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Laurito LD, dos Santos-Ribeiro S, Moreira-de-Oliveira ME, Loureiro CP, Hühne V, Torres B, de Faro LFT, de Menezes GB, Fontenelle LF. Online group therapies for anxiety, obsessive-compulsive, and trauma-related disorders: a systematic review. Front Hum Neurosci 2024; 17:1286865. [PMID: 38273884 PMCID: PMC10809799 DOI: 10.3389/fnhum.2023.1286865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 11/27/2023] [Indexed: 01/27/2024] Open
Abstract
Background This systematic review examined the existing literature to determine the evidence supporting the efficacy of online group treatments for anxiety-, obsessive-compulsive- and trauma-related disorders (AOTDs). Methods A systematic review using the PUBMED, PsycInfo, Web of Science, and ClinicalTrials databases with no language, date, or study design filters was performed. The inclusion criteria comprised studies that examined individuals who had received a formal diagnosis of AOTDs, were aged 18 years or older, and had baseline and endpoint assessments of symptom severity using formal tools. Results Five studies on social anxiety disorder (SAD), four on post-traumatic stress disorder (PTSD) and one on tic disorders (TDs) were found. The studies were open-label (n = 2) and randomized controlled trials (RCTs) (n = 8), with five of the RCTs being non-inferiority trials. Most studies were conducted in the US and investigated psychological CBT based interventions via internet-based therapies (IBT: n = 4), video teleconferencing (VTC: n = 5) or a combination of both (n = 1). In SAD, IBT studies associated with a clinician assisted web-based forum (here termed "forum-enhanced" studies) were superior to waiting lists and not inferior to similar versions that were also "forum enhanced" but self-guided, "telephone enhanced" by a contact with a non-specialist, and "email enhanced" by a contact with a clinician individually. Studies involving VTC have shown comparable effectiveness to in-person interventions across some online group CBT based treatments for PTSD. Two open trials also demonstrated symptoms reductions of social anxiety and tics through VTC. Conclusion There is evidence supporting the effectiveness of online group treatments for SAD and PTSD. Further studies from different research groups may be needed to replicate the use of these and other forms of online treatments in individuals with SAD, PTSD, and other clinical populations, such as OCD, panic disorder, agoraphobia and specific phobias. Systematic review registration https://www.crd.york.ac.uk/prospero/, identifier CRD42023408491.
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Affiliation(s)
- Luana D. Laurito
- Obsessive, Compulsive, and Anxiety Spectrum Research Program, Institute of Psychiatry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Samara dos Santos-Ribeiro
- Obsessive, Compulsive, and Anxiety Spectrum Research Program, Institute of Psychiatry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Maria E. Moreira-de-Oliveira
- Obsessive, Compulsive, and Anxiety Spectrum Research Program, Institute of Psychiatry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Carla P. Loureiro
- Obsessive, Compulsive, and Anxiety Spectrum Research Program, Institute of Psychiatry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Verônica Hühne
- Obsessive, Compulsive, and Anxiety Spectrum Research Program, Institute of Psychiatry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Bianca Torres
- Obsessive, Compulsive, and Anxiety Spectrum Research Program, Institute of Psychiatry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Livi Ferreira Testoni de Faro
- Obsessive, Compulsive, and Anxiety Spectrum Research Program, Institute of Psychiatry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Gabriela B. de Menezes
- Obsessive, Compulsive, and Anxiety Spectrum Research Program, Institute of Psychiatry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
- D’Or Institute for Research and Education, Rio de Janeiro, Brazil
| | - Leonardo F. Fontenelle
- Obsessive, Compulsive, and Anxiety Spectrum Research Program, Institute of Psychiatry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
- D’Or Institute for Research and Education, Rio de Janeiro, Brazil
- Department of Psychiatry, Monash University, Clayton, VIC, Australia
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Dhaliwal R, Yap S, Talarico F, Al-Shamali H, Mcweeny R, Reeson M, Shalaby R, Chen T, Spronk E, Snodgrass R, Tu E, Erick T, Marshall T, Kennedy M, Greenshaw AJ, Winkler O, Burback L. Synchronous Web-Based Psychotherapy for Mental Disorders From a Health Quality Perspective: Scoping Review. J Med Internet Res 2023; 25:e40710. [PMID: 37921863 PMCID: PMC10656669 DOI: 10.2196/40710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 09/12/2023] [Accepted: 10/11/2023] [Indexed: 11/04/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic necessitated rapid changes to health care delivery, including a shift from in-person to digitally delivered psychotherapy. While these changes helped ensure timely psychotherapy provision, many concerns exist, including clinical, cultural, practical, privacy, and security issues. OBJECTIVE This scoping review systematically mapped existing peer-reviewed research on synchronous, therapist-delivered web-based psychotherapy for individuals with a diagnosed mental illness. Data were analyzed through the lens of the Alberta Quality Matrix for Health (AQMH) to assess to what degree this literature addresses key indicators of health care quality. This analysis aided in the identification and organization of knowledge gaps with regard to web-based psychotherapies, highlighting potential disparities between previously prioritized dimensions of care and those requiring further attention. METHODS This review adhered to the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines. We included peer-reviewed primary research studies in the English language investigating synchronous, therapist-delivered remote psychotherapy delivered to adults (aged 18 years and older) with a Diagnostic and Statistical Manual of Mental Disorders or International Statistical Classification of Diseases diagnosed mental illness. All other citations were excluded. Relevant studies were identified through MEDLINE, APA PsycINFO, Embase (OVID), Web of Science: Core Collection (Clarivate), Cochrane Library (Wiley), and Scopus (Elsevier) databases. Databases were searched on March 18, 2021. For every publication that was taken into consideration, the data were charted independently by 2 reviewers, and in the event of a discrepancy, the principal investigator validated the choice of either extractor. Results were thematically described according to the 6 AQMH dimensions: acceptability, accessibility, appropriateness, effectiveness, efficiency, and safety. RESULTS From 13,209 publications, 48 articles were included, largely from North American studies. Most studies measured treatment effectiveness (n=48, 100%) and acceptability (n=29, 60%) health quality dimensions. Over 80% (40/48) of studies investigated either a cognitive or exposure intervention for either posttraumatic stress disorder or a mood or anxiety disorder, generally indicating comparable results to in-person therapy. Safety (n=5, 10%) was measured in fewer studies, while treatment accessibility, appropriateness, and efficiency were not explicitly measured in any study, although these dimensions were mentioned as a future direction, hypothesis, or potential outcome. CONCLUSIONS In relation to web-based therapist-delivered psychotherapies for those with a diagnosed mental illness, important aspects of health care quality (accessibility, appropriateness, efficiency, and safety) have received little scientific examination, underscoring a need to address these gaps. There are also significant issues related to the generalizability of this literature, including the underrepresentation of many geographic regions, cultures, populations, clinical contexts, and psychotherapy modalities. Qualitative research in underrepresented populations and settings may uncover important patient and contextual factors important for the future implementation of quality web-based psychotherapy.
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Affiliation(s)
- Raman Dhaliwal
- Department of Psychiatry, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Sidney Yap
- Department of Psychiatry, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Fernanda Talarico
- Department of Psychiatry, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Huda Al-Shamali
- Department of Psychiatry, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Robert Mcweeny
- Department of Psychiatry, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Matthew Reeson
- Department of Psychiatry, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Reham Shalaby
- Department of Psychiatry, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Teresa Chen
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Elena Spronk
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Rayven Snodgrass
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Eileen Tu
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Taylor Erick
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Tyler Marshall
- Department of Psychiatry, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Megan Kennedy
- Geoffrey and Robyn Sperber Health Sciences Library, University of Alberta, Edmonton, AB, Canada
| | - Andrew J Greenshaw
- Department of Psychiatry, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Olga Winkler
- Department of Psychiatry, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Lisa Burback
- Department of Psychiatry, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
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Wolitzky-Taylor K, Mooney LJ, Otto MW, Metts A, Parsons EM, Hanano M, Ram R. Augmenting the efficacy of benzodiazepine taper with telehealth-delivered cognitive behavioral therapy for anxiety disorders in patients using prescription opioids: A pilot randomized controlled trial. Contemp Clin Trials 2023; 133:107334. [PMID: 37730196 PMCID: PMC10960249 DOI: 10.1016/j.cct.2023.107334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 08/07/2023] [Accepted: 09/15/2023] [Indexed: 09/22/2023]
Abstract
The risks of concomitant benzodiazepine (BZ) and opioid use are significant. Despite the urgent need to reduce BZ use among patients taking opioids, no treatment intervention research to our knowledge has addressed treatment for this concurrent, high-risk use. The current study will evaluate the efficacy of augmenting BZ taper procedures with CBT for anxiety disorders that has been adapted specifically for patients with concomitant BZ and opioid use (either use as prescribed or misuse), a high-risk patient population. Research combining rapidly scalable behavioral interventions ancillary to pharmacological approaches delivered via telehealth in primary care settings is innovative and important given concerning trends in rising prevalence of BZ/opioid co-prescription, BZ-associated overdose deaths, and known barriers to implementation of behavioral health interventions in primary care. CBT delivery using telehealth has the potential to aid adherence and promote access and dissemination of procedures in primary care. Lastly, the current study will utilize an experimental therapeutics approach to preliminarily explore the mechanism of action for the proposed interventions. The overall aim of the present pilot randomized controlled trial is to examine the feasibility and preliminary efficacy of a BZ taper with CBT for anxiety disorders adapted for patients with concomitant BZ (BZT + CBT) and opioid use to a BZ taper with a control health education program (BZT + HE) in a sample of individuals (N = 54) who have been prescribed and are taking benzodiazepines and opioids for at least 3 months prior to baseline and experience anxious distress. Screening and outcome measures, methods, and implications are described. Trial Registration: ClinicalTrials.gov (NCT05573906).
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Affiliation(s)
| | - Larissa J Mooney
- UCLA Department of Psychiatry and Biobehavioral Sciences, Los Angeles, CA, USA; VA Greater Los Angeles Healthcare System, USA
| | - Michael W Otto
- Boston University, Department of Psychological and Brain Sciences, Boston, MA, USA
| | | | - E Marie Parsons
- Boston University, Department of Psychological and Brain Sciences, Boston, MA, USA
| | - Maria Hanano
- UCLA Department of Psychiatry and Biobehavioral Sciences, Los Angeles, CA, USA
| | - Reuben Ram
- UCLA Toluca Lake Clinic, Los Angeles, CA, USA
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Terrazas-Carrillo E, Garcia E, Rodriguez K, Malagon A, Gonzalez M, Garcia S. Telehealth Psychoeducational Groups With Latinx College Students: Findings From Focus Groups. Int J Group Psychother 2023; 73:75-115. [PMID: 38446566 DOI: 10.1080/00207284.2022.2159414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Abstract
The literatures examining psychoeducational groups and telehealth services have demonstrated positive results but less is known about the efficacy of psychoeducational telehealth groups. This study examines the perspectives of 105 Latinx college students who participated in an 8-session psychoeducational group via a telehealth platform during the COVID-19 pandemic. The research questions included (a) What was the experience of these Latinx college students participating in telehealth psychoeducational groups? and (b) What were the potential perceived advantages and disadvantages of implementing telehealth psychoeducational groups? Postintervention, a total of 16 focus groups were convened with a total of 105 Latinx college students (average number of participants per group = 6). Interviews were coded using conventional qualitative analysis and yielded four main themes: (1) group cohesion, which involved group members feeling that they were connected and that the group was a safe space; (2) group leaders, which involved leaders' preparation and knowledge and their ability to foster a safe environment); (3) cultural issues, which involved cultural values and acculturative and first-generation stress.; and (4) telehealth implementation, wherein participants described advantages and disadvantages of the telehealth approach. We discuss study limitations and directions for future research.
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5
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Palmer CS, Brown Levey SM, Kostiuk M, Zisner AR, Tolle LW, Richey RM, Callan S. Virtual Care for Behavioral Health Conditions. Prim Care 2022; 49:641-657. [PMID: 36357068 PMCID: PMC9581698 DOI: 10.1016/j.pop.2022.04.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Christina S. Palmer
- Department of Family Medicine, University of Colorado School of Medicine,Corresponding author
| | | | | | - Aimee R. Zisner
- Department of Family Medicine, University of Colorado School of Medicine
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Shoib S, Armiya'u AY, Roza TH, Saeed F, Swed S, Arif N, Park C, Chandradasa M. Telepsychiatry for conflict-affected settings: Feasibility, ethics, barriers and prospects. Asian J Psychiatr 2022; 75:103203. [PMID: 35870308 DOI: 10.1016/j.ajp.2022.103203] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 07/09/2022] [Accepted: 07/11/2022] [Indexed: 01/17/2023]
Abstract
Telehealth is being broadly developed in all fields of medicine, and online visits seem a particularly suitable alternative to in-person visits in outpatient psychiatry especially in conflict setting. Telepsychiatry has numerous advantages over in-person visits.
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Affiliation(s)
- Sheikh Shoib
- Jawaharlal Nehru Memorial hospital, Directorate of Health Services, Jammu and Kashmir, India.
| | - Aishatu Yusha'u Armiya'u
- Department of Psychiatry, College of Medical Sciences, Abubakar Tafawa Balewa University, University Teaching Hospital Bauchi state, Nigeria.
| | - Thiago Henrique Roza
- Department of Psychiatry, Federal University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil.
| | - Fahimeh Saeed
- Department of Psychiatry, Psychosis Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.
| | - Sarya Swed
- Faculty of Medicine, Aleppo University, Aleppo, Syria.
| | - Nigar Arif
- Republican Psychiatric Hospital, Azerbaijan.
| | - Chan Park
- 2nd year Resident at UCLA-VA Psychiatry Residency Program, United States.
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7
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Enhancing Prolonged Exposure therapy for PTSD using physiological biomarker-driven technology. Contemp Clin Trials Commun 2022; 28:100940. [PMID: 35664505 PMCID: PMC9160482 DOI: 10.1016/j.conctc.2022.100940] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 04/21/2022] [Accepted: 05/25/2022] [Indexed: 11/20/2022] Open
Abstract
Prolonged Exposure (PE) therapy is one of the most efficacious, evidence-based treatments for posttraumatic stress disorder (PTSD). A key component of PE involves in vivo exposures (IVEs) during which patients approach situations or activities in "real life" that are safe but avoided because they elicit a fear response. Despite their critical role in treatment, little research has focused on IVEs. This gap in knowledge is primarily due to the fact that IVEs are typically conducted by patients in between therapy sessions, leaving clinicians reliant upon patient self-report. This approach has numerous shortcomings, which the current study addresses by leveraging technology to develop an innovative device that allows for physiological, biomarker-driven, therapist-guided IVEs. The new system enables clinicians to virtually accompany patients during IVEs and provides real-time physiological (heart rate, skin conductance) and self-report (subjective units of distress) data that clinicians can use to modify the exposure and optimize therapeutic value. This Small Business Innovation Research (SBIR) Phase I project aims to: (1) integrate physiological sensors and live audio/visual streaming into a system for clinicians to guide patients during IVEs; (2) determine feasibility and acceptability of the system; and (3) conduct a pilot randomized clinical trial among veterans with PTSD (N = 40) to evaluate the preliminary efficacy of the system in reducing PTSD symptoms during PE. This paper describes the rationale, design, and methodology of the Phase I project. The findings from this study have the potential to innovate clinical practice, advance the science of exposure therapy, and improve clinical outcomes.
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Key Words
- CAPS-5, Clinician-Administered PTSD Scale for DSM-5
- DSM-5, Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition
- FDA, U.S. Food and Drug Administration
- IRB, Institutional Review Board
- MINI, Mini International Neuropsychiatric Interview
- MUSC, Medical University of South Carolina
- Military
- PCL-5, PTSD Checklist for DSM-5
- PTSD
- PTSD, posttraumatic stress disorder
- Physiology
- Posttraumatic stress disorder
- RCT, randomized controlled trial
- Technology
- U.S., United States
- VA, U.S. Department of Veterans Affairs
- Veterans
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8
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Milosevic I, Cameron DH, Milanovic M, McCabe RE, Rowa K. Face-to-face versus Video Teleconference Group Cognitive Behavioural Therapy for Anxiety and Related Disorders: A Preliminary Comparison. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2022; 67:391-402. [PMID: 34159838 PMCID: PMC9065489 DOI: 10.1177/07067437211027319] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Telehealth is being increasingly incorporated into the delivery of mental health care and has received widespread attention during the COVID-19 pandemic for its ability to facilitate care during physical distancing restrictions. Videoconferencing is a common telehealth modality for delivering psychotherapy and has demonstrated similar outcomes to those of face-to-face therapy. Cognitive behavioural therapy (CBT) is the most common psychotherapy evaluated across various telehealth modalities; however, studies on CBT delivered via videoconference, particularly in a group therapy format, are lacking. Further, little research exists on videoconference group CBT for anxiety disorders. Accordingly, the present study compared the outcomes of group CBT for anxiety and related disorders delivered via videoconference versus face-to-face. METHOD Using a non-randomized design, data on attendance, dropout, clinical outcomes, and functional impairment were collected from 413 adult outpatients of a tertiary care anxiety disorders clinic who attended a CBT group for panic disorder/agoraphobia, social anxiety disorder, generalized anxiety disorder (GAD), or obsessive-compulsive disorder delivered either face-to-face (pre-COVID-19 pandemic) or via videoconference (since the onset of COVID-19 pandemic). Outcomes were assessed using well-validated self-report measures. Data were collected pre-treatment, across 12 weekly sessions, and post-treatment. Intent-to-treat analyses were applied to symptom outcome measures. RESULTS Face-to-face CBT conferred only a slight benefit over videoconference CBT for symptom outcomes across all groups, but when assessed individually, only the GAD group showed greater symptom improvement in the face-to-face format. Effect sizes for significant differences between the delivery formats were small. Participants in videoconference groups tended to have slightly higher attendance rates in some instances, whereas functional improvement and treatment dropout were comparable across the delivery formats. CONCLUSIONS Results provide preliminary evidence that videoconference group CBT for anxiety and related disorders may be a promising and effective alternative to face-to-face CBT. Additional research is needed to establish equivalence between these delivery formats.
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Affiliation(s)
- Irena Milosevic
- Anxiety Treatment and Research Clinic, 25479St. Joseph's Healthcare, Hamilton, Ontario, Canada.,Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Duncan H Cameron
- Anxiety Treatment and Research Clinic, 25479St. Joseph's Healthcare, Hamilton, Ontario, Canada
| | - Melissa Milanovic
- Anxiety Treatment and Research Clinic, 25479St. Joseph's Healthcare, Hamilton, Ontario, Canada.,Department of Psychology, Queen's University, Kingston, Ontario, Canada
| | - Randi E McCabe
- Anxiety Treatment and Research Clinic, 25479St. Joseph's Healthcare, Hamilton, Ontario, Canada.,Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Karen Rowa
- Anxiety Treatment and Research Clinic, 25479St. Joseph's Healthcare, Hamilton, Ontario, Canada.,Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
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Leroux J, Johnston N, Brown AA, Mihic A, DuBois D, Trudell A. Delivery of Distance Counselling to Survivors of Sexual Violence: A Scoping Review of Promising and Best Practices. INQUIRY: THE JOURNAL OF HEALTH CARE ORGANIZATION, PROVISION, AND FINANCING 2022; 59:469580221097427. [PMID: 35514077 PMCID: PMC9082742 DOI: 10.1177/00469580221097427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Distance counselling holds immense potential for improving access to trauma supports for survivors of sexual violence (SV), and particularly for under-served groups who disproportionately experience violence and myriad barriers to accessing in-person supports. And yet, the evidence-base for the practice and delivery of distance counselling remains under-developed. In the context of COVID-19, where telehealth applications have undergone a rapid uptake, we undertook a scoping review of existing evidence of therapeutic and organizational practices related to the real-time (synchronous) delivery of distance counselling to survivors of SV. We based our scoping review methods on Arksey and O’Malley framework and in accordance with the guidance on scoping reviews from the Joanna Briggs Institute (JBI) and PRISMA reporting guidelines for scoping reviews. A comprehensive search of MEDLINE, Embase, PsycINFO, CINAHL, Web of Science, and Sociological Abstracts was undertaken in October 2020, and again in March 2022. Searching, reviewing, appraisal, and data extraction was undertaken by two reviewers. In total, 1094 records were identified that resulted in 20 studies included. Descriptions, findings, and recommendations were gleaned and synthesized into potential practices using inductive thematic analysis. While many studies have an appreciative orientation to distance counselling, these benefits tend to be framed as non-universal, and conditional on survivor safety, flexibility, anonymity, survivor choice, strong and inclusive technology, and a supported workforce. Despite the limited evidence-base, we present several clusters of findings that, taken together, can be used to support current COVID-19 distance counselling initiatives with survivors, as well as guide the future development of best practices.
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Affiliation(s)
- Janette Leroux
- Sexual Assault Centre Kingston, Kingston, Ontario, Canada
- School of Rehabilitation Therapy, Queen’s University, Kingston, Ontario, Canada
| | - Natalie Johnston
- Department of Public Health Sciences, Queen’s University, Kingston, Ontario, Canada
| | | | - Alanna Mihic
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Denise DuBois
- School of Rehabilitation Therapy, Queen’s University, Kingston, Ontario, Canada
| | - AnnaLise Trudell
- Anova, Gender-Based Violence Shelter and Sexual Assault Centre London, Ontario, Canada
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10
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Goyal S. Can telepsychiatry bridge the treatment gap? JOURNAL OF MENTAL HEALTH AND HUMAN BEHAVIOUR 2022. [DOI: 10.4103/jmhhb.jmhhb_157_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
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11
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Hendrikx LJ, Murphy D. Supporting the Mental Health Needs of Military Partners Through the Together Webinar Program: Pilot Randomized Controlled Trial. JMIR Ment Health 2021; 8:e25622. [PMID: 34636734 PMCID: PMC8548968 DOI: 10.2196/25622] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 05/21/2021] [Accepted: 06/03/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Despite an increased risk of psychological difficulties, there remains a lack of evidence-based support for the mental health needs of military partners. OBJECTIVE This study aims to investigate whether the Together Webinar Programme (TTP-Webinar), a 6-week structured, remote access group intervention would reduce military partners' experience of common mental health difficulties and secondary trauma symptoms. METHODS A pilot randomized controlled trial was used to compare the TTP-Webinar intervention with a waitlist control. The sample was UK treatment-seeking veterans engaged in a mental health charity. A total of 196 military partners (1 male and 195 females; aged mean 42.28, SD 10.82 years) were randomly allocated to the intervention (n=97) or waitlist (n=99) condition. Outcome measures were self-reported measures of common mental health difficulties, secondary trauma symptoms, and overall quality of life rating. RESULTS Compared with the waitlist, military partners in the TTP-Webinar had reduced common mental health difficulties (P=.02) and secondary trauma symptoms (P=.001). However, there was no difference in quality-of-life ratings (P=.06). CONCLUSIONS The results suggest that TTP-Webinar is an effective intervention to support the mental health difficulties of military partners. This study provides promising evidence that webinars may be an appropriate platform for providing group-based support. TRIAL REGISTRATION ClinicalTrials.gov NCT05013398; https://clinicaltrials.gov/ct2/show/NCT05013398.
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Affiliation(s)
| | - Dominic Murphy
- Combat Stress, Leatherhead, United Kingdom
- King's Centre for Military Health Research, King's College London, London, United Kingdom
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12
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Mazziotti R, Rutigliano G. Tele-Mental Health for Reaching Out to Patients in a Time of Pandemic: Provider Survey and Meta-analysis of Patient Satisfaction. JMIR Ment Health 2021; 8:e26187. [PMID: 34114956 PMCID: PMC8323764 DOI: 10.2196/26187] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 02/13/2021] [Accepted: 05/13/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic threatened to impact mental health by disrupting access to care due to physical distance measures and the unexpected pressure on public health services. Tele-mental health was rapidly implemented to deliver health care services. OBJECTIVE The aims of this study were (1) to present state-of-the-art tele-mental health research, (2) to survey mental health providers about care delivery during the pandemic, and (3) to assess patient satisfaction with tele-mental health. METHODS Document clustering was applied to map research topics within tele-mental health research. A survey was circulated among mental health providers. Patient satisfaction was investigated through a meta-analysis of studies that compared satisfaction scores between tele-mental health and face-to-face interventions for mental health disorders, retrieved from Web of Knowledge and Scopus. Hedges g was used as the effect size measure, and effect sizes were pooled using a random-effect model. Sources of heterogeneity and bias were examined. RESULTS Evidence on tele-mental health has been accumulating since 2000, especially regarding service implementation, depressive or anxiety disorders, posttraumatic stress disorder, and special populations. Research was concentrated in a few countries. The survey (n=174 respondents from Italy, n=120 international) confirmed that, after the onset of COVID-19 outbreak, there was a massive shift from face-to-face to tele-mental health delivery of care. However, respondents held skeptical views about tele-mental health and did not feel sufficiently trained and satisfied. Meta-analysis of 29 studies (n=2143) showed that patients would be equally satisfied with tele-mental health as they are with face-to-face interventions (Hedges g=-0.001, 95% CI -0.116 to 0.114, P=.98, Q=43.83, I2=36%, P=.03) if technology-related issues were minimized. CONCLUSIONS Mental health services equipped with tele-mental health will be better able to cope with public health crises. Both providers and patients need to be actively engaged in digitization, to reshape their reciprocal trust around technological innovations.
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Affiliation(s)
- Raffaele Mazziotti
- Institute of Neuroscience, National Research Council (CNR), Pisa, Italy.,Department of Neuroscience, Psychology, Drug Research and Child Health (NEUROFARBA), University of Florence, Florence, Italy
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13
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Barnett P, Goulding L, Casetta C, Jordan H, Sheridan-Rains L, Steare T, Williams J, Wood L, Gaughran F, Johnson S. Implementation of Telemental Health Services Before COVID-19: Rapid Umbrella Review of Systematic Reviews. J Med Internet Res 2021; 23:e26492. [PMID: 34061758 PMCID: PMC8335619 DOI: 10.2196/26492] [Citation(s) in RCA: 61] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 03/30/2021] [Accepted: 04/30/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Telemental health care has been rapidly adopted for maintaining services during the COVID-19 pandemic, and a substantial interest is now being devoted in its future role. Service planning and policy making for recovery from the pandemic and beyond should draw on both COVID-19 experiences and the substantial research evidence accumulated before this pandemic. OBJECTIVE We aim to conduct an umbrella review of systematic reviews available on the literature and evidence-based guidance on telemental health, including both qualitative and quantitative literature. METHODS Three databases were searched between January 2010 and August 2020 for systematic reviews meeting the predefined criteria. The retrieved reviews were independently screened, and those meeting the inclusion criteria were synthesized and assessed for risk of bias. Narrative synthesis was used to report these findings. RESULTS In total, 19 systematic reviews met the inclusion criteria. A total of 15 reviews examined clinical effectiveness, 8 reported on the aspects of telemental health implementation, 10 reported on acceptability to service users and clinicians, 2 reported on cost-effectiveness, and 1 reported on guidance. Most reviews were assessed to be of low quality. The findings suggested that video-based communication could be as effective and acceptable as face-to-face formats, at least in the short term. Evidence on the extent of digital exclusion and how it can be overcome and that on some significant contexts, such as children and young people's services and inpatient settings, was found to be lacking. CONCLUSIONS This umbrella review suggests that telemental health has the potential to be an effective and acceptable form of service delivery. However, we found limited evidence on the impact of its large-scale implementation across catchment areas. Combining previous evidence and COVID-19 experiences may allow realistic planning for the future implementation of telemental health.
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Affiliation(s)
- Phoebe Barnett
- Centre for Outcomes Research and Effectiveness, Division of Psychology and Language Sciences, University College London, London, United Kingdom.,NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, London, United Kingdom
| | - Lucy Goulding
- King's Improvement Science, Centre for Implementation Science, King's College London, London, United Kingdom
| | - Cecilia Casetta
- NIHR Applied Research Collaboration, King's College London, London, United Kingdom
| | - Harriet Jordan
- NIHR Applied Research Collaboration, King's College London, London, United Kingdom.,Institute of Psychiatry, Psychology and Neuroscience, King's College London and South London and Maudsley NHS Trust, London, United Kingdom
| | - Luke Sheridan-Rains
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, London, United Kingdom
| | - Thomas Steare
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, London, United Kingdom
| | - Julie Williams
- Centre for Implementation Science, Health Service and Population Research Department, King's College London, London, United Kingdom
| | - Lisa Wood
- Division of Psychiatry, University College London, London, United Kingdom
| | - Fiona Gaughran
- NIHR Applied Research Collaboration, King's College London, London, United Kingdom.,Institute of Psychiatry, Psychology and Neuroscience, King's College London and South London and Maudsley NHS Trust, London, United Kingdom
| | - Sonia Johnson
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, London, United Kingdom.,Camden and Islington NHS Foundation Trust, London, United Kingdom
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14
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Yazla E, Senel E. Evolution of Telepsychiatry: Scientometric Analysis of Telepsychiatry Publications Between 1986 and 2019. Telemed J E Health 2021; 28:362-373. [PMID: 34166115 DOI: 10.1089/tmj.2021.0044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Although telepsychiatry has a long history, medical literature lacks a scientometric study evaluating telepsychiatry publications. The purpose of this study was to perform a holistic analysis of telepsychiatry articles published between 1986 and 2019. Methods: We used the "telepsychiatry" keyword for our search and included all documents indexed in Web of Science (Clarivate Analytics, USA) Core Collection between 1986 and 2019, revealing a total of 1,020 articles, of which only 224 were open access. Results: The peak year for publication was 2015, with 96 articles. The United States ranked first with 601 documents followed by Australia and Canada. The University of California and University of Washington were the most productive institutions and, again, 8 of the 10 leading institutions were from the United States. The peak year for citations was 2019, with a total of 2,080 records. Discussion: We believe that systematic approaches are needed to reveal the positive and negative features of telepsychiatry practice, especially from countries where this method is widely utilized, to elucidate the need for telepsychiatry in other countries/regions and to determine how its use can be increased in regions with limited access to health care workers. Conclusion: Although scientific interest in telepsychiatry appears to have increased almost every year since 1986, it has been observed that this interest is still concentrated in certain countries, such as the United States, Australia, and Canada, indicating that telepsychiatry may not have gained use in other countries.
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Affiliation(s)
- Ece Yazla
- Department of Psychiatry, Hitit University Faculty of Medicine, Corum, Turkey
| | - Engin Senel
- Department of Dermatology, Hitit University Faculty of Medicine, Corum, Turkey
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15
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LaFrance WC, Ho WLN, Bhatla A, Baird G, Altalib HH, Godleski L. Examination of Potential Differences in Reporting of Sensitive Psychosocial Measures via Diagnostic Evaluation Using Computer Video Telehealth. J Neuropsychiatry Clin Neurosci 2021; 32:294-301. [PMID: 32054400 DOI: 10.1176/appi.neuropsych.19080177] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE The authors compared baseline characteristics and reporting of psychosocial measures among veterans with seizures who were evaluated in-clinic or remotely via computer video telehealth (CVT). It was hypothesized that the CVT group would report less trauma history, drug use, and comorbid symptoms compared with veterans seen in-clinic. METHODS A cross-sectional design was used to compare 72 veterans diagnosed with psychogenic nonepileptic seizures (PNES) or concurrent mixed epilepsy and PNES who were consecutively evaluated by a single clinician at the Providence Veterans Affairs Medical Center (PVAMC) Neuropsychiatric Clinic. In-clinic evaluations of veterans were performed at the PVAMC Neuropsychiatric Clinic (N=16), and remote evaluations of veterans referred to the VA National TeleMental Health Center were performed via CVT (N=56). All 72 patients were given comprehensive neuropsychiatric evaluations by direct interview, medical examination, and medical record review. Veterans' reporting of trauma and abuse history, drug use, and psychiatric comorbidities was assessed, along with neurologic and psychiatric variables. RESULTS No significant differences were found between veterans evaluated in-clinic or remotely with regard to baseline characteristics and reporting of potentially sensitive information, including trauma and abuse history, substance use, and comorbid symptoms. CONCLUSIONS Veterans with PNES evaluated via telehealth did not appear to withhold sensitive or personal information compared with those evaluated in-clinic, suggesting that CVT may be a comparable alternative for conducting evaluations. Baseline evaluations are used to determine treatment suitability, and telehealth allows clinicians to gain access to important information that may improve or inform care.
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Affiliation(s)
- W Curt LaFrance
- The Department of Psychiatry, Providence Veterans Affairs Medical Center (PVAMC), and Departments of Neurology and Psychiatry, Brown University, Providence, R.I. (LaFrance, Ho, Bhatla); the Division of Neuropsychiatry (LaFrance) and Division of Biostatistics (Baird), Rhode Island Hospital, Providence, R.I.; the Department of Neurology, Yale University, New Haven, Conn., and Department of Neurology, West Haven Veterans Affairs Medical Center, West Haven, Conn. (Altalib); and the Department of Psychiatry, Yale University, New Haven, Conn., and Department of Psychiatry, West Haven Veterans Affairs Medical Center, West Haven, Conn. (Godleski)
| | - Wing Lam Natalie Ho
- The Department of Psychiatry, Providence Veterans Affairs Medical Center (PVAMC), and Departments of Neurology and Psychiatry, Brown University, Providence, R.I. (LaFrance, Ho, Bhatla); the Division of Neuropsychiatry (LaFrance) and Division of Biostatistics (Baird), Rhode Island Hospital, Providence, R.I.; the Department of Neurology, Yale University, New Haven, Conn., and Department of Neurology, West Haven Veterans Affairs Medical Center, West Haven, Conn. (Altalib); and the Department of Psychiatry, Yale University, New Haven, Conn., and Department of Psychiatry, West Haven Veterans Affairs Medical Center, West Haven, Conn. (Godleski)
| | - Alana Bhatla
- The Department of Psychiatry, Providence Veterans Affairs Medical Center (PVAMC), and Departments of Neurology and Psychiatry, Brown University, Providence, R.I. (LaFrance, Ho, Bhatla); the Division of Neuropsychiatry (LaFrance) and Division of Biostatistics (Baird), Rhode Island Hospital, Providence, R.I.; the Department of Neurology, Yale University, New Haven, Conn., and Department of Neurology, West Haven Veterans Affairs Medical Center, West Haven, Conn. (Altalib); and the Department of Psychiatry, Yale University, New Haven, Conn., and Department of Psychiatry, West Haven Veterans Affairs Medical Center, West Haven, Conn. (Godleski)
| | - Grayson Baird
- The Department of Psychiatry, Providence Veterans Affairs Medical Center (PVAMC), and Departments of Neurology and Psychiatry, Brown University, Providence, R.I. (LaFrance, Ho, Bhatla); the Division of Neuropsychiatry (LaFrance) and Division of Biostatistics (Baird), Rhode Island Hospital, Providence, R.I.; the Department of Neurology, Yale University, New Haven, Conn., and Department of Neurology, West Haven Veterans Affairs Medical Center, West Haven, Conn. (Altalib); and the Department of Psychiatry, Yale University, New Haven, Conn., and Department of Psychiatry, West Haven Veterans Affairs Medical Center, West Haven, Conn. (Godleski)
| | - Hamada Hamid Altalib
- The Department of Psychiatry, Providence Veterans Affairs Medical Center (PVAMC), and Departments of Neurology and Psychiatry, Brown University, Providence, R.I. (LaFrance, Ho, Bhatla); the Division of Neuropsychiatry (LaFrance) and Division of Biostatistics (Baird), Rhode Island Hospital, Providence, R.I.; the Department of Neurology, Yale University, New Haven, Conn., and Department of Neurology, West Haven Veterans Affairs Medical Center, West Haven, Conn. (Altalib); and the Department of Psychiatry, Yale University, New Haven, Conn., and Department of Psychiatry, West Haven Veterans Affairs Medical Center, West Haven, Conn. (Godleski)
| | - Linda Godleski
- The Department of Psychiatry, Providence Veterans Affairs Medical Center (PVAMC), and Departments of Neurology and Psychiatry, Brown University, Providence, R.I. (LaFrance, Ho, Bhatla); the Division of Neuropsychiatry (LaFrance) and Division of Biostatistics (Baird), Rhode Island Hospital, Providence, R.I.; the Department of Neurology, Yale University, New Haven, Conn., and Department of Neurology, West Haven Veterans Affairs Medical Center, West Haven, Conn. (Altalib); and the Department of Psychiatry, Yale University, New Haven, Conn., and Department of Psychiatry, West Haven Veterans Affairs Medical Center, West Haven, Conn. (Godleski)
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16
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Arnedt JT, Conroy DA, Mooney A, Furgal A, Sen A, Eisenberg D. Telemedicine versus face-to-face delivery of cognitive behavioral therapy for insomnia: a randomized controlled noninferiority trial. Sleep 2021; 44:5870824. [PMID: 32658298 DOI: 10.1093/sleep/zsaa136] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Revised: 06/17/2020] [Indexed: 12/22/2022] Open
Abstract
STUDY OBJECTIVES In a randomized controlled noninferiority trial, we compared face-to-face and telemedicine delivery (via the AASM SleepTM platform) of cognitive-behavioral therapy (CBT) for insomnia for improving insomnia/sleep and daytime functioning at posttreatment and 3-month follow-up. A secondary objective compared the modalities on treatment credibility, satisfaction, and therapeutic alliance. METHODS A total of 65 adults with chronic insomnia (46 women, 47.2 ± 16.3 years of age) were randomized to 6 sessions of CBT for insomnia delivered individually via AASM SleepTM (n = 33, CBT-TM) or face-to-face (n = 32, CBT-F2F). Participants completed sleep diaries, the Insomnia Severity Index (ISI), and daytime functioning measures at pretreatment, posttreatment, and 3-month follow-up. Treatment credibility, satisfaction, and therapeutic alliance were compared between treatment modalities. The ISI was the primary noninferiority outcome. RESULTS Based on a noninferiority margin of four points on the ISI and, after adjusting for confounders, CBT-TM was noninferior to CBT-F2F at posttreatment (β = 0.54, SE = 1.10, 95% CI = 1.64 to 2.72) and follow-up (β = 0.34, SE = 1.10, 95% CI = 1.83 to 2.53). Daytime functioning measures, except the physical composite scale of the SF-12, were significantly improved at posttreatment and follow-up, with no difference between treatment formats. CBT-TM sessions were, on average, nearly 10 min shorter, yet participant ratings of therapeutic alliance were similar to CBT-F2F. CONCLUSIONS Telemedicine delivery of CBT for insomnia is not inferior to face-to-face for insomnia severity and yields similar improvements on other sleep and daytime functioning outcomes. Further, telemedicine allows for more efficient treatment delivery while not compromising therapeutic alliance. CLINICAL TRIAL REGISTRATION NUMBER NCT03293745.
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Affiliation(s)
- J Todd Arnedt
- Sleep and Circadian Research Laboratory, Department of Psychiatry, Michigan Medicine, University of Michigan, Ann Arbor, MI
| | - Deirdre A Conroy
- Sleep and Circadian Research Laboratory, Department of Psychiatry, Michigan Medicine, University of Michigan, Ann Arbor, MI
| | - Ann Mooney
- Sleep and Circadian Research Laboratory, Department of Psychiatry, Michigan Medicine, University of Michigan, Ann Arbor, MI
| | - Allison Furgal
- Department of Family Medicine, Michigan Medicine, University of Michigan, Ann Arbor, MI.,Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, MI
| | - Ananda Sen
- Department of Family Medicine, Michigan Medicine, University of Michigan, Ann Arbor, MI.,Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, MI
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17
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Fernandez E, Woldgabreal Y, Day A, Pham T, Gleich B, Aboujaoude E. Live psychotherapy by video versus in-person: A meta-analysis of efficacy and its relationship to types and targets of treatment. Clin Psychol Psychother 2021; 28:1535-1549. [PMID: 33826190 DOI: 10.1002/cpp.2594] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Revised: 03/26/2021] [Accepted: 03/27/2021] [Indexed: 12/14/2022]
Abstract
In-person psychotherapy (IPP) has a long and storied past, but technology advances have ushered in a new era of video-delivered psychotherapy (VDP). In this meta-analysis, pre-post changes within VDP were evaluated as were outcome differences between VDP versus IPP or other comparison groups. A literature search identified k = 56 within-group studies (N = 1681 participants) and 47 between-group studies (N = 3564). The pre-post effect size of VDP was large and highly significant, g = +0.99 95% CI [0.67-0.31]. VDP was significantly better in outcome than wait list controls (g = 0.77) but negligible in difference from IPP. Within-groups heterogeneity of effect sizes was reduced after subgrouping studies by treatment target, of which anxiety, depression, and posttraumatic stress disorder (PTSD) (each with k > 5) had effect sizes nearing 1.00. Disaggregating within-groups studies by therapy type, the effect size was 1.34 for CBT and 0.66 for non-CBT. Adjusted for possible publication bias, the overall effect size of VDP within groups was g = 0.54. In conclusion, substantial and significant improvement occurs from pre- to post-phases of VDP, this in turn differing negligibly from IPP treatment outcome. The VDP improvement is most pronounced when CBT is used, and when anxiety, depression, or PTSD are targeted, and it remains strong though attenuated by publication bias. Clinically, therapy is no less efficacious when delivered via videoconferencing than in-person, with efficacy being most pronounced in CBT for affective disorders. Live psychotherapy by video emerges not only as a popular and convenient choice but also one that is now upheld by meta-analytic evidence.
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Affiliation(s)
- Ephrem Fernandez
- Department of Psychology, University of Texas at San Antonio, USA
| | | | - Andrew Day
- School of Social & Political Sciences, University of Melbourne, Melbourne, Australia
| | - Tuan Pham
- Department of Psychology, University of Texas at San Antonio, USA
| | - Bianca Gleich
- Department of Psychology, University of Texas at San Antonio, USA
| | - Elias Aboujaoude
- Department of Psychiatry & Behavioral Sciences, Stanford University, Stanford, California, USA
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18
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White CN, Kauffman BY, Acierno R. Factors contributing to veterans' satisfaction with PTSD treatment delivered in person compared to telehealth. J Telemed Telecare 2021:1357633X20987704. [PMID: 33497311 DOI: 10.1177/1357633x20987704] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Telehealth is an increasingly popular treatment delivery modality for mental healthcare, including evidence-based treatment for complex and intense psychopathologies such as post-traumatic stress disorder (PTSD). Despite the growing telehealth literature, there is a need for more confirmatory research on satisfaction with PTSD telehealth treatment, particularly among veterans, for whom the most rapid and permanent expansion of telehealth services has been implemented through the Department of Veterans Affairs. METHODS The current paper integrates data from two concurrent PTSD treatment outcome studies that compared prolonged exposure therapy delivered both in person and via telehealth for veterans (N = 140). Using two different measures of satisfaction (the Charleston Psychiatric Outpatient Satisfaction Scale-Veteran Affairs Version (CPOSS) and the Service Delivery Perception Questionnaire (SDPQ)), we hypothesized that PTSD improvement would predict satisfaction, but that delivery modality (in person vs telehealth) would not. RESULTS Results only partially supported the hypotheses, in that PTSD symptom improvement was associated with greater satisfaction, and in-person treatment modality was associated with satisfaction as measured by the CPOSS (but not the SDPQ). Subgroup differences by sex were found, such that male veterans, typically with combat-related trauma, were more satisfied with their PTSD treatment compared to female veterans, who were most frequently seen in this study for military sexual trauma. DISCUSSION Altogether, results illustrate a need for additional satisfaction studies with diverse samples and large sample sizes. Future research may benefit from examining satisfaction throughout treatment, identifying predictors of greater PTSD improvement, and further examining demographic subgroups.
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Affiliation(s)
- C Nicole White
- University of Texas Health Science Center at Houston, USA.,University of South Carolina, USA
| | - Brooke Y Kauffman
- University of Texas Health Science Center at Houston, USA.,University of Houston, USA
| | - Ron Acierno
- University of Texas Health Science Center at Houston, USA
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19
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Serhal E, Iwajomo T, de Oliveira C, Crawford A, Kurdyak P. Characterizing Family Physicians Who Refer to Telepsychiatry in Ontario. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2021; 66:25-33. [PMID: 32911964 PMCID: PMC7890579 DOI: 10.1177/0706743720954061] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Telepsychiatry can improve access to psychiatric services for those who otherwise cannot easily access care. Family physicians are gatekeepers to specialized care in Ontario, so it is essential to understand predictors relating to referrals to telepsychiatry to better plan services and increase telepsychiatry adoption. METHODS This study used an annual retrospective cross-sectional study design to compare physicians who referred their patients to telepsychiatry each year from fiscal year (FY) 2008 to FY 2016. A 1-year (FY 2016) comparison of family physicians who referred to telepsychiatry (FPTs) compared to family physicians who did not refer to telepsychiatry (FPNTs) matched (1:2) by region was also conducted. Finally, we used statistical modeling to understand the predictors of referring to telepsychiatry among physicians. RESULTS Between FY 2008 and FY 2016, the number of patients receiving telepsychiatry increased from 925 visits to 13,825 visits. Thirty-two percent of Ontario primary care physicians referred to telepsychiatry in 2016. Several characteristics were notably different between FPTs and FPNTs: FPTs were more likely to be from a residence with less than 10,000 people, to have more nurse practitioners in the practice, and to be from a family health team than FPNTs. Rostered patients of FPTs were more likely to reside in rural areas, have more clinical complexity, and to utilize more mental health services compared to FPNTs. CONCLUSIONS There has been an increase in the use of telepsychiatry by patients and family physicians over the study period, although there remains opportunity for significant growth. Family physicians who live in rural areas, are part of an FHT, have more NPs, with more rural and complex patients were more likely to refer to telepsychiatry. As recent pro-telemedicine policies support the growth of telepsychiatry, this study will serve as an important baseline.
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Affiliation(s)
- Eva Serhal
- The Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- The Institute for Health Policy, Management and Evaluation, University of Toronto, Ontario, Canada
| | - Tomisin Iwajomo
- The Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
| | - Claire de Oliveira
- The Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
| | - Allison Crawford
- The Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Ontario, Canada
| | - Paul Kurdyak
- The Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
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20
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Ros-DeMarize R, Chung P, Stewart R. Pediatric behavioral telehealth in the age of COVID-19: Brief evidence review and practice considerations. Curr Probl Pediatr Adolesc Health Care 2021; 51:100949. [PMID: 33436319 PMCID: PMC8049735 DOI: 10.1016/j.cppeds.2021.100949] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Considerable efforts over the last decade have been placed on harnessing technology to improve access to behavioral health services. These efforts have exponentially risen since the outbreak of the Coronavirus disease 2019 (COVID-19), which has prompted a move to novel systems of care, largely based on telehealth delivery. This article aims to provide a broad review of evidence for telehealth assessment and treatment of externalizing disorders and internalizing disorders in children and discuss practice considerations and established guidelines for telehealth delivery. Existing literature supports the promise of behavioral health interventions including behavioral parent training and combination approaches for externalizing disorders as well as cognitive-behavioral based interventions for internalizing disorders. There is a scarcity of work on assessment via telehealth compared with the available treatment literature. While treatment may be most pressing given the COVID-19 circumstances to continue delivery of care, movement toward establishing evidence-based assessment via telehealth will be of increased importance. Lastly, practice guidelines have been set forth by national associations, professional societies, and supported by the development of national Telehealth Centers of Excellence. These guidelines and practice considerations are discussed within the context of COVID-19.
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Affiliation(s)
| | - Peter Chung
- University of California, Irvine, United States
| | - Regan Stewart
- Medical University of South Carolina, Charleston, SC, United States
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21
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Batastini AB, Paprzycki P, Jones ACT, MacLean N. Are videoconferenced mental and behavioral health services just as good as in-person? A meta-analysis of a fast-growing practice. Clin Psychol Rev 2020; 83:101944. [PMID: 33227560 DOI: 10.1016/j.cpr.2020.101944] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 10/19/2020] [Accepted: 11/02/2020] [Indexed: 12/11/2022]
Abstract
The use of videoconferencing technologies (VCT) is on the rise given its potential to close the gap between mental health care need and availability. Yet, little is known about the effectiveness of these services compared to those delivered in-person. A series of meta-analyses were conducted using 57 empirical studies (43 examining intervention outcomes; 14 examining assessment reliability) published over the past two decades that included a variety of populations and clinical settings. Using conventional and HLM3 meta-analytical approaches, VCT consistently produced treatment effects that were largely equivalent to in-person delivered interventions across 281 individual outcomes and 4336 clients, with female clients and those treated in medical facilities tending to respond more favorably to VCT than in-person. Results of an HLM3 model suggested assessments conducted using VCT did not appear to lead to differential decisions compared to those conducted in-person across 83 individual outcomes and 332 clients/examinees. Although aggregate findings support the use of VCT as a viable alternative to in-person service delivery of mental healthcare, several limitations in the current literature base were revealed. Most concerning was the relatively limited number of randomized controlled trials and the inconsistent (and often incomplete) reporting of methodological features and results. Recommendations for reporting the findings of telemental health research are provided.
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Affiliation(s)
- Ashley B Batastini
- University of Southern Mississippi, USA; University of Mississippi Medical Center Department of Psychiatry, USA.
| | - Peter Paprzycki
- University of Southern Mississippi, USA; Mississippi Center for Clinical and Translational Research, USA; University of Toledo, USA
| | | | - Nina MacLean
- Michigan Department of Health & Human Services - Center for Forensic Psychiatry, USA
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22
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Simpson S, Guerrini L, Rochford S. Telepsychology in a University Psychology Clinic Setting: A Pilot Project. AUSTRALIAN PSYCHOLOGIST 2020. [DOI: 10.1111/ap.12131] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
| | | | - Shirley Rochford
- Rural and Remote Network, Country Health SA Mental Health Service,
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23
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Simpson SG, Rochford S, Livingstone A, English S, Austin C. Tele‐web Psychology in Rural South Australia: The Logistics of Setting Up a Remote University Clinic Staffed by Clinical Psychologists in Training. AUSTRALIAN PSYCHOLOGIST 2020. [DOI: 10.1111/ap.12049] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
| | - Shirley Rochford
- Rural and Remote Network, Country Health SA Mental Health Service,
| | | | | | - Carly Austin
- Psychology Clinic, University of South Australia,
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24
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Simpson S, Richardson LK, Pelling N. Introduction to the Special Issue “Telepsychology: Research and Practice”. AUSTRALIAN PSYCHOLOGIST 2020. [DOI: 10.1111/ap.12146] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Affiliation(s)
- Susan Simpson
- School of Psychology, Social Work and Social Policy, University of South Australia,
| | | | - Nadine Pelling
- School of Psychology, Social Work and Social Policy, University of South Australia,
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25
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Rees CS, Maclaine E. A Systematic Review of Videoconference‐Delivered Psychological Treatment for Anxiety Disorders. AUSTRALIAN PSYCHOLOGIST 2020. [DOI: 10.1111/ap.12122] [Citation(s) in RCA: 69] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Clare S Rees
- School of Psychology and Speech Pathology, Faculty of Health Sciences, Curtin University,
| | - Ellen Maclaine
- School of Psychology and Speech Pathology, Faculty of Health Sciences, Curtin University,
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26
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Frueh BC. Solving Mental Healthcare Access Problems in the Twenty‐first Century. AUSTRALIAN PSYCHOLOGIST 2020. [DOI: 10.1111/ap.12140] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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27
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Re-engaging Dropouts of Prolonged Exposure for PTSD Delivered via Home-Based Telemedicine or In Person: Satisfaction with Veteran-to-Veteran Support. J Behav Health Serv Res 2020; 48:171-182. [PMID: 33034019 DOI: 10.1007/s11414-020-09734-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/15/2020] [Indexed: 10/23/2022]
Abstract
This paper describes feasibility of and patient and peer satisfaction with a Veteran-to-Veteran peer support program purposefully integrated into prolonged exposure (PE) for post-traumatic stress disorder (PTSD) to address barriers contributing to dropout from both in person and telemedicine delivered PE. Specifically, patients who had dropped out of PE were offered the opportunity to return to treatment, this time with a peer who themselves had completed PE, who would join them during a limited number of PE in vivo exposure homework trials. About half of the Veterans who dropped out indicated willingness to return to treatment, noting the peer as central to this decision, and about a third actually returned to treatment. Participants reported high satisfaction with the program, as did peers. Peers reported that their own symptoms were not exacerbated by engaging in exposure homework with the patients. While in the military, service members are trained to leverage the power of the group toward mission-specific tasks; and this training appears relevant to PTSD treatment in the present context.
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Morland LA, Wells SY, Glassman LH, Greene CJ, Hoffman JE, Rosen CS. Advances in PTSD Treatment Delivery: Review of Findings and Clinical Considerations for the Use of Telehealth Interventions for PTSD. ACTA ACUST UNITED AC 2020; 7:221-241. [PMID: 32837831 PMCID: PMC7261035 DOI: 10.1007/s40501-020-00215-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Purpose of review Effective treatments for posttraumatic stress disorder (PTSD) remain underutilized and individuals with PTSD often have difficulty accessing care. Telehealth, particularly clinical videoconferencing (CVT), can overcome barriers to treatment and increase access to care for individuals with PTSD. The purpose of this review is to summarize the literature on the delivery of PTSD treatments through office-based and home-based videoconferencing, and outline areas for future research. Recent findings Evidence-based PTSD treatments delivered through office-based and home-based CVT have been studied in pilot studies, non-randomized trials, and randomized clinical trials. The studies have consistently demonstrated feasibility and acceptability of these modalities as well as significant reduction in PTSD symptoms, non-inferior outcomes, and comparable dropout rates when compared with traditional face-to-face office-based care. Finally, it has been shown that using CVT does not compromise the therapeutic process. Summary Office-based and home-based CVT can be used to deliver PTSD treatments while retaining efficacy and therapeutic process. The use of these modalities can increase the number of individuals that can access efficacious PTSD care.
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Affiliation(s)
- Leslie A Morland
- VA San Diego Healthcare System, 3375 La Jolla Village Drive, San Diego, CA USA.,University of California, San Diego, San Diego, USA.,Pacific Island Division, National Center for PTSD, Honolulu, HI USA
| | - Stephanie Y Wells
- Durham VA Health Care System, Durham, NC USA.,VISN 6 Mid-Atlantic MIRECC, Durham, NC USA
| | - Lisa H Glassman
- VA San Diego Healthcare System, 3375 La Jolla Village Drive, San Diego, CA USA
| | - Carolyn J Greene
- Department of Veterans Affairs Healthcare System, Little Rock, AR USA.,University of Arkansas for Medical Sciences (UAMS), Little Rock, AR USA
| | - Julia E Hoffman
- Behavioral Health Strategy, Livongo Health, Inc, Silicon Valley, CA USA
| | - Craig S Rosen
- Dissemination & Training Division, National Center for PTSD, Palo Alto, CA USA.,Stanford University School of Medicine, Palo Alto, CA USA
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Hendrikx LJ, Murphy D. Exploring the Acceptability of The Together Webinar Programme for Military Partners: A Qualitative Study. Telemed J E Health 2020; 26:1475-1482. [PMID: 32074478 DOI: 10.1089/tmj.2019.0309] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Military partners appear at risk for developing psychological difficulties such as depression, generalized anxiety, and secondary trauma symptoms. Yet, evidence suggests that participants report an array of barriers that prevent them from seeking and engaging with mental health support. This includes stigma-related beliefs, work and childcare responsibilities, and distance to venue where support is offered. Introduction: The Together Webinar Programme (TTP-Webinar) was developed to increase the accessibility of mental health support for military partners. The efficacy of this program has been explored in a previous study. Materials and Methods: Data for this study were taken from 68 partners who provided qualitative feedback of the program. Thematic qualitative analysis was used to explore the views of participants about the acceptability of TTP-Webinar. Results: Four main themes were identified, namely perceived benefit, modality, general barriers, and areas for improvement. Discussion: Participants found it favorable to develop a better understanding of veterans' difficulties, to have their own difficulties normalized through sharing and discussion, and to feel part of a wider community. They also found the webinar format favorable as it increased the accessibility of support and provided them with an interactive safe platform. Conclusions: The study provides promising qualitative evidence for the use of TTP-Webinar in supporting the mental health needs of military partners.
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Affiliation(s)
| | - Dominic Murphy
- Research Department, Combat Stress, Leatherhead, United Kingdom.,King's Centre for Military Health Research, King's College London, London, United Kingdom
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Serhal E, Lazor T, Kurdyak P, Crawford A, de Oliveira C, Hancock-Howard R, Coyte PC. A cost analysis comparing telepsychiatry to in-person psychiatric outreach and patient travel reimbursement in Northern Ontario communities. J Telemed Telecare 2019; 26:607-618. [DOI: 10.1177/1357633x19853139] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Introduction Residents of Northern Ontario have limited access to local psychiatric care. To address this, three program models exist: (1) telepsychiatry; (2) psychiatrists traveling to underserved areas; and (3) reimbursing patients for travel to a psychiatrist. Evidence shows that telepsychiatry has comparable outcomes to in-person consultations. The objective of this study was to determine the cost difference between programs. Methods A cost-minimization analysis estimating cost per visit from a public healthcare payer economic costing perspective was conducted. Data on fixed and variable costs were obtained. Evidence-based assumptions were made where relevant. Base-case scenarios and a break-even analysis were completed, as well as deterministic and probabilistic sensitivity analyses, to explore the effects of parameter variability on program costs. Results Costs per visit were lowest in telepsychiatry (CAD$360) followed by traveling physicians (CAD$558) and patient reimbursement (CAD$620). Among the 100,000 Monte Carlo simulations, results showed telepsychiatry was the least costly program in 71.2% of the simulations, while the reimbursement and outreach programs were least costly in 15.1% and 13.7% of simulations, respectively. The break-even analysis found telepsychiatry was the least costly program after an annual patient visit threshold of approximately 76 visits (compared to traveling psychiatrists) and 126 visits (compared to reimbursed patients). Discussion Our analyses support telepsychiatry as the least costly program. These results have important implications for program planning, including the prioritization of telepsychiatry, increased integration of telepsychiatry with other modalities of outreach psychiatry, and limiting use of the patient remuneration program to where medically necessary, to reduce overall cost.
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Affiliation(s)
- Eva Serhal
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Tanya Lazor
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Hospital for Sick Children, Toronto, ON, Canada
| | - Paul Kurdyak
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
| | - Allison Crawford
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Claire de Oliveira
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
| | - Rebecca Hancock-Howard
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Peter C Coyte
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
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Murphy D, Turgoose D. Evaluating an Internet-based video cognitive processing therapy intervention for veterans with PTSD: A pilot study. J Telemed Telecare 2019; 26:552-559. [PMID: 31208264 DOI: 10.1177/1357633x19850393] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
INTRODUCTION There remain a number of UK military veterans who are not able to access psychological therapies for post-traumatic stress disorder (PTSD). Some of these barriers are practical, including the need to balance work and other life commitments with attendance at residential or outpatient appointments. There is a need to investigate more accessible and flexible methods of delivering psychological therapies to veterans. One such alternative is to use remote-access video technology, often referred to as tele-therapy. The aims of the present study were to explore the feasibility of using tele-therapy in this population, whilst also reporting mental health outcomes for those who accessed the intervention. METHODS Participants were recruited from a UK veterans mental health charity. The intervention consisted of 12 sessions of cognitive processing therapy delivered via Skype. Participants completed various measures of mental health, including PTSD at three time points: pre-treatment, post-treatment and at three months follow-up. A measure of therapeutic alliance was also completed by participants and the clinician. RESULTS A total of 27 participants engaged in tele-therapy, with a treatment completion rate of 79% and a 'did not attend' rate of 12%, which compared well against similar outpatient services. All mental health outcomes showed maintained improvement at three months follow-up, with the highest effect size recorded for PTSD. Therapeutic alliance was also rated highly by both participants and the clinician. DISCUSSION The findings suggest that tele-therapy could provide a viable alternative format for delivering trauma-focused psychological therapies to veterans. Limitations and recommendations for future research are also presented.
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Affiliation(s)
- Dominic Murphy
- Combat Stress, King's Centre for Military Health Research, Leatherhead, Surrey, UK
| | - David Turgoose
- Combat Stress, King's Centre for Military Health Research, Leatherhead, Surrey, UK
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Abstract
The delivery of teletherapy is an important advancement in clinical care for the treatment of eating disorders (EDs). Specifically, it seems to improve access to highly specialized ED treatment. Research on the application of videoconferencing-based psychotherapy services for EDs is minimal; however, results suggest that this treatment format leads to significant improvements in clinical symptoms and is well accepted by patients. General telemedicine guidelines and administrative and clinical recommendations specific to the treatment of ED patients have been identified. With careful planning and thoughtful application, Internet-based therapy seems to be a valuable resource for practitioners seeking to disseminate specialized ED treatments.
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Mayworm AM, Lever N, Gloff N, Cox J, Willis K, Hoover SA. School-Based Telepsychiatry in an Urban Setting: Efficiency and Satisfaction with Care. Telemed J E Health 2019; 26:446-454. [PMID: 31120378 DOI: 10.1089/tmj.2019.0038] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Background and Introduction: Given the shortage of child psychiatrists in most areas, telepsychiatry may increase accessibility of psychiatric care in schools, in part by improving psychiatrists' efficiency and reach. The current study assessed consumer and provider satisfaction with school-based telepsychiatry versus in-person sessions in 25 urban public schools and compared the efficiency of these service delivery models. Materials and Methods: In total, 714 satisfaction surveys were completed by parents, students, school clinicians, and child psychiatrists following initial (26.3%) and follow-up (67.2%) visits (6.4% did not indicate type of visit). Most of these surveyed visits were for medication management (69.9%) or initiation of medication (22%). Efficiency analyses compared time saved via telepsychiatry versus in-person care. Researchers also conducted focus groups with providers to clarify preferences and concerns about telepsychiatry versus in-person visits. Results: Consumers were highly satisfied with both in-person and telepsychiatry-provided school psychiatry services and showed no significant differences in preference. Providers reported both in-person and telepsychiatry were equally effective and showed a slight preference for in-person sessions, citing concerns about ease of video equipment use. Telepsychiatry services were more efficient than in-person services, as commute/setup occupied about 28 psychiatrist hours total per month. Discussion and Conclusions: Findings suggest that students, parents, and school clinicians perceive school-based telepsychiatry positively and equal to on-site care. Child psychiatrists have apprehension about using equipment, so equipment training/preparation and provision of technical support are needed. Implications of study findings for telepsychiatry training and implementation in schools are discussed.
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Affiliation(s)
- Ashley M Mayworm
- School of Education, Loyola University Chicago, Chicago, Illinois
| | - Nancy Lever
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore, Maryland
| | - Nicole Gloff
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore, Maryland
| | - Jennifer Cox
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore, Maryland
| | - Kelly Willis
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore, Maryland
| | - Sharon A Hoover
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore, Maryland
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Lichtenthal WG, Catarozoli C, Masterson M, Slivjak E, Schofield E, Roberts KE, Neimeyer RA, Wiener L, Prigerson HG, Kissane DW, Li Y, Breitbart W. An open trial of meaning-centered grief therapy: Rationale and preliminary evaluation. Palliat Support Care 2019; 17:2-12. [PMID: 30683164 PMCID: PMC6401220 DOI: 10.1017/s1478951518000925] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To determine the preliminary feasibility, acceptability, and effects of Meaning-Centered Grief Therapy (MCGT) for parents who lost a child to cancer. METHOD Parents who lost a child to cancer and who were between six months and six years after loss and reporting elevated levels of prolonged grief were enrolled in open trials of MCGT, a manualized, one-on-one cognitive-behavioral-existential intervention that used psychoeducation, experiential exercises, and structured discussion to explore themes related to meaning, identity, purpose, and legacy. Parents completed 16 weekly sessions, 60-90 minutes in length, either in person or through videoconferencing. Parents were administered measures of prolonged grief disorder symptoms, meaning in life, and other assessments of psychological adjustment preintervention, mid-intervention, postintervention, and at three months postintervention. Descriptive data from both the in-person and videoconferencing open trial were pooled.ResultEight of 11 (72%) enrolled parents started the MCGT intervention, and six of eight (75%) participants completed all 16 sessions. Participants provided positive feedback about MCGT. Results showed postintervention longitudinal improvements in prolonged grief (d = 1.70), sense of meaning (d = 2.11), depression (d = 0.84), hopelessness (d = 1.01), continuing bonds with their child (d = 1.26), posttraumatic growth (ds = 0.29-1.33), positive affect (d = 0.99), and various health-related quality of life domains (d = 0.46-0.71). Most treatment gains were either maintained or increased at the three-month follow-up assessment.Significance of resultsOverall, preliminary data suggest that this 16-session, manualized cognitive-behavioral-existential intervention is feasible, acceptable, and associated with transdiagnostic improvements in psychological functioning among parents who have lost a child to cancer. Future research should examine MCGT with a larger sample in a randomized controlled trial.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - David W Kissane
- The University of Notre Dame Australia,Fremantle,Western Australia
| | - Yuelin Li
- Memorial Sloan Kettering Cancer Center,New York,NY
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Mahmoud H, Vogt EL, Sers M, Fattal O, Ballout S. Overcoming Barriers to Larger-Scale Adoption of Telepsychiatry. Psychiatr Ann 2019. [DOI: 10.3928/00485713-20181228-02] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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Hassan A, Sharif K. Efficacy of Telepsychiatry in Refugee Populations: A Systematic Review of the Evidence. Cureus 2019; 11:e3984. [PMID: 30972263 PMCID: PMC6443105 DOI: 10.7759/cureus.3984] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Introduction Telepsychiatry is becoming an increasingly appealing option for mental health treatment due to its ability to overcome barriers which prevent certain demographics from having access to mental health services. There is a surprising lack of research being done on this promising mode of health care delivery. The aim of this study is to evaluate the existing literature in order to determine the clinical effectiveness and cost-effectiveness of telepsychiatry in resource-constrained environments. Methods Literature searches were performed in PsychINFO, PubMed, Medline, EMBASE, Centre for Reviews and Dissemination, and the Cochrane Library Controlled Trial Registry databases (2000 - May 2017). A search of the following terms was used: telemedicine; telemedical; telepsychiatry; telepsychiatric; teleconsultation; e-health; video conference; and telecare. Type of mental disorder and intervention, along with the clinical outcome or patient satisfaction, were all identified. Exclusion criteria included studies with a sample size of fewer than 10 cases, as well as studies which failed to analyze intervention outcomes. Results Of the 1,477 identified articles, 14 randomized controlled trials were included for review. Despite the methodological limitations and the small number of existing studies, there appears to be limited evidence pointing towards the efficacy of telepsychiatry in resource-constrained environments, although patients and providers tend to prefer face-to-face treatment over video conferencing. Two of the studies included in this paper found video conferencing to be more effective than face-to-face treatment, while none reported the opposite. At the very least, we hypothesize that psychotherapeutic treatment delivered via video conferencing is just as effective as a traditional treatment, albeit less desirable. Conclusion More research is required in order to further evaluate the efficacy of telepsychiatry in the management of mental illness, as there is a current lack of scientific evidence to draw any conclusions. However, there exists a strong hypothesis that telepsychiatric treatment yields the same results as the traditional, in-person therapy and that telepsychiatry is a useful alternative when traditional therapy is not possible. Countries with substantial numbers of refugees living in resource-constrained areas, such as camps, should be encouraged to develop telepsychiatry programs.
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Affiliation(s)
- Ahmad Hassan
- Psychiatry, Yale University School of Medicine, New Haven, USA
| | - Kareem Sharif
- Psychiatry, University of Pennsylvania School of Medicine, Philadelphia, USA
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Trauma management therapy with virtual-reality augmented exposure therapy for combat-related PTSD: A randomized controlled trial. J Anxiety Disord 2019; 61:64-74. [PMID: 28865911 DOI: 10.1016/j.janxdis.2017.08.005] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Revised: 08/03/2017] [Accepted: 08/17/2017] [Indexed: 11/21/2022]
Abstract
Virtual reality exposure therapy (VRET) realistically incorporates traumatic cues into exposure therapy and holds promise in the treatment of combat-related posttraumatic stress disorder (PTSD). In a randomized controlled trial of 92 Iraq and Afghanistan veterans and active duty military personnel with combat-related PTSD, we compared the efficacy of Trauma Management Therapy (TMT; VRET plus a group treatment for anger, depression, and social isolation) to VRET plus a psychoeducation control condition. Efficacy was evaluated at mid- and post-treatment, and at 3- and 6-month follow-up. Consistent with our hypothesis, VRET resulted in significant decreases on the Clinician Administered PTSD Scale and the PTSD Checklist-Military version for both groups. Also consistent with our hypothesis, significant decreases in social isolation occurred only for those participants who received the TMT group component. There were significant decreases for depression and anger for both groups, although these occurred after VRET and before group treatment. All treatment gains were maintained six-months later. Although not part of the original hypotheses, sleep was not improved by either intervention and remained problematic. The results support the use of VRET as an efficacious treatment for combat-related PTSD, but suggest that VRET alone does not result in optimal treatment outcomes across domains associated with PTSD.
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Tuerk PW, Keller SM, Acierno R. Treatment for Anxiety and Depression via Clinical Videoconferencing: Evidence Base and Barriers to Expanded Access in Practice. FOCUS: JOURNAL OF LIFE LONG LEARNING IN PSYCHIATRY 2018; 16:363-369. [PMID: 31975928 DOI: 10.1176/appi.focus.20180027] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
This review summarizes six decades of clinical outcome research relevant to evidence-based practices for depression and anxiety delivered via clinical videoconferencing. The authors conducted a literature search of previous systematic reviews and an updated search of publications specific to anxiety and depression. Overall, strong evidence supports the safety and clinical effectiveness of administering evidence-based psychotherapy for anxiety and depression via clinical videoconferencing among heterogeneous populations and age ranges, and in multiple care settings, with similar outcomes to in-person care. Despite the overall clinical effectiveness of the modality, the authors discuss common logistical and institutional barriers to long-term effective implementation. Future systems-level research is required to investigate replicable and sustainable models for implementing and expanding access to evidence-based psychotherapies via clinical videoconferencing.
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Affiliation(s)
- Peter W Tuerk
- Dr. Tuerk and Dr. Keller are with the Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston; Dr. Acierno is with the College of Nursing, Medical University of South Carolina. Dr. Tuerk is also with the Sheila C. Johnson Center for Clinical Services, Department of Human Services, University of Virginia, Charlottesville; Dr. Keller and Dr. Acierno are also with the Ralph H. Johnson VA Medical Center, Charleston, South Carolina
| | - Stephanie M Keller
- Dr. Tuerk and Dr. Keller are with the Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston; Dr. Acierno is with the College of Nursing, Medical University of South Carolina. Dr. Tuerk is also with the Sheila C. Johnson Center for Clinical Services, Department of Human Services, University of Virginia, Charlottesville; Dr. Keller and Dr. Acierno are also with the Ralph H. Johnson VA Medical Center, Charleston, South Carolina
| | - Ron Acierno
- Dr. Tuerk and Dr. Keller are with the Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston; Dr. Acierno is with the College of Nursing, Medical University of South Carolina. Dr. Tuerk is also with the Sheila C. Johnson Center for Clinical Services, Department of Human Services, University of Virginia, Charlottesville; Dr. Keller and Dr. Acierno are also with the Ralph H. Johnson VA Medical Center, Charleston, South Carolina
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Turgoose D, Ashwick R, Murphy D. Systematic review of lessons learned from delivering tele-therapy to veterans with post-traumatic stress disorder. J Telemed Telecare 2018; 24:575-585. [PMID: 28958211 DOI: 10.1177/1357633x17730443] [Citation(s) in RCA: 77] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/19/2023]
Abstract
Introduction Despite increases in the number of ex-service personnel seeking treatment for post-traumatic stress disorder (PTSD), there remain a number of barriers to help-seeking which prevents many veterans from accessing psychological therapies. Tele-therapy provides one potential method of increasing the number of veterans accessing support. This review aimed to systematically review the literature in order to summarise what lessons have been learned so far from providing trauma-focused tele-therapies to veterans with PTSD. Methods A systematic literature review was conducted from which 41 papers were reviewed. Studies were included if they involved the use of trauma-focused therapies carried out using tele-therapy technologies. Only studies using tele-therapy interventions via video or telephone with populations of ex-military personnel with PTSD were included. Results In the majority of cases tele-therapy was found to be as effective in reducing PTSD symptoms as in-person interventions. Similarly, there were few differences in most process outcomes such as dropout rates, with tele-therapy helping to increase uptake in some cases. Veterans using tele-therapy reported high levels of acceptability and satisfaction. Some challenges were reported in terms of therapeutic alliance, with some studies suggesting that veterans felt less comfortable in using tele-therapy. Several studies suggested it was harder for clinicians to read non-verbal communication in tele-therapy, but this did not affect their ability to build rapport. Technological issues were encountered, but these were not found to impede therapy processes or outcomes. Discussion Tele-therapy provides a viable alternative to in-person therapies and has the potential to increase access to therapy for veterans. Tele-therapy should continue to be evaluated and scrutinised in order to establish the most effective methods of delivery.
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Gentry MT, Lapid MI, Clark MM, Rummans TA. Evidence for telehealth group-based treatment: A systematic review. J Telemed Telecare 2018; 25:327-342. [DOI: 10.1177/1357633x18775855] [Citation(s) in RCA: 87] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background Interest in the use of telehealth interventions to increase access to healthcare services is growing. Group-based interventions have the potential to increase patient access to highly needed services. The aim of this study was to systematically review the available literature on group-based video teleconference services. Methods The English-language literature was searched using Ovid MEDLINE, PubMed, PsycINFO and CINAHL for terms related to telehealth, group therapy and support groups. Abstracts were reviewed for relevance based on inclusion criteria. Multiple study types were reviewed, including open-label, qualitative and randomised controlled trial study designs. Data were compiled regarding participants, study intervention and outcomes. Specific areas of interest were the feasibility of and satisfaction with telehealth technology, as well as the effect of video teleconference delivery on group dynamics, including therapeutic alliance. Results Forty published studies met the inclusion criteria and were included in the review. Six were randomised controlled trials. Among the studies, there was a broad range of study designs, participants, group interventions and outcome measures. Video teleconference groups were found to be feasible and resulted in similar treatment outcomes to in-person groups. However, few studies were designed to demonstrate noninferiority of video teleconference groups compared with in-person groups. Studies that examined group process factors showed small decreases in therapeutic alliance in the video teleconference participants. Conclusions Video teleconference groups are feasible and produce outcomes similar to in-person treatment, with high participant satisfaction despite technical challenges. Additional research is needed to identify optimal methods of video teleconference group delivery to maximise clinical benefit and treatment outcomes.
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Affiliation(s)
| | - Maria I Lapid
- Department of Psychiatry and Psychology, Mayo Clinic, USA
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Moreau JL, Cordasco KM, Young AS, Oishi SM, Rose DE, Canelo I, Yano EM, Haskell SG, Hamilton AB. The Use of Telemental Health to Meet the Mental Health Needs of Women Using Department of Veterans Affairs Services. Womens Health Issues 2018; 28:181-187. [DOI: 10.1016/j.whi.2017.12.005] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Revised: 11/27/2017] [Accepted: 12/11/2017] [Indexed: 01/01/2023]
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Dalton J, Thomas S, Melton H, Harden M, Eastwood A. The provision of services in the UK for UK armed forces veterans with PTSD: a rapid evidence synthesis. HEALTH SERVICES AND DELIVERY RESEARCH 2018. [DOI: 10.3310/hsdr06110] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background
Our research arises from anticipated increases in demand for psychological trauma services in the UK, with particular reference to armed forces veterans with post-traumatic stress disorder (PTSD). Commissioning and service provider activity to improve veterans’ health is evolving.
Objectives
To explore what UK services exist and establish potentially effective models of care and effective treatments for armed forces veterans with PTSD.
Design
A four-stage rapid evidence synthesis comprising information gathering on UK service provision; an evidence review on models of care; a metareview on treatment effectiveness; and a synthesis highlighting research priorities.
Setting
For the evidence reviews, any setting that was relevant to the UK health and social care system.
Participants
UK armed forces veterans with PTSD following repeated exposure to traumatic events.
Interventions
Any model of care or treatment.
Main outcome measures
Any relevant outcome.
Data sources
Information about current UK practice. Searches of databases [including MEDLINE, PsycINFO and PILOTS (Published International Literature on Traumatic Stress)], guidelines and relevant websites, up to November 2016.
Review methods
We screened titles and abstracts using EPPI-Reviewer 4 (EPPI-Centre, Social Science Research Unit, Institute of Education, University of London, UK) and EndNote X7 [Clarivate Analytics (formerly Thomson Reuters), Philadelphia, PA, USA]. Decisions to include papers were made by two reviewers independently. We conducted a narrative synthesis of research literature on models of care and on treatments, guided by information from UK practice. In our evidence reviews, we assessed (when appropriate) the quality of included studies using established criteria. To help interpret our findings, we consulted recently published public and patient involvement data, a veteran service user and experts with academic, military and commissioning backgrounds.
Results
We gathered information about current UK practice. Sixty-one studies were included in the rapid evidence review on models of care and seven systematic reviews in the rapid metareview of treatments. The quality of evidence in both evidence reviews was limited. Promising models of care from more robust studies (three randomised controlled trials and one qualitative study) were collaborative arrangements and community outreach for improving intervention access and uptake; integrated mental health services and behavioural intervention on increased smoking abstinence; and peer support as an acceptable complement to PTSD treatment. A poor fit was noted between the research literature and UK service provision. Promising treatments were psychosocial interventions (eye movement desensitisation and reprocessing, cognitive processing therapy, trauma-focused and exposure-based intervention) and pharmacotherapy (selective serotonin reuptake inhibitors, antidepressants, anticonvulsants, antipsychotics) for improving PTSD and mental health symptoms.
Limitations
The literature pool was larger than anticipated. Evidence for potentially effective models of care and potentially effective treatments is limited in quality and quantity. Although we aimed for a comprehensive evidence synthesis, pragmatic decisions in searching, screening and inclusion of studies may mean that relevant studies were overlooked.
Conclusions
There is tentative support for the effectiveness of some models of care and certain treatments currently delivered in UK practice. Our findings are timely for commissioners and service providers when developing present activity in veterans’ health care.
Future work
We report potential implications for future health-care practice, including early intervention for veterans transitioning from military life, improving general practitioners’ knowledge about services, implementing needs-based service design and tackling wider-system challenges. Regarding potential areas of future research, we have identified the need for more-robust (and longer) evaluative studies in the UK setting.
Funding
The National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
- Jane Dalton
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Sian Thomas
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Hollie Melton
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Melissa Harden
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Alison Eastwood
- Centre for Reviews and Dissemination, University of York, York, UK
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Preliminary evidence for the use and efficacy of mobile health applications in managing posttraumatic stress disorder symptoms. Health Syst (Basingstoke) 2017. [DOI: 10.1057/hs.2016.2] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Glassman LH, Mackintosh MA, Talkovsky A, Wells SY, Walter KH, Wickramasinghe I, Morland LA. Quality of life following treatment for PTSD: Comparison of videoconferencing and in-person modalities. J Telemed Telecare 2017; 25:123-127. [DOI: 10.1177/1357633x17740610] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Introduction Quality of life (QOL) is significantly impaired among individuals with post-traumatic stress disorder (PTSD); however, few treatment outcome studies examine QOL following treatment. Furthermore, the use of videoconferencing to deliver evidence-based treatments for PTSD is increasing dramatically. Although videoconferencing has demonstrated non-inferiority to in-person treatment modalities for improving PTSD symptom severity, no studies to date have directly compared QOL outcomes of an evidence-based intervention delivered via videoconferencing to one delivered in-person. Methods This study presents a secondary data analysis of two randomized controlled trials comparing cognitive processing therapy (CPT) delivered via videoconferencing or a traditional in-person modality. The Men’s study delivered group CPT to 125 male veterans with PTSD, whereas the Women’s study delivered individuals CPT to 126 female civilians and veterans. Multigroup latent growth curve models were used to model changes in QOL Inventory (QOLI) scores over time. Results There was no effect of treatment modality on changes in QOLI scores over time (modality effect on slope estimate = 0.004 (–0.60, 0.61) and on quadratic estimate = 0.001 (–0.18, 0.20); all ps > 0.33). Model fit was the same for both genders (Δ χ2 (2) = 2.28, p = 0.32) and for the gender × treatment modality interaction (Δ χ2 (2) = 2.87, p = 0.24). QOLI scores improved at post-treatment and three-month follow-up assessments, but declined at the six-month follow-up assessment. Discussion This secondary analysis extends the findings of the parent studies by establishing the efficacy of the videoconferencing platform in improving QOL. Clinical implications of findings are discussed.
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Affiliation(s)
- Lisa H Glassman
- Department of Psychiatry, University of California, USA
- VA San Diego Healthcare System, USA
| | | | - Alexander Talkovsky
- Department of Psychiatry, University of California, USA
- VA San Diego Healthcare System, USA
- Center of Excellence for Stress and Mental Health, San Diego, USA
| | - Stephanie Y Wells
- Department of Psychiatry, University of California, USA
- VA San Diego Healthcare System, USA
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, USA
| | | | - Induni Wickramasinghe
- Department of Psychiatry, University of California, USA
- VA San Diego Healthcare System, USA
| | - Leslie A Morland
- Department of Psychiatry, University of California, USA
- VA San Diego Healthcare System, USA
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, USA
- Department of Veterans Affairs Pacific Islands Healthcare System, National Center for PTSD – Pacific Islands Division, USA
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45
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Clinical Update: Telepsychiatry With Children and Adolescents. J Am Acad Child Adolesc Psychiatry 2017; 56:875-893. [PMID: 28942810 DOI: 10.1016/j.jaac.2017.07.008] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Accepted: 07/17/2017] [Indexed: 01/17/2023]
Abstract
This Clinical Update reviews the use of telepsychiatry to deliver psychiatric, mental health, and care coordination services to children and adolescents across settings as direct service and in collaboration with primary care providers or other clinicians. The update defines terms and presents the current status of telepsychiatry as a mode of health service delivery. The update presents procedures for conducting telepsychiatry services and optimizing the clinical experience.
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Hernandez-Tejada MA, Hamski S, Sánchez-Carracedo D. Incorporating peer support during in vivo exposure to reverse dropout from prolonged exposure therapy for posttraumatic stress disorder: Clinical outcomes. Int J Psychiatry Med 2017; 52:366-380. [PMID: 29179664 DOI: 10.1177/0091217417738938] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective Prolonged exposure is characterized by reported dropout rates ranging from 25% to 40%. This premature attrition is also observed in other evidence-based treatments for posttraumatic stress disorder. While home-based telehealth delivery of prolonged exposure resolves logistical barriers to care such as travel time and cost, dropout appears unaffected. A previous study on dropouts from prolonged exposure delivered via telehealth found that Veterans, particularly those receiving care via telehealth, reported problems with in vivo exposure and that having a peer to offer support during in vivo exposure assignments might have prevented their attrition from treatment. Methods The present pilot study treatment was designed in a manner consistent with the aforementioned Veteran suggestions, specifically to involve peers offering verbal support and encouragement during in vivo exposure homework. Such a treatment modification might be particularly useful for those receiving care via telehealth, given increased difficulties with exposure reported when this treatment delivery modality is used. It was hypothesized that dropouts would agree to reengage in treatment with a peer and would subsequently evince improvement in posttraumatic stress disorder and depression scores as a result of this treatment reengagement. Results Of 82 dropouts from prolonged exposure, 29 reentered treatment when offered peer support during exposure (12 in telehealth and 17 in person). Conclusion Treatment reentry was effective insofar as indices of both posttraumatic stress disorder and depression were significantly reduced in both telehealth and in person groups, indicating that using peers in this way may be an effective means by which to return Veterans to care, and ultimately reduce symptomatology.
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Affiliation(s)
- Melba A Hernandez-Tejada
- 1 Department of Health and Clinical Psychology, Universitat Autònoma de Barcelona, Barcelona, Spain
- 2 Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC, USA
- 3 College of Nursing, Medical University of South Carolina, Charleston, SC, USA
| | - Stephanie Hamski
- 2 Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC, USA
| | - David Sánchez-Carracedo
- 1 Department of Health and Clinical Psychology, Universitat Autònoma de Barcelona, Barcelona, Spain
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Franklin CL, Cuccurullo LA, Walton JL, Arseneau JR, Petersen NJ. Face to face but not in the same place: A pilot study of prolonged exposure therapy. J Trauma Dissociation 2017; 18:116-130. [PMID: 27348462 DOI: 10.1080/15299732.2016.1205704] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
This pilot study examined use of smartphone technology to deliver prolonged exposure (PE) therapy to patients with posttraumatic stress disorder (PTSD) with geographic limitations hindering in-person therapy. The primary goal was to examine the feasibility and acceptability of using video teleconferencing (i.e., computer-based and iPhone 4 streaming technology), with a secondary goal of examining clinical outcomes of PE delivered via teleconferencing compared with treatment as usual (TAU) on PTSD and depressive/anxious symptom reduction. Rural veterans (N = 27) were randomized to receive PE by computer teleconferencing at a Veterans Administration community clinic, PE by an iPhone issued for the duration of the study, or TAU provided by a referring clinician. To examine the research goals, we collected data on the number of referrals to the study, number of patients entering the study, and number completing psychotherapy and documented pragmatic and technical issues interfering with the ability to use teleconferencing to deliver PE; results are discussed. In addition, measures of symptom change examined clinical outcomes. Results indicated decreases in PTSD symptoms in veterans who completed PE therapy via teleconferencing; however, there was significantly more attrition in these groups than in the TAU group.
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Affiliation(s)
- C Laurel Franklin
- a Southeast Louisiana Veterans Health Care System , New Orleans , Louisiana , USA.,b South Central VA Mental Illness Research, Education, and Clinical Center , New Orleans , Louisiana , USA.,c Department of Psychiatry and Behavioral Sciences , Tulane University Medical School , New Orleans , Louisiana , USA
| | - Lisa-Ann Cuccurullo
- a Southeast Louisiana Veterans Health Care System , New Orleans , Louisiana , USA
| | - Jessica L Walton
- a Southeast Louisiana Veterans Health Care System , New Orleans , Louisiana , USA
| | - Julie R Arseneau
- a Southeast Louisiana Veterans Health Care System , New Orleans , Louisiana , USA.,c Department of Psychiatry and Behavioral Sciences , Tulane University Medical School , New Orleans , Louisiana , USA
| | - Nancy J Petersen
- d Michel E. Debakey VA Medical Center , Houston , Texas , USA.,e Department of Medicine , Baylor College of Medicine , Houston , Texas , USA
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Egede LE, Gebregziabher M, Walker RJ, Payne EH, Acierno R, Frueh BC. Trajectory of cost overtime after psychotherapy for depression in older Veterans via telemedicine. J Affect Disord 2017; 207:157-162. [PMID: 27721190 DOI: 10.1016/j.jad.2016.09.044] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Revised: 08/30/2016] [Accepted: 09/27/2016] [Indexed: 01/18/2023]
Abstract
BACKGROUND Little evidence exists regarding the costs of telemedicine, especially considering changes over time. This analysis aimed to analyze trajectory of healthcare cost before, during, and after a behavioral activation intervention delivered via telepsychology and same-room delivery to elderly Veterans with depression. METHODS 241 participants were randomly assigned into one of two study groups: behavioral activation for depression via telemedicine or via same-room treatment. Patients received 8 weeks of weekly 60-min individual sessions of behavioral activation for depression. Primary outcomes were collected at 12-months. Inpatient, outpatient, pharmacy, and total costs were collected from VA Health Economics Resource Center (HERC) datasets for FY 1998-2014 and compared between the two treatment groups. Generalized mixed models were used to investigate the trajectories over time. RESULTS Overall cost, as well as, outpatient and pharmacy cost show increasing trend over time. Unadjusted and adjusted trajectories over time for any cost were not different between the two treatment groups. There was a significant overall increasing trend over time for outpatient (p<0.001) and total cost (p<0.001) but not for inpatient (p=0.543) or pharmacy cost (p=0.084). LIMITATIONS Generalizability to younger, healthier populations may be limited due to inclusion criteria for study participants. CONCLUSION Healthcare costs before, during, and after intervention did not differ between the telemedicine and in-person delivery methods. Outpatient costs accounted for most of the increasing trend of cost over time. These results support policies to use both telehealth and in-person treatment modalities to effectively and efficiently provide high quality care.
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Affiliation(s)
- Leonard E Egede
- Health Equity and Rural Outreach Innovation Center (HEROIC), Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC, United States; Center for Health Disparities Research, Department of Medicine, Medical University of South Carolina, Charleston, SC, United States; Department of Medicine, Division of General Internal Medicine and Geriatrics, Medical University of South Carolina, Charleston, SC, United States.
| | - Mulugeta Gebregziabher
- Health Equity and Rural Outreach Innovation Center (HEROIC), Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC, United States; Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, United States
| | - Rebekah J Walker
- Health Equity and Rural Outreach Innovation Center (HEROIC), Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC, United States; Center for Health Disparities Research, Department of Medicine, Medical University of South Carolina, Charleston, SC, United States; Department of Medicine, Division of General Internal Medicine and Geriatrics, Medical University of South Carolina, Charleston, SC, United States
| | - Elizabeth H Payne
- Health Equity and Rural Outreach Innovation Center (HEROIC), Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC, United States; Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, United States
| | - Ron Acierno
- Health Equity and Rural Outreach Innovation Center (HEROIC), Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC, United States; College of Nursing, Medical University of South Carolina, Charleston, SC, United States
| | - B Christopher Frueh
- Department of Psychology, University of Hawaii, Hilo, HI, United States; Department of Psychology, The Menninger Clinic, Houston, TX, United States
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Olthuis JV, Wozney L, Asmundson GJG, Cramm H, Lingley-Pottie P, McGrath PJ. Distance-delivered interventions for PTSD: A systematic review and meta-analysis. J Anxiety Disord 2016; 44:9-26. [PMID: 27697658 DOI: 10.1016/j.janxdis.2016.09.010] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2016] [Revised: 09/20/2016] [Accepted: 09/20/2016] [Indexed: 12/20/2022]
Abstract
This systematic review and meta-analysis evaluated the efficacy of distance-delivered, guided approaches to treatment (e.g., delivered via telephone, Internet, mail, videoconferencing) for clinical and subclinical posttraumatic stress disorder (PTSD). A comprehensive search yielded 19 randomized controlled trials (1491 participants) to be included. Meta-analyses revealed that distance-delivered interventions led to significant within-group improvements in PTSD symptoms at post-treatment (g=0.81, 95% CI 0.65 to 0.97) and 3-6 month follow-up (g=0.78, 95% CI 0.59 to 0.97). Within-group depression and quality of life outcomes showed similar results, with medium post-treatment and follow-up effects. Compared to a waiting list, distance delivery (specifically, Internet treatments) led to superior PTSD outcomes (g=0.68, 95% CI 0.51 to 0.86). Compared to face-to-face interventions, distance delivery (specifically, videoconferencing treatments) did not result in significantly different PTSD outcomes at post-treatment (g=-0.05, 95% CI -0.31 to 0.20) but led to inferior outcomes at 3-6 month follow-up (g=-0.25, 95% CI -0.44 to -0.07). Distance delivery of PTSD treatment is promising, but research is needed to determine its optimal use.
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Affiliation(s)
- Janine V Olthuis
- Department of Psychology, University of New Brunswick, PO Box 4400, Fredericton, NB, E3B 5A3, Canada.
| | - Lori Wozney
- Centre for Research in Family Health, IWK Health Centre, Halifax, NS.
| | | | - Heidi Cramm
- School of Rehabilitation Therapy, Queen's University, Kingston, ON.
| | - Patricia Lingley-Pottie
- Centre for Research in Family Health, IWK Health Centre, Halifax, NS; Department of Psychiatry, Dalhousie University, Canada.
| | - Patrick J McGrath
- Departments of Psychiatry, Pediatrics, and Community Health and Epidemiology, Dalhousie University, Canada; IWK Health Centre and Nova Scotia Health Authority, Halifax, NS.
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Simpson SG, Reid CL. Therapeutic alliance in videoconferencing psychotherapy: a review. Aust J Rural Health 2016; 22:280-99. [PMID: 25495622 DOI: 10.1111/ajr.12149] [Citation(s) in RCA: 176] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/17/2014] [Indexed: 01/06/2023] Open
Abstract
Psychotherapy services are limited in remote and rural areas in Australia and across the globe. Videoconferencing has become well established as a feasible and acceptable mode of psychological treatment delivery. Therapeutic alliance (TA) is an essential factor underlying successful therapy across therapeutic models. In order to determine the state of knowledge regarding TA in psychotherapy via videoconferencing, a literature review was conducted on research studies that formally measured TA as primary, secondary or tertiary outcome measures over the past 23 years. The databases searched were Medline, PsycArticles, PsycINFO, PsycEXTRA and EMBASE. Searching identified 9915 articles that measured satisfaction, acceptability or therapeutic rapport, of which 23 met criteria for the review. Three studies were carried out in Australia, 11 in USA, 4 in Canada, 3 in Scotland and 2 in England. Studies overwhelmingly supported the notion that TA can be developed in psychotherapy by videoconference, with clients rating bond and presence at least equally as strongly as in-person settings across a range of diagnostic groups. Therapists also rated high levels of TA, but often not quite as high as that of their clients early in treatment. The evidence was examined in the context of important aspects of TA, including bond, presence, therapist attitudes and abilities, and client attitudes and beliefs. Barriers and facilitators of alliance were identified. Future studies should include observational measures of bond and presence to supplement self-report.
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Affiliation(s)
- Susan G Simpson
- Psychology Clinic, University of South Australia, Adelaide, South Australia, Australia
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