Telepsychology: Public Speaking Fear Treatment on the Internet

Dropping out of a transdiagnostic online intervention: A qualitative analysis of client's experiences

INTRODUCTION

An important concern in Internet-based treatments (IBTs) for emotional disorders is the high dropout rate from these protocols. Although dropout rates are usually reported in research studies, very few studies qualitatively explore the experiences of patients who drop out of IBTs. Examining the experiences of these clients may help to find ways to tackle this problem.

METHOD

A Consensual Qualitative Research study was applied in 10 intentionally-selected patients who dropped out of a transdiagnostic IBT.

RESULTS

22 categories were identified within 6 domains. Among the clients an undeniable pattern arose regarding the insufficient support due to the absence of a therapist and the lack of specificity of the contents to their own problems.

CONCLUSIONS

The analyzed content has direct impact on the clinical application of IBTs. A more tailored manage of expectations as well as strategies to enhance the therapeutic relationship in certain clients are identified as the two key elements in order to improve the dropout in IBTs. Going further, in the mid and long run, ideographic interventions would be vital. The present study permits to better grasp the phenomenon of dropout in IBTs and delineate specific implications both in terms of research, training and practice.

Design considerations of a randomized clinical trial on a cognitive behavioural intervention using communication and information technologies for managing chronic low back pain

Background

Psychological treatments have been successful in treating chronic low back pain (CLBP). However, the effect sizes are still modest and there is room for improvement. A way to progress is by enhancing treatment adherence and self-management using information and communication technologies (ICTs). Therefore, the objective of this study was to design a trial investigating the short- and long-term efficacy of cognitive behavioural treatment (CBT) for CLBP using or not ICTs. A secondary objective of this trial will be to evaluate the influence of relevant variables on treatment response. Possible barriers in the implementation of CBT with and without ICT will also be investigated.

Methods

A randomised controlled trial with 180 CLBP patients recruited from specialised care will be conducted. Participants will be randomly assigned to three conditions: Control group (CG), CBT, and CBT supported by ICTs (CBT + ICT). Participants belonging to the three conditions will receive a conventional rehabilitation program (back school). The CBT group program will last six sessions. The CBT + ICT group will use the internet and SMS to practice the therapeutic strategies between sessions and in the follow-ups at their homes. Primary outcome variables will be self-reported disability and pain intensity. Assessment will be carried out by blinded assessors in five moments: pre-treatment, post-treatment and 3-, 6-, and 12-month follow-ups. The influence of catastrophizing, fear-avoidance beliefs, anxiety and depression in response to treatment in the primary outcomes will also be analysed.

Discussion

This study will show data of the possible benefits of using ICTs in the improvement of CBT for treating CLBP.

Trial registration

ClinicalTrials.gov, NCT01802671

An Internet-based self-help treatment for fear of public speaking: a controlled trial

This study offers data about the efficacy of "Talk to Me," an Internet-based telepsychology program for the treatment of fear of public speaking that includes the most active components in cognitive-behavior therapy (CBT) for social phobia (exposure and cognitive therapies). One hundred twenty-seven participants with social phobia were randomly assigned to three experimental conditions: (a) an Internet-based self-administered program; (b) the same program applied by a therapist; (c) a waiting-list control group. Results showed that both treatment conditions were equally efficacious. In addition, Talk to Me and the same treatment applied by a therapist were more efficacious than the waiting-list condition. Treatment gains were maintained at 1-year follow-up. The results from this study support the utility of Internet-delivered CBT programs in order to reach a higher number of people who could benefit from CBT. Internet-delivered CBT programs could also play a valuable role in the dissemination of CBT.

Interapy: treatment of post-traumatic stress via the internet

This paper describes the theoretical background and procedures (including psycho-education, screening, treatment protocol and outcome measurement) involved in a protocol-driven internet treatment of post-traumatic stress and grief in a group of people who have suffered from mild to relatively severe trauma. The paper examines the results of 3 outcome and process studies, which were carried out initially in a student population and subsequently in the general population of highly traumatized people. In the latter study, participants in the experimental condition (n = 69) improved significantly more than participants in the waiting list control condition (n = 32), with respect to trauma-related symptoms and general psychopathology. The effect sizes were large. More than 50% of the participants treated showed reliable change and clinically significant improvement after treatment for avoidance and depression. Treatment proved most beneficial for participants who had suffered from intentional trauma and those who had not previously discussed the traumatic events with significant others. Content analysis of the publications indicates a remarkable increase in cognitive coping during treatment. The possibilities for future research into internet-driven treatment of post-traumatic stress symptomatology are discussed, including the proposal to study the effects of sending a final written letter to a significant other person.

Virtual Reality in Psychotherapy: Review

Virtual reality (VR) has recently emerged as a potentially effective way to provide general and specialty health care services, and appears poised to enter mainstream psychotherapy delivery. Because VR could be part of the future of clinical psychology, it is critical to all psychotherapists that it be defined broadly. To ensure appropriate development of VR applications, clinicians must have a clear understanding of the opportunities and challenges it will provide in professional practice. This review outlines the current state of clinical research relevant to the development of virtual environments for use in psychotherapy. In particular, the paper focuses its analysis on both actual applications of VR in clinical psychology and how different clinical perspectives can use this approach to improve the process of therapeutic change.

Virtual reality exposure therapy of anxiety disorders: a review

Virtual reality exposure therapy (VRET) is an altered form of behavioral therapy and may be a possible alternative to standard in vivo exposure. Virtual reality integrates real-time computer graphics, body tracking devices, visual displays, and other sensory input devices to immerse patients in a computer-generated virtual environment. Research on this type of treatment for anxiety disorders is discussed in this article, and the mediating and moderating variables that influence VR treatment effectiveness as well. Evidence is found that VRET is effective for participants with fear of heights and of flying. For other phobias, research to date is not conclusive. More randomized clinical trials in which VRET is compared with standard exposure are required. Furthermore, studies are needed in which VRET is not just a component of the treatment package evaluated, but in which VRET should be assessed as a stand-alone treatment.

From psychotherapy to e-therapy: the integration of traditional techniques and new communication tools in clinical settings

Technology is starting to influence psychological fields. In particular, computer-mediated communication (CMC) is providing new tools that can be fruitfully applied in psychotherapy. These new technologies do not substitute for traditional techniques and approaches but they could be used as integration in the clinical process, enhancing or making easier particular steps of it. This paper focuses on the concept of e-therapy as a new modality of helping people resolve life and relationship issues. It utilizes the power and convenience of the Internet to allow synchronous and asynchronous communication between patient and therapist. It is important to underline that e-therapy is not an alternative treatment, but a resource that can be added to traditional psychotherapy. The paper also discusses how different forms of CMC can be fruitfully applied in psychology and psychotherapy, by evaluating the effectiveness of them in the clinical practice. To enhance the diffusion of e-therapy, further research is needed to evaluate all the pros and cons.

A self-applied, Internet-based intervention for fear of public speaking

The aim of this article is to introduce, illustrate, and present effectiveness data on a new telepsychology program for the treatment of fear of public speaking. The Talk to Me program is an Internet-based self-applied intervention that has several components, including a diagnostic assessment, a structured treatment, and an outcome protocol that evaluates treatment efficacy in a continuous manner. We describe the characteristics of the program and present a case study. Results demonstrated a significant decrease in levels of fear and avoidance related to speaking in public.

Internet-Based Telehealth System for the Treatment of Agoraphobia

In this work that is being validated within the VEPSY project, we present a system that allows the patient to continue a psychological virtual reality treatment from his or her home PC as complementary therapy. In the consulting room, we have been using virtual therapy for panic disorder and agoraphobia treatment to expose the patient to several situations. For the complementary therapy, a structured treatment via the Internet has been prepared, which consists of several parts: an assessment protocol; a structured treatment protocol organized in several blocks (such as psychoeducation and exposure); and an outcome protocol. The same situations as in the consulting room have been selected for the exposure, but each of them has been divided into several virtual environments with specific characteristics that limit its difficulty level. The stimuli that are used at each level are controlled automatically by the system. The information of the patient is stored in a database, which is placed in a remote server using XML format and used to control which stages of the treatment he or she can access. The psychologist can limit the evolution of the patient. The virtual environments are installed in the patient's PC, and they are implemented with a mechanism that ensures that they can only be run when the patient connects to the web. The user should not have any special virtual reality hardware at home, so head rotations have been simulated with the navigation system.

Virtual reality for health care: the status of research

As information technology has advanced and costs have declined over the past decade, there has been a steady growth in the use of virtual reality (VR) in health care. According to the data of the two leading clinical databases--MEDLINE and PSYCINFO--the research in the virtual reality field is moving fast: under the "virtual reality" keyword, there are 739 papers listed in MEDLINE and 569 in PSYCINFO (accessed 6 December 2001). Much of this growth, however, has been in the form of feasibility studies and pilot trials. In fact, many researchers tried to use VR, but only a few were able to deepen their study. According to MEDLINE, only 16 research groups published more than three papers related to health care applications of VR. This number lowers to 12 for papers included in PSYCLIT. Therefore, apart from surgical training and some behavioral treatments, there is little convincing evidence coming from controlled studies of the clinical and economical advantages of this approach. This paper discusses recent evidence and outlines some guidelines for future research in this area.