ArticlePDF Available

The COVID-19 pandemic: The ‘black swan’ for mental health care and a turning point for e-health

Journal Pre-proof
The COVID-19 pandemic: The ‘black swan’ for mental health
care and a turning point for e-health
Tim R. Wind, Marleen Rijkeboer, Gerhard Andersson, Heleen
PII: S2214-7829(20)30046-4
Reference: INVENT 100317
To appear in: Internet Interventions
Received date: 17 March 2020
Revised date: 18 March 2020
Accepted date: 18 March 2020
Please cite this article as: T.R. Wind, M. Rijkeboer, G. Andersson, et al., The COVID-19
pandemic: The ‘black swan’ for mental health care and a turning point for e-health,
Internet Interventions (2020),
This is a PDF file of an article that has undergone enhancements after acceptance, such
as the addition of a cover page and metadata, and formatting for readability, but it is
not yet the definitive version of record. This version will undergo additional copyediting,
typesetting and review before it is published in its final form, but we are providing this
version to give early visibility of the article. Please note that, during the production
process, errors may be discovered which could affect the content, and all legal disclaimers
that apply to the journal pertain.
© 2020 Published by Elsevier.
Journal Pre-proof
The COVID-19 pandemic: The black swan for mental health care and a turning point for e-
Tim R. Wind, PhD1, Marleen Rijkeboer, PhD2 Gerhard Andersson, PhD3, & Heleen Riper,
PhD 4 5
1Foundation Centrum '45, Oegstgeest, The Netherlands | partner in Arq Psychotrauma Expert
Group, Nienoord 5, 1112 XE Diemen, The Netherlands
2Department of Clinical Psychological Science, Faculty of Psychology and Neuroscience,
Maastricht University, The Netherlands
3Department of Behavioural Science and Learning, Linköping University, Linköping, Sweden
and Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
4Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit,
Amsterdam, The Netherlands
5 Department of Research and Innovation, GGZ in Geest/Amsterdam University Medical
Center, VU University Medical Center, Amsterdam, Netherlands
In February 2020, Duan and Zhu (2020) stressed the need for a solid Chinese evidence-based
mental health care system in times of public health emergencies such as the outbreak of the
Coronavirus disease-2019 (COVID-19). That would enable treatment of people who suffer
from mental health problems in relation to the epidemic. The WHO has meanwhile labelled
the Coronavirus a pandemic, and it is now hitting Europe, the USA, and Australia hard as
well. In an attempt to reduce the risk of infections, many mental health care providers in
Journal Pre-proof
Journal Pre-proof
afflicted countries are currently closing their doors for patients who need ambulatory face-to-
face therapy. They are simultaneously trying to replace some of these contacts with digital
therapies. Most probably, European mental health care institutions have yet to experience the
full impact of the coronavirus crisis. At the same time, the demand for mental health care
among infected patients and their relatives is expected to rise (Blumenstyk, 2020). Levels of
anxiety will increase, both through direct causes including fears of contamination, stress,
grief, and depression triggered by exposure to the virus, and through influences from the
consequences of the social and economic mayhem that is occurring on individual and societal
levels. We expect that this "black swan" moment (Blumenstyk, 2020) - an unforeseen event
that changes everything - will lead to a partly, though robust, shift in mental health care
provision towards online prevention, treatment, and care in the near future. We also need to
consider the role of psychological processes and fear that may cause further harm on top of
the pandemic (Asmundson, & Taylor, 2020).
The obvious solution to continue mental health care within a pandemic is to provide mental
health care at a „warm‟ distance by video-conferencing psychotherapy and internet
interventions. A systematic review showed that videoconferencing psychotherapy show
promising results for anxiety and mood disorders (Berryhill et al., 2019), and the evidence-
base for therapist-guided internet interventions is even stronger (Andersson, 2016; ). Yet,
despite two decades of evidence-based e-mental health services, numerous barriers have
stalled the overall implementation in routine care thus far (Vis et al., 2018; Tuerk et al.,
2019). One of the most important barriers highlighted, however, has been that e-mental health
has not been integrated as a normal part of routine care practice due to the lack of acceptance
by health professionals themselves (Topocoo et al., 2017). Myths on telehealth such as “the
therapeutic alliance can only be established face-to-face” have dominated the field, in spite of
Journal Pre-proof
Journal Pre-proof
research showing the opposite (Berger, 2017). In that sense, learning curves in the adoption of
new e-mental health technologies by both patients and psychologists have progressed far
more slowly than initially expected, thus tallying with the estimate that it takes on average16
years for a health care innovation to be implemented (Rogers et al., 2017). There are however
exceptions in the world but progress is still slow.
In the Netherlands and elsewhere, we are now witnessing a phenomenon whereby the
outbreak of COVID-19 is hastening managers, ICT-staff, and clinicians to overcome all such
barriers overnight, from a pragmatic standpoint seldom seen before. The virus seems a
greater catalyst for the implementation of online therapy and e-health tools in routine practice
than two decades of many brilliant, but failed, attempts in this domain (Mohr et al., 2018).
After all, since predictions about COVID-19 are largely unclear as of yet, it is now time to
create a longer-term solution to the problem of heterogeneous patient populations, such as
those still active in the community and those that are house-bound or isolated in hospitals.
Videoconferencing and internet interventions could therefore be very helpful in mental health
care, as well as in physical care and can be easily upscaled to serve isolated regions and reach
across borders.
Thus, the “black swan virus” has already enabled wide-scale acceptance of videoconferencing
by health professionals and patients alike creating a win-win situation for both. We should
stress that e-mental health applications hold value far beyond the provision of
videoconferencing psychotherapy in the current situation of crisis. Countries hit by the
Corona virus may also consider adopting a wider public e-mental health approach, which
would focus additionally on prevention and on reaching people at risk for mental health
disorders. In this respect, not only guided but also fully self-guided interventions, such as self-
Journal Pre-proof
Journal Pre-proof
help apps or online therapeutic modules, could also be applied in settings and countries with
scarce mental health resources (Christiani & Setiawan, 2018). We should also consider the
need for treatment development (for the psychological problems caused by corona virus
isolation), which is by far more rapid in the field of internet interventions than in traditional
psychotherapy (Andersson et al., 2019).
It is likely that the response to this emergency will be more than a temporary increase in
online work (Blumenstyk, 2020). Once mental health care institutions have developed the
capabilities of serving their patients via videoconferencing and other digital technologies,
there is little reason for them to give these up, in view of the many advantages (Blumenstyk,
2020; Tuerk et al., 2019).This black swan should be a call for action by encouraging providers
to move more rapidly towards blended care models (van der Vaart et al., 2014; Kooistra et al
2019). Agility, flexibility, and resilience are essential skills for 21-st-century institutions,
particularly when unforeseen disruptive viruses and devastating events driven by climate
change are likely to be increasingly common (Blumenstyk, 2020). We urge practitioners to
promptly start adopting e-mental health care applications, both as methods to continue their
care to current patients in need and as interventions to cope with the imminent upsurge in
mental health symptoms due to the coronavirus.
Andersson, G. (2016). Internet-delivered psychological treatments. Annu. Rev. Clin.
Psychol, 12, 157-179.
Andersson, G., Titov, N., Dear, B. F., Rozental, A., & Carlbring, P. (2018). Internet-
delivered psychological treatments: from innovation to implementation. World
Psychiatry, 18, 20-28.
Journal Pre-proof
Journal Pre-proof
Asmundson, G. J. G., & Taylor, S. (2020). How health anxiety influences responses to
viral outbreaks like COVID-19: What all decision-makers, health authorities, and
health care professionals need to know. J Anxiety Disord, 71, 102211.
Berger, T. (2017). The therapeutic alliance in internet interventions: A narrative
review and suggestions for future research. Psychother Res, 27, 511-524.
Berryhill, M.B., Culmer, N., Williams, N., Halli-Tierney, A., Betancourt, A., Roberts,
H. & King, M. (2019). Videoconferencing psychotherapy and depression: A
systematic review. Telemedicine and e-Health, 25, 435-446.
Blumenstyk, G. (2020). Why coronavirus looks like a „black swan‟ moment for higher
ed. The Chronicle. Published March 11, 2020:
Christiani, Y. & Setiawan, A. (2018). Internet-based treatment of depression in
Indonesia. Lancet Psychiatry, 5, 688-689.
Duan, L. & Zhu, G. (2020). Psychological interventions for people affected by the
COVID-19 epidemic. Lancet Psychiatry, S2215-0366(20)30073-0.
Karyotaki, E., Ebert, D. D., Donkin, L., Riper, H., Twisk, J., Burger, S., … &
Cuijpers, P. (2018). Do guided internet-based interventions result in clinically relevant
changes for patients with depression? An individual participant data meta-
analysis. Clinical Psychology Review, 63, 80-92.
Kooistra, L. C., Wiersma J. E., Ruwaard J., Neijenhuijs K., Lokkerbol J., van Oppen
P., Smit F., & Riper, H. (2019). Cost and Effectiveness of Blended Versus Standard
Cognitive Behavioral Therapy for Outpatients With Depression in Routine Specialized
Mental Health Care: Pilot Randomized Controlled Trial. Journal of Medical Internet
Research, 10, e14261
Journal Pre-proof
Journal Pre-proof
Mohr, D. C., Riper, H., & Schueller, S. M. (2018). A solution-focused research
approach to achieve an implementable revolution in digital mental health. JAMA
Psychiatry, 75, 113-114.
Rogers, H., Madathil, K.C., Agnisarman, S., Narashima, S., Ashok, A., Nair, A.,
Welch, B.M. & McElligott, J.T. (2017). A systematic review of the implementation
challenges of telemedicine systems in ambulances. Telemedicine and e-Health, 23(9),
Topooco, N., Riper, H., Araya, R., Berking, M., Brunn, M., Chevreul, K., Cieslak, R.,
Ebert, D. D., Etchmendy, E., Herrero, R., Kleiboer, A., Krieger, T., García-Palacios,
A., Cerga-Pashoja, A., Smoktunowicz, E., Urech, A., Vis, C., Andersson, G., & On
behalf of the E-COMPARED consortium. (2017). Attitudes towards digital treatment
for depression: A European stakeholder survey. Internet Interv, 8, 1-9.
Tuerk, P.W., Keller, S.M. & Acierno, R. (2019). Treatment for anxiety and depression
via clinical videoconferencing: Evidence base and barriers to expanded access in
practice. Focus, 16, 363-369.
Vis, C., Mol, M., Kleiboer, A., Bührmann, L., Finch, T., Smit, J., & Riper, H. (2018).
Improving implementation of eMental health for mood disorders in routine practice:
Systematic review of barriers and facilitating factors. JMIR Mental Health, 5, e20
van der Vaart, R., Witting, M., Riper, H., Kooistra, L., Bohlmeijer, E. T., & van
Gemert-Pijnen, L. J. (2014). Blending online therapy into regular face-to-face therapy
for depression: content, ratio and preconditions according to patients and therapists
using a Delphi study. BMC Psychiatry, 14, 355.
Journal Pre-proof
... COVID-19 has further necessitated an increased adoption of e-therapy as evidenced by the robust shift to online mental health care (Asmundson & Taylor, 2020). This has further enabled a wider acceptance of web-based interventions by both providers and clients (Wind et al., 2020). In South Asian countries, there is an added advantage as it offers a more discreet option to avail of mental help, which helps to address the public stigma of mental health (Gaiha et al., 2020). ...
... The pandemic has further necessitated an increased adoption of e-therapy as evidenced by the robust shift to online mental health care (Asmundson & Taylor, 2020). This has further enabled a wider acceptance of web-based interventions by both providers and clients (Wind et al., 2020). There is a zero to minimal cost element, making it extremely affordable to implement. ...
The South Asian patriarchal and socio-cultural environment adolescent girls are raised in may disempower them, creating a perception of them being social and economic burdens (Theerthaana & Manzoor, 2018). South Asian American youth born of immigrant parents also face this gendered double standard and patriarchal attitude (Ragavan et al., 2018). Prevention and promotive-based programs for adolescents is a protective factor, as it supports and builds resilience, self-esteem and acts as a buffer against the potential occurrence of a mental illness (Martyn-Nemeth et al., 2009; WHO, 2020). The adolescence period provides a significant and dynamic developmental opportunity (Morton & Montgomery, 2013; Steinberg, 2014) to positively influence and foster strengths, skills, and attitudes. Despite South Asia having the largest population of adolescent girls worldwide (UNICEF, 2011), there is a paucity of such initiatives. This dissertation aimed to fill this gap. The development of the Go Girls- e-Huddle practice manual is presented as a culturally competent online group intervention for enhancing the resilience and self-esteem of adolescent girls raised in South Asian families (AGRSAF). It is developed as a digital resource that allows for increased accessibility and is designed for a non-clinical population that is led by a culturally responsive facilitator. The content, pedagogical design, intervention strategy, and methodology of the Go-Girls e-Huddle program was grounded and informed by four sources of information- evidence-based research, sound theoretical frameworks, focus group discussions (FGD) that captured the lived experience of AGRSAF, and consultations with subject matter experts. A qualitative thematic analysis of the FGD data was conducted to identify key content and design elements that were meaningful and culturally relevant. The Go-Girls e-Huddle practice manual is submitted as a ready-to-use, comprehensive yet flexible resource guide, that includes sections on effective facilitation skills, seven detailed session plans, digitally available worksheets, and supporting PowerPoints.
... A promising approach is the use of internet-based self-help interventions since they do not require direct on-site contact and are easily scalable (17)(18)(19). Studies indicate that internetbased self-help interventions are an effective treatment option for various psychological problems, including depressive symptoms (20,21). ...
Full-text available
IntroductionFirst evidence suggests that internet-based self-help interventions effectively reduce COVID-19 related psychological distress. However, it is yet unclear which participant characteristics are associated with better treatment outcomes. Therefore, we conducted secondary analyses on data from a randomized controlled trial investigating the efficacy of a 3-week internet-based self-help intervention for COVID-19 related psychological distress. In this exploratory analysis, we examined several predictors ranging from sociodemographic variables to psychological distress, resource-related, and treatment-related variables. This includes, for example, age, motivation, and emotion regulation skills. Treatment outcomes were defined as post-treatment depressive symptoms and post-treatment resilience.Methods In a total of 107 participants with at least mild depressive symptoms, possible predictor variables and treatment outcomes were assessed using self-report measures. For example, emotion regulation skills were assessed by the Self-report measure for the assessment of emotion regulation skills. In a first step, we performed a separate linear regression analysis for each potential predictor. In a second step, predictors meeting a significant threshold of p < 0.05 were entered in linear multiple regression models. Baseline scores of the respective outcome measure were controlled for.ResultsThe mean age of the participants was 40.36 years (SD = 14.59, range = 18–81 years) with the majority being female (n = 87, 81.3%). Younger age predicted lower post-treatment depressive symptoms. Additionally, higher motivation to use the intervention and better pre-treatment emotion regulation skills predicted higher post-treatment resilience.Conclusion The current study provides preliminary evidence regarding the relationship between participant characteristics and treatment outcome in internet-based self-help interventions for COVID-19 related distress. Our results suggest that under the circumstances surrounding COVID-19 such interventions might be particularly beneficial for young adults regarding depressive symptoms. Moreover, focusing on participants' existing strengths might be a promising approach to promote resilience through internet-based self-help interventions. However, since this was an exploratory analysis in an uncontrolled setting, further studies are needed to draw firm conclusions about the relationship of participant characteristics and treatment outcome in internet-based self-help interventions for COVID-19 related psychological distress.
... Çin'de, sağlık otoriteleri ve akademik kuruluşlar tarafından birçok rehber ve uzman konsensüsü geliştirilmiştir. Online eğitim ve danışmanlık hizmetleri ile ruh sağlığı girişimleri ülke çapında yaygın olarak benimsenmiştir (1,(25)(26)(27) . ...
Full-text available
Yeni koronavirüsün (COVID-19) neden olduğu enfeksiyon Çin'de başlamış ve tüm dünyaya yayılmıştır. Dünya Sağlık Örgütü tarafından bu durum pandemi olarak ilan edilmiştir. COVID-19, tüm dünya için ruh sağlığı dahil olmak üzere yaşamın her alanında zorluklar ortaya çıkarmaktadır. Hastalığın verdiği stres dışında, evde kalma, damgalama, sosyal mesafe, karantina ve izolasyon durumları ruh sağlığının bozulmasına neden olmaktadır. COVID-19 salgını; bireylerde anksiyete, stres, depresyon, post travmatik stres bozukluğu ve korkuya yol açmaktadır. Pandemilerde her birey için ruh sağlığı bakımı farklı düzeylerde (koruma, yükseltme ve klinik bakım) olmaktadır. Bireyler, aileleri ve sağlık profesyonelleri aracılığı ile duygusal desteğe ihtiyaç duyabilmektedir. İzolasyon durumlarında online hizmetlerle ruhsal sağlık hizmetlerinin sürdürülmesi gerekmektedir. Ayrıca medya, COVID-19'da ruh sağlığı için bir tehdit oluşturmaktadır. Bu sebeple güvenilir kaynaklardan güncel bilgiler edinilmelidir. Ayrıca hastanede ön cephedeki sağlık çalışanları enfekte olma ve virüsü ailelerine yayma korkusu yaşayabilmektedir. Sağlık çalışanlarının, ailelerine bulaştırma korkusunu azaltmak için kalacak yer, yeterli koruyucu ekipman; COVID-19'lu hastaların tedavisi, bakımı ve psikolojik sorunları için eğitim ve sağlık personeline psikolojik destek verilerek ruh sağlığı korunabilir. Bu derlemede, COVID-19'un ruh sağlığına olası etkilerinin açıklanması ve ruh sağlının korunması için yapılması gerekenler amaçlanmıştır.
... In reaction to the constraints of the pandemic, various services-ranging from employment and education to leisure activities and healthcare-abruptly moved from the analogue to the digital space (Bokolo, 2020;Feijt et al., 2020;Lee, 2020;Nagel, 2020;Petts et al., 2021;Vargo et al., 2021). In the domain of mental health, outpatient psychotherapeutic treatments often experienced this transition when moving from conventional F2F to VCT (Sammons et al., 2020;Wind et al., 2020). ...
Full-text available
Videoconferencing psychotherapy (VCT) is an effective treatment option. Yet, it is unclear whether a similar therapeutic alliance as in conventional face‐to‐face psychotherapy (F2F) can be achieved, since previous studies yielded mixed results. Furthermore, surveys about the attitudes towards VCT amongst patients have been missing until now. The current study gathered opinions from patients and psychotherapists about the perceived comparability of VCT and F2F regarding contextual factors and treatment characteristics, focusing on therapeutic alliance and empathy. An online survey amongst patients (N = 189) and practitioners (N = 57) taking part in cognitive behavioural therapy was conducted after the first lockdown in Germany due to the COVID‐19 pandemic and a resulting transition from F2F to VCT for most participants. While patients experienced therapeutic alliance and empathy as comparable, psychotherapists indicated advantages of F2F. Both groups indicated advantages of F2F for the therapy contents and expressed advantages of VCT for flexibility regarding location and time. More than half of the participants expressed a preference for a combination of analogue and digital therapy. The perceived disadvantages of VCT can be addressed, for example, with training programmes for psychotherapists targeting communication in VCT and adapting established psychotherapy methods to a digital format to further improve VCT.
Growth in e‐mental health services in the past decade has been significant, corresponding with rising rates of mental health concerns and amplified by social isolation strategies imposed by the COVID‐19 global pandemic. Governments, mental health services and practitioners have identified this as a significant area for investment and highlight its capacity for widespread reach, prevention and early intervention. At a time of growth and investment, it is critical to evaluate the extent to which online mental health platforms are effective in reaching the diverse populations they aim to serve. The current study used content analysis to evaluate 33 Australian mental health websites receiving government funding for the availability of translated materials and resources for culturally and linguistically diverse people. The websites analysed covered a range of mental health topics and overall had limited translated materials available. Only four websites (12.12%) provided a translation tool and none of the interactive tools offered, such as web chat services, were available in languages other than English. From a total of 1100 subsections across all websites, eight subsections (0.73%) were specifically targeting populations identifying as culturally and linguistically diverse. Strategic reconsideration and investment are required to enhance the capacity of current mental health platforms to engage and support the mental health needs of the diverse communities they intend to serve. The research and its findings can provide a basis for research and reflection within other health and social services as online platforms proliferate.
Introduction: Tele-medicine services have been developed in response to the COVID-19 pandemic, which disrupts mental health services. The present study investigates the effectiveness of telephone-delivered services for psychological disorders in the COVID-19 pandemic. Methods: We searched PubMed/Medline, Embase and Cochrane Controlled Register of Trials for relevant clinical studies up to February 1, 2022. Following terms were used: "severe acute respiratory syndrome", "Coronavirus", "Coronavirus infection", "SARS-CoV-2", "COVID-19", "mental disorder", "mental health", "mental health program", "mental health service", "psychiatric service", "telemedicine", "Telehealth", "Tele-health", "Telecare", "Mobile health". Results: Twelve relevant clinical articles were included in our study. Eight articles were parallel randomized controlled trials (RCTs), two were Quasi-experimental, and one was a multicenter retrospective cohort study. A total of 1900 adults (18 years old or above that) were included. Online telecommunication methods like online apps and videoconference were the most common interventions. The most prevalent measured outcome was levels of anxiety and depression among participants. Eleven out of 12 articles showed a significant association between telemedicine and mental health improvement. Conclusions: The included studies in the current systematic review reported the probable efficacy of telemedicine in improving mental health disorders during the COVID-19 pandemic. But it is not possible to determine the best telecommunication method for each mental disorder in different populations and the preference of patients is still face to face therapy. So RCTs in different populations with previous mental disorders or chronic diseases are required to investigate the further telemedicine's efficacy on managing mental problems.
COVID-19 has not only killed and infected millions of people worldwide but has also resulted in unprecedented psychosocial stressors that continue to have profound mental health consequences for many people, exacerbating pre-existing psychological suffering and contributing to the onset of new stress related conditions. It has also resulted in a major revolution in the delivery of mental health treatment abruptly shifting psychotherapeutic practice to online technology. Psychotherapists need to be prepared for how their clinical work may change. This qualitative research study has been phenomenological in nature, attempting to capture and contribute to the literature on the lived experience of psychotherapists in navigating the transition through a global pandemic and exploring how the accompanying shift to telehealth has impacted clinical practice and the therapeutic relationship, if at all. A single-session, semi-structured interview lasting approximately one hour was conducted over Zoom with 15 mental health clinicians certified in an integrative psychotherapeutic attachment-based treatment model Accelerated Experiential Dynamic Psychotherapy (AEDP). Research findings and data were analyzed using a thematic coding process and principles of grounded theory. Significant findings of this study included the identification of factors that might negatively impact the online therapeutic relationship and the recognition of ways to strengthen and enhance telehealth effectiveness with an attachment-based and relational lens. Advantages and disadvantages of telehealth practice were identified and explored in addition to the effects of shared trauma on the therapeutic relationship and the post-traumatic growth and resilience of the therapist. Implications for theory, practice and social work education are discussed. Limitations included the small size and homogeneity of the study sample.
Full-text available
The current COV-19 pandemic increases the need for remote treatment. Among several provision strategies, tele groups have been tested as an efficient option. Still, the number of studies is comparably low, with a clear lack of studies investigating supposed treatment mechanisms. Sixty-one mildly to moderately depressed participants from Salzburg, Bavaria, and Upper Austria were randomized to the intervention or a waiting list control group (RCT). The seven-week treatment comprised preparatory online modules, followed by personalized feedback and a subsequent tele group session. Large treatment effects were observed for depression (CES-D: d=0.99, p<.001; PHQ-9: d=0.87, p=.002), together with large effects for cognitive behavioral skills (cognitive style, and behavioral activation, d=0.88-0.97). Changes in skills mediated treatment outcomes for CES-D and PHQ-9, suggesting comparable mechanisms as in face-to-face therapy. Two typical moderators, therapeutic alliance, and group cohesion, however, failed to predict outcome (p=.289), or only exhibited statistical tendencies (p=.049 to .071). Client satisfaction, system usability, and treatment adherence were high. Blending Internet-based and tele group interventions offers additional options for low-threshold care that is less dependent on population density, commuting distances, or constraints due to the current COV-19 crisis. Results indicate that the blended intervention is clinically effective by fostering core CBT skills. While findings suggest the notion that working alliance and group cohesion can be established online, their relevancy for outcomes of blended treatment needs to be further investigated.
Background/objective Poor subjective well-being is a risk factor for poor health; and threatens school administrators' leadership roles and overall occupational and personal outcomes. Online digital care and coaching such as Zoom-delivered GROW (Z-GROW) coaching may be an invaluable approach to building resilience and improving well-being. This study investigated the effectiveness of the Z-GROW coaching model in enhancing self-reported well-being in a sample of school administrators in South-East Nigeria. Method A randomized control trial was conducted with a sample of 109 school administrators who met the inclusion criteria. Participants were allocated into Z-GROW (N = 55) and waitlist control (N = 54) groups. A 2-hour Z-GROW programme was delivered to the Z-GROW intervention group weekly for 9 weeks. Subjective well-being was measured using the Satisfaction with Life Scale (SWLS), the Scale of Positive and Negative Experience (SPANE), and the Flourishing Scale (FS). Data were collected on three occasions: pre-intervention, post-intervention, and follow-up using the same measures. All data were analyzed using descriptive and inferential statistics. The presentation of data was supported by figures and charts. Results Results revealed that school administrators' three dimensions of subjective well-being significantly improved following the Z-GROW intervention. It was further shown that the improved state of participants was sustained through a 3-monthfollow-up assessment. Conclusion Based on the findings, it can be concluded that intervention using GROW coaching in the zoom platform improves the self-reported well-being of school administrators. The outcomes of this study present the Z-GROW model as a viable intervention for subjective well-being and other mental health conditions among school administrators. Through the Z-GROW model, employees can access occupational health coaching from the comfort of their homes.
Full-text available
Introduction: Depression is the leading cause of disability in the world. Despite the prevalence of depression, a small proportion of individuals seek mental health services. A cost-effective method for increasing access to mental health services is the implementation of telemental-health programs. This review aims to summarize the state of the field on the efficacy and effectiveness of videoconferencing psychotherapy (VCP) for the treatment of depression. Materials and methods: Systematic literature searches were performed using PsychINFO, PubMed, and EMBASE. Specific inclusion criteria were used to identify controlled and uncontrolled studies evaluating VCP for the treatment of depression. Data extraction included study assessment quality, research design, sample size, intervention details, outcome results, intervention effect size, and statistical differences between VCP and in-person (IP) therapy. Results: Of the 1,424 abstracts screened, 92 articles were critically reviewed. Thirty-three articles were included in the review, with 14 randomized controlled studies, 4 controlled nonrandomized studies, and 15 uncontrolled studies. Sample size ranged from 1 to 243 participants. Twenty-one studies reported statistically significant reductions in depressive symptoms following VCP, and the median effect size for studies ranged from medium to the very large range. Most controlled studies reported no statistical differences between VCP and IP groups receiving the same intervention. Conclusions: VCP for the treatment of depression is a promising method for delivering mental health services. More rigorous research is needed to evaluate VCP on depression in various contexts and participants.
Full-text available
Background: Electronic mental health interventions (eMental health or eMH) can be used to increase accessibility of mental health services for mood disorders, with indications of comparable clinical outcomes as face-to-face psychotherapy. However, the actual use of eMH in routine mental health care lags behind expectations. Identifying the factors that might promote or inhibit implementation of eMH in routine care may help to overcome this gap between effectiveness studies and routine care. Objective: This paper reports the results of a systematic review of the scientific literature identifying those determinants of practices relevant to implementing eMH for mood disorders in routine practice. Methods: A broad search strategy was developed with high sensitivity to four key terms: implementation, mental health care practice, mood disorder, and eMH. The reach, effectiveness, adoption, implementation, and maintenance (RE-AIM) framework was applied to guide the review and structure the results. Thematic analysis was applied to identify the most important determinants that facilitate or hinder implementation of eMH in routine practice. Results: A total of 13,147 articles were screened, of which 48 studies were included in the review. Most studies addressed aspects of the reach (n=33) of eMH, followed by intervention adoption (n=19), implementation of eMH (n=6), and maintenance (n=4) of eMH in routine care. More than half of the studies investigated the provision of mental health services through videoconferencing technologies (n=26), followed by Internet-based interventions (n=20). The majority (n=44) of the studies were of a descriptive nature. Across all RE-AIM domains, we identified 37 determinants clustered in six main themes: acceptance, appropriateness, engagement, resources, work processes, and leadership. The determinants of practices are expressed at different levels, including patients, mental health staff, organizations, and health care system level. Depending on the context, these determinants hinder or facilitate successful implementation of eMH. Conclusions: Of the 37 determinants, three were reported most frequently: (1) the acceptance of eMH concerning expectations and preferences of patients and professionals about receiving and providing eMH in routine care, (2) the appropriateness of eMH in addressing patients' mental health disorders, and (3) the availability, reliability, and interoperability with other existing technologies such as the electronic health records are important factors for mental health care professionals to remain engaged in providing eMH to their patients in routine care. On the basis of the taxonomy of determinants of practices developed in this review, implementation-enhancing interventions can be designed and applied to achieve better implementation outcomes. Suggestions for future research and implementation practice are provided.
Full-text available
Digital mental health (DMH) interventions have promised to revolutionize mental health care by increasing its accessibility, availability, attractiveness, and cost-effectiveness. The first generation of web-based DMH interventions have consistently been found to be clinically effective for common mental disorders, such as depression and anxiety, in more than 100 randomized clinical trials (RCTs) and meta-analyses, particularly when accompanied by low-intensity coaching.¹ Inspired by this research, numerous health care systems have attempted to implement DMH interventions to address the large burden of mental health. However, these real-world implementation efforts have failed, often because they are not used by patients or therapists. This large research to practice gap suggests failures at many points, including DMH intervention design, research methods, and implementation approaches. The promised revolution in mental health will require a paradigm shift that addresses all 3 components to overcome the design, research, and routine care chasms.
This review summarizes six decades of clinical outcome research relevant to evidence-based practices for depression and anxiety delivered via clinical videoconferencing. The authors conducted a literature search of previous systematic reviews and an updated search of publications specific to anxiety and depression. Overall, strong evidence supports the safety and clinical effectiveness of administering evidence-based psychotherapy for anxiety and depression via clinical videoconferencing among heterogeneous populations and age ranges, and in multiple care settings, with similar outcomes to in-person care. Despite the overall clinical effectiveness of the modality, the authors discuss common logistical and institutional barriers to long-term effective implementation. Future systems-level research is required to investigate replicable and sustainable models for implementing and expanding access to evidence-based psychotherapies via clinical videoconferencing.
Background: Cognitive behavioral therapy (CBT) is an effective treatment, but access is often restricted due to costs and limited availability of trained therapists. Blending online and face-to-face CBT for depression might improve cost-effectiveness and treatment availability. Objective: This pilot study aimed to examine the costs and effectiveness of blended CBT compared with standard CBT for depressed patients in specialized mental health care to guide further research and development of blended CBT. Methods: Patients were randomly allocated to blended CBT (n=53) or standard CBT (n=49). Blended CBT consisted of 10 weekly face-to-face sessions and 9 Web-based sessions. Standard CBT consisted of 15 to 20 weekly face-to-face sessions. At baseline and 10, 20, and 30 weeks after start of treatment, self-assessed depression severity, quality-adjusted life-years (QALYs), and costs were measured. Clinicians, blinded to treatment allocation, assessed psychopathology at all time points. Data were analyzed using linear mixed models. Uncertainty intervals around cost and effect estimates were estimated with 5000 Monte Carlo simulations. Results: Blended CBT treatment duration was mean 19.0 (SD 12.6) weeks versus mean 33.2 (SD 23.0) weeks in standard CBT (P<.001). No significant differences were found between groups for depressive episodes (risk difference [RD] 0.06, 95% CI -0.05 to 0.19), response to treatment (RD 0.03, 95% CI -0.10 to 0.15), and QALYs (mean difference 0.01, 95% CI -0.03 to 0.04). Mean societal costs for blended CBT were €1183 higher than standard CBT. This difference was not significant (95% CI -399 to 2765). Blended CBT had a probability of being cost-effective compared with standard CBT of 0.02 per extra QALY and 0.37 for an additional treatment response, at a ceiling ratio of €25,000. For health care providers, mean costs for blended CBT were €176 lower than standard CBT. This difference was not significant (95% CI -659 to 343). At €0 per additional unit of effect, the probability of blended CBT being cost-effective compared with standard CBT was 0.75. The probability increased to 0.88 at a ceiling ratio of €5000 for an added treatment response, and to 0.85 at €10,000 per QALY gained. For avoiding new depressive episodes, blended CBT was deemed not cost-effective compared with standard CBT because the increase in costs was associated with negative effects. Conclusions: This pilot study shows that blended CBT might be a promising way to engage depressed patients in specialized mental health care. Compared with standard CBT, blended CBT was not considered cost-effective from a societal perspective but had an acceptable probability of being cost-effective from the health care provider perspective. Results should be carefully interpreted due to the small sample size. Further research in larger replication studies focused on optimizing the clinical effects of blended CBT and its budget impact is warranted. Trial registration: Netherlands Trial Register NTR4650; International registered report identifier (irrid): RR2-10.1186/s12888-014-0290-z.
Internet interventions, and in particular Internet‐delivered cognitive behaviour therapy (ICBT), have existed for at least 20 years. Here we review the treatment approach and the evidence base, arguing that ICBT can be viewed as a vehicle for innovation. ICBT has been developed and tested for several psychiatric and somatic conditions, and direct comparative studies suggest that therapist‐guided ICBT is more effective than a waiting list for anxiety disorders and depression, and tends to be as effective as face‐to‐face CBT. Studies on the possible harmful effects of ICBT are also reviewed: a significant minority of people do experience negative effects, although rates of deterioration appear similar to those reported for face‐to‐face treatments and lower than for control conditions. We further review studies on change mechanisms and conclude that few, if any, consistent moderators and mediators of change have been identified. A recent trend to focus on knowledge acquisition is considered, and a discussion on the possibilities and hurdles of implementing ICBT is presented. The latter includes findings suggesting that attitudes toward ICBT may not be as positive as when using modern information technology as an adjunct to face‐to‐face therapy (i.e., blended treatment). Finally, we discuss future directions, including the role played by technology and machine learning, blended treatment, adaptation of treatment for minorities and non‐Western settings, other therapeutic approaches than ICBT (including Internet‐delivered psychodynamic and interpersonal psychotherapy as well as acceptance and commitment therapy), emerging regulations, and the importance of reporting failed trials.