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Yarwood B, Taylor R, Angelakis I. User Experiences of CBT for Anxiety and Depression: A Qualitative Systematic Review and Meta-synthesis. Community Ment Health J 2024; 60:662-671. [PMID: 37884830 DOI: 10.1007/s10597-023-01196-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 09/27/2023] [Indexed: 10/28/2023]
Abstract
Cognitive behavioural therapy (CBT) is an evidence-based treatment for anxiety and depression. It is important to determine the positive and negative aspects of CBT from the perspective of service users. However, there has been a lack of qualitative exploration into service user experiences of the therapy. This review aimed to address this gap by examining participants' experiences of CBT for anxiety and depression. Databases were searched and data were synthesised thematically. CBT was well-received by participants, though barriers to engagement were identified. CBT was often perceived as too difficult or demanding, as well as interventions being short and therefore superficial. Clinician qualities of being trustworthy, non-judgemental, and understanding appear to be significant contributors to client engagement and recovery. Findings support the delivery of in-depth clinician led CBT for anxiety and depression, as well as highlighting the need to review CBT delivery to better support service users.
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Mak WWS, Tong ACY, Fu ACM, Leung IWY, Jung OHC, Watkins ER, Lui WWS. Efficacy of Internet-based rumination-focused cognitive behavioral therapy and mindfulness-based intervention with guided support in reducing risks of depression and anxiety: A randomized controlled trial. Appl Psychol Health Well Being 2024; 16:696-722. [PMID: 38073271 DOI: 10.1111/aphw.12512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 11/06/2023] [Indexed: 05/02/2024]
Abstract
Rumination and worry are common risk factors of depression and anxiety. Internet-based transdiagnostic interventions targeting individuals with these specific risks may be an effective way to prevent depression and anxiety. This three-arm randomized controlled trial compared the efficacy of Internet-based rumination-focused cognitive behavioral therapy (RFCBT), mindfulness-based intervention (MBI), and psychoeducation (EDU) control among 256 at-risk individuals. Participants' levels of rumination, worry, depressive, and anxiety symptoms were assessed at post-intervention (6 weeks), 3-month, and 9-month follow-ups. Linear mixed model analysis results showed similar levels of improvement in all outcomes across the three conditions. Changes in rumination differed comparing RFCBT and MBI, where a significant reduction in rumination was noted at a 3-month follow-up among participants in RFCBT, and no significant long-term effect among participants in MBI was noted at a 9-month follow-up. All three conditions showed similar reductions in risks and symptoms, implying that the two active interventions were not superior to EDU control. The high attrition at follow-ups suggested a need to exercise caution when interpreting the findings. Future studies should tease apart placebo effect and identify ways to improve adherence.
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Affiliation(s)
- Winnie W S Mak
- Department of Psychology, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Alan C Y Tong
- Department of Psychology, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Amanda C M Fu
- Department of Psychology, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Ivy W Y Leung
- Department of Psychology, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Olivia H C Jung
- Department of Psychology, The Chinese University of Hong Kong, Shatin, Hong Kong
| | | | - Wacy W S Lui
- Center for Personal Growth and Crisis Intervention of the Corporate Clinical Psychology Services, Hospital Authority, Ma Tau Wai, Hong Kong
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Bjornstad G, Sonthalia S, Rouse B, Freeman L, Hessami N, Dunne JH, Axford N. A comparison of the effectiveness of cognitive behavioural interventions based on delivery features for elevated symptoms of depression in adolescents: A systematic review. CAMPBELL SYSTEMATIC REVIEWS 2024; 20:e1376. [PMID: 38188230 PMCID: PMC10771715 DOI: 10.1002/cl2.1376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 11/03/2023] [Indexed: 01/09/2024]
Abstract
Background Depression is a public health problem and common amongst adolescents. Cognitive behavioural therapy (CBT) is widely used to treat adolescent depression but existing research does not provide clear conclusions regarding the relative effectiveness of different delivery modalities. Objectives The primary aim is to estimate the relative efficacy of different modes of CBT delivery compared with each other and control conditions for reducing depressive symptoms in adolescents. The secondary aim is to compare the different modes of delivery with regard to intervention completion/attrition (a proxy for intervention acceptability). Search Methods The Cochrane Depression, Anxiety and Neurosis Clinical Trials Register was searched in April 2020. MEDLINE, PsycInfo, EMBASE, four other electronic databases, the CENTRAL trial registry, Google Scholar and Google were searched in November 2020, together with reference checking, citation searching and hand-searching of two databases. Selection Criteria Randomised controlled trials (RCTs) of CBT interventions (irrespective of delivery mode) to reduce symptoms of depression in young people aged 10-19 years with clinically relevant symptoms or diagnosis of depression were included. Data Collection and Analysis Screening and data extraction were completed by two authors independently, with discrepancies addressed by a third author. CBT interventions were categorised as follows: group CBT, individual CBT, remote CBT, guided self-help, and unguided self-help. Effect on depressive symptom score was estimated across validated self-report measures using Hedges' g standardised mean difference. Acceptability was estimated based on loss to follow-up as an odds ratio. Treatment rankings were developed using the surface under the cumulative ranking curve (SUCRA). Pairwise meta-analyses were conducted using random effects models where there were two or more head-to-head trials. Network analyses were conducted using random effects models. Main Results Sixty-eight studies were included in the review. The mean age of participants ranged from 10 to 19.5 years, and on average 60% of participants were female. The majority of studies were conducted in schools (28) or universities (6); other settings included primary care, clinical settings and the home. The number of CBT sessions ranged from 1 to 16, the frequency of delivery from once every 2 weeks to twice a week and the duration of each session from 20 min to 2 h. The risk of bias was low across all domains for 23 studies, 24 studies had some concerns and the remaining 21 were assessed to be at high risk of bias. Sixty-two RCTs (representing 6435 participants) were included in the pairwise and network meta-analyses for post-intervention depressive symptom score at post-intervention. All pre-specified treatment and control categories were represented by at least one RCT. Although most CBT approaches, except remote CBT, demonstrated superiority over no intervention, no approaches performed clearly better than or equivalent to another. The highest and lowest ranking interventions were guided self-help (SUCRA 83%) and unguided self-help (SUCRA 51%), respectively (very low certainty in treatment ranking). Nineteen RCTs (3260 participants) were included in the pairwise and network meta-analyses for 6 to 12 month follow-up depressive symptom score. Neither guided self-help nor remote CBT were evaluated in the RCTs for this time point. Effects were generally attenuated for 6- to 12-month outcomes compared to posttest. No interventions demonstrated superiority to no intervention, although unguided self-help and group CBT both demonstrated superiority compared to TAU. No CBT approach demonstrated clear superiority over another. The highest and lowest ranking approaches were unguided self-help and individual CBT, respectively. Sixty-two RCTs (7347 participants) were included in the pairwise and network meta-analyses for intervention acceptability. All pre-specified treatment and control categories were represented by at least one RCT. Although point estimates tended to favour no intervention, no active treatments were clearly inferior. No CBT approach demonstrated clear superiority over another. The highest and lowest ranking active interventions were individual CBT and group CBT respectively. Pairwise meta-analytic findings were similar to those of the network meta-analysis for all analyses. There may be age-based subgroup effects on post-intervention depressive symptoms. Using the no intervention control group as the reference, the magnitudes of effects appear to be larger for the oldest age categories compared to the other subgroups for each given comparison. However, they were generally less precise and formal testing only indicated a significant difference for group CBT. Findings were robust to pre-specified sensitivity analyses separating out the type of placebo and excluding cluster-RCTs, as well as an additional analysis excluding studies where we had imputed standard deviations. Authors' Conclusions At posttreatment, all active treatments (group CBT, individual CBT, guided self-help, and unguided self-help) except for remote CBT were more effective than no treatment. Guided self-help was the most highly ranked intervention but only evaluated in trials with the oldest adolescents (16-19 years). Moreover, the studies of guided self-help vary in the type and amount of therapist support provided and longer-term results are needed to determine whether effects persist. The magnitude of effects was generally attenuated for 6- to 12-month outcomes. Although unguided self-help was the lowest-ranked active intervention at post-intervention, it was the highest ranked at follow-up. This suggests the need for further research into whether interventions with self-directed elements enable young people to maintain effects by continuing or revisiting the intervention independently, and whether therapist support would improve long-term outcomes. There was no clear evidence that any active treatments were more acceptable to participants than any others. The relative effectiveness of intervention delivery modes must be taken into account in the context of the needs and preferences of individual young people, particularly as the differences between effect sizes were relatively small. Further research into the type and amount of therapist support that is most acceptable to young people and most cost-effective would be particularly useful.
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Affiliation(s)
- Gretchen Bjornstad
- NIHR Applied Research Collaboration South West Peninsula (PenARC)University of Exeter Medical SchoolExeterUK
- Dartington Service Design LabBuckfastleighUK
| | - Shreya Sonthalia
- Dartington Service Design LabBuckfastleighUK
- MRC/CSO Social and Public Health Sciences UnitUniversity of GlasgowGlasgowUK
| | - Benjamin Rouse
- Center for Clinical Evidence and Guidelines, ECRI InstitutePlymouth MeetingPennsylvaniaUSA
| | | | | | - Jo Hickman Dunne
- The Centre for Youth ImpactLondonUK
- University of ManchesterManchesterUK
| | - Nick Axford
- NIHR Applied Research Collaboration South West Peninsula (PenARC)University of PlymouthPlymouthUK
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Grudin R, Vigerland S, Ahlen J, Widström H, Unger I, Serlachius E, Engberg H. "Therapy without a therapist?" The experiences of adolescents and their parents of online behavioural activation for depression with and without therapist support. Eur Child Adolesc Psychiatry 2024; 33:105-114. [PMID: 36650254 PMCID: PMC9844942 DOI: 10.1007/s00787-023-02142-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 01/05/2023] [Indexed: 01/19/2023]
Abstract
Behavioural Activation (BA) is an established treatment for adults with depression, and research on BA for adolescents is promising. However, there is a knowledge gap in terms of the experiences of adolescents and their parents BA for depression delivered online. Furthermore, there have been no previous studies conducted on the experiences of respondents with regard to the role of the therapist in online treatment. Therefore, the primary aim of this study is to explore the experiences of online BA among adolescents with depression and how their parents experience supporting their adolescent through treatment. Second, the experiences of having online therapy with or without a therapist were explored. Semi-structured interviews were conducted with eight adolescents and nine parents (n = 17) who completed guided or self-guided online BA. Reflexive thematic analysis was used to identify aspects of the experience of treatment that were important to adolescents and their parents. Two main themes were generated: (1) opportunities or barriers to engaging in treatment and (2) parental involvement is valued and welcomed. This study contributes valuable information regarding user experiences of BA treatment, the importance of therapist support and parental involvement in treating adolescents with depression.Trial registration number: ClinicalTrials.gov Identifier NCT04117789, Date of registration: 07 October 2019.
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Affiliation(s)
- Rebecca Grudin
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Healthcare Services, Region Stockholm, Gävlegatan 22, 113 30, Stockholm, Sweden.
| | - Sarah Vigerland
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Healthcare Services, Region Stockholm, Gävlegatan 22, 113 30, Stockholm, Sweden
| | - Johan Ahlen
- The Centre for Epidemiology and Community Medicine, Region Stockholm, Box 45436, 104 31, Stockholm, Sweden
- Department of Global Public Health, Karolinska Institutet, 171 77, Stockholm, Sweden
| | - Hanna Widström
- Moment Psychology, Drottninggatan 99, 113 60, Stockholm, Sweden
| | - Irma Unger
- Wemind Psychiatry, Rehnsgatan 20, 113 57, Stockholm, Sweden
| | - Eva Serlachius
- Department of Clinical Neuroscience, Karolinska Institutet, 171 77, Stockholm, Sweden
- Department of Clinical Sciences, Faculty of Medicine, Lund University, Baravägen 1, 222 40, Lund, Sweden
| | - Hedvig Engberg
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
- Department of Obstetrics and Gynaecology, Karolinska University Hospital, Stockholm, Sweden
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Freund J, Buntrock C, Braun L, Thielecke J, Baumeister H, Berking M, Ebert DD, Titzler I. Digital prevention of depression for farmers? A qualitative study on participants' experiences regarding determinants of acceptance and satisfaction with a tailored guided internet intervention program. Internet Interv 2022; 29:100566. [PMID: 36039069 PMCID: PMC9418375 DOI: 10.1016/j.invent.2022.100566] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 07/23/2022] [Accepted: 08/08/2022] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Farmers, forest workers and gardeners have a higher risk of developing depression compared to other occupational populations. As part of the German pilot project "With us in balance", the potential of six guided internet- and mobile-based interventions (IMIs) to prevent depression among their insurants is examined. The IMI program is tailored to various risk factors of depression, individual symptoms, and needs. Although IMIs have been shown to be effective in reducing depressive symptoms, there is little qualitative research about the acceptance of digital preventive IMIs. The aim of this qualitative study is to gain insights into participants' experiences with the guided IMIs by focusing on determinants for acceptance and satisfaction. METHODS Semi-structured interviews were conducted with 22/171 (13 %) intervention group (IG) participants of a randomized controlled trial. The interview guide was developed based on theoretical models of user acceptance (Unified Theory of Acceptance and Use of Technology) and patient satisfaction (evaluation model, discrepancy theory). The interviews were evaluated independently by two coders performing a deductive-inductive content analysis and attaining a substantial level of agreement (K = 0.73). RESULTS The qualitative analysis revealed 71 determinants for acceptance and satisfaction across ten dimensions: performance expectancy, organisation, e-coach, usability, training content and structure, training usage, training outcome, financing, social influence, and behavioural intention. The most frequently identified drivers for the IMI use include "location independence", "positive relationship to the e-coach" (each n = 19, 86 %), "personal e-coach guidance", "expertise of the e-coach", "target group specific adaptation" (each n = 18, 82 %), "flexibility", "high willingness for renewed participation" (each n = 17, 77 %), "fast and easy availability", "training of health enhancing attitudes and behaviours" and "content with figurative expressions" (each n = 16, 73 %). DISCUSSION The qualitative findings predominantly suggest the acceptance of and satisfaction with the IMI program for the prevention of depression in famers and related lines of work. Many identified positive drivers are related to the e-coach guidance, which emphasizes its importance in the preventive setting from the perspective of the participants. Nevertheless, some negative aspects have been identified which help to understand potential weaknesses of the IMI program. Participants indicated different needs in terms of IMI content and usage, which points towards the potential benefit of individualisation. The possibility of being able to use IMIs anonymously, flexibly and independently of location might be highly relevant for this specific target group.
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Affiliation(s)
- Johanna Freund
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Friedrich-Alexander-University of Erlangen-Nürnberg, Erlangen, Germany
- Faculty TUM Department of Sport and Health Sciences, TU Munich, Munich, Germany
- Corresponding author at: Friedrich-Alexander-University of Erlangen-Nürnberg, Institute of Psychology, Department of Clinical Psychology and Psychotherapy, Nägelsbachstraße 25a, 91052 Erlangen, Germany.
| | - Claudia Buntrock
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Friedrich-Alexander-University of Erlangen-Nürnberg, Erlangen, Germany
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, Ulm University, Ulm, Germany
- Institute of Social Medicine and Health Systems Research, Faculty of Medicine, Otto von Guericke University Magdeburg, Magdeburg, Germany
| | - Lina Braun
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, Ulm University, Ulm, Germany
| | - Janika Thielecke
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Friedrich-Alexander-University of Erlangen-Nürnberg, Erlangen, Germany
- Faculty TUM Department of Sport and Health Sciences, TU Munich, Munich, Germany
| | - Harald Baumeister
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, Ulm University, Ulm, Germany
| | - Matthias Berking
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Friedrich-Alexander-University of Erlangen-Nürnberg, Erlangen, Germany
| | - David Daniel Ebert
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Friedrich-Alexander-University of Erlangen-Nürnberg, Erlangen, Germany
- Faculty TUM Department of Sport and Health Sciences, TU Munich, Munich, Germany
| | - Ingrid Titzler
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Friedrich-Alexander-University of Erlangen-Nürnberg, Erlangen, Germany
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Tong AC, Ho FS, Chu OH, Mak WW. Time-Dependent Changes in Depressive Symptoms among Control Participants in Digital-based Psychological Intervention Studies: A Meta-analysis of Randomized Controlled Trials (Preprint). J Med Internet Res 2022; 25:e39029. [PMID: 37043276 PMCID: PMC10134030 DOI: 10.2196/39029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 11/30/2022] [Accepted: 02/21/2023] [Indexed: 02/23/2023] Open
Abstract
BACKGROUND Digital-based psychological interventions (DPIs) have been shown to be efficacious in many randomized controlled trials (RCTs) in dealing with depression in adults. However, the effects of control comparators in these DPI studies have been largely overlooked, and they may vary in their effects on depression management. OBJECTIVE This meta-analytical study aimed to provide a quantitative estimate of the within-subject effects of control groups across different time intervals and explore the moderating effects of control types and symptom severity at baseline. METHODS A systematic literature search was conducted in late September 2021 on selected electronic databases: PubMed; ProQuest; Web of Science; and the Ovid system with MEDLINE, PsycINFO, and Embase. The control conditions in 107 RCTs with a total of 11,803 adults with depressive symptoms were included in the meta-analysis, and effect sizes (Hedges g) were calculated using the standardized mean difference approach. Study quality was assessed using the Cochrane risk-of-bias tool for randomized trials version 2. RESULTS The control conditions collectively yielded small to moderate effects in reducing depressive symptoms within 8 weeks since the baseline assessment (g=-0.358, 95% CI -0.434 to -0.281). The effects grew to moderate within 9 to 24 weeks (g=-0.549, 95% CI -0.638 to -0.460) and peaked at g=-0.810 (95% CI -0.950 to -0.670) between 25 and 48 weeks. The effects were maintained at moderate to large ranges (g=-0.769, 95% CI -1.041 to -0.498) beyond 48 weeks. The magnitude of the reduction differed across the types of control and severity of symptoms. Care as usual was the most powerful condition of all and produced a large effect (g=-0.950, 95% CI -1.161 to -0.739) in the medium term. The findings showed that waitlist controls also produced a significant symptomatic reduction in the short term (g=-0.291, 95% CI -0.478 to -0.104), refuting the previous suspicion of a nocebo effect. In addition, a large effect on depressive symptom reduction in the long term (g=-1.091, 95% CI -1.210 to -0.972) was noted among participants with severe levels of depressive symptoms at baseline. CONCLUSIONS This study provided evidence that depressive symptoms generally reduced over time among control conditions in research trials of DPIs. Given that different control conditions produce variable and significant levels of symptomatic reduction, future intervention trials must adopt an RCT design and should consider the contents of control treatments when investigating the efficacy of DPIs. The results of waitlist controls confirmed previous findings of spontaneous recovery among people with mild to moderate depressive symptoms in face-to-face studies. Researchers may adopt watchful waiting as participants wait for the availability of digital-based psychological services.
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Affiliation(s)
- Alan Cy Tong
- Department of Psychology, The Chinese University of Hong Kong, New Territories, Hong Kong
| | - Florence Sy Ho
- Department of Psychology, The Chinese University of Hong Kong, New Territories, Hong Kong
| | - Owen Hh Chu
- Department of Psychology, The Chinese University of Hong Kong, New Territories, Hong Kong
| | - Winnie Ws Mak
- Department of Psychology, The Chinese University of Hong Kong, New Territories, Hong Kong
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Ørskov PT, Lichtenstein MB, Ernst MT, Fasterholdt I, Matthiesen AF, Scirea M, Bouchard S, Andersen TE. Cognitive behavioral therapy with adaptive virtual reality exposure vs. cognitive behavioral therapy with in vivo exposure in the treatment of social anxiety disorder: A study protocol for a randomized controlled trial. Front Psychiatry 2022; 13:991755. [PMID: 36299540 PMCID: PMC9589352 DOI: 10.3389/fpsyt.2022.991755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 09/13/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Social anxiety disorder (SAD) has a high prevalence and an early onset with recovery taking decades to occur. Current evidence supports the efficacy of cognitive behavioral therapy (CBT) with virtual reality (VR) exposure. However, the evidence is based on a sparse number of studies with predominantly small sample sizes. There is a need for more trials investigating the optimal way of applying VR based exposure for SAD. In this trial, we will test the efficacy of CBT with adaptive VR exposure allowing adjustment of the exposure based on real-time monitoring of the participants's anxiety level. METHODS The trial is a randomized controlled, assessor-blinded, parallel-group superiority trail. The study has two arms: (1) CBT including exposure in vivo (CBT-Exp), (2) CBT including exposure therapy using individually tailored VR-content and a system to track anxiety levels (CBT-ExpVR). Treatment is individual, manual-based and consists of 10 weekly sessions with a duration of 60 min. The study includes 90 participants diagnosed with SAD. Assessments are carried out pre-treatment, mid-treatment and at follow-up (6 and 12 months). The primary outcome is the mean score on the Social Interaction Anxiety Scale (SIAS) with the primary endpoint being post-treatment. DISCUSSION The study adds to the existing knowledge by assessing the efficacy of CBT with adaptive VR exposure. The study has high methodological rigor using a randomized controlled trial with a large sample size that includes follow-up data and validated measures for social anxiety outcomes. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov, identifier: NCT05302518.
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Affiliation(s)
- Per Trads Ørskov
- Research Unit for Digital Psychiatry, Mental Health Services in the Region of Southern Denmark, Odense, Denmark
| | - Mia Beck Lichtenstein
- Research Unit for Digital Psychiatry, Mental Health Services in the Region of Southern Denmark, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Mathias Torp Ernst
- Research Unit for Digital Psychiatry, Mental Health Services in the Region of Southern Denmark, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Iben Fasterholdt
- Centre for Innovative Medical Technology, Odense University Hospital, Odense, Denmark
| | | | - Marco Scirea
- Maersk Mc-Kinney Moller Institute, University of Southern Denmark, Odense, Denmark
| | - Stephane Bouchard
- Department of Psychoeducation and Psychology, University du Québec en Outaouais, Gatineau, QC, Canada
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A qualitative study of patients’ experiences and acceptance of computerised cognitive behavioural therapy in primary care, Scotland. COGNITIVE BEHAVIOUR THERAPIST 2021. [DOI: 10.1017/s1754470x21000210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Abstract
Computerised cognitive behavioural therapy (CCBT) has been made available within the National Health Service (NHS) across Scotland as an alternative treatment for mild to moderate anxiety and depression. However, the provision of CCBT services is still limited in the NHS, possibly affecting delivery of this computer-aided therapy to patients and inhibiting acceptance and uptake of this intervention. This paper reports on the qualitative exploration of patients’ experiences and acceptance of one CCBT programme delivering computer-assisted therapy (Beating the Blues: BTB), examining particularly the point of referral, access to treatment, and support. Thematic analysis was conducted on semi-structured face-to-face and email interviews with 33 patients at different NHS organisations across Scotland. Data analysis generated six key themes which illustrated patients’ experiences relating to referral and access to the treatment, and the challenges they faced: (1) information dissemination; (2) expectations and the impact of waiting for BTB; (3) impact of locations on experience of BTB; (4) preference for home access; (5) desire for better human support; and (6) desire for additional application support features. The findings highlighted that better methods of implementing and delivering such CCBT services together with the design of the technological interventions are vital to the success of these services.
Key learning aims
(1)
To understand the service models and methods of implementing and delivering one CCBT programme (BTB) in routine care;
(2)
To learn about user experiences of accessing and using BTB; and
(3)
To learn about the implications and factors that might have influenced uptake and understand the implications.
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Tremain H, McEnery C, Fletcher K, Murray G. The Therapeutic Alliance in Digital Mental Health Interventions for Serious Mental Illnesses: Narrative Review. JMIR Ment Health 2020; 7:e17204. [PMID: 32763881 PMCID: PMC7442952 DOI: 10.2196/17204] [Citation(s) in RCA: 61] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 06/07/2020] [Accepted: 06/07/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Digital mental health interventions offer unique advantages, and research indicates that these interventions are effective for a range of mental health concerns. Although these interventions are less established for individuals with serious mental illnesses, they demonstrate significant promise. A central consideration in traditional face-to-face therapies is the therapeutic alliance, whereas the nature of a digital therapeutic alliance and its relationship with outcomes requires further attention, particularly for individuals with serious mental illnesses. OBJECTIVE This narrative review aims to encourage further consideration and critical evaluation of the therapeutic alliance in digital mental health, specifically for individuals with serious mental illnesses. METHODS A narrative review was conducted by combining 3 main areas of the literature: the first examining the evidence for digital mental health interventions for serious mental illnesses, the second illuminating the nature and role of the therapeutic alliance in digital interventions, and the third surrounding practical considerations to enhance a digital therapeutic alliance. RESULTS Results indicated that a therapeutic alliance can be cultivated in digital interventions for those with serious mental illnesses, but that it may have unique, yet-to-be-confirmed characteristics in digital contexts. In addition, a therapeutic alliance appears to be less directly associated with outcomes in digital interventions than with those in face-to-face therapies. One possibility is that the digital therapeutic alliance is associated with increased engagement and adherence to digital interventions, through which it appears to influence outcomes. A number of design and implementation considerations may enhance the digital therapeutic alliance, including human support and technological features. CONCLUSIONS More research is required to further understand the nature and specific role of a therapeutic alliance in digital interventions for serious mental illnesses, particularly in informing their design. This review revealed several key research priorities to advance the therapeutic alliance in digital interventions.
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Affiliation(s)
- Hailey Tremain
- Centre for Mental Health, Faculty of Health, Arts and Design, Swinburne University of Technology, Hawthorn, Australia
| | | | - Kathryn Fletcher
- Centre for Mental Health, Faculty of Health, Arts and Design, Swinburne University of Technology, Hawthorn, Australia
| | - Greg Murray
- Centre for Mental Health, Faculty of Health, Arts and Design, Swinburne University of Technology, Hawthorn, Australia
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Patel S, Akhtar A, Malins S, Wright N, Rowley E, Young E, Sampson S, Morriss R. The Acceptability and Usability of Digital Health Interventions for Adults With Depression, Anxiety, and Somatoform Disorders: Qualitative Systematic Review and Meta-Synthesis. J Med Internet Res 2020; 22:e16228. [PMID: 32628116 PMCID: PMC7381032 DOI: 10.2196/16228] [Citation(s) in RCA: 71] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 02/20/2020] [Accepted: 03/23/2020] [Indexed: 12/20/2022] Open
Abstract
Background The prevalence of mental health disorders continues to rise, with almost 4% of the world population having an anxiety disorder and almost 3.5% having depression in 2017. Despite the high prevalence, only one-third of people with depression or anxiety receive treatment. Over the last decade, the use of digital health interventions (DHIs) has risen rapidly as a means of accessing mental health care and continues to increase. Although there is evidence supporting the effectiveness of DHIs for the treatment of mental health conditions, little is known about what aspects are valued by users and how they might be improved. Objective This systematic review aimed to identify, appraise, and synthesize the qualitative literature available on service users’ views and experiences regarding the acceptability and usability of DHIs for depression, anxiety, and somatoform disorders. Methods A systematic search strategy was developed, and searches were run in 7 electronic databases. Qualitative and mixed methods studies published in English were included. A meta-synthesis was used to interpret and synthesize the findings from the included studies. Results A total of 24 studies were included in the meta-synthesis, and 3 key themes emerged with descriptive subthemes. The 3 key themes were initial motivations and approaches to DHIs, personalization of treatment, and the value of receiving personal support in DHIs. The meta-synthesis suggests that participants’ initial beliefs about DHIs can have an important effect on their engagement with these types of interventions. Personal support was valued very highly as a major component of the success of DHIs. The main reason for this was the way it enabled individual personalization of care. Conclusions Findings from the systematic review have implications for the design of future DHIs to improve uptake, retention, and outcomes in DHIs for depression, anxiety, and somatoform disorders. DHIs need to be personalized to the specific needs of the individual. Future research should explore whether the findings could be generalized to other health conditions.
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Affiliation(s)
- Shireen Patel
- Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Athfah Akhtar
- School of Social Sciences, Birmingham City University, Birmingham, United Kingdom
| | - Sam Malins
- Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Nicola Wright
- Faculty of Medicine, School of Health Sciences, University of Nottingham, Nottingham, United Kingdom
| | - Emma Rowley
- School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Emma Young
- Nottinghamshire Healthcare NHS Foundation Trust, Nottingham, United Kingdom
| | - Stephanie Sampson
- NIHR MindTech MedTech Co-operative, University of Nottingham, Nottingham, United Kingdom
| | - Richard Morriss
- Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham, United Kingdom.,Nottinghamshire Healthcare NHS Foundation Trust, Nottingham, United Kingdom.,NIHR MindTech MedTech Co-operative, University of Nottingham, Nottingham, United Kingdom
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11
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Kemp J, Zhang T, Inglis F, Wiljer D, Sockalingam S, Crawford A, Lo B, Charow R, Munnery M, Singh Takhar S, Strudwick G. Delivery of Compassionate Mental Health Care in a Digital Technology-Driven Age: Scoping Review. J Med Internet Res 2020; 22:e16263. [PMID: 32141833 PMCID: PMC7084292 DOI: 10.2196/16263] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2019] [Revised: 11/19/2019] [Accepted: 12/14/2019] [Indexed: 12/17/2022] Open
Abstract
Background Compassion is a vital component to the achievement of positive health outcomes, particularly in mental health care. The rise of digital technologies may influence the delivery of compassionate care, and thus this relationship between compassion and digital health care needs to be better understood. Objective This scoping review aimed to identify existing digital technologies being used by patients and health professionals in the delivery of mental health care, understand how digital technologies are being used in the delivery of compassionate mental health care, and determine the facilitators of and barriers to digital technology use among patients and health professionals in the delivery of compassionate mental health care. Methods We conducted this scoping review through a search of Cumulative Index to Nursing and Allied Health Literature, Medical Literature Analysis and Retrieval System Online (MEDLINE), MEDLINE In-Process and EPub Ahead of Print, PsycINFO, and Web of Science for articles published from 1990 to 2019. Results Of the 4472 articles screened, 37 articles were included for data extraction. Telemedicine was the most widely used technology by mental health professionals. Digital technologies were described as facilitating compassionate care and were classified using a conceptual model to identify each digital intersection with compassionate care. Facilitators of and barriers to providing compassionate care through digital technology were identified, including increased safety for providers, health care professional perceptions and abilities, and the use of picture-in-picture feedback to evaluate social cues. Conclusions Implementing digital technology into mental health care can improve the current delivery of compassionate care and create novel ways to provide compassion. However, as this is a new area of study, mental health professionals and organizations alike should be mindful that compassionate human-centered care is maintained in the delivery of digital health care. Future research could develop tools to facilitate and evaluate the enactment of compassion within digital health care.
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Affiliation(s)
- Jessica Kemp
- Faculty of Science, University of Waterloo, Waterloo, ON, Canada.,Information Management Group, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Timothy Zhang
- Faculty of Science, University of Waterloo, Waterloo, ON, Canada.,Information Management Group, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Fiona Inglis
- Office of Education, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - David Wiljer
- Office of Education, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Education Technology and Innovation, University Health Network, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Sanjeev Sockalingam
- Office of Education, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Allison Crawford
- Office of Education, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Brian Lo
- Information Management Group, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Office of Education, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Rebecca Charow
- Education Technology and Innovation, University Health Network, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Mikayla Munnery
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.,Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Shuranjeet Singh Takhar
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Gillian Strudwick
- Information Management Group, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.,Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
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12
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Clemmensen L, Bouchard S, Rasmussen J, Holmberg TT, Nielsen JH, Jepsen JRM, Lichtenstein MB. STUDY PROTOCOL: EXPOSURE IN VIRTUAL REALITY FOR SOCIAL ANXIETY DISORDER - a randomized controlled superiority trial comparing cognitive behavioral therapy with virtual reality based exposure to cognitive behavioral therapy with in vivo exposure. BMC Psychiatry 2020; 20:32. [PMID: 32000725 PMCID: PMC6990574 DOI: 10.1186/s12888-020-2453-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 01/22/2020] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Social Anxiety Disorder (SAD) is characterized by an intense fear of negative judgement by others. Cognitive Behavioral Therapy (CBT) is recommended for treatment, but a substantial part of individuals with SAD either do not seek treatment or drop-out. CBT with Virtual Reality (VR)-based exposure has several advantages compared to traditional exposure methods, mainly due to increased control of situational elements. The aim of the current study is to develop a CBT program containing VR-based exposure. The intervention is targeted to adult patients suffering from SAD and treatment effect will be assessed by changes in SAD symptoms. METHODS This article describes the study protocol of a Randomized Controlled Trial with three arms: 1) CBT with VR exposure based on 360° videos 2) CBT with in vivo exposure and 3) VR relaxation therapy. There will be 30 participants in each arm with a crossover at the end of the treatment period during which the participants in the third group will be randomly re-allocated to one of the two former groups. The treatment program consists of 10 weekly individual sessions with a psychologist, and a six month follow-up consisting of a questionnaire. The primary outcome measure is reduction in SAD symptoms which will be assessed with the Social Interaction Anxiety Scale (SIAS). DISCUSSION There are currently no published studies on CBT with VR exposure based on 360° videos for SAD treatment. Furthermore, the current study will be the first Danish SAD treatment program that includes VR technology. TRIAL REGISTRATION clinicaltrials.gov (NCT03973541) June 3rd 2019.
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Affiliation(s)
- Lars Clemmensen
- Center for Telepsychiatry, Mental Health Services in the Region of Southern, Copenhagen, Denmark.
| | - Stéphane Bouchard
- 0000 0001 2112 1125grid.265705.3Department of Psychoeducation and Psychology, University du Québec en Outaouais, Gatineau, Canada
| | - Johan Rasmussen
- Center for Telepsychiatry, Mental Health Services in the Region of Southern, Copenhagen, Denmark
| | - Trine Theresa Holmberg
- Center for Telepsychiatry, Mental Health Services in the Region of Southern, Copenhagen, Denmark
| | - Jakob Hyldig Nielsen
- Center for Telepsychiatry, Mental Health Services in the Region of Southern, Copenhagen, Denmark
| | - Jens Richardt Møllegaard Jepsen
- 0000 0001 0674 042Xgrid.5254.6Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research (CINS) and Center for Neuropsychiatric Schizophrenia Research (CNSR), Mental Health Centre Glostrup, University of Copenhagen, Glostrup, Denmark
| | - Mia Beck Lichtenstein
- Center for Telepsychiatry, Mental Health Services in the Region of Southern, Copenhagen, Denmark
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13
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"Unrigging the support wheels" - A qualitative study on patients' experiences with and perspectives on low-intensity CBT. BMC Health Serv Res 2019; 19:686. [PMID: 31597555 PMCID: PMC6784338 DOI: 10.1186/s12913-019-4495-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Accepted: 08/30/2019] [Indexed: 01/18/2023] Open
Abstract
Background Low-intensity treatments imply reduced therapist contact due to an emphasis on self-help and the use of technologies to deliver treatment. The role of the remoteness, the reduced therapist contact, and the interplay of these components has not been differentiated from a patients’ perspective so far. This study’s purpose is to capture patients’ experiences with telephone-based self-help cognitive behavioural therapy (tel-CBT). Methods A subsample of mildly to moderately depressed patients (N = 13) who finished tel-CBT as part of a larger randomised controlled trial (RCT) in routine care were interviewed using a semi-structured questionnaire. Interviews were audiotaped, transcribed verbatim, and independently coded by two coders blind to treatment outcome. Using qualitative content analysis with deductive and inductive procedures, a two-level category system was established. Results The category system contains four category clusters regarding expectations, self-help related aspects, telephone-related aspects, and implications for patients’ treatment pathway, and subsumes a total of 15 categories. Self-help related aspects circulate around the interplay between written materials and professional input, trust and support in the therapeutic relationship and its relation to the initial personal contact, as well as CBT principles. Telephone-related aspects entail perceived advantages and disadvantages of the telephone on an organisational and content level as well as a discourse around distance and closeness in the interaction. Although patients raised doubts regarding the long-term effect of the intervention on symptomatology, patients expressed satisfaction with the treatment and reported an immediate as well as a longer lasting personal impact of the treatment. These results indicate user acceptance with tel-CBT. Conclusions This qualitative analysis captures patients’ experiences with tel-CBT and the perceived helpfulness of the diverse treatment components. This can facilitate refining aspects of low-intensity treatments and might improve dissemination. Trial registration ClinicalTrials.gov NCT02667366. Registered on 3 December 2015. Electronic supplementary material The online version of this article (10.1186/s12913-019-4495-1) contains supplementary material, which is available to authorized users.
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14
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Hronis A, Roberts R, Roberts L, Kneebone I. Fearless Me! © : A feasibility case series of cognitive behavioral therapy for adolescents with intellectual disability. J Clin Psychol 2019; 75:919-932. [PMID: 30659608 DOI: 10.1002/jclp.22741] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 10/26/2018] [Accepted: 11/06/2018] [Indexed: 12/20/2022]
Abstract
OBJECTIVE This study evaluated the feasibility of the Fearless Me! program, an online cognitive behavioral therapy (CBT) program for children with intellectual disability (ID) and anxiety. METHOD Twenty-one adolescents with mild to moderate ID participated in ten sessions of the therapist-assisted Fearless Me! program, combining face-to-face group sessions and an online component. A case series design was adopted to assess anxiety symptoms at baseline, throughout intervention, and postintervention. Feasibility of the measures, intervention, and trial design were considered. RESULTS The measures were appropriate and sensitive to changes in anxiety, whereas the need for attention to factors influencing parent's completion of them was identified. Reliable Change Index and visual analyses of results indicated reductions in anxiety, particularly for older adolescents with heightened levels of anxiety at baseline. CONCLUSIONS This is one of the first CBT programs for adolescents with ID, and provides preliminary evidence of adapted CBT as a feasible treatment.
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Affiliation(s)
- Anastasia Hronis
- Discipline of Clinical Psychology, Graduate School of Health, University of Technology Sydney, Ultimo, NSW, Australia
| | - Rachel Roberts
- School of Psychology, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia
| | - Lynette Roberts
- Discipline of Clinical Psychology, Graduate School of Health, University of Technology Sydney, Ultimo, NSW, Australia
| | - Ian Kneebone
- Discipline of Clinical Psychology, Graduate School of Health, University of Technology Sydney, Ultimo, NSW, Australia
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15
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Helpful and Hindering Events in Internet-Delivered Cognitive Behavioural Treatment for Generalized Anxiety. Behav Cogn Psychother 2018; 47:386-399. [DOI: 10.1017/s1352465818000504] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Background: Anxiety disorders are a highly prevalent cause of impairment globally with generalized anxiety disorder (GAD) sharing many features with other anxiety disorders. Aims: The present study investigated the helpful and hindering events and impacts for individuals with generalized anxiety who engaged with a supported 6-week online intervention based on cognitive behavioural therapy (iCBT). Method: Participants (n = 36) completed the Helpful and Hindering Aspects of Therapy (HAT) for each session. A descriptive-interpretative framework was used to analyse the data. Results: Helpful events were identified by participants as CBT techniques including psychoeducation, monitoring, cognitive restructuring and relaxation, and found supporter interaction, mindfulness and reading personal stories helpful. The associated impacts were identified as support and validation; behavioural change/applying coping strategies; clarification, awareness, and insight; reassurance/relief; and self-efficacy/empowerment. Hindering events were identified as treatment content/form; and amount of work/technical issues, which led to impacts such as frustration/irritation; increased anxiety; and isolation. Conclusion: The implications of the results, potential future directions of research and limitations of the study are discussed.
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16
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Bartholomew TT, Lockard AJ. Mixed methods in psychotherapy research: A review of method(ology) integration in psychotherapy science. J Clin Psychol 2018; 74:1687-1709. [PMID: 29900532 DOI: 10.1002/jclp.22653] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Revised: 04/15/2018] [Accepted: 05/26/2018] [Indexed: 12/26/2022]
Abstract
OBJECTIVE Mixed methods can foster depth and breadth in psychological research. However, its use remains in development in psychotherapy research. Our purpose was to review the use of mixed methods in psychotherapy research. METHOD Thirty-one studies were identified via the PRISMA systematic review method. Using Creswell & Plano Clark's typologies to identify design characteristics, we assessed each study for rigor and how each used mixed methods. RESULTS Key features of mixed methods designs and these common patterns were identified: (a) integration of clients' perceptions via mixing; (b) understanding group psychotherapy; (c) integrating methods with cases and small samples; (d) analyzing clinical data as qualitative data; and (e) exploring cultural identities in psychotherapy through mixed methods. CONCLUSION The review is discussed with respect to the value of integrating multiple data in single studies to enhance psychotherapy research.
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17
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Thielsch MT, Thielsch C. Depressive symptoms and web user experience. PeerJ 2018; 6:e4439. [PMID: 29507832 PMCID: PMC5834939 DOI: 10.7717/peerj.4439] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Accepted: 02/11/2018] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Depression, as one of the most prevalent mental disorders, is expected to become a leading cause of disability. While evidence-based treatments are not always easily accessible, Internet-based information and self-help appears as a promising approach to improve the strained supply situation by avoiding barriers of traditional offline treatment. User experience in the domain of mental problems therefore emerges as an important research topic. The aim of our study is to investigate the impact of depressive symptoms on subjective and objective measures of web user experience. METHOD In this two-part online study (Ntotal = 721) we investigate the relationship between depressive symptoms of web users and basic website characteristics (i.e., content, subjective and objective usability, aesthetics). Participants completed search and memory tasks on different fully-functional websites. In addition, they were asked to evaluate the given websites with standardized measures and were screened for symptoms of depression using the PHQ-9. We used structural equation modeling (SEM) to determine whether depression severity affects users' perception of and performance in using information websites. RESULTS We found significant associations between depressive symptoms and subjective user experience, specifically of website content, usability, and aesthetics, as well as an effect of content perception on the overall appraisal of a website in terms of the intention to visit it again. Small yet significant negative effects of depression severity on all named subjective website evaluations were revealed, leading to an indirect negative effect on the intention to revisit a website via impaired content perceptions. However, objective task performance was not influenced by depressiveness of users. DISCUSSION Depression emerges as capable of altering the subjective perception of a website to some extend with respect to the main features content, usability, and aesthetics. The user experience of a website is crucial, especially as it facilitates revisiting a website and thus might be relevant in avoiding drop-out in online interventions. Thus, the biased impression of persons affected by symptoms of depression and resulting needs of those users should be considered when designing and evaluating E-(Mental)-Health-platforms. The high prevalence of some mental disorders such as depression in the general population stresses the need for further investigations of the found effects.
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Affiliation(s)
| | - Carolin Thielsch
- Department of Psychology, University of Münster, Münster, Germany
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18
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Richards D, Dowling M, O'Brien E, Viganò N, Timulak L. Significant events in an Internet-delivered (Space from Depression
) intervention for depression. COUNSELLING & PSYCHOTHERAPY RESEARCH 2017. [DOI: 10.1002/capr.12142] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Affiliation(s)
- Derek Richards
- E-mental Health Research Group; School of Psychology; University of Dublin; Trinity College Dublin; Dublin Ireland
- SilverCloud Health; Dublin Ireland
| | - Mairéad Dowling
- E-mental Health Research Group; School of Psychology; University of Dublin; Trinity College Dublin; Dublin Ireland
| | - Emma O'Brien
- E-mental Health Research Group; School of Psychology; University of Dublin; Trinity College Dublin; Dublin Ireland
| | - Noemi Viganò
- E-mental Health Research Group; School of Psychology; University of Dublin; Trinity College Dublin; Dublin Ireland
| | - Ladislav Timulak
- E-mental Health Research Group; School of Psychology; University of Dublin; Trinity College Dublin; Dublin Ireland
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19
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Earley C, Joyce C, McElvaney J, Richards D, Timulak L. Preventing depression: Qualitatively examining the benefits of depression-focused iCBT for participants who do not meet clinical thresholds. Internet Interv 2017; 9:82-87. [PMID: 30135841 PMCID: PMC6096201 DOI: 10.1016/j.invent.2017.07.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Accepted: 07/01/2017] [Indexed: 01/19/2023] Open
Abstract
•First qualitative study on the benefits of iCBT for those who do not meet clinical thresholds•Successful application of cognitive and behavioural strategies reported•Increased insight/awareness and improved self-efficacy reported•The format of online delivery was reported as helpful.•Findings align with previous face-to-face and iCBT treatments.
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Affiliation(s)
- C. Earley
- SilverCloud Health, The Priory, John's Street West, Dublin, Ireland
- School of Psychology, Trinity College Dublin, Ireland
| | - C. Joyce
- SilverCloud Health, The Priory, John's Street West, Dublin, Ireland
| | - J. McElvaney
- School of Psychology, Trinity College Dublin, Ireland
| | - D. Richards
- SilverCloud Health, The Priory, John's Street West, Dublin, Ireland
- School of Psychology, Trinity College Dublin, Ireland
| | - L. Timulak
- School of Psychology, Trinity College Dublin, Ireland
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Guided Self-Help for Patients with Chronic Fatigue Syndrome Prior to Starting Cognitive Behavioural Therapy: a Cohort Study. Behav Cogn Psychother 2017; 45:448-466. [PMID: 28473005 DOI: 10.1017/s135246581700025x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Previous research suggests that minimal interventions such as self-help guidance can improve outcomes in patients with fatigue or chronic fatigue syndrome (CFS). AIMS The aim of the current study was to investigate whether self-help guidance could improve physical functioning, social adjustment and fatigue in a group of patients with CFS who were awaiting CBT at a clinic in secondary care. METHOD Patients completed questionnaires at their initial assessment (baseline), immediately before beginning CBT (pre-treatment), and after their last session of CBT (end of treatment). The primary outcome was physical functioning, and the secondary outcomes were social adjustment and fatigue. Multi-level linear models were used to assess change over time after adjustment for gender and age. RESULTS Multi-level models revealed that from baseline to pre-treatment, patients showed statistically significant improvements in physical functioning, but there were no statistically significant improvements in fatigue or social adjustment. However, all the primary and secondary outcomes showed statistically significant changes after CBT. CONCLUSIONS The findings of this study indicate that self-help guidance may be beneficial for patients with CFS who are awaiting CBT treatment or those who are unable to access specialist treatment in their local area.
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21
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Gega L. The virtues of virtual reality in exposure therapy. Br J Psychiatry 2017; 210:245-246. [PMID: 28373222 DOI: 10.1192/bjp.bp.116.193300] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Accepted: 01/19/2017] [Indexed: 12/29/2022]
Abstract
Virtual reality can be more effective and less burdensome than real-life exposure. Optimal virtual reality delivery should incorporate in situ direct dialogues with a therapist, discourage safety behaviours, allow for a mismatch between virtual and real exposure tasks, and encourage self-directed real-life practice between and beyond virtual reality sessions.
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Affiliation(s)
- Lina Gega
- Lina Gega, PhD, RMN, EMB650, Reader in Mental Health, Mental Health and Addiction Research Group (MHARG), Department of Health Sciences & Hull York Medical School, University of York, Alcuin Research Resource Centre, Heslington, York YO10 5DD, UK.
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22
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Cipolletta S, Mocellin D. Online counseling: An exploratory survey of Italian psychologists’ attitudes towards new ways of interaction. Psychother Res 2017; 28:909-924. [DOI: 10.1080/10503307.2016.1259533] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Affiliation(s)
- Sabrina Cipolletta
- Dipartimento di Psicologia Generale, Università degli Studi di Padova, Padova, Italy
| | - Damiano Mocellin
- Dipartimento di Psicologia Generale, Università degli Studi di Padova, Padova, Italy
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23
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Cotter P, Meysner L, Lee CW. Participant experiences of Eye Movement Desensitisation and Reprocessing vs. Cognitive Behavioural Therapy for grief: similarities and differences. Eur J Psychotraumatol 2017; 8:1375838. [PMID: 29163856 PMCID: PMC5687803 DOI: 10.1080/20008198.2017.1375838] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Accepted: 08/22/2017] [Indexed: 12/28/2022] Open
Abstract
Background and Objective: Previous research has used quantitative methods to assess the impact of grief therapy. However, rarely have participants been asked about how they have been affected by treatment using qualitative methods. This study sought to explore participants' experiences of two therapeutic approaches to grief: Cognitive Behavioural Therapy (CBT) and Eye Movement Desensitisation and Reprocessing (EMDR). Method: Nineteen participants were randomly allocated to receive seven weekly therapy sessions of either CBT or EMDR. Approximately two weeks after completing therapy, a semi-structured interview was conducted with each participant. Interviews were transcribed and a thematic analysis was performed. Results: Participant reports common to both therapies included developments in insight, a positive shift in emotions, increased activity, improved self-confidence and a healthier mental relationship to the deceased. Participants also responded by describing experiences that were unique to each therapy. Those who completed CBT described the acquisition of emotion regulation tools and shifting from being in an ongoing state of grief to feeling that they were at a new stage in their lives. Participants who completed EMDR reported that distressing memories were less clear and felt more distant from such memories following treatment. Conclusions: Although both therapies resulted in some similar changes for participants, there were unique experiences associated with each therapy. These findings are discussed in terms of implications for the underlying key processes of each therapy and the processes of recovery in grief.
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Affiliation(s)
- Prudence Cotter
- Department of Psychology and Exercise Science, Murdoch University, Perth, Australia
| | - Larissa Meysner
- Department of Psychology and Exercise Science, Murdoch University, Perth, Australia
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Mogoașe C, Cobeanu O, David O, Giosan C, Szentagotai A. Internet-Based Psychotherapy for Adult Depression: What About the Mechanisms of Change? J Clin Psychol 2016; 73:5-64. [DOI: 10.1002/jclp.22326] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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25
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Feather JS, Howson M, Ritchie L, Carter PD, Parry DT, Koziol-McLain J. Evaluation Methods for Assessing Users' Psychological Experiences of Web-Based Psychosocial Interventions: A Systematic Review. J Med Internet Res 2016; 18:e181. [PMID: 27363519 PMCID: PMC4945819 DOI: 10.2196/jmir.5455] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Revised: 05/03/2016] [Accepted: 05/24/2016] [Indexed: 12/15/2022] Open
Abstract
Background The use of Web-based interventions to deliver mental health and behavior change programs is increasingly popular. They are cost-effective, accessible, and generally effective. Often these interventions concern psychologically sensitive and challenging issues, such as depression or anxiety. The process by which a person receives and experiences therapy is important to understanding therapeutic process and outcomes. While the experience of the patient or client in traditional face-to-face therapy has been evaluated in a number of ways, there appeared to be a gap in the evaluation of patient experiences of therapeutic interventions delivered online. Evaluation of Web-based artifacts has focused either on evaluation of experience from a computer Web-design perspective through usability testing or on evaluation of treatment effectiveness. Neither of these methods focuses on the psychological experience of the person while engaged in the therapeutic process. Objective This study aimed to investigate what methods, if any, have been used to evaluate the in situ psychological experience of users of Web-based self-help psychosocial interventions. Methods A systematic literature review was undertaken of interdisciplinary databases with a focus on health and computer sciences. Studies that met a predetermined search protocol were included. Results Among 21 studies identified that examined psychological experience of the user, only 1 study collected user experience in situ. The most common method of understanding users’ experience was through semistructured interviews conducted posttreatment or questionnaires administrated at the end of an intervention session. The questionnaires were usually based on standardized tools used to assess user experience with traditional face-to-face treatment. Conclusions There is a lack of methods specified in the literature to evaluate the interface between Web-based mental health or behavior change artifacts and users. Main limitations in the research were the nascency of the topic and cross-disciplinary nature of the field. There is a need to develop and deliver methods of understanding users’ psychological experiences while using an intervention.
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Affiliation(s)
- Jacqueline Susan Feather
- Centre for Interdisciplinary Trauma Research, Department of Psychology, Auckland University of Technology, Auckland, New Zealand.
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Knopp-Hoffer J, Knowles S, Bower P, Lovell K, Bee PE. 'One man's medicine is another man's poison': a qualitative study of user perspectives on low intensity interventions for Obsessive-Compulsive Disorder (OCD). BMC Health Serv Res 2016; 16:188. [PMID: 27194033 PMCID: PMC4870799 DOI: 10.1186/s12913-016-1433-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Accepted: 05/11/2016] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Low intensity interventions based on cognitive-behavioral therapy (CBT) such as computerized therapy or guided self-help can offer effective and accessible care for mild to moderate mental health problems. However, critics argue that by reducing therapist input and the level of experience of the professionals delivering therapy, low intensity interventions deprive users of critical 'active ingredients'. Thus, while demand management arguments support the use of low intensity interventions for OCD, their integration into existing mental health services remains incomplete. Studies of user views of low intensity interventions can offer valuable insights to define their role and optimize their implementation in practice. METHODS Qualitative interviews (n = 36) in adults with OCD explored user perspectives on the initiation, continuation and acceptability of two low intensity CBT interventions: guided self-help (6 h of professional support) and computerized CBT (1 h of professional support), delivered within the context of a large pragmatic effectiveness trial (ISRCTN73535163). RESULTS While uptake was relatively high, continued engagement with the low intensity interventions was complex, with the perceived limitations of self-help materials impacting on users' willingness to continue therapy. The addition of professional support provided an acceptable compromise between the relative benefits of self-help and the need for professional input. However, individual differences were evident in the extent to which this compromise was considered necessary and acceptable. The need for some professional contact to manage expectations and personalize therapy materials was amplified in users with OCD, given the unique features of the disorder. However, individual differences were again evident regarding the perceived value of face-to-face support. CONCLUSIONS Overall the findings demonstrate the need for flexibility in the provision of low intensity interventions for OCD, responsive to user preferences, as these preferences impact directly on engagement with therapy and perceptions of effectiveness.
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Affiliation(s)
- Jasmin Knopp-Hoffer
- NIHR School for Primary Care Research, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK.
| | - Sarah Knowles
- NIHR School for Primary Care Research, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Peter Bower
- NIHR School for Primary Care Research, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Karina Lovell
- School of Nursing, Midwifery and Social Work, The University of Manchester, Manchester, UK
| | - Penny E Bee
- School of Nursing, Midwifery and Social Work, The University of Manchester, Manchester, UK
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Heinrich S, Rozental A, Carlbring P, Andersson G, Cotter K, Weise C. Treating tinnitus distress via the Internet: A mixed methods approach of what makes patients seek help and stay motivated during Internet-based cognitive behavior therapy. Internet Interv 2016; 4:120-130. [PMID: 30135798 PMCID: PMC6096122 DOI: 10.1016/j.invent.2016.04.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Revised: 04/16/2016] [Accepted: 04/17/2016] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Internet-based cognitive behavioral therapy (ICBT) has proven to be an effective treatment in improving patients' ability to cope with tinnitus. However, some patients prefer face-to-face therapy to ICBT, and a few studies have shown considerable dropout rates if the treatment is not guided. This renders it important to identify factors that contribute to the commencement and continuation of ICBT programs. AIMS Because treatment motivation and expectations are important factors in psychological treatment, the aim of our study was to investigate what leads tinnitus patients to seek out ICBT, what helps them to keep up with the treatment, and what (if any) impact these factors have on dropout rates and treatment outcomes. METHOD 112 tinnitus patients taking part in ICBT for tinnitus responded to symptom-related questionnaires at three points in time (pre-treatment, post-treatment, and one-year-follow-up) and to a questionnaire consisting of open-ended questions about their treatment motivation and expectations before beginning treatment. Data were analyzed using qualitative content analysis, and the results were used to divide the participants into groups. The treatment outcomes of these groups were compared using t-tests, χ2-tests, and both one-factorial and mixed ANOVAs. RESULTS Four main categories emerged as factors conducive to starting treatment: 1) Targets participants wanted to address, 2) circumstances that led to participation, 3) attitudes towards the treatment, and 4) training features. Participants identified six facilitators for continuing the treatment: success, training, individual attitude, hope, evidence, and support. Naming specific tinnitus-associated problems as targets was associated with greater improvement from pre-treatment to 1-year-follow-up. Describing an active involvement in the treatment was related to increased improvement from post-treatment to follow-up. CONCLUSION There are several motivational factors that tinnitus patients consider relevant for beginning and continuing ICBT. Particularly, focusing on specific targets that do not involve the tinnitus itself, and encouraging participants to take an active role in treatment may increase treatment effectiveness. However, further hypothesis-guided research is necessary to confirm our explorative results.
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Affiliation(s)
- Sarah Heinrich
- Department of Psychology, Stockholm University, Stockholm, Sweden
| | | | - Per Carlbring
- Department of Psychology, Stockholm University, Stockholm, Sweden
| | - Gerhard Andersson
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden,Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Katherine Cotter
- Department of Psychology, Stockholm University, Stockholm, Sweden
| | - Cornelia Weise
- Department of Psychology, Division of Clinical Psychology and Psychotherapy, Philipps-University Marburg, Marburg, Germany,Department of Behavioural Sciences and Learning, Linnaeus Centre HEAD, Swedish Institute for Disability Research, Linköping University, Linköping, Sweden,Corresponding author at: Philipps-University Marburg, Department of Psychology, Division of Clinical Psychology and Psychotherapy, Gutenbergstrasse 18, 35032 Marburg, Germany
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Vaks Y, Bensen R, Steidtmann D, Wang TD, Platchek TS, Zulman DM, Malcolm E, Milstein A. Better health, less spending: Redesigning the transition from pediatric to adult healthcare for youth with chronic illness. HEALTHCARE (AMSTERDAM, NETHERLANDS) 2016; 4:57-68. [PMID: 27001100 PMCID: PMC4805882 DOI: 10.1016/j.hjdsi.2015.09.001] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Revised: 09/01/2015] [Accepted: 09/01/2015] [Indexed: 01/18/2023]
Abstract
Adolescents and young adults (AYA) with serious chronic illnesses face costly and dangerous gaps in care as they transition from pediatric to adult health systems. New, financially sustainable approaches to transition are needed to close these gaps. We designed a new transition model for adolescents and young adults with a variety of serious chronic conditions. Our explicit goal was to build a model that would improve the value of care for youth 15-25 years of age undergoing this transition. The design process incorporated a review, analysis, and synthesis of relevant clinical and health services research; stakeholder interviews; and observations of high-performing healthcare systems. We identified three major categories of solutions for a safer and lower cost transition to adult care: (1) building and supporting self-management during the critical transition; (2) engaging receiving care; and (3) providing checklist-driven guide services during the transition. We propose that implementation of a program with these interventions would have a positive impact on all three domains of the triple aim - improving health, improving the experience of care, and reducing per capita healthcare cost. The transition model provides a general framework as well as suggestions for specific interventions. Pilot tests to assess the model's ease of implementation, clinical effects, and financial impact are currently underway.
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Affiliation(s)
- Yana Vaks
- Clinical Excellence Research Center, Stanford University School of Medicine, United States; Department of Pediatrics, Loma Linda University Children's Hospital, United States.
| | - Rachel Bensen
- Clinical Excellence Research Center, Stanford University School of Medicine, United States; Department of Pediatrics, Stanford University School of Medicine, United States
| | - Dana Steidtmann
- Clinical Excellence Research Center, Stanford University School of Medicine, United States; Department of Family Medicine, University of Colorado School of Medicine, United States
| | - Thomas D Wang
- Clinical Excellence Research Center, Stanford University School of Medicine, United States
| | - Terry S Platchek
- Clinical Excellence Research Center, Stanford University School of Medicine, United States; Department of Pediatrics, Stanford University School of Medicine, United States
| | - Donna M Zulman
- Clinical Excellence Research Center, Stanford University School of Medicine, United States; Division of General Medical Disciplines, Stanford University School of Medicine, United States; Center for Innovation to Implementation, VA Palo Alto Health Care System, United States
| | - Elizabeth Malcolm
- Clinical Excellence Research Center, Stanford University School of Medicine, United States
| | - Arnold Milstein
- Clinical Excellence Research Center, Stanford University School of Medicine, United States
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Abstract
A rather large body of literature now exists on the use of telemental health services in the diagnosis and management of various psychiatric conditions. This review aims to provide an up-to-date assessment of telemental health, focusing on four main areas: computerized CBT (cCBT), Internet-based CBT (iCBT), virtual reality exposure therapy (VRET), and mobile therapy (mTherapy). Four scientific databases were searched and, where possible, larger, better-designed meta-analyses and controlled trials were highlighted. Taken together, published studies support an expanded role for telepsychiatry tools, with advantages that include increased care access, enhanced efficiency, reduced stigma associated with visiting mental health clinics, and the ability to bypass diagnosis-specific obstacles to treatment, such as when social anxiety prevents a patient from leaving the house. Of technology-mediated therapies, cCBT and iCBT possess the most efficacy evidence, with VRET and mTherapy representing promising but less researched options that have grown in parallel with virtual reality and mobile technology advances. Nonetheless, telepsychiatry remains challenging because of the need for specific computer skills, the difficulty in providing patients with a deep understanding or support, concerns about the "therapeutic alliance", privacy fears, and the well documented problem of patient attrition. Future studies should further test the efficacy, advantages and limitations of technology-enabled CBT, as well as explore the online delivery of other psychotherapeutic and psychopharmacological modalities.
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Affiliation(s)
- Elias Aboujaoude
- OCD Clinic, Stanford University School of MedicineStanford, CA, USA
| | - Wael Salame
- Department of Psychiatry, Lebanese American UniversityBeirut, Lebanon
| | - Lama Naim
- Department of Psychiatry, Lebanese American UniversityBeirut, Lebanon
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Reynolds J, Griffiths KM, Cunningham JA, Bennett K, Bennett A. Clinical Practice Models for the Use of E-Mental Health Resources in Primary Health Care by Health Professionals and Peer Workers: A Conceptual Framework. JMIR Ment Health 2015; 2:e6. [PMID: 26543912 PMCID: PMC4607387 DOI: 10.2196/mental.4200] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Revised: 02/10/2015] [Accepted: 02/12/2015] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Research into e-mental health technologies has developed rapidly in the last 15 years. Applications such as Internet-delivered cognitive behavioral therapy interventions have accumulated considerable evidence of efficacy and some evidence of effectiveness. These programs have achieved similar outcomes to face-to-face therapy, while requiring much less clinician time. There is now burgeoning interest in integrating e-mental health resources with the broader mental health delivery system, particularly in primary care. The Australian government has supported the development and deployment of e-mental health resources, including websites that provide information, peer-to-peer support, automated self-help, and guided interventions. An ambitious national project has been commissioned to promote key resources to clinicians, to provide training in their use, and to evaluate the impact of promotion and training upon clinical practice. Previous initiatives have trained clinicians to use a single e-mental health program or a suite of related programs. In contrast, the current initiative will support community-based service providers to access a diverse array of resources developed and provided by many different groups. OBJECTIVE The objective of this paper was to develop a conceptual framework to support the use of e-mental health resources in routine primary health care. In particular, models of clinical practice are required to guide the use of the resources by diverse service providers and to inform professional training, promotional, and evaluation activities. METHODS Information about service providers' use of e-mental health resources was synthesized from a nonsystematic overview of published literature and the authors' experience of training primary care service providers. RESULTS Five emerging clinical practice models are proposed: (1) promotion; (2) case management; (3) coaching; (4) symptom-focused treatment; and (5) comprehensive therapy. We also consider the service provider skills required for each model and the ways that e-mental health resources might be used by general practice doctors and nurses, pharmacists, psychologists, social workers, occupational therapists, counselors, and peer workers. CONCLUSIONS The models proposed in the current paper provide a conceptual framework for policy-makers, researchers and clinicians interested in integrating e-mental health resources into primary care. Research is needed to establish the safety and effectiveness of the models in routine care and the best ways to support their implementation.
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Affiliation(s)
- Julia Reynolds
- National Institute for Mental Health Research Research School of Population Health Australian National University Canberra Australia
| | - Kathleen M Griffiths
- National Institute for Mental Health Research Research School of Population Health Australian National University Canberra Australia
| | - John A Cunningham
- National Institute for Mental Health Research Research School of Population Health Australian National University Canberra Australia ; Centre for Addiction and Mental Health Toronto, ON Canada
| | - Kylie Bennett
- National Institute for Mental Health Research Research School of Population Health Australian National University Canberra Australia
| | - Anthony Bennett
- National Institute for Mental Health Research Research School of Population Health Australian National University Canberra Australia
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Cavanagh K, Millings A. (Inter)personal Computing: The Role of the Therapeutic Relationship in E-mental Health. JOURNAL OF CONTEMPORARY PSYCHOTHERAPY 2013. [DOI: 10.1007/s10879-013-9242-z] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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