. JOURNAL OF MARITAL AND FAMILY THERAPY 2019; 45:296-308. [PMID: 29361194 DOI: 10.1111/jmft.12319] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
Studies have generally supported telehealth as a feasible, effective, and safe alternative to in-office visits. Telehealth may also be of particular benefit to couples/families interested in relational treatments, as it addresses some of the barriers that may be more prominent for families, such as childcare and scheduling difficulties. Therapists interested in expanding their practice to include telehealth should understand ethical and practical considerations of this modality. This article discusses areas unique to the delivery of telehealth to couples and families. Each broad domain is then elaborated upon with case examples from actual clinical practice and specific recommendations for addressing potential difficulties. Authors recommend further empirical research examining differences in modality outcome, as well as feasibility of the suggestions proposed here.
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Kelly SL, Steinberg EA, Suplee A, Upshaw NC, Campbell KR, Thomas JF, Buchanan CL. Implementing a Home-Based Telehealth Group Adherence Intervention with Adolescent Transplant Recipients. Telemed J E Health 2019; 25:1040-1048. [PMID: 30681398 DOI: 10.1089/tmj.2018.0164] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Introduction: To improve access to care and engage adolescent transplant recipients for adherence-promoting interventions, innovative solutions utilizing technology are needed. Materials and Methods: This study describes the implementation of a five-session group intervention targeting medication adherence in adolescent transplant recipients through home-based telemedicine. Results: Seven videoconferencing groups were conducted with a total of 33 participants living a median of 57 miles away from their transplant medical center. The median coefficient of variation (CV) of tacrolimus (immunosuppression medication) decreased from 32.2% to 23.5% from the pregroup to postgroup phase. Analyses indicated that the group was acceptable and engaging for participants, as highlighted by one participant reporting, "I liked how me and the group members came together… it felt like a little family." Overall satisfaction with the group and with the technology was endorsed by 86%. The group intervention was generally feasible; however, there were technological difficulties reported by participants and the facilitator, particularly given the diversity of the home-based connections and equipment. Other adaptations helped improve recruitment, attendance, and participation. Discussion: Implementing a telehealth group can pose unique challenges, especially with a group of adolescent participants. Although nonsignificant, we observed a decrease in the median CV of tacrolimus, indicating that medication adherence generally improved after group intervention. Our experience facilitating these groups provides insights into strategies to optimize feasibility and the participant experience. Distance of participants from the hospital is an important consideration and provides a strong rationale for the need for telemedicine-enabled approaches. We explore and discuss the challenges to implementing a home-based group, suggest practical strategies and developmentally sensitive adjustments when working with adolescents, and propose strategies to prepare clinicians for obstacles that may present when implementing a telehealth group with youth.
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Affiliation(s)
- Sarah L Kelly
- Department of Pediatrics and University of Colorado School of Medicine, Aurora, Colorado.,Department of Psychiatry, University of Colorado School of Medicine, Aurora, Colorado
| | - Elizabeth A Steinberg
- Department of Pediatrics and University of Colorado School of Medicine, Aurora, Colorado.,Department of Psychiatry, University of Colorado School of Medicine, Aurora, Colorado
| | - Amanda Suplee
- Pediatric Mental Health Institute, Children's Hospital Colorado, Aurora, Colorado
| | - Naadira C Upshaw
- Pediatric Mental Health Institute, Children's Hospital Colorado, Aurora, Colorado
| | - Kristen R Campbell
- Department of Pediatrics and University of Colorado School of Medicine, Aurora, Colorado
| | - John F Thomas
- Department of Psychiatry, University of Colorado School of Medicine, Aurora, Colorado.,Department of Epidemiology, University of Colorado School of Public Health, Aurora, Colorado
| | - Cindy L Buchanan
- Department of Psychiatry, University of Colorado School of Medicine, Aurora, Colorado.,Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado
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Turgoose D, Ashwick R, Murphy D. Systematic review of lessons learned from delivering tele-therapy to veterans with post-traumatic stress disorder. J Telemed Telecare 2018; 24:575-585. [PMID: 28958211 DOI: 10.1177/1357633x17730443] [Citation(s) in RCA: 77] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/19/2023]
Abstract
Introduction Despite increases in the number of ex-service personnel seeking treatment for post-traumatic stress disorder (PTSD), there remain a number of barriers to help-seeking which prevents many veterans from accessing psychological therapies. Tele-therapy provides one potential method of increasing the number of veterans accessing support. This review aimed to systematically review the literature in order to summarise what lessons have been learned so far from providing trauma-focused tele-therapies to veterans with PTSD. Methods A systematic literature review was conducted from which 41 papers were reviewed. Studies were included if they involved the use of trauma-focused therapies carried out using tele-therapy technologies. Only studies using tele-therapy interventions via video or telephone with populations of ex-military personnel with PTSD were included. Results In the majority of cases tele-therapy was found to be as effective in reducing PTSD symptoms as in-person interventions. Similarly, there were few differences in most process outcomes such as dropout rates, with tele-therapy helping to increase uptake in some cases. Veterans using tele-therapy reported high levels of acceptability and satisfaction. Some challenges were reported in terms of therapeutic alliance, with some studies suggesting that veterans felt less comfortable in using tele-therapy. Several studies suggested it was harder for clinicians to read non-verbal communication in tele-therapy, but this did not affect their ability to build rapport. Technological issues were encountered, but these were not found to impede therapy processes or outcomes. Discussion Tele-therapy provides a viable alternative to in-person therapies and has the potential to increase access to therapy for veterans. Tele-therapy should continue to be evaluated and scrutinised in order to establish the most effective methods of delivery.
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Gentry MT, Lapid MI, Clark MM, Rummans TA. Evidence for telehealth group-based treatment: A systematic review. J Telemed Telecare 2018; 25:327-342. [DOI: 10.1177/1357633x18775855] [Citation(s) in RCA: 87] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background Interest in the use of telehealth interventions to increase access to healthcare services is growing. Group-based interventions have the potential to increase patient access to highly needed services. The aim of this study was to systematically review the available literature on group-based video teleconference services. Methods The English-language literature was searched using Ovid MEDLINE, PubMed, PsycINFO and CINAHL for terms related to telehealth, group therapy and support groups. Abstracts were reviewed for relevance based on inclusion criteria. Multiple study types were reviewed, including open-label, qualitative and randomised controlled trial study designs. Data were compiled regarding participants, study intervention and outcomes. Specific areas of interest were the feasibility of and satisfaction with telehealth technology, as well as the effect of video teleconference delivery on group dynamics, including therapeutic alliance. Results Forty published studies met the inclusion criteria and were included in the review. Six were randomised controlled trials. Among the studies, there was a broad range of study designs, participants, group interventions and outcome measures. Video teleconference groups were found to be feasible and resulted in similar treatment outcomes to in-person groups. However, few studies were designed to demonstrate noninferiority of video teleconference groups compared with in-person groups. Studies that examined group process factors showed small decreases in therapeutic alliance in the video teleconference participants. Conclusions Video teleconference groups are feasible and produce outcomes similar to in-person treatment, with high participant satisfaction despite technical challenges. Additional research is needed to identify optimal methods of video teleconference group delivery to maximise clinical benefit and treatment outcomes.
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Affiliation(s)
| | - Maria I Lapid
- Department of Psychiatry and Psychology, Mayo Clinic, USA
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30
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Ellis AE, Simiola V, Brown L, Courtois C, Cook JM. The role of evidence-based therapy relationships on treatment outcome for adults with trauma: A systematic review. J Trauma Dissociation 2018; 19:185-213. [PMID: 28509624 DOI: 10.1080/15299732.2017.1329771] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE The purpose of this paper was to systematically review and synthesize the empirical literature on the effects of evidence-based therapy relationship (EBR) variables in the psychological treatment for adults who experienced trauma-related distress. METHOD Studies were identified using comprehensive searches of PsycINFO, Medline, Published International Literature on Traumatic Stress, and Cumulative Index to Nursing and Allied Health Literature databases. Included in the review were articles published between 1980 and 2015, in English that reported on the impact of EBRs on treatment outcome in clinical samples of adult trauma survivors. RESULTS Nineteen unique studies met inclusion criteria. The bulk of the studies were on therapeutic alliance and the vast majority found that alliance was predictive of or associated with a reduction in various symptomotology. Methodological concerns included the use of small sample sizes, little information on EBRs beyond alliance as well as variability in its measurement, and non-randomized assignment to treatment conditions or the lack of a comparison group. CONCLUSIONS More research is needed on the roles of client feedback, managing countertransference, and other therapist characteristics on treatment outcome with trauma survivors. Understanding the role of EBRs in the treatment of trauma survivors may assist researchers, clinicians, and psychotherapy educators to improve therapist training as well as client engagement and retention in treatment.
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Affiliation(s)
- Amy E Ellis
- a Undergraduate Psychology Department , Albizu University and Nova Southeastern University , Miami , FL , USA
| | - Vanessa Simiola
- b Yale School of Medicine and National Center for PTSD , West Haven , CT , USA
| | | | | | - Joan M Cook
- b Yale School of Medicine and National Center for PTSD , West Haven , CT , USA
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Moreau JL, Cordasco KM, Young AS, Oishi SM, Rose DE, Canelo I, Yano EM, Haskell SG, Hamilton AB. The Use of Telemental Health to Meet the Mental Health Needs of Women Using Department of Veterans Affairs Services. Womens Health Issues 2018; 28:181-187. [DOI: 10.1016/j.whi.2017.12.005] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Revised: 11/27/2017] [Accepted: 12/11/2017] [Indexed: 01/01/2023]
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Burton RL, O'Connell ME. Telehealth Rehabilitation for Cognitive Impairment: Randomized Controlled Feasibility Trial. JMIR Res Protoc 2018; 7:e43. [PMID: 29422453 PMCID: PMC5824099 DOI: 10.2196/resprot.9420] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 12/14/2017] [Accepted: 01/01/2018] [Indexed: 11/29/2022] Open
Abstract
Background Nonpharmacological interventions are needed to support the function of older adults struggling with subjective cognitive impairment (SCI), mild cognitive impairment (MCI), and dementia due to Alzheimer disease (AD). Telerehabilitation aims to provide rehabilitation at a distance, but cognitive rehabilitation by videoconferencing has not been explored. Objective The objective of this study was to compare goal-oriented cognitive rehabilitation delivered in-person with videoconferencing to determine whether telehealth cognitive rehabilitation appears feasible. Methods Random assignment to in-person or telehealth videoconferencing cognitive rehabilitation with a combined between-subjects, multiple baseline single-case experimental design, cognitive rehabilitation was delivered by a therapist to 6 participants with SCI (n=4), MCI (n=1), or dementia due to AD (n=1). Results Two of the 6 participants randomly assigned to the telehealth condition withdrew before beginning the intervention. For those who participated in the intervention, 6 out of 6 goals measured with the Canadian Occupational Performance Measure improved for those in the in-person group, and 7 out of 9 goals improved for those in the telehealth group. Conclusions Delivery of cognitive rehabilitation by telehealth appeared feasible but required modifications such as greater reliance on caregivers and clients for manipulating materials.
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Affiliation(s)
- Rachel L Burton
- Department of Psychology, University of Saskatchewan, Saskatoon, SK, Canada
| | - Megan E O'Connell
- Department of Psychology, University of Saskatchewan, Saskatoon, SK, Canada
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Singulane BAR, Sartes LMA. Aliança Terapêutica nas Terapias Cognitivo-comportamentais por Videoconferência: uma Revisão da Literatura. PSICOLOGIA: CIÊNCIA E PROFISSÃO 2017. [DOI: 10.1590/1982-3703000832016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Resumo Nos últimos anos houve um aumento do número de usuários da internet no Brasil e no mundo, enquanto as intervenções por videoconferência surgiram como formas de tratamento para diversos transtornos mentais. Sabe-se que a aliança terapêutica é um componente essencial para se implementar a prática psicoterapêutica, porém, não há um consenso sobre sua formação na psicoterapia por videoconferência. Portanto, o presente artigo teve como objetivo realizar uma revisão de literatura acerca da formação e papel da aliança terapêutica nas Terapias Cognitivo-comportamentais (TCC) por videoconferência. Para isso, foi realizada uma busca em quatro bases de dados, Pubmed, Psycarticles, Lilacs e SciELO, com descritores específicos dos dicionários de cada base. No total, foram encontrados 365 artigos, mas apenas nove preencheram os critérios de inclusão baseados no objetivo deste estudo. Observou-se que a maioria dos artigos indicou que a aliança foi alta no decorrer das sessões de TCC por videoconferência, podendo ser comparada com a aliança formada na terapia presencial, e que poucos artigos avaliaram a aliança como fator preditivo de resultados e de adesão. Apesar deste indicativo, este estudo discute as limitações metodológicas dos artigos e indica a necessidade de estudos que tornem mais claras as evidências sobre a formação da aliança e o o seu papel nesta modalidade alternativa de tratamento.
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Anderson T, McClintock AS, McCarrick SS, Heckman TG, Heckman BD, Markowitz JC, Sutton M. Working Alliance, Interpersonal Problems, and Depressive Symptoms in Tele-Interpersonal Psychotherapy for HIV-infected Rural Persons: Evidence for Indirect Effects. J Clin Psychol 2017; 74:286-303. [PMID: 28586534 DOI: 10.1002/jclp.22502] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Revised: 04/12/2017] [Accepted: 04/20/2017] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Interpersonal psychotherapy (IPT) has demonstrated efficacy for the treatment of depression, yet little is known about its therapeutic mechanisms. As a specific treatment, IPT has been shown to directly reduce depressive symptoms, although it is unclear whether these reductions occur via interpersonal changes. Within IPT, the potential role of the working alliance, a common factor, as a predictor of depression and interpersonal changes is also unclear. METHOD Participants were 147 depressed persons living with HIV in rural communities of 28 U.S. states enrolled in a randomized clinical trial. Seventy-five patients received up to 9 sessions of telephone-administered IPT (tele-IPT) plus standard care and 72 patients received standard care only. Two models were tested; one included treatment condition (tele-IPT vs. control) and another included the working alliance as independent variables. RESULTS The first model found an indirect effect whereby tele-IPT reduced depression via decreased social avoidance. There was a direct effect between tele-IPT and reduced depression. In the second model, the working alliance influenced depressive symptom relief via reductions in social avoidance. Both goal and task working alliance subscales were indirectly associated with reductions in depressive symptoms, also through reductions in social avoidance. There were no direct effects involving the working alliance. Tele-IPT's influence on depressive symptom reduction was primarily through a direct effect, whereas the influence of working alliance depression was almost entirely via an indirect effect through interpersonal problems. CONCLUSION Study findings have implications for IPT when intervening with depressed rural people living with HIV/AIDS over the telephone.
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Grubbs KM, Fortney JC, Kimbrell T, Pyne JM, Hudson T, Robinson D, Moore WM, Custer P, Schneider R, Schnurr PP. Usual Care for Rural Veterans With Posttraumatic Stress Disorder. J Rural Health 2017; 33:290-296. [PMID: 28112433 DOI: 10.1111/jrh.12230] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2016] [Revised: 10/17/2016] [Accepted: 10/27/2016] [Indexed: 01/18/2023]
Abstract
PURPOSE Community-Based Outpatient Clinics (CBOCs) provide primary-care-based mental health services to rural veterans who live long distances from Veterans Affairs (VA) hospitals. Characterizing the composition of usual care will highlight the need and potential strategies to improve access to and engagement in evidence-based psychotherapy for posttraumatic stress disorder (PTSD). METHOD Veterans (N = 132) with PTSD recruited from 5 large- (5,000-10,000 patients) and 6 medium-sized (1,500-4,999) CBOCs were enrolled in the usual care arm of a randomized control trial for a PTSD collaborative care study. Chart review procedures classified all mental health encounters during the 1-year study period into 10 mutually exclusive categories (7 psychotherapy and 3 medication management). FINDINGS Seventy-two percent of participants received at least 1 medication management encounter with 30% of encounters being delivered via interactive video. More than half of veterans (58.3%) received at least 1 session of psychotherapy. Only 12.1% received a session of therapy classified as an evidence-based psychotherapy for PTSD. The vast majority of psychotherapy encounters were delivered in group format and only a small proportion were delivered via interactive video. CONCLUSIONS Findings suggest that veterans diagnosed with PTSD who receive their mental health treatment in large and medium CBOCs are likely to receive medication management, and very few veterans received evidence-based psychotherapy. There may be ways to increase access to evidence-based psychotherapy by expanding the use of interactive video to connect specialty mental health providers with patients, hosted either in CBOCs or in home-based care, and to offer more group-based therapies.
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Affiliation(s)
- Kathleen M Grubbs
- Center for Mental Health Outcomes Research, Health Services Research and Development, Central Arkansas Veterans Healthcare System, North Little Rock, Arkansas.,South Central Mental Illness Education and Clinical Center, Central Arkansas Veterans Healthcare System, North Little Rock, Arkansas.,Division of Health Services Research, Department of Psychiatry, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - John C Fortney
- Health Services Research and Development, Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, Seattle, Washington.,Division of Population Health, Department of Psychiatry, University of Washington, Seattle, Washington
| | - Tim Kimbrell
- Center for Mental Health Outcomes Research, Health Services Research and Development, Central Arkansas Veterans Healthcare System, North Little Rock, Arkansas.,South Central Mental Illness Education and Clinical Center, Central Arkansas Veterans Healthcare System, North Little Rock, Arkansas.,Division of Health Services Research, Department of Psychiatry, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Jeffrey M Pyne
- Center for Mental Health Outcomes Research, Health Services Research and Development, Central Arkansas Veterans Healthcare System, North Little Rock, Arkansas.,South Central Mental Illness Education and Clinical Center, Central Arkansas Veterans Healthcare System, North Little Rock, Arkansas.,Division of Health Services Research, Department of Psychiatry, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Teresa Hudson
- Center for Mental Health Outcomes Research, Health Services Research and Development, Central Arkansas Veterans Healthcare System, North Little Rock, Arkansas.,South Central Mental Illness Education and Clinical Center, Central Arkansas Veterans Healthcare System, North Little Rock, Arkansas.,Division of Health Services Research, Department of Psychiatry, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Dean Robinson
- Department of Psychiatry, Louisiana State University Health Sciences Center, Shreveport, Louisiana
| | - William Mark Moore
- Center for Mental Health Outcomes Research, Health Services Research and Development, Central Arkansas Veterans Healthcare System, North Little Rock, Arkansas.,South Central Mental Illness Education and Clinical Center, Central Arkansas Veterans Healthcare System, North Little Rock, Arkansas
| | - Paul Custer
- VA Loma Linda Health Care System, Loma Linda, California
| | - Ronald Schneider
- Department of Psychiatry, Louisiana State University Health Sciences Center, Shreveport, Louisiana.,Overton Brooks VA Medical Center, Shreveport, Louisiana
| | - Paula P Schnurr
- National Center for PTSD, VA Medical Center, White River Junction, Vermont.,Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire
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Lauckner C, Whitten P. The State and Sustainability of Telepsychiatry Programs. J Behav Health Serv Res 2017; 43:305-18. [PMID: 25794639 DOI: 10.1007/s11414-015-9461-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Telepsychiatry, or the provision of psychiatric care across a distance using communication technologies, has become widespread and has been used successfully for treating a variety of mental illnesses. Little is known, however, about the sustainability of telepsychiatry programs and their long-term success. The goal of this study was to determine current trends in telepsychiatry by completing an extensive literature review and to follow-up with the authors of telepsychiatry research to examine the current status of their programs and success factors or barriers associated with their experiences. Results indicated that modern telepsychiatry programs often target veteran/military or child populations and that many rely on either federal or internal funding. Interestingly, several researchers indicated that they wished to improve current funding mechanisms, while others wished for improvements in the technology used. Implications of these findings for behavioral health researchers are discussed, along with suggestions for improving future telepsychiatry programs.
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Simpson SG, Reid CL. Therapeutic alliance in videoconferencing psychotherapy: a review. Aust J Rural Health 2016; 22:280-99. [PMID: 25495622 DOI: 10.1111/ajr.12149] [Citation(s) in RCA: 176] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/17/2014] [Indexed: 01/06/2023] Open
Abstract
Psychotherapy services are limited in remote and rural areas in Australia and across the globe. Videoconferencing has become well established as a feasible and acceptable mode of psychological treatment delivery. Therapeutic alliance (TA) is an essential factor underlying successful therapy across therapeutic models. In order to determine the state of knowledge regarding TA in psychotherapy via videoconferencing, a literature review was conducted on research studies that formally measured TA as primary, secondary or tertiary outcome measures over the past 23 years. The databases searched were Medline, PsycArticles, PsycINFO, PsycEXTRA and EMBASE. Searching identified 9915 articles that measured satisfaction, acceptability or therapeutic rapport, of which 23 met criteria for the review. Three studies were carried out in Australia, 11 in USA, 4 in Canada, 3 in Scotland and 2 in England. Studies overwhelmingly supported the notion that TA can be developed in psychotherapy by videoconference, with clients rating bond and presence at least equally as strongly as in-person settings across a range of diagnostic groups. Therapists also rated high levels of TA, but often not quite as high as that of their clients early in treatment. The evidence was examined in the context of important aspects of TA, including bond, presence, therapist attitudes and abilities, and client attitudes and beliefs. Barriers and facilitators of alliance were identified. Future studies should include observational measures of bond and presence to supplement self-report.
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Affiliation(s)
- Susan G Simpson
- Psychology Clinic, University of South Australia, Adelaide, South Australia, Australia
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38
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Morland LA, Poizner JM, Williams KE, Masino TT, Thorp SR. Home-based clinical video teleconferencing care: Clinical considerations and future directions. Int Rev Psychiatry 2016; 27:504-12. [PMID: 26619273 DOI: 10.3109/09540261.2015.1082986] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Clinical video teleconferencing (CVT) is a treatment delivery modality that can be used to provide services to clinical populations that experience barriers to accessing mental health care. Recently, home-based CVT (HBCVT) has been developed in order to deliver treatment via CVT to patients in their homes. A number of clinical considerations, including the appropriate clinical population and individual patient factors, need to be taken into account when delivering CVT. Particular challenges can exist when setting up the home environment for HBCVT. Concerns about maintaining patient privacy while living in shared spaces, ensuring adequate CVT technology in the patient's home, and conducting risk management remotely are important to consider when delivering treatment via CVT. Since treatments delivered via CVT are often conducted across state lines, novel ethical and legal issues such as privacy laws, licensing of providers, prescribing practices, and insurance reimbursements need to be addressed when conducting services via these modalities. Future research on HBCVT will provide researchers and clinicians with information regarding which patients are most appropriate for treatment delivered via this modality and help further develop evidence for the cost-effectiveness of CVT and HBCVT clinical practice guidelines.
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Affiliation(s)
- Leslie A Morland
- a Department of Veterans Affairs , San Diego Healthcare System , California
| | - Jeffrey M Poizner
- a Department of Veterans Affairs , San Diego Healthcare System , California
| | - Kathryn E Williams
- a Department of Veterans Affairs , San Diego Healthcare System , California
| | - Tonya T Masino
- a Department of Veterans Affairs , San Diego Healthcare System , California
| | - Steven R Thorp
- a Department of Veterans Affairs , San Diego Healthcare System , California ;,b Center of Excellence for Stress and Mental Health , San Diego, California ;,c Department of Psychiatry, University of California , San Diego , USA
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Abstract
The delivery of psychiatric care via video-teleconferencing (VTC) technology is thought to have reached a tipping point. As a medical speciality with relatively few material or technical requirements for service delivery, psychiatry has been one of the earliest to embrace the possibility of providing evaluations and treatment at a distance. Such technical infrastructure as is necessary can often be found in the institutions already in existence. It was natural therefore that institutionally based telepsychiatry would lay the foundation for the development of the field. In this article we review the history and development of institutional VTC in a wide variety of clinically supervised settings such as hospitals, outpatient clinics, and forensic settings. We cite evidence supporting institutionally sponsored use and expand on key takeaways for the development and expansion of videoconferencing in these settings. We also speculate on the future direction and development of psychiatric care provided by these arrangements.
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Affiliation(s)
- Robert Lee Caudill
- a Department of Psychiatry and Behavioral Sciences , University of Louisville, School of Medicine, University of Louisville Healthcare Outpatient Center , Louisville , Kentucky , USA
| | - Zachary Sager
- a Department of Psychiatry and Behavioral Sciences , University of Louisville, School of Medicine, University of Louisville Healthcare Outpatient Center , Louisville , Kentucky , USA
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Hilty DM, Shoemaker EZ, Myers K, Snowdy CE, Yellowlees PM, Yager J. Need for and Steps Toward a Clinical Guideline for the Telemental Healthcare of Children and Adolescents. J Child Adolesc Psychopharmacol 2016; 26:283-95. [PMID: 26871510 DOI: 10.1089/cap.2015.0129] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE This article identifies and describes key considerations toward the development of a clinical guideline intended to optimize telemental healthcare (TMH) of children and adolescents. METHODS The literature was searched with key terms and title words. Of 2824 articles that met primary or secondary key word search criteria, 326 met both criteria, and 118 thematically related directly to child and adolescent TMH. Only 44 studies met levels of evidence I-III and expert recommendation criteria used in clinical guidelines; review of their references found 8 additional studies (52 total). Data from adult, child, and adolescent in-person psychiatric care and adult TMH were applied to provide context in developing the key considerations. RESULTS TMH guidelines for adults are well delineated, and TMH guidelines for children and adolescents are likely to closely overlap in terms of general clinical, technical, and administrative issues. However, for a child and adolescent focus, modifications of existing general guidelines appear necessary; for example, based on developmental status, family involvement, and patient-site modifications for space and sound. Additional clinical issues include specify who, exactly, is the "patient" (i.e., the patient, family, and /or other stakeholders), modalities of care (i.e., age-related psychotherapies such as play therapy or behavior management), and psychopharmacology. CONCLUSIONS Specific clinical, administrative, and technical issues are key considerations - based on the nuances of established child and adolescent mental healthcare - and must be considered in developing a clinical guideline for TMH of these patients. Developing such guidance should proceed from a careful review of the growing evidence base, and through expert consensus processes.
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Affiliation(s)
- Donald M Hilty
- 1 Kaweah Delta Medical Center, Visalia, California.,2 Department of Psychiatry and Keck School of Medicine at the University of Southern California , Los Angeles, California
| | - Erica Z Shoemaker
- 2 Department of Psychiatry and Keck School of Medicine at the University of Southern California , Los Angeles, California.,3 Child and Adolescent Services Los Angeles County and University of Southern California Medical Center , Los Angeles, California
| | - Kathleen Myers
- 4 Department of Psychiatry and Behavioral Sciences, University of Washington , Seattle, Washington.,5 Telemental Health Service, Seattle Children's Hospital , Seattle, Washington
| | - Christopher E Snowdy
- 2 Department of Psychiatry and Keck School of Medicine at the University of Southern California , Los Angeles, California
| | - Peter M Yellowlees
- 6 Department of Psychiatry, UC Davis School of Medicine , Davis, California
| | - Joel Yager
- 7 Department of Psychiatry, University of Colorado at Denver School of Medicine , Denver, Colorado
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Batastini AB. Improving Rehabilitative Efforts for Juvenile Offenders Through the Use of Telemental Healthcare. J Child Adolesc Psychopharmacol 2016; 26:273-7. [PMID: 26288198 DOI: 10.1089/cap.2015.0011] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
The use of videoconferencing technology in the provision of mental health services is expected to increase rapidly over the next several years. Given the high rates of juvenile offenders in need of such services and the new norms of communication among young people in general, technology-based service modalities are a promising approach for increasing the availability and intensity of services, as well as engagement and compliance with treatment recommendations. This article will discuss the current state of the juvenile justice system, the literature on the use of telemental healthcare (TMH) with delinquent youth, how TMH fits within the generally accepted model of correctional rehabilitation, and special considerations for applying TMH to this population and setting. Although there is no evidence to suggest negative outcomes associated with TMH, future research is greatly needed to justify its use.
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Affiliation(s)
- Ashley B Batastini
- Department of Psychological Sciences, Texas Tech University , Lubbock, Texas
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Heckman TG, Heckman BD, Anderson T, Bianco JA, Sutton M, Lovejoy TI. Common Factors and Depressive Symptom Relief Trajectories in Group Teletherapy for Persons Ageing with HIV. Clin Psychol Psychother 2015; 24:139-148. [PMID: 26538241 DOI: 10.1002/cpp.1989] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Revised: 10/06/2015] [Accepted: 10/07/2015] [Indexed: 11/08/2022]
Abstract
Telepsychology research has focused primarily on treatment efficacy, with far less attention devoted to how common factors relate to teletherapy outcomes. This research identified trajectories of depressive symptom relief in 105 older people living with HIV with elevated depressive symptoms enrolled in a randomized clinical trial testing two 12-session group teletherapies and compared common factors (e.g., therapeutic alliance and group cohesion) across depressive symptom trajectory groups. Growth mixture modelling of weekly depression scores identified three depressive symptom change groups: (1) 'early improvers' (31%) who reported reductions in depressive symptoms by Session 4; (2) 'delayed improvers' (16%) whose symptoms improved after Session 5 and (3) 'non-improvers' (53%). Therapeutic alliance was unrelated to treatment outcome group. Group cohesion was greater in early improvers than non-improvers. Group cohesion was unexpectedly lower, and group member similarity was greater in delayed improvers than non-improvers. Early improvers had been living with HIV/AIDS for fewer years than non-improvers. In group teletherapy, group cohesion and group member similarity are more important than client-therapist alliance. Copyright © 2015 John Wiley & Sons, Ltd. KEY PRACTITIONER MESSAGE In group teletherapy with older people living with HIV (OPLWHIV), three latent outcome trajectory groups emerged over the 12-week treatment period: (1) non-improvers (53%); (2) early improvers (31%) and (3) delayed improvers (16%). In group teletherapy with OPLWHIV, group cohesion is a stronger predictor of depressive symptom relief than is client-therapist alliance. OPLWHIV in group teletherapy who do not respond to treatment until the latter therapy sessions can still experience depressive symptom relief comparable with early responders.
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Affiliation(s)
- Timothy G Heckman
- College of Public Health, Department of Health Promotion and Behavior, University of Georgia, Athens, GA, USA
| | | | | | - Joseph A Bianco
- Department of Social Medicine, Ohio University Heritage College of Osteopathic Medicine, Athens, OH, USA
| | - Mark Sutton
- College of Public Health, Department of Health Promotion and Behavior, University of Georgia, Athens, GA, USA
| | - Travis I Lovejoy
- Department of Psychiatry, Oregon Health and Science University, Portland, OR, USA
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Morland LA, Mackintosh MA, Rosen CS, Willis E, Resick P, Chard K, Frueh BC. TELEMEDICINE VERSUS IN-PERSON DELIVERY OF COGNITIVE PROCESSING THERAPY FOR WOMEN WITH POSTTRAUMATIC STRESS DISORDER: A RANDOMIZED NONINFERIORITY TRIAL. Depress Anxiety 2015; 32:811-20. [PMID: 26243685 DOI: 10.1002/da.22397] [Citation(s) in RCA: 89] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Revised: 06/18/2015] [Accepted: 06/19/2015] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND This study examined the effectiveness of telemedicine to provide psychotherapy to women with posttraumatic stress disorder (PTSD) who might be unable to access treatment. Objectives were to compare clinical and process outcomes of PTSD treatment delivered via videoteleconferencing (VTC) and in-person (NP) in an ethnically diverse sample of veteran and civilian women with PTSD. METHODS A randomized controlled trial of Cognitive Processing Therapy, an evidence-based intervention for PTSD, was conducted through a noninferiority design to compare delivery modalities on difference in posttreatment PTSD symptoms. Women with PTSD, including 21 veterans and 105 civilians, were assigned to receive psychotherapy delivered via VTC or NP. Primary treatment outcomes were changes in PTSD symptoms in the completer sample. RESULTS Improvements in PTSD symptoms in the VTC condition (n = 63) were noninferior to outcomes in the NP condition (n = 63). Clinical outcomes obtained when both conditions were pooled together (N = 126) demonstrated that PTSD symptoms declined substantially posttreatment (mean = -20.5, 95% CI -29.6 to -11.4) and gains were maintained at 3- (mean = -20.8, 95% CI -30.1 to -11.5) and 6-month followup (mean = -22.0, 95% CI -33.1 to -10.9. Veterans demonstrated smaller symptom reductions posttreatment (mean = -9.4, 95% CI -22.5 to 3.7) than civilian women (mean = -22.7, 95% CI -29.9 to -15.5. CONCLUSIONS Providing psychotherapy to women with PTSD via VTC produced outcomes comparable to NP treatment. VTC can increase access to specialty mental health care for women in rural or remote areas.
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Affiliation(s)
- Leslie A Morland
- Pacific Islands Division, National Center for PTSD, Department of Veterans Affairs Pacific Islands Healthcare System, Honolulu, Hawaii
| | - Margaret-Anne Mackintosh
- Pacific Islands Division, National Center for PTSD, Department of Veterans Affairs Pacific Islands Healthcare System, Honolulu, Hawaii
| | - Craig S Rosen
- Dissemination and Training Division, National Center for PTSD, Department of Veterans Affairs Palo Alto Healthcare System, Menlo Park, California.,Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, California
| | - Emy Willis
- Pacific Islands Division, National Center for PTSD, Department of Veterans Affairs Pacific Islands Healthcare System, Honolulu, Hawaii.,Pacific Health Research and Education Institute, Honolulu, Hawaii
| | | | - Kathleen Chard
- Trauma Recovery Center, Cincinnati VA Medical Center, Cincinnati, Ohio.,Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - B Christopher Frueh
- Department of Psychiatry, University of Hawaii, Hilo, Hawaii.,The Menninger Clinic, Baylor College of Medicine, Houston, Texas
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Osilla KC, Paddock SM, Leininger TJ, D'Amico EJ, Ewing BA, Watkins KE. A pilot study comparing in-person and web-based motivational interviewing among adults with a first-time DUI offense. Addict Sci Clin Pract 2015; 10:18. [PMID: 26334629 PMCID: PMC4636762 DOI: 10.1186/s13722-015-0039-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Accepted: 08/19/2015] [Indexed: 12/01/2022] Open
Abstract
Background Driving under the influence (DUI) is a significant problem, and there is a pressing need to develop interventions that reduce future risk. Methods We pilot-tested the acceptance and efficacy of web-motivational interviewing (MI) and in-person MI interventions among a diverse sample of individuals with a first-time DUI offense. Participants (N = 159) were 65 percent male, 40 percent Hispanic, and an average age of 30 (SD = 9.8). They were enrolled at one of three participating 3-month DUI programs in Los Angeles County and randomized to usual care (UC)-only (36-h program), in-person MI plus UC, or a web-based intervention using MI (web-MI) plus UC. Participants were assessed at intake and program completion. We examined intervention acceptance and preliminary efficacy of the interventions on alcohol consumption, DUI, and alcohol-related consequences. Results Web-MI and in-person MI participants rated the quality of and satisfaction with their sessions significantly higher than participants in the UC-only condition. However, there were no significant group differences between the MI conditions and the UC-only condition in alcohol consumption, DUI, and alcohol-related consequences. Further, 67 percent of our sample met criteria for alcohol dependence, and the majority of participants in all three study conditions continued to report alcohol-related consequences at follow-up. Conclusions Participants receiving MI plus UC and UC-only had similar improvements, and a large proportion had symptoms of alcohol dependence. Receiving a DUI and having to deal with the numerous consequences related to this type of event may be significant enough to reduce short-term behaviors, but future research should explore whether more intensive interventions are needed to sustain long-term changes.
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Affiliation(s)
- Karen Chan Osilla
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90407-2138, USA.
| | - Susan M Paddock
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90407-2138, USA.
| | - Thomas J Leininger
- Department of Statistical Science, Duke University, Box 90251, Durham, NC, 27708-0251, USA.
| | | | - Brett A Ewing
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90407-2138, USA.
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Hilty D, Yellowlees PM, Parrish MB, Chan S. Telepsychiatry: Effective, Evidence-Based, and at a Tipping Point in Health Care Delivery? Psychiatr Clin North Am 2015; 38:559-92. [PMID: 26300039 DOI: 10.1016/j.psc.2015.05.006] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Patient-centered health care questions how to deliver quality, affordable, and timely care in a variety of settings. Telemedicine empowers patients, increases administrative efficiency, and ensures expertise gets to the place it is most needed--the patient. Telepsychiatry or telemental health is effective, well accepted, and comparable to in-person care. E-models of care offer variety, flexibility, and positive outcomes in most settings, and clinicians are increasingly interested in using technology for care, so much so that telepsychiatry is now being widely introduced around the world.
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Affiliation(s)
- Donald Hilty
- Psychiatry & Behavioral Sciences, Telehealth, USC Care Health System, Keck School of Medicine, University of Southern California, 2250 Alcazar Street, CSC Suite 2200, Los Angeles, CA 90033, USA.
| | - Peter M Yellowlees
- Psychiatry & Behavioral Sciences, Health Informatics Graduate Program, University of California, Davis School of Medicine and Health System, 2450 48th Street, Suite 2800, Sacramento, CA 95817, USA
| | - Michelle B Parrish
- Telepsychiatry and Health Informatics, University of California, Davis School of Medicine & Health System, 2450 48th Street Suite 2800, Sacramento, CA 95817, USA
| | - Steven Chan
- Department of Psychiatry & Behavioral Sciences, University of California, Davis School of Medicine & Health System, 2150 Stockton Boulevard, Sacramento, CA 95817, USA
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Jenkins-Guarnieri MA, Pruitt LD, Luxton DD, Johnson K. Patient Perceptions of Telemental Health: Systematic Review of Direct Comparisons to In-Person Psychotherapeutic Treatments. Telemed J E Health 2015; 21:652-60. [PMID: 25885491 DOI: 10.1089/tmj.2014.0165] [Citation(s) in RCA: 122] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Although there is growing empirical support for the clinical efficacy of telemental health (TMH) treatments, questions remain about how patient perceptions of the TMH treatment process may compare with those of traditional in-person psychotherapy treatments. MATERIALS AND METHODS Through a systematic review, we specifically examine measures of patient treatment satisfaction and therapeutic alliance in studies that included direct comparisons of video teleconferencing or telephone-based psychotherapeutic TMH treatments with in-person treatment delivery. We performed a comprehensive search of the PsychINFO and MEDLINE databases for articles published in the last 10 years (2004-2014) on TMH treatments that included in-person comparison groups, yielding 552 initial results with 14 studies meeting our full inclusion criteria. RESULTS The findings generally show comparable treatment satisfaction as well as similar ratings of therapeutic alliance. Some results suggested the potential for decreased patient comfort with aspects of group treatment delivered via TMH. CONCLUSIONS We discuss implications for providing psychotherapeutic treatments via TMH and review practice recommendations for assuring and enhancing satisfaction with TMH services.
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Affiliation(s)
| | - Larry D Pruitt
- 1 National Center for Telehealth & Technology , Tacoma, Washington
| | - David D Luxton
- 1 National Center for Telehealth & Technology , Tacoma, Washington
- 2 Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine , Seattle, Washington
| | - Kristine Johnson
- 1 National Center for Telehealth & Technology , Tacoma, Washington
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Grubbs KM, Fortney JC, Dean T, Williams JS, Godleski L. A Comparison of Mental Health Diagnoses Treated via Interactive Video and Face to Face in the Veterans Healthcare Administration. Telemed J E Health 2015; 21:564-6. [DOI: 10.1089/tmj.2014.0152] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Affiliation(s)
| | - John C. Fortney
- Central Arkansas VA Healthcare System–MIRECC, Little Rock, Arkansas
| | - Tisha Dean
- Central Arkansas VA Healthcare System–MIRECC, Little Rock, Arkansas
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Crisis Management and Conflict Resolution: Using Technology to Support Couples Throughout Deployment. CONTEMPORARY FAMILY THERAPY 2015. [DOI: 10.1007/s10591-015-9343-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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Therapeutic Alliance in Clinical Videoconferencing: Optimizing the Communication Context. ACTA ACUST UNITED AC 2014. [DOI: 10.1007/978-3-319-08765-8_10] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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