ABSTRACT
Background: A substantial proportion of individuals with spinal cord injury (SCI) experience depression, which has been negatively associated with recovery and community participation after injury. Despite significant barriers to seeking and receiving in-person mental health care, little research has focused on the efficacy of telepsychology among individuals with SCI. Objectives: To describe the design and implementation of an ongoing single-center, randomized controlled, video-based cognitive behavioral therapy (CBT) intervention among individuals with SCI. Methods: Participants within 1 year of SCI will be randomized 1:1 to intervention or usual care in a 24-week study. Intervention participants will engage in 10 sessions of CBT over 12 weeks with a licensed clinical psychologist, using iPads via Apple FaceTime. Primary outcomes are depressive symptomatology, anxiety, and life satisfaction (as measured by the Patient Health Questionnaire-9, Generalized Anxiety Disorder-7 and Satisfaction with Life Scale, respectively) measured at three time points (baseline, 12 weeks, and 24 weeks). These and other measures are also assessed during monthly telephone surveys conducted between primary timepoints. Results: Recruitment is ongoing. Forty-six participants have been enrolled thus far. Conclusion: Telepsychology is a convenient, flexible, and effective alternative to traditional in-person services. We anticipate that intervention participants will experience improvements in depressive and anxiety symptoms and will have greater life satisfaction. Telepsychology interventions among individuals with SCI are tasked to maintain participant privacy, provide assistive technology and/or engage caregivers to minimize mobility limitations, and manage risk remotely. Challenges encountered include recruitment during the COVID-19 pandemic. Early intervention on symptoms of psychological morbidity using telepsychology may facilitate greater adaptation following SCI.
Subject(s)
COVID-19 , Cognitive Behavioral Therapy , Self-Help Devices , Spinal Cord Injuries , Humans , Pandemics , Randomized Controlled Trials as TopicABSTRACT
To characterize domains of life stressors encountered by individuals with acute spinal cord injury (SCI) and change in psychological distress in the context of tele-cognitive behavioral therapy (tele-CBT). A within-arm (tele-CBT) mixed methods analysis in an ongoing randomized controlled trial to assess the efficacy of CBT telepsychology intervention on depressive symptomology, secondary symptoms (anxiety), and quality of life (QoL). Community setting. Fifteen individuals (Demographics: mean injury age=47.93years [SD=20.17], 53.3% male, 26.7% White;Injury Characteristics: time since injury mean=67.97days [SD=53.36], 66.7% traumatic etiology, 46.7% tetraplegia, 33.3% complete SCI) with acute SCI. The intervention group received 10 tele-CBT sessions over 12 weeks via Apple's FaceTime application with a licensed psychologist specializing in treating individuals with SCI. Session adhered to the basic structure outlined in Wenzel et al. (2011)1 and the study psychologist used individualized behavioral and/or cognitive strategies. Domains of life stressors qualitatively coded from CBT therapy notes. Patient Health Questionnaire-9 (PHQ-9)2 and Generalized Anxiety Disorder-7 (GAD-7)3 measured each session. Findings are preliminary as the study is ongoing. Participants attended an average of 9.8 CBT sessions. Thirty life stressors typically associated with psychological distress were identified from participants' CBT notes. The most frequently concerns were pain (73.3%), relationship issues (66.7%), sleep problems (60.0%), other non-SCI medical concerns (46.7%), COVID-19 (46.7%), UTIs (40.0%), perceived burden (26.7%), fatigue (26.7%), and returning to work (26.7%). At the first CBT session, the average PHQ-9 and GAD-7 total scores were 7.00 (SD= 3.72) and 5.80 (SD= 4.42). Over the course of therapy, symptoms of depression and anxiety decreased (PHQ-9:B=-0.346, SE=0.051, p<.001;GAD-7:B=-0.232, SE=0.109, p<.05). Individuals with acute SCI experience a diverse range of challenges that may impact mood.4–6 Although the majority of concerns and life stressors endorsed were medical, a substantial number were related to relationships, perceived burden, and resumption of functional roles.5 Tele-CBT provided by an SCI specialist may be an effective intervention to support adjustment and bolster against life stressors after acute SCI. The authors have no disclosures to report.