Article

Delivery of Evidence-Based Psychotherapy via Video Telehealth

December 2013
Journal of Psychopathology and Behavioral Assessment 35(4)

DOI:10.1007/s10862-013-9363-4

Authors:

Daniel F Gros

Medical University of South Carolina

Leslie A Morland

U.S. Department of Veterans Affairs

Ron Acierno

The University of Texas Health Science Center at Houston

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There has been increasing interest in using video telehealth to deliver evidence-based psychotherapies (EBPs). Telehealth may have numerous advantages over standard in-person care, including decreasing patients’ and providers’ costs and increasing system coverage area. However, little is known regarding the effectiveness of EBPs via video telehealth. This review had two goals, including a review of the existing literature and ongoing research on using video telehealth technologies to deliver EBPs as well as an informal survey of telehealth experts to discuss the special considerations and challenges present in adapting practices to video telehealth. Together, findings suggest that telehealth practices could represent an important component of the future of psychotherapy and clinical practice, especially in dissemination and implementation of EBPs in traditionally underserved areas and populations.

Strategies to improve access to cognitive behavioral therapies for anxiety disorders: A scoping review

Article

Full-text available

Mar 2022
PLOS ONE

Background Strategies to improve access to evidence-based psychological treatments (EBPTs) include but are not limited to implementation strategies. No currently available framework accounts for the full scope of strategies available to allow stakeholders to improve access to EBPTs. Anxiety disorders are common and impactful mental conditions for which EBPTs, especially cognitive-behavioral therapies (CBT), are well-established yet often hard to access. Objective Describe and classify the various strategies reported to improve access to CBT for anxiety disorders. Methods Scoping review with a keyword search of several databases + additional grey literature documents reporting on strategies to improve access to CBT for anxiety disorders. A thematic and inductive analysis of data based on grounded theory principles was conducted using NVivo. Results We propose to classify strategies to improve access to CBT for anxiety disorders as either "Contributing to the evidence base," "Identifying CBT delivery modalities to adopt in practice," "Building capacity for CBT delivery," "Attuning the process of access to local needs," "Engaging potential service users," or "Improving programs and policies." Each of these strategies is defined, and critical information for their operationalization is provided, including the actors that could be involved in their implementation. Implications This scoping review highlights gaps in implementation research regarding improving access to EBPTs that should be accounted for in future studies.

Occupational health professionals’ and HR specialists’ perceptions of telemental health services in occupational health care settings: A qualitative study

Article

Full-text available

Jan 2025

Objective The rise in mental health-related work disability pensions highlights the need for more research on how occupational health care (OHC) can support mental health, including the use of telehealth (TH) services in mental health care. Methods The research, employing a descriptive qualitative approach through interviews (n = 42), focused on experiences of professionals from a private OHC service provider in Finland and human resource representatives (HRRs) of OHC client companies. Inductive content analysis was used to analyze the data. Results Our research suggests that TH services provided by OHC can enhance access to care and expedite the initiation of work ability support, particularly in mental health cases. However, potential challenges include a perceived sense of distance, superficiality in interactions, and difficulty in forming a comprehensive understanding due to few non-verbal cues. Conclusion A combined approach of TH and face-to-face services is suggested to provide flexible, and individualized support. Further studies on remote low-threshold discussion mental health services and studies comparing TH and face-to-face services are advised.

A mixed-methods examination of clinicians’ perceived barriers to telehealth delivered applied behavior analysis

Article

Full-text available

Jul 2023

Following the COVID-19 pandemic, clinicians relied on telehealth to ensure continuity of essential healthcare services, such as Applied Behavior Analysis (ABA). Identifying barriers and examining them in the context of other implementation outcomes is important to support appropriate adaptations and sustainability of telehealth-delivered ABA services. Convergent mixed methods design was utilized to identify barriers experienced by ABA clinicians (N = 388) when delivering ABA services over telehealth to autistic children and their families following the first six months of the COVID-19 pandemic. Additionally, barriers were examined in relation to telehealth implementation outcomes and intentions for continued adoption. Findings reveal that clinicians rated providing direct services (M = 3.52, SD = 1.14) as more difficult than conducting assessments (M = 3.29, SD = 1.06), and both as more difficult than providing parent-mediated interventions [(M = 2.47, SD = 1.11), F(2, 381) = 162.26, p < 0.001]. A principal components analysis indicated a 3-factor solution of barriers related to: (1) technology (α = 0.82), (2) administrative tasks (α = 0.88), and (3) client characteristics (α = 0.88). The most frequently endorsed barriers were related to client characteristics, including increased difficulty providing telehealth services to children who elope (M = 4.37, SD = 0.81), children who exhibit challenging behaviors (M = 4.31; SD = 0.83), and children who are in the preverbal stage or use nonverbal language to communicate (M = 4.07; SD = 1.00). Fewer barriers related to client characteristics uniquely predicted implementation variables including acceptability, appropriateness, and feasibility. Thematic analysis revealed challenges related to technology, caregiver involvement, child engagement, implementation of intervention strategies over telehealth, and administrative or logistical barriers. These findings highlight the need for targeted strategies that facilitate telehealth use to address specific client needs and support the implementation of telehealth services in usual care settings.

The Role of Depression and Anxiety Symptom Severity in Remotely Delivered Mental Health Care

Article

Full-text available

Jun 2023

This study examined differences in mental health characteristics of Veterans who received VA Video Connect (VVC) or audio-only care during initial phases of the COVID-19 pandemic. A cohort of Veterans with primary diagnoses of depressive or anxiety disorders (diagnosed between March 2019 and February 2020) was identified, and data were obtained for Veterans who engaged in virtual care from April to December 2020. Two groups were created: Veterans receiving audio-only care (n = 161,071) and Veterans receiving two or more VVC visits (n = 84,505). Multiple logistic regression models examined symptom severity in the year before COVID as a predictor of treatment modality during COVID. Chi-square tests examined associations between modality and the number of assessments. Symptom severity as evaluated by the nine-item Patient Health Questionnaire and Generalized Anxiety Disorder–7 significantly predicted modality of encounters during the pandemic such that those who had moderate or severe symptoms prior to COVID-19 were more likely than those with low or no symptoms to have two or more VVC encounters during the pandemic. Of those who received VVC, 55.62% had no Patient Health Questionnaire–9 assessments compared to 68.96% of those who received audio-only. In the VVC group, 70.36% had no Generalized Anxiety Disorder–7 assessments compared to 81.02% in the audio-only group. Taken together, these findings suggest that VVC, when compared to audio-only, was used during the pandemic to reach Veterans with more severe mental health symptomatology and to engage in administration of measurement-based care.

Feasibility of delivering a virtual 1-day acceptance and commitment therapy workshop to rural veterans through community partnerships

Article

Full-text available

Jun 2023

Background: This single-arm, open pilot study examined the feasibility and initial efficacy of a 1-day virtual Acceptance and Commitment Therapy (ACT) group workshop for distressed veterans. Methods: We collaborated with veteran-serving community-based organizations to enhance outreach to veterans, especially those in rural areas. Veterans completed a baseline assessment and two follow-up assessments (1 month, 3 months) after workshop participation. Feasibility outcomes included reach (workshop recruitment and completion rates; veteran characteristics) and acceptability (open-ended survey question about satisfaction). Clinical outcomes included psychological distress (Outcome Questionnaire-45), stressor-related distress (PTSD Checklist-5), community reintegration (Military to Civilian Questionnaire), and meaning and purpose (PROMIS Short Form). Psychological flexibility (Action and Acceptance Questionnaire-II) - the proposed change mechanism underlying ACT - was also measured. Results: Sixty-four veterans (50% rural, 39% self-identified as female) participated in a virtual workshop (97.1% completion rate). Overall, veterans liked the format and interactive nature of workshops. Convenience was noted as a benefit, while connectivity issues were highlighted as a drawback. Veterans showed improvements in psychological distress (F(2,109) = 3.30; p = 0.041), stressor-related distress (F(2,110) = 9.50; p = 0.0002), community reintegration (F(2,108) = 4.34; p = 0.015), and meaning and purpose (F(2,100) = 4.06; p = 0.020) over time. No between-group differences were detected, based on rurality or gender. Conclusion: Pilot findings were promising and warrant a larger randomized trial to assess the efficacy of the 1-day virtual ACT workshop. Integrating community-engaged and participatory-research designs can enhance the external validity of these future studies and promote greater health equity.

The Evolution of Telepsychiatry for Substance Use Disorders During COVID-19: a Narrative Review

Article

Full-text available

Apr 2023

Purpose of Review This article aims to review and synthesize the current research evidence regarding the efficacy of telepsychiatry-delivered substance use disorder treatment using a narrative review with a focus on the effects of remote healthcare delivery within the substance abuse treatment space. Recent Findings The COVID-19 pandemic exerted substantial pressures on all levels of society. Social isolation, loss of employment, stress, physical illness, overburdened health services, unmet medical needs, and rapidly changing pandemic restrictions had particularly severe consequences for people with mental health issues and substance use disorders. Since the start of the pandemic, addiction treatment (and medical treatment overall) using remote health platforms has significantly expanded to different platforms and delivery systems. The USA, in particular, reported transformational policy developments to enable the delivery of telehealth during the COVID-19 pandemic. However, systemic barriers such as a widespread lack of internet access and insufficient patient and provider digital skills remain. Summary Overall, telepsychiatry is a promising approach for the treatment of substance use disorders, but more randomized controlled trials are needed in the future to assess the evidence base of available interventions.

Adherence to online psychotherapy during the COVID-19: a scoping review

Article

Full-text available

Mar 2023

Evidence suggests that changes in online psychotherapy adherence factors occurred during the COVID-19 pandemic. Thus, this study aimed to review the perception of patients and psychotherapists regarding factors associated with adherence to online psychotherapy during the pandemic. Thus, 18 articles remained for analysis after searches in five databases and 25 factors associated with adherence to online psychotherapy were identified. The main factors for psychotherapists were confidence in professional skills and connection stability. For the patients, basic informatics skills and finding an adequate setting to participate in sessions. Furthermore, the factors fear of contagion, tiredness and the impossibility of face-to-face meetings emerged during the pandemic. Modifications of factors associated with pre-pandemic adherence were identified and strategies to overcome barriers related to online sessions were presented and discussed. The pandemic has increased adherence to online psychotherapy, although not everyone intends to follow this modality in the post-pandemic.

Eliciting emotional expressions in psychodynamic psychotherapies using telehealth: a clinical review and single case study using emotional awareness and expression therapy

Article

Mar 2022
Psychoanal Psychother

The COVID-19 pandemic and ensuing social distancing requirements resulted in an abrupt transition in the provision of most mental healthcare to telehealth; yet it was, at first, unclear whether patients’ emotional expressions – of great import to the success of many psychodynamic therapies – could be facilitated using teletherapy. This article first presents a targeted literature review focused on emotional expressions in psychotherapy and implementing psychodynamic therapy over telehealth and then describes our clinical experience transitioning a psychodynamically-informed, evidence-based, and experiential group treatment for chronic pain, emotional awareness and expression therapy (EAET), to video telehealth at VA Greater Los Angeles Healthcare System. We discuss barriers we encountered in our implementation of EAET over video telehealth but also illustrate the ultimate success of the approach using verbatim excerpts from our therapeutic work, which aim to demonstrate the potential to facilitate powerful emotional expressions over video telehealth when conducting a psychodynamically-informed treatment. We examine the possible applications for video telehealth to maintain emotionally focused, psychodynamic psychotherapy administration and enhance its teaching and training. Although we describe limitations of our specific approach, ultimately, our experience supports the potential efficacy of experiential, emotion-focused psychodynamic therapies in a telehealth setting.

Teletherapy Versus In-Person Psychotherapy for Depression: A Meta-Analysis of Randomized Controlled Trials

Article

Jan 2022

Introduction: The recent surge in telehealth service delivery represents a promising development in the field's ability to address access gaps in health care across underserved populations. Telehealth also carries the potential to help reduce the societal burden of mental illnesses such as major depression, which often go untreated. There is now a sufficiently large corpus of randomized controlled trials to examine the comparative effectiveness of teletherapy and in-person services meta-analytically. Methods: We searched the PubMed, PsycINFO, and Cochrane Central Register of Controlled Trials (CENTRAL) databases for articles from January 1, 2000 to February 1, 2021 to identify randomized head-to-head trials of video-based versus in-person delivery of psychotherapy to reduce depressive symptoms. We conducted a random-effects meta-analysis to evaluate potential differences in efficacy rates. We calculated and meta-analyzed odds ratios to examine differential attrition rates between video and in-person conditions. Finally, we conducted subgroup analyses based on the primary treatment focus (depression or another condition) of each trial. Results: Primary study analyses yielded evidence that video-based psychotherapy is roughly comparable in efficacy with in-person psychotherapy for reducing depressive symptoms (g = 0.04, 95% confidence interval [CI = -0.12 to 0.20], p = 0.60, I2 = 5%). Likewise, attrition rates between the two conditions were not significantly different (odds ratio = 1.07, 95% CI = [0.78 to 1.49], p = 0.63, I2 = 25%). Finally, we did not observe significant subgroup differences in either efficacy (p = 0.38) or attrition (p = 0.94). Conclusions: The present findings suggest that video-based teletherapy may be a feasible and effective alternative to in-person services for reducing depressive symptoms. Continued research on the effectiveness of telehealth in clinically depressed samples, and further elucidation of the access barriers entailed by each delivery modality, can help the field better determine which patients will derive the greatest benefit from each mode of intervention.

Transitioning to telehealth due to COVID‐19: Maintaining model fidelity in a home visiting program for parents of vulnerable infants

Article

Dec 2021

Maintaining treatment fidelity when implementing evidence-based interventions is a significant challenge. The inability to deliver in-person services due to the COVID-19 pandemic critically challenged the foundation of implementation fidelity for home visiting programs across the globe. The Attachment and Biobehavioral Catch-Up (ABC) program is an evidence-based home visiting intervention designed to increase sensitivity in parents of infants who have experienced early adversity. ABC's community effectiveness is due to rigorous fidelity monitoring and supervision. Fidelity is measured by microanalytic coding of parenting opportunities and “in-the-moment” commenting, the active ingredient of ABC. In this study, we examined intervention fidelity among parent coaches implementing ABC through telehealth. Random 5-min clips from 510 telehealth ABC session videos conducted by 91 parent coaches at 48 agencies were coded for their frequency and quality of in-the-moment comments. On average, parent coaches were able to exceed in-person commenting fidelity standards when implementing ABC through the telehealth format. The active fidelity monitoring and supervision inherent to ABC's dissemination afforded a smooth transition to implementing ABC through telehealth while adhering to fidelity standards. Procedural and clinical challenges to telehealth implementation are discussed, along with future directions for telehealth program effectiveness.

Comparing remote versus in-person assessment of learning skills in children with specific learning disabilities

Article

Full-text available

Aug 2024

Background Interactive telemedicine applications have been progressively introduced in the assessment of cognitive and literacy skills. However, there is still a lack of research focusing on the validity of this methodology for the neuropsychological assessment of children with Specific Learning Disorder (SLD). Methods Seventy-nine children including 40 typically developing children (18 males, age 11.5 ± 1.06) and 39 children with SLD (24 males, age 12.3 ± 1.28) were recruited. Each participant underwent the same neuropsychological battery assessing reading accuracy, speed, and comprehension, writing, numerical processing, computation, and semantic numerical sense, twice (once during an in-person session (I) and once during a remote (R) home-based videoconference session). Four groups were subsequently defined based on the administration order. Repeated-measure-ANOVAs with assessment type (R vs. I testing) as within-subject factor and diagnosis (SLD vs. TR) and administration order (R-I vs. I-R) as between-subject factors, and between-group t-tests comparing the two assessment types within each time of administration, were run. Results No differences emerged between I and R assessments of reading accuracy and speed, numerical processing, and computation; on the contrary, potential biases against R assessment emerged when evaluating skills in writing, reading comprehension, and semantic numerical sense. However, regardless of the assessment type, the scores obtained with I and R assessments within the same administration time point overlapped. Discussion These results partially support the validity and reliability of the assessment of children's learning skills via a remote home-based videoconferencing system. Implementing telemedicine as an assessment tool may increase timely access to primary health care and to support research activity.

Demystifying the virtualization process: A call for standard reporting of virtual modifications to evidence-based psychotherapies, using the FRAME model

Article

May 2024

The sudden onset of the coronavirus disease led to a rapid expansion of video telehealth to deliver mental healthcare. Although video telehealth was not a new clinical practice, there was limited guidance on how best to modify evidence-based psychotherapies (EBPs) for virtual delivery (a process also referred to as virtualization). The virtualization process for EBPs remains unclear as newly emerging reports on this topic do not consistently report modification decisions. This commentary calls attention to the need to improve documentation practices to allow a greater understanding of modifications needed to maximize the positive effects of EBPs transported to a virtual format. We used the Framework for Reporting Adaptations and Modifications-Expanded (FRAME) to capture details about the nature, process, and outcomes of intervention modifications across a given clinical setting or population. To illustrate the use of the FRAME, we present a case example describing our experiences with transporting a 1-day in-person Acceptance and Commitment Therapy group workshop to a virtual format. Workshop modifications primarily involved changes to the delivery format, administration procedures, and content. The case example walks through how, why, and by whom specific modifications were made as well as the degree to which fidelity was maintained. In the wake of the telemedicine revolution, further investigation into the virtualization process for EBPs is warranted. Improving reporting practices by using the FRAME or a similar adaptation framework will promote a more rigorous study of virtual modifications to EBPs that inform future guidelines and best practices.

Implementation of Cognitive Behavioral Therapy for Psychosis via Telehealth: An Expert Consultation and Clinical Service Model

Article

Full-text available

Apr 2024

Individuals living with psychosis are often underserved in the United States, partly due to the dearth of providers trained in evidence-based practices for this population. One such practice is Cognitive Behavioral Therapy for psychosis, which the Substance Abuse and Mental Health Services Administration has identified as a standard of care for this population. The explosion of telehealth, in large part due to the COVID-19 pandemic, has led to increased opportunities for virtual psychotherapy. Telehealth offers a number of benefits, such as the ability to address service inequities, including lack of access to a local provider well-trained in the modality of therapy needed. The current article describes the National Psychosis Telehealth Program within the National Expert Consultation and Specialized Services (formerly VA National Telemental Health Center) program, U.S. Department of Veterans Affairs. The goal of this telehealth program is to utilize an expert consultation model and offer a remote individual, time-limited Cognitive Behavioral Therapy for psychosis protocol to Veterans across the nation in order to decrease access disparities to this relatively scarce service. We share our initiation activities and lessons learned as we developed this program in hopes of encouraging others to consider similar efforts at their sites. We also include a typical, complex case that serves to illustrate the challenges and benefits of this approach.

Disruption and sustainment of cognitive behavioral therapy for chronic pain in the Veterans Health Administration following the onset of the COVID-19 pandemic

Preprint

Full-text available

Dec 2023

The sustainability of evidence-based practices (EBPs) is a pressing issue for implementation science and healthcare systems. The COVID-19 pandemic and related policies severely strained healthcare systems, thus representing a key test of the sustainability of EBPs. The current study examined the sustainability of one EBP- cognitive-behavioral therapy for chronic pain (CBT-CP) - in the Veterans Health Administration. Changes in provision of CBT-CP after the onset of COVID-19 were examined both qualitatively, using administrative datasets, and qualitatively, through interviews with CBT-CP providers. Changes in total psychotherapy services were also examined for reference. Results indicated CBT-CP provision was substantially disrupted by COVID-19. Interviewees reported difficulties regarding engagement in virtual sessions, disruptions from the home environment, and logistical challenges. Results indicate specific pathways by which the pandemic may have negatively affected the sustainability of this EBP.

Problems With the Interjurisdictional Regulation of Psychological Practice

Article

Full-text available

Dec 2023

The U.S. Constitutional structure creates ethical conflicts for the cross-jurisdictional practice of professional psychology. The profession has chosen to seek interstate agreements to overcome such barriers, and such agreements now include almost 80% of American jurisdictions. Although an improvement over a patchwork of state laws regarding practice, the structure of this agreement and the exclusion of the remaining states continue to pose barriers to the principles of beneficence and nonmaleficence. It creates a system that is extraordinarily difficult to change and places an unrealistic burden on professionals to know, address, and act under complex legal mandates. As psychological services have moved increasingly to remote platforms, cross-jurisdictional business models, and a nationwide mental health crisis emerged alongside the pandemic, it is time to consider a national professional licensing system more seriously, both to further reduce barriers to care and complexity and permit the best interests of patients to prevail.

A Year After Implementation of the Telehealth Waiver: Being Offered and Utilizing Video-Specific Telehealth Among Dual-Eligible Medicare Recipients During the COVID-19 Pandemic

Article

Nov 2023

Objective Telehealth is an essential tool to provide access to care while reducing infection exposure for high-risk populations during the COVID-19 pandemic. Our study aims to examine factors associated with telehealth availability and usage among Medicare and dual-eligible recipients 1 year after implementation of the Medicare's temporary telehealth waiver. Design, Setting, and Participant A cross-sectional, phone survey with a national representative sample of Medicare recipients. We obtained a final study sample from the Winter 2021 COVID-19 Supplement of Medicare Current Beneficiary Survey dataset (N = 10 586). We examined associations for being offered and having had telehealth visits or any video telehealth visits during the pandemic since November 1, 2020. Main Outcome Measures Our primary outcomes were being offered any telehealth, being offered any video telehealth, having had any telehealth visit, and having had any video telehealth. Results Although dual eligibility was not significantly associated with being offered or having had any telehealth services during the pandemic, those who were dual eligible were more likely to have had video telehealth visits (adjusted odds ratio = 1.39, 95% confidence interval 1.04-1.86, P = .03) compared with those with non-dual eligibility. Recipients with disability eligibility, technology access, and severe chronic conditions were more likely to have been offered or have had telehealth. At the same time, those who lived in the nonmetropolitan area were less likely to have been offered or have had telehealth, including video telehealth. Conclusions Our findings suggest that the federal waivers to expand telehealth services were successful in continuing care for vulnerable Medicare recipients. The providers' specific outreach and intervention efforts to offer telehealth visits are crucial for dual-eligible recipients. To increase video telehealth uptake, technology access and services to rural areas should be prioritized.

Telemental Health in Vietnam: A Rapid Review of The Framework and Recommendations

Conference Paper

Full-text available

Dec 2021

COVID-19 can be viewed as a timely motivator to accelerate telehealth-based adoption and create a more efficient health system under the "social distancing" model of health. Furthermore, in Vietnam, to address the gap in social demands with resource-scarce conditions, telemental health (TMH) should be utilized to offer well-being and mental stability to communities. To explore and recommend a relevant adaption on TMH in Vietnam, the author will provide a rapid systematic review based on electronic databases such as Google, PubMed, and Cochrane reviews for articles using keywords such as "telehealth" OR "telemental health" OR "eHealth" OR "tele behavioural health" AND "guidelines" AND/OR "Southeast Asia" OR "Vietnam" published up to 2021. Inclusion criteria were articles and grey materials related to the keywords. In addition, English and Vietnamese were imposed. The exclusion criteria included abstracts, duplicate publications, blogs, news articles, promotional brochures, conference proceedings, and telehealth projects unrelated to telehealth guidelines. We suggested that to guarantee uniformity of TMH services and client safety, a complete and successful telemental care model will be recommended for Vietnam to adapt to the local and cultural context. The advantages and drawbacks of telehealth compared to face-to-face consults were also explicitly mentioned. Further studies should be implemented to provide strong evidence of telehealth procedures and the evaluation of these field gaps.

Barriers and Facilitators to Behavioral Healthcare for Women Veterans: a Mixed-Methods Analysis of the Current Landscape

Article

Full-text available

Oct 2023

Women veterans have historically faced barriers to behavioral health treatment, particularly through the VA. In conjunction, there have been changes in behavioral healthcare delivery resulting from efforts to improve care for women veterans and the COVID-19 pandemic (e.g., widespread telehealth implementation). The current study draws on a quantitative and qualitative study centering current perspectives of women veterans in their choices to seek or not seek behavioral healthcare in VA and non-VA settings through interviewing 18 women recruited from a larger survey study on veteran behavioral health ( n = 83 women, n = 882 men) on their experiences with behavioral health care access and satisfaction, including barriers and facilitators to seeking care. Quantitative findings are descriptively reported from the larger study, which outlined screening for behavioral health problems, behavioral health utilization, treatment modality preferences, and barriers/facilitators to care. While women in the survey sample screened for various behavioral health disorders, rates of treatment seeking remained relatively low. Women reported positive and negative experiences with telehealth and endorsed many barriers to treatment seeking in interviews not captured by survey findings, including lack of women-specific care (e.g., care for military sexual trauma, women-only groups), reports of stranger harassment at the VA, and lack of female providers. Women veterans continue to face barriers to behavioral healthcare; however, ongoing efforts to improve care access and quality, including the implementation of telehealth, show promise in reducing these obstacles. Continued efforts are needed to ensure diverse treatment modalities continue to reach women veterans as this population grows.

Decreased inpatient psychiatric admissions with telepsychiatry use during the COVID-19 pandemic

Article

Full-text available

Jun 2023

Objective This study examines the quality of care provided through telepsychiatry by comparing psychiatric hospitalization rates among patients receiving in-person psychiatric care prior to the COVID-19 pandemic with rates among patients receiving virtual psychiatric care during the COVID-19 pandemic. Methods Mental health-related hospitalization rates among patients enrolled in a large academic hospital’s outpatient psychiatry programs between March 1, 2018 and February 28, 2022 were retrospectively analyzed. Four time periods were created, spanning March 1 to February 28 of the following year. Demographic and clinical data were collected from the electronic health record, and descriptive statistics were calculated. Change in hospitalization rate between time periods was evaluated using McNemar’s test. Results In the 2018 time period, 7.38% of all enrolled patients were hospitalized, compared to 7.70% hospitalized in the 2019 period, 5.74% in the 2020 period, and 5.38% in the 2021 period. Patients enrolled in both the 2018 and the 2019 periods saw no difference in hospitalization rate between the 2 years (2.93% in 2018, 2.83% in 2019; p = 0.830); patients enrolled in both 2019 and 2020 saw significantly lower hospitalization rates in 2020 (5.47% in 2019, 4.58% in 2020; p = 0.022); and patients enrolled in both 2020 and 2021 saw no difference (3.34% in 2020, 3.23% in 2021; p = 0.777). Conclusion Psychiatric hospitalization rates significantly decreased between the 2019 and the 2020 periods, suggesting a decrease in admissions associated with adoption of telepsychiatry. Future research should differentiate the roles played by telepsychiatry and COVID-19-related factors in reducing hospitalization rates during the pandemic.

Engagement over telehealth: comparing attendance between dialectical behaviour therapy delivered face-to-face and via telehealth for programs in Australia and New Zealand during the Covid-19 pandemic

Article

Full-text available

May 2023

Background While the COVID-19 crisis has had numerous global negative impacts, it has also presented an imperative for mental health care systems to make digital mental health interventions a part of routine care. Accordingly, through necessity, many Dialectical Behaviour Therapy (DBT) programs transitioned to telehealth, despite little information on clinical outcomes compared with face-to-face treatment delivery. This study examined differences in client engagement (i.e. attendance) of DBT: delivered face-to-face prior to the first COVID-19 lockdown in Australia and New Zealand; delivered via telehealth during the lockdown; and delivered post-lockdown. Our primary outcomes were to compare: [1] client attendance rates of DBT individual therapy delivered face-to-face with delivery via telehealth, and [2] client attendance rates of DBT skills training delivered face-to-face compared with delivery via telehealth. Methods DBT programs across Australia and New Zealand provided de-identified data for a total of 143 individuals who received DBT treatment provided via telehealth or face-to-face over a six-month period in 2020. Data included attendance rates of DBT individual therapy sessions; attendance rates of DBT skills training sessions as well as drop-out rates and First Nations status of clients. Results A mixed effects logistic regression model revealed no significant differences between attendance rates for clients attending face-to-face sessions or telehealth sessions for either group therapy or individual therapy. This result was found for clients who identified as First Nations persons and those who didn’t identify as First Nations persons. Conclusions Clients were as likely to attend their DBT sessions over telehealth as they were face-to-face during the first year of the Covid-19 pandemic. These findings provide preliminary evidence that providing DBT over telehealth may be a viable option to increase access for clients, particularly in areas where face-to-face treatment is not available. Further, based on the data collected in this study, we can be less concerned that offering telehealth treatment will compromise attendance rates compared to face-to-face treatment. Further research is needed comparing clinical outcomes between treatments delivered face-to-face compared delivery via telehealth.

Engagement over telehealth: Comparing attendance and drop-out between Dialectical Behaviour Therapy delivered face-to-face and via telehealth for programs in Australia and New Zealand during the Covid-19 pandemic

Preprint

Full-text available

Jan 2023

Background While the COVID-19 crisis has had numerous global negative impacts, it has also presented an imperative for mental health care systems to make digital mental health interventions a part of routine care. Accordingly, through necessity, many Dialectical Behaviour Therapy (DBT) programs transitioned to telehealth, despite little information on clinical outcomes compared with face-to-face treatment delivery. This study examined differences in client engagement (i.e. attendance and drop-out rates) of DBT: delivered face-to-face prior to the first COVID-19 lockdown in Australia and New Zealand; delivered via telehealth during the lockdown; and delivered post-lockdown. Our primary outcomes were to compare: (1) client attendance rates of DBT individual therapy delivered face-to-face with delivery via telehealth, and (2) client attendance rates of DBT skills training delivered face-to-face compared with delivery via telehealth. Methods DBT programs across Australia and New Zealand provided de-identified data for a total of 143 individuals who received DBT treatment provided via telehealth and face-to-face over a six-month period in 2020. Data included attendance rates of DBT individual therapy sessions; attendance rates of DBT skills training sessions as well as drop-out rates and First Nations status of clients. Results A mixed effects logistic regression model revealed no significant differences between attendance rates for clients attending face-to-face sessions or telehealth sessions for either group therapy or individual therapy. This result was found for clients who identified as First Nations persons and those who didn’t identify as First Nations persons. Conclusions Clients were as likely to attend their DBT sessions over telehealth as they were face-to-face during the first year of the Covid-19 pandemic. These findings provide preliminary evidence that providing DBT over telehealth may be a viable option to increase access for clients, particularly in areas where face-to-face treatment is not available. Further, based on the data collected in this study, we can be less concerned that offering telehealth treatment will compromise attendance rates compared to face-to-face treatment. Further research is needed comparing clinical outcomes between treatments delivered face-to-face compared delivery via telehealth.

IoT based medical image encryption using linear feedback shift register – Towards ensuring security for teleradiology applications

Article

Full-text available

Jan 2023

Telemedicine gains prominence in today’s scenario and image security plays a vital role in the healthcare sector for authenticating data transfer. Medical data, when transferred through a cloud network should be encrypted to ensure security, this research work proposes a medical image encryption scheme using a linear feedback shift register (LFSR). The LFSR generates pseudo-random numbers and shuffles the pixel position. The encrypted image was transferred through a cloud platform, receiver side node decrypts the data to recover the original image. The Digital Imaging and Communications in Medicine (DICOM) computed tomography images are utilized in this research work and for IoT implementation, a Raspberry Pi B+ processor was used. The IoT implementation facilitates data transfer through the cloud network. The performance validation was done by metrics and the results reveal the proficiency of the encryption/decryption model. The decrypted image quality was evaluated in terms of the Peak to Signal Noise Ratio (PSNR) and Means Square Error (MSE), low value of the correlation coefficient proves the robustness of the encryption. The outcome of the research work paves the way for the researchers in the secure transfer of medical data through the cloud platform.

Exploring social determinants of health: Comparing lower and higher income individuals participating in telepsychiatric care for depression

Article

Full-text available

Jan 2023

Background Telemental health may increase access to care; there has been little research on efficacy with those at the lower end of the income distribution. The purpose of this study was to determine whether lower vs. higher income patients receiving telepsychiatric care for depression achieve: (1) effective symptom reduction and (2) similar outcomes. Methods Data utilized were obtained from a national mental health telehealth company and consisted of 5,426 U.S.-based patients receiving psychiatric care for moderate to severe depression between October, 2018 and January, 2022. Propensity matching was used to create lower and higher income samples (n = 379 in each) using 22 covariates. These samples were then compared using repeated measures ANOVA on Patient Health Questionnaire-9 (PHQ-9) scores at start of treatment, 6, 8, 10, 12, 14, and 16 weeks. Results Both lower and higher income groups made significant improvement over time, with groups averaging mild symptom severity by week 16. There was a significant group x time interaction, such that the lower income group had significantly greater depression severity at the last two timepoints. Conclusion Lower and higher income groups both made significant improvement in depression symptom severity over time following initiation of psychiatric treatment via a telehealth platform, though higher income individuals, all else being equal besides employment, tend to do better. These findings suggest that when lower income individuals do participate in care, good outcomes can be achieved. Further research is needed to better understand the role social determinants of health (SDOH) play in outcome disparities.

Telehealth treatment of patients with major depressive disorder during the COVID-19 pandemic: Comparative safety, patient satisfaction, and effectiveness to prepandemic in-person treatment

Article

Dec 2022
J AFFECT DISORDERS

Background: The COVID-19 pandemic impelled a transition from in-person to telehealth psychiatric treatment. There are no studies of partial hospital telehealth treatment for major depressive disorder (MDD). In the present report from the Rhode Island Methods to Improve Diagnostic Assessment and Services (MIDAS) project, we compared the effectiveness of partial hospital care of patients with MDD treated virtually versus in-person. Methods: Outcome was compared in 294 patients who were treated virtually from May 2020 to December 2021 to 542 patients who were treated in the in-person partial program in the 2 years prior to the pandemic. Patients completed self-administered measures of patient satisfaction, symptoms, coping ability, functioning, and general well-being. Results: In both the in-person and telehealth groups, patients with MDD were highly satisfied with treatment and reported a significant reduction in symptoms from admission to discharge. Both groups also reported a significant improvement in positive mental health, general well-being, coping ability, and functioning. A large effect size of treatment was found in both treatment groups. Contrary to our hypothesis, the small differences in outcome favored the telehealth-treated patients. The length of stay and the likelihood of staying in treatment until completion were significantly greater in the virtually treated patients. Limitations: The treatment groups were ascertained sequentially, and telehealth treatment was initiated after the COVID-19 pandemic began. Outcome assessment was limited to a self-administered questionnaire. Conclusions: In an intensive acute care setting, delivering treatment to patients with MDD using a virtual, telehealth platform was as effective as treating patients in-person.

FIT Teens RCT for juvenile fibromyalgia: Protocol adaptations in response to the COVID 19 pandemic

Article

Full-text available

Nov 2022

Objective To describe protocol adaptations to the Fibromyalgia Integrative Training for Teens (FIT Teens) randomized controlled trial in response to the COVID-19 pandemic. The overarching aims of the FIT Teens multi-site 3-arm comparative effectiveness trial are to assess whether a specialized neuromuscular exercise training intervention combined with cognitive-behavioral therapy (CBT) is superior to CBT alone or graded aerobic exercise alone. Design/methods The trial was originally designed as an in-person, group-based treatment with assessments at baseline, mid- and post-treatment, and four follow-up time points. The original study design and methodology was maintained with specific modifications to screening, consenting, assessments, and group-based treatments to be delivered in remote (telehealth) format in response to COVID-19 restrictions. Results Study enrollment was paused in March 2020 for five months to revise operations manuals, pilot remote treatment sessions for accuracy and fidelity, complete programming of REDCap assent/consent and assessment materials, train study staff for new procedures and obtain regulatory approvals. The trial was relaunched and has been successfully implemented in remote format since July 2020. Trial metrics thus far demonstrate a consistent rate of enrollment, strong attendance at remote treatment sessions, high retention rates and high treatment fidelity after protocol adaptations were implemented. Conclusions Preliminary findings indicate that FIT Teens protocol adaptations from in-person to remote are feasible and allowed for sustained enrollment, retention, and treatment fidelity comparable to the in-person format. Methodologic and statistical considerations resulting from the adaptations are discussed as well as implications for interpretation of results upon completion of the trial.

The Impact of COVID-19 on Veterans’ Resilience, Attachment, and Negative Affect

Article

Full-text available

Nov 2022

A qualitative exploration of adolescents’ experiences of digital Dialectical Behaviour Therapy during the COVID-19 pandemic

Article

Full-text available

Nov 2022

The UK government implemented national social-distancing measures in response to the global COVID19 pandemic. As a result, many appointments in the National Health Service (NHS) took place virtually, including psychological interventions in out-patient settings. This study explored the experiences of adolescents participating in a dialectical behaviour therapy (DBT-A) programme via teletherapy (i.e. via video or telephone call) in a Children and Adolescent Mental Health Service (CAMHS). Thirteen adolescents with emotion dysregulation and related problems completed an online qualitative survey about their experience and acceptance of DBT-A delivered virtually. Thematic analysis was conducted on the survey data and generated three over-arching themes: (1) sense of loss; (2) feeling uncontained; and (3) benefits of virtual DBT. These over-arching themes were composed of eight subthemes (‘loss of connection with group and therapist’; ‘loss of skills-building opportunities’; ‘limited privacy’; ‘lack of safe therapy space’; ‘difficult endings’; ‘home comforts’; ‘convenience and accessibility’; and ‘easier to participate with others’). This study suggests that adolescents doing virtual DBT-A need approaches that acknowledge and address the additional relational, emotional and practical challenges of online therapy while maintaining fidelity to the evidence-based treatment model. Suggestions for further research and preliminary practice guidelines are discussed. Key learning aims (1) To learn about the experiences of adolescents participating in a DBT programme for adolescents (DBT-A) conducted virtually, including the challenges and benefits they identified. (2) To learn about implications for clinical practice and future research directions.

Telehealth for Substance Use Disorders Treatment in Nigeria: Implementation Strategies Post-COVID-19

Article

Full-text available

Jan 2022

Predicting a Rapid Transition to Telehealth-Delivered Parent–Child Interaction Therapy Amid COVID-19: A Mixed Methods Study

Article

Full-text available

Sep 2022

The sudden onset of COVID-19 forced mental health therapists to rapidly transition to telehealth services. While some therapists and organizations were able to achieve an expeditious transition, others struggled. Using the Exploration, Preparation, Implementation, and Sustainment (EPIS) framework, which outlines key phases that guide the implementation process, the current mixed methods study examined what factors predicted the transition to internet-based Parent–Child Interaction Therapy (iPCIT), a telehealth-delivered evidence-based practice (EBP). We investigated two areas related to the transition: (1) if PCIT therapists transitioned to provide iPCIT and (2) if they made this transition quickly. In Fall 2019, 324 therapists completed a survey about implementing PCIT. After stay-at-home orders, 223 of those therapists completed a follow-up survey about their transition to telehealth, organizational characteristics, their caseloads, and telehealth training. The majority of therapists (82%) transitioned to provide iPCIT, with 48% making the transition in less than a week. Open-ended responses indicated that therapists who did not transition-faced challenges related to limited client resources, a lack of training, and organizational delays. Qualitative findings informed predictors for two logistic regression models that are statistical models that predict the probability of an event occurring, with criterion variables (1) whether therapists transitioned to provide iPCIT and (2) whether they transitioned in less than a week. Results showed that caseload in Fall 2019 and receipt of iPCIT training were associated with iPCIT transition. Organizational setting, resiliency, and baseline caseload predicted rapid transition to iPCIT. Implications regarding supporting the implementation of telehealth delivery of EBPs are discussed.

Acceptability and feasibility of the World Health Organization's Caregiver Skills Training Programme (WHO CST) delivered via eLearning, videoconferencing, and in-person hybrid modalities in Hong Kong

Article

Full-text available

Sep 2022

Background Local children with developmental disabilities were deprived of learning opportunities due to recent social and health incidents, resulting in elevating challenging behaviors and familial conflicts. This study explored the acceptability and feasibility of the World Health Organization's Caregiver Skills Training Programme (WHO CST) in alternative delivery modes under new normal and post COVID-19 period. Method CST was delivered via eLearning (EL), videoconferencing (VC), and in-person hybrid (IP) modes to 34 parent-child dyads, being randomly assigned to modes of asynchronous non-interfering EL (n = 9), synchronous with online coaching VC (n = 7), synchronous with in-person coaching IP (n = 9) and Wait-list Control WLC (n = 9). Data from two standardized scales of General Health Questionnaire (GHQ-12) and Strengths and Difficulties Questionnaire (SDQ), and Post-session and Home Visit Feedback Form by Caregivers that included both structured and open-ended questions were collected before and after intervention. Both quantitative and qualitative approaches were used in studying the collected data. Results High levels of acceptability and feasibility of the training programme were supported by ratings on comprehensiveness and relevance, agreement with their personal values, duration, and usefulness. IP and VC groups yielded more positive changes than EL and WLC groups with 3, 16, 13, and −3% in General Health Questionnaire (GHQ-12), −13, −15, −6 and 0% in Difficulties-total, and 36.5, 35.5, 5.8 and 2.4% in Prosocial Scale at Strengths and Difficulties Questionnaire (SDQ) for EL, VC, IP, and WLC groups respectively from baseline to 12 weeks after intervention. Results from two standardized scales echoed with qualitative observations that the programme helped improve caregivers' well-being, child's communication, and behaviors across intervention groups. Conclusions Current findings revealed that CST delivered in three alternative modes were acceptable and feasible, and yielded positive impacts toward both caregivers and children. In-person coaching, and skill-practicing sessions were effective in mitigating child's challenging behaviors while personal interaction, either face-to-face or virtual, is a significant factor in uplifting caregivers' well-being, whereas the self-learning model was appreciated by the busy caregivers. In clinical practice, needs and goals of families and the constraints of remote interventions at the settings should be balanced.

Cognitive-behavioral therapy for psychological harm in domestically abused women: systematic review and meta-analysis

Article

Full-text available

Jul 2022

La violencia doméstica vulnera la salud física y mental de la víctima y de su entorno familiar; habitualmente las mujeres son las más afectadas, por razones culturales y sociales la violencia ha sido normalizada dentro del contexto familiar. Los perjuicios, sobre todo el daño psicológico, es una de las consecuencias que perduran en el tiempo a menos que la víctima reciba una atención integral enfocada en sus principales necesidades. Objetivo. El objetivo fue valorar la evidencia empírica actual de la Terapia Cognitivo-Conductual (TCC) para el tratamiento del daño psicológico en mujeres violentadas domésticamente por su pareja. Metodología. La revisión se realizó en la base de datos Scopus, PubMed y Web of Science, se utilizaron los lineamientos de la declaración Prisma y Consort para obtener la muestra final de los artículos seleccionados en base a los criterios de inclusión y exclusión propuestos. Resultados. La mayor parte de intervenciones cognitivo-conductuales se han centrado en el abordaje de la sintomatología del TEPT, depresión o ansiedad, logrando resultados favorables para este tipo de población. Conclusión. La TCC es eficaz para el tratamiento del daño psicológico en mujeres violentadas domésticamente por su pareja. Sin embargo, la ausencia de especificidad de las intervenciones constituye una limitante importante al momento de replicar en la práctica clínica.

Do older adults benefit from telepsychiatric care: Comparison to younger adults

Article

Full-text available

Aug 2022

Background Telemental health platforms may increase access to care for older adults. Historically, older adults have tended to adopt new technologies at a slower rate which creates a perception that they may not be able to benefit from them. The purpose of this study was to determine whether or not older adult patients receiving psychiatric care for depression via a telemental health platform achieve the same outcomes as younger adults. Method Participant data utilized in the current investigation were obtained from a national mental health telehealth company (i.e., Brightside) and consisted of 12,908 U.S.-based adult patients receiving psychiatric care for depression between October, 2018 and January, 2022. Propensity matching was used to create an older and younger sample (n = 141 in each) using 23 covariates. These samples were then compared using repeated measures ANOVA on Patient Health Questionnaire-9 (PHQ-9) scores at start of treatment, 6 weeks, 8 weeks, 10 weeks, 12 weeks, 14 weeks, and 16 weeks. Results Despite matching, the groups still significantly differed on prior mental health treatment, such that more older adults reported having had prior mental health treatment. There were no other differences between the groups on assessed variables. Both younger and older adults had decreasing scores over time with no significant differences between them. Conclusion Older adults have similar improvement in depression symptom severity over time following initiation of psychiatric treatment via a telehealth platform. These findings suggest that age is not a barrier to benefitting from telepsychiatric care.

Covid-19 y desafíos para la salud mental: experiencia de atención a distancia desde un centro de psicología universitario

Article

Full-text available

Aug 2022

Antecedentes: Habiendo transcurrido más de un año desde que la OMS declarara a la covid-19 como una pandemia, el deterioro de la salud de la población y las medidas que los Estados han implementado para mitigarlo han derivado en una serie de consecuencias directas e indirectas para la salud mental de las personas en todo su ciclo vital. Durante este periodo de confinamiento y restricciones a la movilidad, esto ha significado grandes desafíos para los profesionales de la salud mental, quienes no solo han debido idear estrategias para continuar atendiendo a las personas que ya estaban recibiendo prestaciones antes de la pandemia, sino también para proporcionar contención a quienes, producto de la pandemia y las medidas sanitarias que ésta exige, han sufrido la aparición de síntomas ansiosos y depresivos. Objetivos: En este artículo damos a conocer a la comunidad psicológica las estrategias implementadas por un centro de atención universitario, tendientes a resolver los desafíos antes mencionados. Resultados y conclusiones: Analizamos críticamente los aprendizajes conseguidos y entregamos recomendaciones preliminares acerca del trabajo psicoterapéutico a distancia.

Economic costs of implementing evidence-based telemedicine outreach for posttraumatic stress disorder in VA

Article

Full-text available

Aug 2022

Background Telemedicine outreach for posttraumatic stress disorder (TOP) is a virtual evidence-based practice (EBP) involving telephone care management and telepsychology that engages rural patients in trauma-focused psychotherapy. This evaluation examined implementation and intervention costs attributable to deploying TOP from a health system perspective. Methods Costs were ascertained as part of a stepped wedge cluster randomized trial at five sites within the Veterans Affairs (VA) Healthcare System. All sites initially received a standard implementation strategy, which included internal facilitation, dissemination of an internal facilitators operational guide, funded care manager, care managing training, and technical support. A subset of clinics that failed to meet performance metrics were subsequently randomized to enhanced implementation, which added external facilitation that focused on incorporating TOP clinical processes into existing clinic workflow. We measured site-level implementation activities using project records and structured activity logs tracking personnel-level time devoted to all implementation activities. We monetized time devoted to implementation activities by applying an opportunity cost approach. Intervention costs were measured as accounting-based costs for telepsychiatry/telepsychology and care manager visits, ascertained using VA administrative data. We conducted descriptive analyses of strategy-specific implementation costs across five sites. Descriptive analyses were conducted instead of population-level cost-effectiveness analysis because previous research found enhanced implementation was not more successful than the standard implementation in improving uptake of TOP. Results Over the 40-month study period, four of five sites received enhanced implementation. Mean site-level implementation cost per month was

919 (SD =

238) during standard implementation and increased to

1,651 (SD =

460) during enhanced implementation. Mean site-level intervention cost per patient-month was

46 (SD =

28) during standard implementation and

31 (SD =

21) during enhanced implementation. Conclusions Project findings inform the expected cost of implementing TOP, which represents one factor health systems should consider in the decision to broadly adopt this EBP. Plain Language Summary: What is already known about the topic: Trauma-focused psychotherapy delivered through telemedicine has been demonstrated as an effective approach for the treatment of post-traumatic stress disorder (PTSD). However, uptake of this evidence-based approach by integrated health systems such as the Veterans Affairs (VA) Health Care System is low. What does this paper add: This paper presents new findings on the costs of two implementation approaches designed to increase adoption telemedicine outreach for PTSD from a health system perspective. What are the implications for practice, research, and policy: Cost estimates from this paper can be used by health systems to inform the relative value of candidate implementation strategies to increase adoption of evidence-based treatments for PTSD or other mental health conditions.

Feasibility and acceptability of a novel telepsychiatry-delivered precision prescribing intervention for anxiety and depression

Article

Full-text available

Jul 2022
BMC PSYCHIATRY

Background: Major Depressive Disorder and Generalized Anxiety Disorder are pervasive and debilitating conditions, though treatment is often inaccessible and based on trial-and-error prescribing methods. The present observational study seeks to describe the use of a proprietary precision prescribing algorithm piloted during routine clinical practice as part of Brightside's telepsychiatry services. The primary aim is to determine the feasibility and acceptability of implementing this intervention. Secondary aims include exploring remission and symptom improvement rates. Methods: Participants were adult patients enrolled in Brightside who completed at least 12 weeks of treatment for depression and/or anxiety and received a prescription for at least one psychiatric medication. A prescription recommendation was made by Brightside's algorithm at treatment onset and was utilized for clinical decision support. Participants received baseline screening surveys of the PHQ-9 and GAD-7, and at weeks 2,4,6,8,10 and 12. Intent-to-treat (ITT) sensitivity analyses were conducted. Feasibility of the implementation was measured by the platform's ability to enroll and engage participants in timely psychiatric care, as well as offer high touch-point treatment options. Acceptability was measured by patient responses to a 5-star satisfaction rating. Results: Brightside accessed and treated 6248 patients from October 2018 to April 2021, treating a majority of patients within 4-days of enrollment. The average plan cost was

115/month. 89% of participants utilized Brightside's core medication plan at a cost of

95/month. 13.4% of patients in the study rated Brightside's services as highly satisfactory, averaging a 4.6-star rating. Furthermore, 90% of 6248 patients experienced a MCID in PHQ-9 or GAD-7 score. Remission rates were 75% (final PHQ-9 or GAD-7 score < 10) for the study sample and 59% for the ITT sample. 69.3% of Brightside patients were treated with the medication initially prescribed at intake. Conclusions: Results suggest that the present intervention may be feasible and acceptable within the assessed population. Exploratory analyses suggest that Brightside's course of treatment, guided by precision recommendations, improved patients' symptoms of anxiety and depression.

Better than expected: client and clinician experiences of videoconferencing therapy (VT) during the COVID-19 pandemic

Article

Full-text available

May 2022

Videoconferencing therapy (VT) has been an emerging medium of psychological therapy, and during the COVID-19 pandemic there has been substantial growth in its usage as a result of home working. However, there is a paucity of research into client and clinician perceptions of VT. This study sought to assess client and staff experiences of VT. This mixed methods study produced both quantitative and qualitative data. Seven clients who had previously received VT and 11 psychotherapists who had previously delivered VT were recruited from two NHS sites. Clients and psychotherapists took part in qualitative interviews which were analysed using thematic analysis. Quantitative surveys were developed based on themes generated from the interviews and were completed by 172 clients and 117 psychotherapists. These were analysed using simple percentages. VT often exceeded client and psychotherapist expectations and overall experiences of VT were generally positive, although there were mixed findings regarding the therapeutic alliance. Several barriers to VT were cited, such as IT issues, and challenges identified in conducting behavioural experiments, and potential exclusion of certain populations were also cited. The medium of VT was received well by both clients and clinicians, with advantages around convenience seemingly outweighing losses in quality of therapeutic relationship. Future research should focus on overcoming barriers to accessing VT in populations prone to digital exclusion. NHS services not currently employing VT may wish to reconsider their stance, expanding choice of therapy delivery and improving accessibility. Key learning aims (1) To gain insight into client and clinician experiences of VT during the COVID-19 pandemic. (2) To assess the acceptability and feasibility of VT within two NHS short-term psychological support services. (3) To identify barriers and facilitators to the implementation of VT within two NHS short-term psychological support services.

Caregiver Satisfaction with Delivery of Telehealth Autism Services

Article

Full-text available

Jun 2022

Objective The purpose of this study was to assess satisfaction with telehealth interventions for a large nonprofit organization that transitioned interventions for individuals with autism spectrum disorder (ASD) to telehealth during a pandemic. Services provided via telehealth included applied behavior analysis (ABA), speech and language, and occupational therapies. A secondary survey evaluated reasons for declining telehealth services. Methods A survey was administered to 10,567 families who were receiving autism interventions. A total of 440 respondents answered all the questions on the survey, and their results were included in this study. A secondary survey was administered to 223 individuals who declined to have telehealth autism interventions. Results There was not a clinically meaningful difference in satisfaction across service types. Although all ratings were in the high range, caregivers ranked speech therapists as more dependable than ABA therapists, and this difference was statistically significant. The findings suggested that the majority of caregivers were generally satisfied with services provided in a telehealth format. For those who declined services, the majority indicated a discomfort with the use of technology. Conclusions The participants of telehealth autism interventions reported high general satisfaction and indicated an improvement in their quality of life. Results provide suggestive evidence that increased satisfaction of telehealth services may allow for further acceptability and access for participants. Future research should evaluate participant and clinician satisfaction with telehealth versus in-person interventions.

The Eyes Have It: Psychotherapy in the Era of Masks

Article

Full-text available

Feb 2022
J CLIN PSYCHOL MED S

Nonverbal communication is integral to the success of psychotherapy and facial expression is an important component of nonverbal communication. The SARS CoV-2 pandemic has caused alterations in how psychotherapy services are provided. In this paper, potential issues that may arise from conducting psychotherapy when both the patient and therapist are wearing masks are explored. These include higher likelihood of misidentifying facial expression, especially when expression is incongruent with body language, and when the lower face is more important for correct identification of emotion. These issues may be particularly problematic for patient populations for whom emotion recognition may be a problem at baseline, or for those more prone to biases in emotional recognition. Suggestions are made for therapists to consider when seeing patients in-person when masks are necessary.

Clinician Perspectives on Telehealth Assessment of Autism Spectrum Disorder During the COVID-19 Pandemic

Article

Full-text available

Feb 2022
J AUTISM DEV DISORD

This study examined clinician insights into telehealth assessment services for autism spectrum disorder implemented during the COVID-19 pandemic. 35 clinicians from multiple disciplines across 17 sites in the Autism Care Network were interviewed. Themes identified through qualitative analyses included factors related to confidence in diagnosis (impressions of in-home observation; child and family factors that affected diagnostic confidence; changes in rapport); patient and family factors related to telehealth (perceived family benefits of and barriers to telehealth; factors related to healthcare disparities; factors specific to non-native English speakers); and institutional and workplace factors related to transitioning to telehealth (institutional support; changes to efficacy, attendance, and work satisfaction). Results suggest that telehealth has potential to be an effective tool in autism assessment practice.

Organizational E-Readiness for the Digital Transformation of Primary Healthcare Providers during the COVID-19 Pandemic in Poland

Article

Full-text available

Dec 2021

The COVID-19 pandemic has forced many countries to implement a variety of restrictive measures to prevent it from spreading more widely, including the introduction of medical teleconsultations and the use of various tools in the field of inpatient telemedicine care. Digital technologies provide a wide range of treatment options for patients, and at the same time pose a number of organizational challenges for medical entities. Therefore, the question arises of whether organizations are ready to use modern telemedicine tools during the COVID-19 pandemic. The aim of this article is to examine two factors that impact the level of organizational e-readiness for digital transformation in Polish primary healthcare providers (PHC). The first factor comprises operational capabilities, which are the sum of valuable, scarce, unique, and irreplaceable resources and the ability to use them. The second factor comprises technological capabilities, which determine the adoption and usage of innovative technologies. Contrary to the commonly analyzed impacts of technology on operational capabilities, we state the reverse hypothesis. The verification confirms the significant influence of operational capabilities on technological capabilities. The research is conducted using a questionnaire covering organizational e-readiness for digital transformation prepared by the authors. Out of the 32 items examined, four are related to the operational capabilities and four to the technological capabilities. The result of our evaluation shows that: (i) a basic set of four variables can effectively measure the dimensions of OC, namely the degree of agility, level of process integration, quality of resources, and quality of cooperation; (ii) a basic set of three variables can effectively measure the dimensions of TC, namely adoption and usage of technologies, customer interaction, and process automation; (iii) the empirical results show that OC is on a higher level than TC in Polish PHCs; (iv) the assessment of the relationship between OC and TC reveals a significant influence of operational capabilities on technological capabilities with a structural coefficient of 0.697. We recommend increasing the level of technological capability in PHC providers in order to improve the contact between patients and general practitioners (GPs) via telemedicine in lockdown conditions.

Using Acceptance and Commitment Therapy to Develop Self-Confidence in a Neurodivergent Athlete

Article

Full-text available

May 2024

This case study outlines the sport psychology service delivery provided to a 17-year-old international-level competitive figure skater. The client had a diagnosis for autism spectrum disorder and reported experiencing low self-confidence, which hindered his performance in training and competition. An acceptance and commitment therapy intervention was implemented over 25 sessions across a 15-month period. The aim of the intervention was to develop self-confidence by encouraging acceptance of unhelpful thoughts, rather than changing or removing them, to move the client toward the athlete he wanted to be. This case offers a novel contribution to the wider literature by reporting an acceptance and commitment therapy intervention to develop self-confidence in sport. We report how psychological flexibility was achieved through exercises to “unhook” the client from his thoughts around perfection and self-imposed pressure. Reflections from the client and practitioner capture the evaluation of the service delivery process.

Using an Acceptance and Commitment Therapy Approach for Fear of (Re)Injury With a Competitive Figure Skater

Article

Full-text available

Dec 2023

This case study outlines the sport psychology service delivery provided to an 18-year-old competitive figure skater. The client reported fearing (re)injury in training following her return to sport, which hindered her performance and concentration in training. An acceptance and commitment therapy (ACT) intervention was implemented over six sessions across a 3-month period. The ACT matrix was used to conceptualize the client’s “stuckness” and provide a foundation for the strategies and techniques implemented. The aim of our work was to increase psychological flexibility, helping the client sit with, rather than change or remove, her unhelpful thoughts, moving her toward the athlete she wanted to be. This case reports how psychological flexibility was achieved through exercises to help the client “unhook” from her thoughts around fear of injury. Reflections from the client and practitioner capture the evaluation of the service delivery process.

Virtual reality (VR) treatments for anxiety disorders are unambiguously successful, so why are so few therapists using it? Barriers to adoption and potential solutions

Article

Jun 2023

Anxiety disorders are a significant cause of disability globally, yet only one in ten sufferers receives adequate quality treatment. Exposure-based therapies are effective in reducing symptoms associated with a number of anxiety disorders. However, few therapists use exposure techniques to treat these conditions, even when they are adequately trained in them, often because of concerns about provoking distress, drop out, logistical barriers, and other concerns. Virtual reality exposure therapy (VRET) can address many of these concerns, and a large body of research decisively shows that VRET is as efficacious for treating these conditions as in vivo exposures. Yet, use of VRET remains low. In this article, we discuss several factors we believe are contributing to low VRET adoption among therapists and raise potential solutions to address them. We consider steps that VR experience developers and researchers might take, such as leading studies of VRET's real-world effectiveness and treatment optimization trials and continuing to improve the fit of platforms with clinicians' workflows. We also discuss steps to address therapist reservations using aligned implementation strategies, as well as barriers for clinics, and the roles that professional organizations and payers could have in improving care by encouraging adoption of VRET.

Telemedicina en trastorno alimentario. Revisión sistemática

Book

Jan 2023

Introducción: Los trastornos de la conducta alimentaria son enfermedades graves definidos por hábitos alimentarios anormales asociados con importantes consecuencias médicas, psiquiátricas y psicosociales. Se considera telemedicina, a la prestación de servicios sanitarios a través de la utilización de tecnologías de la información y la comunicación, cuyo objetivo es proporcionar una mayor cobertura de servicios sanitarios con calidad a la población. Entre sus ventajas encontramos: mejor acceso a la población necesitada, eliminación de desplazamientos y mayor comodidad, en la literatura científica están descritos también los inconvenientes: problemas técnicos o de conexión, calidad de sonido y video, o falta de conocimientos y capacidad de manejo de la tecnología. Últimamente, la crisis mundial provocada por la pandemia de COVID-19 ha impulsado la necesidad de considerar los beneficios y las limitaciones de la telemedicina en la prestación y utilización de la atención sanitaria. Los pacientes con trastornos de la conducta alimentaria son uno de los colectivos más afectados, que podrían beneficiarse de esta forma de la prestación de la terapia. Objetivo: Evaluar la seguridad, efectividad, así como el análisis de costes de la telemedicina como medio complementario para favorecer la adherencia y para realizar el seguimiento de las terapias presenciales cognitivas en pacientes con trastorno alimentario. Metodología: Se realizó una búsqueda sistemática de la literatura científica en las siguientes bases de datos referenciales hasta abril de 2022: MEDLINE (Ovid), EMBASE (Embase.com), Science Citation Index expanded (Web of Science – WOS), EconLit, EHealth, Cochrane Library, International HTA database (INAHTA), Cinahl (Ebsco) y PsycInfo (Ebsco). Por otro lado, se revisaron las webs de las principales agencias de evaluación de tecnologías sanitarias: CADTH, AHRQ, NICE, HIS, HIQA y las pertenecientes a la Red Española de Agencias de Evaluación de Tecnologías Sanitarias (RedETS). Se incluyeron las revisiones sistemáticas que analizan la seguridad, efectividad, el análisis de costes de la telemedicina como medio complementario de la terapia presencial en pacientes con trastornos alimentarios, y los estudios de evaluación económica. Se llevó a cabo la selección de los estudios y la extracción de los datos relevantes. Se evaluó la calidad de los estudios incluidos mediante la herramienta de evaluación critica de revisiones sistemáticas AMSTAR-2, y la FLC 3.0 de Osteba para la evaluación económica. Resultados: Se identificaron y analizaron 5 revisiones sistemáticas que aportan información sobre la efectividad y seguridad de la telemedicina y 3 estudios de evaluación económica. Se identificaron algunas debilidades en el análisis de calidad de los trabajos incluidos siendo en general moderada o baja. En relación a las intervenciones realizadas como tratamiento complementario de la terapia presencial, los estudios incluidos hacían referencia al uso de correo electrónico, aplicaciones para smartphones, vodcast y mensajes de texto SMS. En cuanto a los resultados de seguridad de esta tecnología, no se identificaron reacciones adversas directamente relacionadas con el uso de la telemedicina, salvo la preocupación por la falta de privacidad informática de los usuarios de la terapia mediante el uso de correo electrónico y aplicaciones para smartphone. En cuanto a los resultados de efectividad, en relación al tratamiento de anorexia nerviosa con el uso de vodcast se observó en los estudios revisados un aumento significativo en la cantidad de comida consumida, estado de ánimo, y reducciones significativas en la ansiedad, pensamientos negativos, la angustia y sesgo atencional en la comida. El tratamiento adicional con el correo electrónico de bulimia nerviosa presentó en los estudios revisados, una disminución significativa en el número de atracones y purgas, comidas nocturnas, síntomas de depresión y de disfunción eréctil. La aplicación para smartphone como tratamiento complementario para los pacientes con bulimia nerviosa o trastorno por atracón mejoró significadamente los síntomas de TCAs e incrementó el IMC. Por otro lado, se observaron reducciones significativas en los episodios de atracones y purga. El uso adicional de mensajes de texto (SMS) mejoró significadamente la abstinencia y la tasa de la remisión en los pacientes con bulimia nerviosa o EDNOS, reduciendo significadamente los síntomas de estos trastornos. En el caso de los pacientes con anorexia nerviosa o bulimia nerviosa se han observado reducciones significativas en la restricción dietética y aumento en la disposición al cambio. La evaluación económica está basada en la evidencia procedente de tres estudios que incluyen el mismo estudio de análisis de costes, dicho estudio sugiere que, la provisión de la terapia cognitiva a través de la telemedicina supone un coste menor que el tratamiento presencial

Introduction - Advances in Online Therapy

Chapter

Full-text available

Dec 2022

The introduction chapter describes the scope and purpose of this book and summarizes key topics regarding online therapy. We explain that the book addresses most of the main approaches and schools of psychotherapy that are prevalent in the therapeutic field nowadays. Thus, in addition to exploring how each of them adjust to online therapy, we also have created a collection of the most practiced therapeutic approaches nowadays. Beyond the theories, we describe why flexibility and creativity are among the main factors that contribute to the success of online therapy. Also discussed briefly are skills and training required for the successful provision of online therapy. The introduction also presents the current research about online therapeutic alliance, elements influencing the therapeutic alliance such as the setting and rupture and repair, and the outcome of online therapy. We show that there is enough evidence that online therapy is beneficial no less than in-person. We address the question whether it is suitable for everyone, and summarize how the factors that unify all psychodynamic approaches can be applied online.

An Exploration of Virtual Multi-Family Groups in Schools during a Pandemic – Physically Distanced but Emotionally Close?

Thesis

Oct 2022

Elizabeth Annette Williams

A body of evidence attests to the link between parenting styles and children’s emotional, cognitive and social outcomes. Consequently, many parenting interventions have developed utilising both behavioural and relational frameworks to support family functioning. One therapeutic, evidence-based approach, Multi-Family Groups (MFG) in schools, seeks to enable families to work with and alongside other families who have similar experiences to reduce social stigma, further social collaboration and equip parents and schools with new resources to tackle individual, specific problems. Social disruption caused by the Coronavirus outbreak has been found to cause cumulative stressors for families, potentially altering parenting practices and placing children at risk of harsher parenting. Arguably this increases the importance of effective interventions to support family functioning. This study provides a unique opportunity to explore the impact of the MFG model being delivered virtually in three, contrasting school settings as social distancing became mandatory. This case study used semi-structured interviews (n=9) with parents, school partners and educational psychologists, triangulated with the researcher’s presence at MFG meetings and supervision sessions. Qualitative data collected was analysed using Thematic Analysis which elicited six key themes within the overarching theme of ‘The Pandemic’: ‘connection as a coping mechanism’; ‘processes for change’; ‘challenges with online therapy’; ‘challenges with the structure online’; and ‘the future for online MFGs’. This study found strong therapeutic alliance online, essential for therapeutic approaches to create significant impact and benefits to all stakeholders. Implications of the research for Educational Psychology Service practice is discussed including evolving technology to enable fidelity of implementation.

Diffusionsprozesse digitaler Interventionen erfolgreich gestalten: Hintergrund und Gestaltungsempfehlungen

Chapter

Jan 2022

Use of Extended Reality in Medicine During the Covid-19 Pandemic

Chapter

Jan 2022

Samuel Sherng Young Wang

The ongoing Covid-19 pandemic has generated a strong impetus to digitalize the economy and aspects of our daily life. Clinical medicine traditionally being conservative has seen a limited uptake of these new technologies which has seen widespread adoption in other industries. But due to disruptive nature of the pandemic, clinical medicine has also been forced to adapt and capitalize on these new technologies. Chief amongst them is the utilization of extended reality (XR) technologies, which is an umbrella term that encompasses a spectrum of virtual reality (VR) and Augmented reality (AR) devices that blend the physical world with the digital world. VR technologies immerses users in 3D worlds while AR technologies project 3D objects into the user’s physical environment while permitting full visibility of the user’s surroundings. XR technologies can assist in infection control measures by revolutionizing clinical ward rounds. Patient’s key blood results and vitals can be projected above each patient enhancing the speed of clinical ward rounds for large number of patient’s in community isolation facilities. Examination findings can then be dictated and automatically recorded. XR technologies can also assist clinicians during the planning and execution of highly infective/risky procedures. XR can help proceduralists simulate the procedure, limiting timing spent during the actual procedure. While XR guided robots can actually perform the high risk and delicate procedures, limiting infection risk for the proceduralist. XR technologies can overcome the disruption caused clinical education due to Covid-19 pandemic infection control measures. They can help simulate patient interaction/ clinical scenarios for medical students while keeping both patient and medical students safe from infection. Covid-19 has also generated much psychosocial distress due to the isolation stemming from infection control. XR technologies can be used to help bridge the psychosocial isolation by connecting patients with their family members, hobbies or home towns. This can be especially therapeutic when counselling patients that suffer pandemic related depression/anxiety. Particularly in palliative patients XR technologies can help simulate experiences that would be physically impossible for them.

Telepsychology

Chapter

Jan 2022

Ramiro Mitre

Because of recent scientific and technological developments, new forms of human interaction are emerging. For some time now, health care providers from different disciplines have been using technology to enhance their practice, improve client outcomes, and increase access to services. Any use of information and communication technologies in the process of health care falls within the scope of telemedicine and therefore rehabilitation services can also be mediated by technology. The purpose of this chapter is to focus on psychological interventions that may be used in telerehabilitation. It begins with a short review of the history of telemedicine and telepsychology and a brief description of the specialty. The different uses of telepsychological interventions are also outlined, and commonly implemented tools, best practice principles, benefits, limitations, and recommendations are described.

Telepsychiatry and video-to-home (including security issues)

Chapter

Jan 2022

Telemental health (TMH) conducted via videoconferencing allows for the real-time delivery of mental health care when patients and providers are at a distance. TMH can be provided from larger hospitals to smaller clinics lacking mental health services, as well as to nonclinical locations such as prisons, schools, community centers, and increasingly, directly to patients’ homes. Patients and providers can connect via a variety of video-enabled devices, including smartphones, tablets, and desktop or laptop computers. A full spectrum of mental health services has been successfully provided via TMH, ranging from individual and group psychotherapy, to psychiatric medication management, diagnostic consultation, and neuropsychological assessment. Over its 60-year history, TMH has evolved from a relative novelty to a common mode of care delivery that is becoming increasingly integrated into health-care systems worldwide. This chapter will provide an overview of TMH, including factors related to effectiveness, safety, and uptake on a global scale.

Crossing the Line: Interstate Delivery of Remote Psychological Services

Article

Full-text available

Jan 2012

Cognitive Behavior Therapy for Panic Disorder with Agoraphobia in Videoconference: Preliminary Results

Article

Full-text available

Dec 2000

Many studies have shown the feasibility of psychiatric consultation in telehealth, and some have addressed the effectiveness of telepsychotherapy. However, outcome studies on telepsychiatry essentially amount to a few case studies, none of which have used an empirically validated psychosocial treatment to treat a specific mental disorder. This article presents the preliminary results of an outcome study on the effectiveness of telepsychotherapy for panic disorder with agoraphobia. Participants received 12 sessions of cognitive-behavior therapy, which is an empirically validated treatment for panic disorder with agoraphobia. The treatment was delivered via videoconference by trained therapists according to a standardized treatment manual. The remote site was located at 130 km north of the local site and both were linked by six ISDN lines. Telepsychotherapy demonstrated statistically and clinically significant improvements on measures of target symptoms (frequency, of panic attacks, panic apprehension, severity of panic disorder, perceived self-efficacy) and measures of global functioning (trait anxiety, general improvement). Of interest was the fact that a very good therapeutic alliance was built after only the first telepsychotherapy session. Factors that may reduce the effectiveness of telepsychotherapy are discussed.

Behavioral Activation and Therapeutic Exposure: An Investigation of Relative Symptom Changes in PTSD and Depression During the Course of Integrated Behavioral Activation, Situational Exposure, and Imaginal Exposure Techniques

Article

Full-text available

Jun 2012

Effectiveness of exposure therapy for posttraumatic stress disorder (PTSD) may be adversely influenced by comorbid disorders. The present study investigated behavioral activation and therapeutic exposure (BA-TE), a new integrated treatment designed specifically for comorbid symptoms of PTSD and depression. Combat veterans with PTSD (N = 117) completed eight sessions of BA-TE that included two phases of treatment: (a) behavioral activation (BA) in which some activities involved situational exposures and (b) BA and situational exposures with imaginal exposures. Findings supported improvements in symptoms of PTSD, and overlapping symptoms of PTSD and depression, but not in nonoverlapping symptoms of depression. The findings also demonstrated a relatively consistent rate of change in PTSD and depression symptoms during BA-TE, despite the addition of imaginal exposures midway through the treatment. Together, these findings provide preliminary support for BA-TE as a treatment for PTSD and depression, and highlight the utility of transdiagnostic treatments in addressing comorbidity and symptom overlap.

Group Cognitive Processing Therapy Delivered to Veterans via Telehealth: A Pilot Cohort

Article

Full-text available

Aug 2011
J TRAUMA STRESS

The authors report clinical findings from the pilot cohort of the first prospective, noninferiority-designed randomized clinical trial evaluating the clinical outcomes of delivering a cognitive-behavioral group intervention for posttraumatic stress disorder (PTSD), cognitive processing therapy (CPT), via video teleconferencing (VT) compared to the in-person modality. The treatment was delivered to 13 veterans with PTSD residing on the Hawaiian Islands. Results support the general feasibility and safety of using VT. Both groups showed clinically meaningful reductions in PTSD symptoms and no significant between-group differences on clinical or process outcome variables. In keeping with treatment manual recommendations, a few changes were made to the CPT protocol to accommodate this population. Novel aspects of this trial and lessons learned are discussed.

Rural Adults' Use of Health-Related Information Online: Data from a 2006 National Online Health Survey

Article

Full-text available

Jun 2011
TELEMED J E-HEALTH

The objective of this study was to examine access and use of health-related information online in rural versus nonrural Internet users, using national data from the 2006 Pew Internet and American Life Project. A national telephone survey of 2,928 adults in August 2006 yielded a sample of 1,992 adults who use the Internet regularly. A structured interview was administered to assess frequency of Internet use and access and use of health-related information online. Most Internet-using rural adults search for health-related information online; two-thirds seek information about specific medical problems and over half seek information about treatment. Three-fifths of rural adults surveyed stated that online health-related information affected the decisions they made in health maintenance and managing treatment of an illness. More than one-third reported being significantly helped by information they found, whereas one-fourth reported being confused. Comparisons between rural and nonrural Internet users suggested that rural users were more likely to seek information about smoking cessation (χ(2)[1, N=1,990]=7.91, p<0.01) and mental health issues (χ(2)[1, N=1,988]=3.71, p=0.05), less likely to seek information about a particular doctor or hospital (χ(2)[1, N=1,983]=15.49, p<0.001), and more likely to report being helped (χ(2)[1, N=1,534]=5.24, p<0.05)-but also confused (χ(2)[1, N=1,592]=9.83, p<0.01)-by information they found. Rural Americans are increasingly using the Internet to acquire information about chronic disease, mental health, doctors, and treatment options. Priorities should include further development and rigorous evaluation of online resources to ensure high-quality, more direct tailoring of resources to rural families and development of tools to assist consumers in assessing the credibility of online information.

Evidence-Based Practice for Telemental Health

Article

Full-text available

Mar 2011
TELEMED J E-HEALTH

This document was prepared in response to the needs and requests of providers, organizations, and the ATA membership interested in or engaged in TMH activities, for the development of evidence-based TMH guidelines. The broad nature of the mental health field along with an unlimited number of ways to use technology in mental health services led the committee to limit this evidence-based document to interactive video conferencing applications. Appreciating the broad range of providers and settings involved in TMH, recommendations are organized by patient age, types of treatment, treatment setting, and provider specialty. The coding system was developed to encourage more specific descriptions of the technology being used in TMH interactive videoconferencing research and methods publication. It provides recommendations based on clinical confidence derived from the published literature, committee members, and expert reviewers. The committee hopes that the users of this document will benefit from the recommendations, literature references, and the development of a clinical/technical coding system. The document structure and headings were selected in anticipation that users will note the clinical applications that are in most need of additional evidence-based research and perhaps select these areas as a focus of future research.

Ten Year Revision of the Brief Behavioral Activation Treatment for Depression: Revised Treatment Manual

Article

Full-text available

Mar 2011

Following from the seminal work of Ferster, Lewinsohn, and Jacobson, as well as theory and research on the Matching Law, Lejuez, Hopko, LePage, Hopko, and McNeil developed a reinforcement-based depression treatment that was brief, uncomplicated, and tied closely to behavioral theory. They called this treatment the brief behavioral activation treatment for depression (BATD), and the original manual was published in this journal. The current manuscript is a revised manual (BATD-R), reflecting key modifications that simplify and clarify key treatment elements, procedures, and treatment forms. Specific modifications include (a) greater emphasis on treatment rationale, including therapeutic alliance; (b) greater clarity regarding life areas, values, and activities; (c) simplified (and fewer) treatment forms; (d) enhanced procedural details, including troubleshooting and concept reviews; and (e) availability of a modified Daily Monitoring Form to accommodate low literacy patients. Following the presentation of the manual, the authors conclude with a discussion of the key barriers in greater depth, including strategies for addressing these barriers.

How Does Tele-Mental Health Affect Group Therapy Process? Secondary Analysis of a Noninferiority Trial

Article

Full-text available

Oct 2010

Video teleconferencing (VTC) is used for mental health treatment delivery to geographically remote, underserved populations. However, few studies have examined how VTC affects individual or group psychotherapy processes. This study compares process variables such as therapeutic alliance and attrition among participants receiving anger management group therapy either through traditional face-to-face delivery or by VTC. The current study represents secondary analyses of a randomized noninferiority trial (Morland et al., in press) in which clinical effectiveness of VTC delivery proved noninferior to in-person delivery. Participants were male veterans (N = 112) with posttraumatic stress disorder (PTSD) and moderate to severe anger problems. The present study examined potential differences in process variables, including therapeutic alliance, satisfaction, treatment credibility, attendance, homework completion, and attrition. No significant differences were found between the two modalities on most process variables. However, individuals in the VTC condition exhibited lower alliance with the group leader than those in the in-person condition. Mean self-leader alliance scores were 4.2 (SD = 0.8) and 4.5 (SD = 0.4), respectively, where 5 represents strongly agree and 4 represents agree with positive statements about the relationship, suggesting that participants in both conditions felt reasonably strong alliance in absolute terms. Individuals who had stronger alliance tended to have better anger outcomes, yet the effect was not strong enough to result in the VTC condition producing inferior aggregate outcomes. Our findings suggest that even if group psychotherapy via VTC differs in subtle ways from in-person delivery, VTC is a viable and effective means of delivering psychotherapy.

Recruitment Challenges and Strategies in a Home-Based Telehealth Study

Article

Full-text available

Sep 2010
TELEMED J E-HEALTH

The difficulty in recruiting subjects for home-based telehealth research is well documented. This article shares the recruitment statistics and experiences in the Assessment of Caregivers for Team Intervention via Videophone Encounters pilot study, a home-based telehealth intervention. The study obtained 83% of the desired sample. Challenges included issues with initial inclusion criteria, weather-related problems, timely referrals and follow-up, the enrollment process, the need for multiple visits, and unforeseen cases of multiple caregivers. Detailed monitoring and tracking of recruitment statistics and immediate response to overcome challenges were critical to the eventual recruitment success. Strategies included the reallocation of resources to add a second research site, adjustments in inclusion criteria, process improvement with the hospice admissions process, and strategies to address staff gate-keeping. Recruitment continues to be an important barrier to home-based telehealth research and the sharing of recruitment statistics, challenges, and strategies can be beneficial. Gathering of recruitment data is a critical component of pilot studies, which assists in the development of successful randomized clinical trials for future home-based telehealth research.

Current Directions in Videoconferencing Tele-Mental Health Research

Article

Full-text available

Sep 2009

The provision of mental health services via videoconferencing tele-mental health has become an increasingly routine component of mental health service delivery throughout the world. Emphasizing the research literature since 2003, we examine: 1) the extent to which the field of tele-mental health has advanced the research agenda previously suggested; and 2) implications for tele-mental health care delivery for special clinical populations. Previous findings have demonstrated that tele-mental health services are satisfactory to patients, improve outcomes, and are probably cost effective. In the very small number of randomized controlled studies that have been conducted to date, tele-mental health has demonstrated equivalent efficacy compared to face-to-face care in a variety of clinical settings and with specific patient populations. However, methodologically flawed or limited research studies are the norm, and thus the research agenda for tele-mental health has not been fully maximized. Implications for future research and practice are discussed.

Toward the Development of National Telehealth Services: The Role of Veterans Health Administration and Future Directions for Research

Article

Full-text available

Feb 2010
TELEMED J E-HEALTH

The Veterans Health Administration (VHA) in the Department of Veteran Affairs (VA) has emerged as a national and international leader in the delivery and research of telehealth-based treatment. Several unique characteristics of care in VA settings intersect to create an ideal environment for telehealth modalities and research. However, the value of telehealth experience and initiatives in VA settings is limited if telehealth strategies cannot be widely exported to other public or private systems. Whereas a hierarchical organization, such as VA, can innovate and fund change relatively quickly based on provider and patient preferences and a growing knowledge base, other health provider organizations and third-party payers may likely require replicable scientific findings over time before incremental investments will be made to create infrastructure, reform regulatory barriers, and amend laws to accommodate expansion of telehealth modalities. Accordingly, large-scale scientifically rigorous telehealth research in VHA settings is essential not only to investigate the efficacy of existing and future telehealth practices in VHA, but also to hasten the development of telehealth infrastructure in private and other public health settings. We propose an expanded partnership between the VA, NIH, and other funding agencies to investigate creative and pragmatic uses of telehealth technology. To this end, we identify six specific areas of research we believe to be particularly relevant to the efficient development of telehealth modalities in civilian and military contexts outside VHA.

Rationale and design: Telepsychology service delivery for depressed elderly veterans

Article

Full-text available

May 2009
TRIALS

Older adults who live in rural areas experience significant disparities in health status and access to mental health care. "Telepsychology," (also referred to as "telepsychiatry," or "telemental health") represents a potential strategy towards addressing this longstanding problem. Older adults may benefit from telepsychology due to its: (1) utility to address existing problematic access to care for rural residents; (2) capacity to reduce stigma associated with traditional mental health care; and (3) utility to overcome significant age-related problems in ambulation and transportation. Moreover, preliminary evidence indicates that telepsychiatry programs are often less expensive for patients, and reduce travel time, travel costs, and time off from work. Thus, telepsychology may provide a cost-efficient solution to access-to-care problems in rural areas. We describe an ongoing four-year prospective, randomized clinical trial comparing the effectiveness of an empirically supported treatment for major depressive disorder, Behavioral Activation, delivered either via in-home videoconferencing technology ("Telepsychology") or traditional face-to-face services ("Same-Room"). Our hypothesis is that in-homeTelepsychology service delivery will be equally effective as the traditional mode (Same-Room). Two-hundred twenty-four (224) male and female elderly participants will be administered protocol-driven individual Behavioral Activation therapy for depression over an 8-week period; and subjects will be followed for 12-months to ascertain longer-term effects of the treatment on three outcomes domains: (1) clinical outcomes (symptom severity, social functioning); (2) process variables (patient satisfaction, treatment credibility, attendance, adherence, dropout); and (3) economic outcomes (cost and resource use). Results from the proposed study will provide important insight into whether telepsychology service delivery is as effective as the traditional mode of service delivery, defined in terms of clinical, process, and economic outcomes, for elderly patients with depression residing in rural areas without adequate access to mental health services. National Institutes of Health Clinical Trials Registry (ClinicalTrials.gov identifier# NCT00324701).

Effectiveness of Cognitive Behavioural Therapy Administered by Videoconference for Posttraumatic Stress Disorder

Article

Full-text available

Feb 2009

Telehealth, or health care via videoconferencing, constitutes a clinical option that makes it possible to treat patients remotely. A growing number of studies have demonstrated that telehealth is a feasible and effective method for diagnostic interviews and psychiatric consultations. However, few studies have assessed the effectiveness of psychotherapy given by videoconference. This study examines the effectiveness of cognitive behavioural therapy (CBT) administered by videoconference for posttraumatic stress disorder (PTSD). Forty-eight participants with PTSD were recruited for the study: 16 in the videoconferencing condition and 32 in a control face-to-face condition. Each participant received CBT for 16 to 25 weeks and completed various questionnaires before and after treatment. The results show a significant decline in the frequency and severity of posttraumatic symptoms after treatment in both conditions. A clinical improvement in overall functioning was also observed. No significant difference was observed in the effectiveness of the two therapeutic conditions. The examination of effect sizes supports these results. A number of clinical implications and certain avenues for future research are discussed.

Assessing the effectiveness of an Internet-based videoconferencing platform for delivering intensified substance abuse counseling

Article

Full-text available

Oct 2008

Enhanced schedules of counseling can improve response to routine opioid-agonist treatment, although it is associated with increased time demands that enhance patient resistance and nonadherence. Internet-based counseling can reduce these concerns by allowing patients to participate from home. This study assesses treatment satisfaction and response to Internet-based (CRC Health Group's e-Getgoing) group counseling for partial responders to methadone maintenance treatment. Patients testing positive for an illicit substance (n = 37) were randomly assigned to e-Getgoing or onsite group counseling and followed for 6 weeks. Patients in both conditions responded favorably to intensified treatment by achieving at least 2 consecutive weeks of abstinence and 100% attendance to return to less-intensive care (e-Getgoing: 70% vs. routine: 71%, ns). Treatment satisfaction was good and comparable across conditions. E-Getgoing patients expressed a preference for the Internet-based service, reporting convenience and increased confidentiality as major reasons. Integrating Internet-based group counseling with on-site treatment services could help expand the continuum of care in methadone maintenance clinics.

Cost evaluation of a telepsychiatry service in northern Queensland

Article

Full-text available

Feb 1998

We conducted a simple comparison of the costs associated with delivering a mental health service by telepsychiatry and by conventional methods. The telepsychiatry rural outreach service was delivered to a mining town 900 km from the regional hospital in Townsville. When the telemedicine service was well established, 40 cases a month were seen for general adult psychiatry, four for child and adolescent mental health, four for psychology and two for forensic services. Costs and quality-of-life issues were considered. The savings to the health authority were estimated to be

85,380 in the first year and

112,790 in subsequent years, not allowing for maintenance and equipment upgrading. We also estimated a 40% reduction in patient transfers due to the introduction of telemedicine. Based on the previous year's figures of 27 transfers at

8920 each, this would produce an annual saving of

96,336 for the Royal Flying Doctor Service. The results of the study showed considerable savings from reduced travel by patients and health-care workers.

Procedural and Methodological Issues in Telepsychiatry Research and Program Development

Article

Full-text available

Jan 2001

The authors reviewed the literature related to telepsychiatry-applications of videoconferencing technology for mental health care-which offers hope for an affordable means of solving long-standing workforce problems, particularly in geographical areas where specialist providers are not readily available. To conduct a comprehensive review of the telepsychiatry literature, the authors searched the MEDLINE database (1970 to February 2000), using the keywords telepsychiatry, telemedicine, and videoconferencing. Studies were selected that included the use of videoconferencing technology for the provision of any form of mental health care services. Psychiatric interviews conducted by telepsychiatry appear to be generally reliable, and patients and clinicians generally report high levels of satisfaction with telepsychiatry. A significant limitation of the literature is the lack of empirical research on telepsychiatry, especially cost analyses and clinical outcome studies. The authors outline a research agenda addressing the procedural and methodological issues that should shape future research: study design, outcome measurement, consideration of patient characteristics, and program design.

Telepathology Networking in VISN-12 of the Veterans Health Administration

Article

Full-text available

Feb 2000

The Veterans Integrated Service Network (VISN)-12, headquartered in Chicago, has implemented a telepathology network between the eight VISN-12 hospital laboratories and Loyola University Medical School linked by an economical, high-speed wide-area network (WAN). Implementation of the WAN has reduced monthly telecommunications costs in VISN-12 by approximately 67%. In addition to telepathology, the WAN enables real-time teleradiology (general, computer tomography, and ultrasound), telefluoroscopy, telenuclear medicine imaging, telepsychiatry, and other forms of teleconsultation. Current applications of telepathology in VISN-12 include: primary diagnosis and consultation in surgical pathology, interpretation of serum protein electrophoresis and immunofixation gels, provision of support for consolidated microbiology laboratories, review of problematic peripheral blood smears, and distance learning. We have learned a variety of lessons from telepathology. The enthusiasm and technical skill of providers are essential for success. As well, frequent communication and rapid technical support are necessary. Finally, in a supportive environment, telepathology is a tool that can help bring together clinical laboratories with shared missions and goals.

Empirically Supported Psychological Interventions: Controversies and Evidence

Article

Full-text available

Feb 2001

Efforts to increase the practice of evidence-based psychotherapy in the United States have led to the formation of task forces to define, identify, and disseminate information about empirically supported psychological interventions. The work of several such task forces and other groups reviewing empirically supported treatments (ESTs) in the United States, United Kingdom, and elsewhere is summarized here, along with the lists of treatments that have been identified as ESTs. Also reviewed is the controversy surrounding EST identification and dissemination, including concerns abou research methodology, external validity, and utility of EST research, as well as the reliability and transparency of the EST review process.

Case Report: Delivery of Family Therapy in the Treatment of Anorexia Nervosa Using Telehealth

Article

Full-text available

Feb 2003

Family therapy plays an important role in the comprehensive treatment of adolescents with anorexia nervosa (AN). However, most comprehensive hospital-based treatment facilities for eating disorders are situated in large urban centers, thus not accessible to individuals living in underserviced rural communities. Telehealth is now being used to provide psychiatric services to individuals who do not have access to urban-based treatment centers. We report the therapeutic outcome and patient satisfaction of using telehealth to provide family therapy as an adjunctive treatment for AN to an adolescent female admitted to a large urban-based hospital treatment program. Family therapy was delivered via telehealth in a therapeutic environment within a hospital setting, and was received in a telehealth facility in the rural community. Family therapy was effectively delivered and contributed to patient recovery, as measured by objective criteria (weight gain, improved medical condition) and subjective clinical observations. In addition, all family members reported high satisfaction with telehealth without any concern regarding confidentiality. The advantages of telehealth are discussed in the context of legal and ethical issues relating to the use of this technology to deliver psychiatric care.

A multidisciplinary approach to the treatment of eating disorders via videoconferencing in north-east Scotland

Article

Full-text available

Feb 2003

Until recently many remote communities in Scotland, especially on the northern islands, were unable to access specialist eating disorder services. The Grampian Eating Disorder Service, based in the north-east of Scotland, has developed a video-therapy service that offers specialist psychological and nutritional therapy for sufferers of eating disorders. Twelve patients have been treated via videoconferencing. Patients consistently rated high levels of satisfaction with all aspects of video-therapy, and after their last session 67% preferred video-therapy to face-to-face therapy. A number of patients commented that, compared with face-to-face therapy, they felt more in control and less intimidated in video-therapy. There was also a trend for patients to become more comfortable with video-therapy over the course of treatment. Nutritional knowledge increased for all patients, and the nutritional content of dietary intake also markedly improved over the course of therapy.

Delivering Cognitive-Behavior Therapy for Panic Disorder with Agoraphobia in Videoconference

Article

Full-text available

Feb 2004

Delivering psychotherapy by videoconference could significantly increase the accessibility of empirically validated treatments. The aim of this study was to compare the effectiveness of cognitive-behavior therapy (CBT) for panic disorder with agoraphobia (PDA) when the therapy is delivered either face-to-face or by videoconference. A sample of 21 participants was treated either face-to-face or by videoconference. Results showed that CBT delivered by videoconference was as effective as CBT delivered face-to-face. There was a statistically significant reduction in all measures, and the number of panic-free participants among those receiving CBT by videoconference was 81% at post-treatment and 91% at the 6-month follow-up. None of the comparisons with face-to-face psychotherapy suggested that CBT delivered by videoconference was less effective. These results were confirmed by analyses of effect size. The participants reported the development of an excellent therapeutic alliance in videoconference as early as the first therapy session. The importance of these results for treatment accessibility is discussed. Hypotheses are proposed to explain the rapid creation of strong therapeutic alliances in videoconferencing.

Prolonged Exposure Therapy for PTSD: Therapist Guide: Emotional processing of traumatic experiences

Book

Mar 2007

This online therapist guide gives clinicians the information they need to treat clients who exhibit the symptoms of PTSD. It is based on the principles of Prolonged Exposure Therapy, the most scientifically-tested and proven treatment that has been used to effectively treat victims of all types of trauma. Clients are exposed to imagery of their traumatic memories, as well as real-life situations related to the traumatic event in a step-by-step, controllable way, and through this, will learn to confront the trauma and begin to think differently about it, leading to a marked decrease in levels of anxiety and other PTSD symptoms. Clients are provided education about PTSD and other common reactions to traumatic events. Breathing retraining is taught as a method for helping the client manage anxiety in daily life. Designed to be used in conjunction with the corresponding online client workbook, this therapist guide includes all the tools necessary to effectively implement the prolonged exposure program including assessment measures, session outlines, case studies, sample dialogues, and homework assignments.

Prolonged Exposure Therapy for PTSD: Emotional Processing of Traumatic Experiences - Therapist GuideEmotional Processing of Traumatic Experiences - Therapist Guide

Book

Aug 2019

This therapist guide of prolonged exposure (PE) treatment is accompanied by the patient workbook, Reclaiming Your Life from a Traumatic Experience. The treatment and manuals are designed for use by a therapist who is familiar with cognitive behavioral therapy (CBT) and who has undergone an intensive training workshop for prolonged exposure by experts in this therapy. The therapist guide instructs therapists to implement this brief CBT program that targets individuals who are diagnosed with posttraumatic stress disorder (PTSD) or who manifest PTSD symptoms that cause distress and/or dysfunction following various types of trauma. The overall aim of the treatment is to help trauma survivors emotionally process their traumatic experiences to diminish or eliminate PTSD and other trauma-related symptoms. The term prolonged exposure (PE) reflects the fact that the treatment program emerged from the long tradition of exposure therapy for anxiety disorders in which patients are helped to confront safe but anxiety-evoking situations to overcome their unrealistic, excessive fear and anxiety. At the same time, PE has emerged from the adaption and extension of Emotional Processing Theory (EPT) to PTSD, which emphasizes the central role of successfully processing the traumatic memory in the amelioration of PTSD symptoms. Throughout this guide, the authors highlight that emotional processing is the mechanism underlying successful reduction of PTSD symptoms.

Cognitive Processing Therapy

Chapter

Jan 2015

Cognitive processing therapy (CPT) is an evidence-based, cognitive-behavioral treatment designed specifically to treat posttraumatic stress disorder (PTSD) and comorbid symptoms. This chapter will first review the theoretical underpinnings of the intervention and then provide more detail about the actual protocol including a clinical case description. We then will review several special considerations and challenges in administering the protocol to specific groups of trauma survivors and finally end with an overview of the published randomized controlled clinical trials demonstrating the efficacy of the therapy.

Delivery of Evidence-Based Psychotherapy via Video Telehealth

Abstract

No full-text available