Rehabilitation needs after critical illness: Referral outcomes from a ICU follow up clinic in Northern Ireland

Introduction: In 2019/20 a total of 171,900 people were admitted to adult general intensive care units (ICU) across England, Wales and Northern Ireland, with a survival rate of 79.6% at hospital discharge.1 Patients who survive critical illness and admission to ICU often experience ICU-related long-term physical and non-physical impairments and disability following hospital discharge.2 National guidance advocates multidisciplinary team (MDT) follow up to identify and manage the unmet health needs of this patient population.3-4 The UK has seen an increase in the number of follow up services available in the last 7 years.2 The Covid-19 pandemic further highlighted the need to provide this service, locally resulting in the establishment of the Belfast Health and Social Care Trust (BHSCT) ICU follow up clinic in July 2020. The follow up clinic is offered to patients aged = 18 years, an ICU length of stay of = 4 days, who have been discharged from an inpatient setting within the last 12 weeks and do not receive follow up from any other established care pathway. The clinic consists of an ICU Nurse, Doctor, Clinical Psychologist and Physiotherapist. Patients are offered either a virtual, face-to-face or telephone appointment. Objective(s): To identify unmet rehabilitation needs and onward referral requirements of patients presenting at an ICU follow-up clinic in Northern Ireland. Method(s): Data was gathered retrospectively using an excel database detailing patient demographics, appointment details and onward referrals generated from the clinic. Data was analysed for a set time period between the 01/12/2021 - 09/02/2022. The type of referral and the profession responsible were captured. Result(s): During the time period eight post ICU follow up clinics were completed. A total of 36 patient's attended (14 male and 22 female). Six appointments were attended virtually via MS Teams, 12 via telephone and 18 face-to-face. Twenty-three (64%) of the patients required at least one onward health referral. A total of 61 onward health referrals were generated from this population. Table 1 details the number of onwards referrals by speciality. Conclusion(s): Approximately 64% of patients who attended the post ICU follow up clinic, during a 10 week period, demonstrated unmet rehabilitation needs resulting in onward health referrals. This data supports the need for a post ICU follow up clinic at BHSCT to identify ongoing need, ensure transition of care to relevant services and optimise patient's physical and psychological outcomes. One limitation of this study is that not all recommended allied health professionals are commissioned for the clinic which may impact on the health needs identified. Future work should consider the impact of this and discussions regarding the need for a commissioned post ICU follow up clinic which is truly MDT for this patient population should be considered.

Experiences and preferences of Healthcare Professionals using telegenetics in a UK Clinical Genetics centre during the COVID-19 pandemic

Background/Objectives: The changes and restrictions precipitated by the COVID-19 pandemic have led to innovation in Clinical Genetics service delivery worldwide. At the Guy's and St Thomas' (GSTT) Clinical Genetics Service, telegenetics was implemented at the beginning of the pandemic using the AttendAnywhere videoconferencing platform. We subsequently designed a qualitative study to capture experiences and preferences of Healthcare Professional's (HCP) using this service delivery model. Method(s): We conducted semi-structured interviews with seven HCPs working at the GSTT Clinical Genetics Service, including Genetic Counsellors, Clinical Geneticists and a Clinical Psychologist. Interview content was analysed using a thematic analysis approach. Result(s): We present HCPs' experiences of transitioning between virtual and in-person appointments and their appraisal of the technical and practical aspects of telegenetics. We also present themes that emerged about how HCPs' clinical practice has changed to adapt to telegenetics, as well as differences in both patients' and HCPs' attitudes towards virtual appointments when compared to in-person encounters. Future considerations will be shared regarding the suitability of telegenetics for Clinical Genetics appointments. Conclusion(s): Based on their experience at GSTT, HCPs interviewed would welcome the addition of telegenetics to the Clinical Genetics toolkit beyond the COVID-19 pandemic, and we will provide considerations for future guidelines.

Everybody hurts - What can physical health professionals learn about how mental health professionals support their own emotional resilience and mental health?

The physical aspects of ultrasonography, difficult posture with prolonged pressure exertion, have been extensively researched and addressed with advances in machine ergonomics, operator awareness of posture and positioning and workplace tools to identify musculoskeletal problems. The mental stresses are less well recognized and have only recently started getting investigated. Ultrasonography is a mentally challenging activity requiring long periods of intense concentration, empathy and communication of complex and often difficult information to patients and clinicians, all of which carries an emotional toll. Practitioners are also under increasing time and caseload pressures exacerbated by COVID recovery and chronic fatigue from two years of pandemic. A survey of UK obstetric sonographers showed 92.1% and 91.0% met the burnout thresholds for exhaustion and disengagement, respectively).1 While many Trusts provide training to support physical health, few radiology departments educate their staff on emotional resilience or offer regular support to either promote or maintain mental wellbeing. Training, when available, is often focused on the receiver and not on the impact of vicarious traumas experienced as a result of repeatedly discovering/delivering difficult outcomes to patients on a regular and prolonged basis. Few health professionals are face-to-face with their patient at point of significant discovery whether that information is imparted to the patient or not. Mental health professionals have adopted a traumainformed stance into their working practices. This has not only informed the direct clinical work with patients but is also evident in the way the workforce is supported by the trust. Regular supervision, reflective practice and debriefs are required and monitored by the trust, based on research in clinical psychology to inform best practice. Some of these practices could be applied to physical health professionals to address some of the emotional burdens experienced as part of day-to-day delivery of care.

Similar symptoms at 3 months post discharge in ICU, COVID-19 ICU, and COVID-19 patients that received non-invasive ventilation in high dependency areas

Introduction: It is well documented that survivors of ICU admissions struggle to return to pre-admission level of function because of both physical and psychological burden. Current guidance therefore recommends a follow-up service to review patients 2-3 months post discharge from ICU [NICE 2009]. Prior to 2020 University Hospitals Bristol and Weston (UHBW) had no such service. With the increase in patient numbers seen during the COVID-19 pandemic, funding was received to provide a follow-up clinic to COVID-19 survivors. Spare clinic spaces were used for non COVID ICU patients. Objective(s): To review symptoms reported by patients in the following 3 groups, COVID-19 patients treated in ICU (COVID ICU), COVID-19 patients treated with continuous positive airway pressure ventilation in high dependency areas (COVID CPAP) and non COVID-19 ICU patients (ICU), at 2-3 months post discharge from UHBW. Method(s): Referred patients had an initial phone call at 8 weeks post discharge. The call identified both physical and psychological symptoms. Advice regarding recovery, signposting to resources and onwards referrals to appropriate specialities were provided. If symptoms indicated, patients would then be referred into the multidisciplinary team follow up clinic. Here they met with an intensivist, clinical psychologist, physiotherapist, occupational therapist, speech and language therapist and dietitian. Result(s): As Graph 1 shows all 3 patient groups had a wide variety of ongoing symptoms at 2-3 months post discharge. Fatigue was the most common symptom reported in all 3 groups. Breathlessness was the second most common symptom reported by COVID patients but was less frequently reported in the ICU population who had a variety of non-respiratory related reasons for admission. COVID ICU patients more commonly reported ongoing problems with their swallowing, voice and communication compared to the COVID CPAP group, most probably due to invasive ventilation. Psychological burden post critical illness was high in all 3 groups. More than 20% of all patients scored =10 on a PHQ-9 depression scale showing moderate to severe depression. More than 15% of all patients scored =10 on a GAD-7 showing moderately severe to severe anxiety. COVID ICU group had the highest incidence of post-traumatic stress disorder (PTSD). This may be linked to the higher level of delirium we saw in this group, as a result of change in practice, such as full PPE and absence of visiting during the pandemic. ICU patients presented with a significantly higher percentage of physiotherapy needs. This is likely because patients with the longest and most complex ICU admissions were selected for the clinic. Sleep likely goes under reported in these results as we only began questioning specifically about this later on in the clinic. Conclusion(s): This data goes some way in supporting current literature that the rehabilitation needs of COVID ICU patients equal that of ICU patients (Puthucheary et al 2021). It also shows the need to follow up patients who receive advanced respiratory support outside of the ICU environment, as their symptoms, and therefore rehabilitation needs are very similar to ICU patients at 2-3 months post discharge.

ICU follow-up clinic provides the opportunity to recognise and address symptoms post critical illness, which may otherwise have been missed

Introduction: It is well documented that survivors of ICU admissions struggle to return to pre-admission level of function because of both physical and psychological burden. Current guidance therefore recommends a follow-up service to review patients 2-3 months post discharge [NICE 2009]. Prior to 2020 University Hospitals Bristol and Weston had no such service. With the increase in patient numbers seen during the COVID-19 pandemic, funding was received to provide a follow-up clinic to COVID-19 survivors. Objective(s): To provide a service that supports and empowers patients with their recovery from critical illness. Improving quality of life, speed of recovery and reducing longer term health care needs. Method(s): Referral criteria for the clinic included COVID-19 patients who received advanced respiratory support within intensive care and the high dependence unit. 8 weeks post discharge patients had a telephone appointment where ongoing symptoms could be identified. Advice around recovery, signposting to resources and onward referrals to appropriate specialities were provided. At 10 weeks post discharge patients had lung function tests and a chest X-ray which were reviewed by respiratory consultants. Based on the combination of these assessments, patients would be discharged or referred into the multidisciplinary team (MDT) follow-up clinic. The face to face clinic consisted of appointments with an intensivist, clinical psychologist, physiotherapist, and occupational therapist. Where needed patients would also be seen by a speech and language therapist or dietitian. Patients were seen only once in follow up clinic but again would be referred onto appropriate services within trust or the community, including but not exclusively community therapy services, secondary care services, SALT, dietetic or psychology clinics. Result(s): One of the key outcomes was the need for 147 onward referrals (an average of 1.13 referrals per patient). This included, 31 referrals to musculoskeletal physiotherapy outpatients for problems originating or made worse by their admission. 20 referrals to secondary care, including cardiology and ENT. 16 referrals to community occupational therapy, for provision of equipment, home adaptations and support in accessing the community. Subjectively, patient feedback was excellent. When asked what they felt was the most valuable thing they had taken from the clinic they reported: "Reassurance";"To know I'm not alone, others feel like this";"They listened to me and gave advice";"The ability to ask anything I wanted and the obvious kindness and support from all the clinicians I saw". Conclusion(s): Onward referral rates made by the follow-up clinic highlight the many issues faced by patients following discharge from ICU and hospital. With timely recognition and management, we can prevent a majority of these symptoms manifesting into chronic problems. This has the potential to lower the long-term burden on health care and improve quality of life for patients in both the short and long term. Without the follow-up clinic, these issues may have been missed or delayed. This reinforces the importance of the follow-up clinic and the need for ongoing investment.

Longitudinal Findings on the Oneiric Activity Changes Across the Pandemic.

Purpose: COVID-19 pandemic waves have strongly influenced individuals' behaviors and mental health. Here, we analyzed longitudinal data collected in the Spring 2020 and 2021 from a large Italian sample with the aim of assessing changes in dream features between the first and third wave. Specifically, we evaluated the modifications of pandemic dream activity as a function of the general distress variations over time. Also, we detected the best explanatory variables of nightmare frequency and distress. Materials and Methods: Participants previously involved in the web survey during the first wave of the pandemic were asked to complete a new online survey on sleep and dream features available in Spring 2021 (N=728). Subjects decreasing their level of psychological general distress in the third (T3) vs the first (T1) pandemic wave were defined as "Improved" (N=330). In contrast, participants with an unchanged or increased level of general distress were defined as "Not Improved" (N=398). Results: Statistical comparisons revealed that dream recall frequency, nightmare frequency, lucid dream frequency, and emotional intensity show a reduction in T3 than T1. Moreover, the Improved group is characterized by lower nightmare rate and nightmare distress than Not Improved people. Our findings confirmed that beyond the trait-like variables (ie, age, sex), specific sleep-related measures are related to nightmare features. In particular, poor sleep hygiene was one of the best determinants of nightmare distress among Not Improved subjects. Conclusion: Our findings revealed that people experienced an adaptation to the pandemic during the third wave. We also strengthen the notion that nightmares and their variations over time are strongly related to human well-being, suggesting that specific trait-like and sleep-related factors could modulate the relationship between mental health and nightmare features.

Implementing peer support in our intensive care unit to improve the mental wellbeing of trainees

Introduction: Working on the intensive care unit (ICU) exposes staff to the suffering of patients and their families as a consequence of devastating illnesses and injuries, often leading to psychological trauma. The COVID-19 pandemic has amplified pressures on healthcare staff, resulting in deteriorating mental health and increased incidence of stress and burn out. The Intensive Care Society (ICS) has placed emphasis on peer support to combat this;recognising that working in a 'psychologically safe' environment improves wellbeing, enables safe and compassionate care, and reduces mistakes [1]. The aim of peer support is to improve wellbeing by offering a systematic, strategic approach to sustain staff who are coping well and provide initial support to those who are struggling. Method(s): Staff who have undertaken ICS training, under the supervision of a clinical psychologist, facilitate fortnightly meetings open to all ICU trainees. They also act as an initial contact to provide advice and guidance on addressing the psychological difficulties highlighted above. An anonymous screening questionnaire at the start of each session allows a moment of reflection for trainees prior to discussion. This, in addition to anonymous feedback, provides qualitative data to both audit the programme and inform improvement. Result(s): Participation in peer support is voluntary, nonetheless attendance at meetings has been excellent. Initial qualitative results indicate that most trainees feel 'nervous, anxious or on edge', 'question their capability at work' and are 'unable to stop thinking about work/a significant event at work' at least a few days per week. Feedback from trainees regarding the programme has been intensely positive. Conclusion(s): Anxiety and stress are high amongst ICU trainees which can lead to psychological harm if not addressed. Engagement from trainees in our programme has been good and feedback positive, emphasising the need for peer support in the ICU.

Case study on psychological first aid on Italian COVID-Hospital

Coronavirus disease had an enormous impact on public health by affecting millions of people who have either fallen ill or died as a result of this disease. The pandemic resulted in several short- and long-term psychological effects, while restrictive measures adopted resulted in challenges in terms of support and counselling meetings, demonstrating the need to move to a digital health care system. In this context, the Psychological First Aid Service at Sant'Andrea, a service for COVID-19 patients and their loved ones, was set up in the Lazio region (Italy). The service provides two free telephone interviews, and if necessary, people are directed to other free support services in the region. In this article, we report a case study of two brothers who contacted the service during the second pandemic wave in Italy. The case has been discussed according to the recent literature, taking the practical and operational aspects of psychological first aid into account. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

Feasibility and effect of a self-help online acceptance and commitment therapy program focused on repetitive negative thinking for Colombian young women

Online psychological interventions (OPI) are evidence-based programs that provide mental health treatment over the internet. Meta-analytic data suggests that OPI's effectively treat emotional symptomatology. RNT-focused ACT consider psychological inflexibility and RNT as trans-diagnostic process that significantly predict emotional symptomatology. The present study analyzed the effect of a self-help OPI which contents have previously shown content validity, user feasibility and effectivity. This is an open trial design with repeated measures of emotional symptomatology and behavioral change processes. Bayesian analysis of variance for repeated measures was conducted with JASP for each variable, Bayes Factors (BF10) determined how much the evidence favored OPI effect. Effect sizes, reliable and significant change and moderation analyses were also conducted. 18 cisgender women around 30 years old mostly heterosexual, single and unemployed finished the OPI. There is decisive evidence for OPI effect on emotional symptomatology and behavioral change processes (experiential avoidance, cognitive fusion and RNT). There is also anecdotal evidence for the moderating role of the number of hierarchical RNT triggers ( private events), their type and intimate partner relationship distress as well as anecdotal evidence against the moderating role of being a psychologist. Results need to be considered in the context of the study limitations and future research should explore the program's feasibility and effect in other populations and cultures. However, the program is feasible and efficacious for the treatment of emotional symptomatology at least for young cisgender women in Colombia.

Clinical Psychology and the COVID-19 Pandemic: A Mixed Methods Survey Among Members of the European Association of Clinical Psychology and Psychological Treatment (EACLIPT).

Background: The COVID-19 pandemic has affected people globally both physically and psychologically. The increased demands for mental health interventions provided by clinical psychologists, psychotherapists and mental health care professionals, as well as the rapid change in work setting (e.g., from face-to-face to video therapy) has proven challenging. The current study investigates European clinical psychologists and psychotherapists' views on the changes and impact on mental health care that occurred due to the COVID-19 pandemic. It further aims to explore individual and organizational processes that assist clinical psychologists' and psychotherapists' in their new working conditions, and understand their needs and priorities. Method: Members of the European Association of Clinical Psychology and Psychological Treatment (EACLIPT) were invited (N = 698) to participate in a survey with closed and open questions covering their experiences during the first wave of the pandemic from June to September 2020. Participants (n = 92) from 19 European countries, mostly employed in universities or hospitals, completed the online survey. Results: Results of qualitative and quantitative analyses showed that clinical psychologists and psychotherapists throughout the first wave of the COVID-19 pandemic managed to continue to provide treatments for patients who were experiencing emotional distress. The challenges (e.g., maintaining a working relationship through video treatment) and opportunities (e.g., more flexible working hours) of working through this time were identified. Conclusions: Recommendations for mental health policies and professional organizations are identified, such as clear guidelines regarding data security and workshops on conducting video therapy.

The techniques doctoral level clinical psychology programs use to teach administration and scoring of cognitive assessment measures

American Psychological Association (APA)-accredited clinical psychology doctoral programs across the United States were surveyed to gather information on typical practices used to teach administration and scoring of cognitive assessment measures in the introductory cognitive assessment course. The 48-item survey included the following areas: program information, instructor information, course setup, cognitive assessment measures and practice administrations, course assignments, feedback and evaluation of students, and teleassessment training. Fifty-three instructors from these programs (21% response rate) completed the survey. Findings indicated that the measures taught with greatest frequency are the most recent versions of the Wechsler scales and the Woodcock-Johnson Tests of Cognitive Abilities. Assignments utilized in the course include observations of administrations, practice administrations, written reports, previously administered protocols, vignettes, manual familiarization assignments, and assignments to increase students' verbal response scoring skills. Programs utilize a variety of methods to provide feedback to students on practice administrations and scoring, including live in-the-moment feedback. Evaluation methods include midterm and final exams as well as other exams and quizzes. The majority of programs also require students to complete a final competency check of their administration and scoring skills. There were no significant differences between the course offered in Ph.D. vs. Psy.D. programs. When compared with previous findings, current results suggest clinical psychology doctoral programs are incorporating training techniques that are consistent with the body of knowledge regarding the teaching of cognitive assessment measures. Generalizability of the results may be limited due to the lower response rate and the current COVID-19 pandemic. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

"I'm a man now”: Using Narrative Therapy to support an adult with Down syndrome transition to a new life

Background: Residential transitions have long been recognised as challenging for people with learning disabilities and can be packed with problem stories. Narrative Therapy practices have the potential to centre the voice of people with learning disabilities;to enable alternative stories to be told;and to shine a light on their own and their support system's resources for change. Methods: Colin, a 36-year-old man with Down syndrome and a learning disability, met with the first author for nine sessions. Narrative Therapy practices (also drawing on systemic ideas) were used, including the Tree of Life, Outsider Witness Practice, Therapeutic Documentation and Definitional Ceremony. Feedback from Colin and the staff team was gathered through qualitative and quantitative means. Findings: Colin was keen to share his life stories and explored ideas about his "new life”, wanting to "stay strong” and "stay happy”. Staff noted an improvement in household stress and perceived ability to support Colin. An improvement in quality of life was also demonstrated with a self-report questionnaire. Conclusions: By acknowledging the power of language, narrative practices offer tools to help people with learning disabilities and their support system in making sense of and navigating important life transitions. © 2023 The Authors. British Journal of Learning Disabilities published by John Wiley & Sons Ltd.

Innovative Approaches to Data Collection Needs in Clinical Trials: Considerations, Lessons Learned and Future Directions

Technological advances and unique data collection requirements across multiple data streams have led to a proliferation of options for data collection in clinical trials. This includes traditional clinical trial data collected in 21CFR Part 11-compliant electronic casereport forms, patient-reported outcomes via standardized assessments and/or computerized tasks, passive or interactive data collection from application-based systems, provider, and/or hospital/clinic-level surveys. The COVID-19 pandemic has led to additional data collection considerations and necessitated policy changes accelerating the ability to conduct health care, clinical trial study visits, and other data collection procedures remotely. Such developments will leave enduring marks on policy related to healthcare and the conduct of clinical trials. The National Institute on Drug Abuse Clinical Trials Network (NIDA CTN) conducts multisite clinical trials on pharmacological and behavioral interventions for Substance Use Disorders (SUDs). The Data and Statistics Center at Emmes is responsible for developing data systems across many NIDA CTN trials and works with Lead Investigative teams such as the New York Node to develop novel approaches to data collection that suit the needs of individuals with SUDs and the studies designed to test and implement effective treatments. This presentation will include different perspectives from members of these teams. Challenges with technological literacy, access to smartphone devices with active data plans, and limitations to remote support from research staff can be barriers to completing assessments for SUD populations. The development of different data system approaches allowing (1) remote completion of web-based surveys and (2) encrypted, automated remote login to a 21CFR11-compliant system (no user ID and password required) will be discussed, as well as interactions between systems and considerations of approaches for different clinical research scenarios. For example, populating a survey link onto an eCRF if research staff assistance is needed for survey completion or for manual distribution of unique links embedded with participant information. Pros and cons of varied approaches to allow participants to access surveys will be discussed, including QR codes, automated vs personalized distribution via SMS and email, and mailed paper invitations with vanity URLs, which may differ by respondent population. In addition, studies targeting a specific patient population may require prescreening a large number in order to attain enrollment targets (e.g. tens of thousands of primary care patients who are sub-clinical threshold but at-risk for SUD). Approaches for conducting extensive prescreening anonymously and lessons learned (predicting prescreen targets accurately, monitoring enrollment rate, staffing and resource considerations) will be presented. Finally, an increasing number of clinical trials examine implementation of SUD interventions in specific patient populations or settings alongside traditional efficacy outcomes. Implementation assessments present unique considerations for data collection;in particular, the need to collect pre-implementation assessments of provider and site-level readiness prior to the onset of training and the new intervention;and before sites have been endorsed for trial data collection in order to avoid contamination. Another unique consideration involves qualitative data collection around the implementation process, and any adaptations made to the intervention or implementation facilitation based on a combination of qualitative and quantitative data. Balancing implementation needs with efficacy testing in clinical trials will also be discussed. Dr. Kathryn Hefner is a clinical psychologist and the Scientific Director of the National Institute on Drug Abuse Clinical Trials Network's (NIDA CTN) Data and Statistics Center (DSC). Her research interests involve substance use and effective treatments for substance use and comorbid mental health conditions. She leads the DSC's efforts in p tient-reported outcomes, including the adoption of novel data collection practices for the NIDA CTN. In addition, she serves as Co- Lead Investigator on CTN-0126, a longitudinal followup study of participants in CTN-0097 and CTN-0100. Dr. Matisyahu Shulman is a clinician-scientist at New York State Psychiatric Institute (NYSPI) and Columbia University Irving Medical Center. His research focus is on opioid use disorders clinical trials and the use of technology to enhance implementation, quality improvement, and treatment delivery. He is part of the lead team of several large multisite opioid treatment trials, including the CTN-0097 trial, a hybrid type I effectiveness-implementation trial, and CTN- 0126, a longitudinal follow-up study. Ms. Onumara Opara, MPH, is the National Project Director for CTN-0097. She has over 9 years of experience in project management for clinical and community-based research. Onumara oversees the dayto- day operations of the CTN-0097 trial, including coordination of protocol activities, implementation efforts at clinical sites, organization and supervision of study teams, training of research staff, quality assurance, and monitoring study progress. Ms. Christina Scheele,MA, is a Senior Data Manager at the CTN Data and Statistics Center at the Emmes Company. She has supported multiple CTN studies during system development and helped to troubleshoot and implement novel approaches to data collection to ease participant and staff burden. Ms. Scheele also has experience using multiple electronic database capture systems for other research studies which required unique and innovative system development for implementation. She currently serves as Data Management Lead on the CTN- 0097, CTN-0100, and CTN-0126 studies. Rebecca Price is a Senior Data Manager who has been at Emmes since 2016, currently supporting the NIDA DSC. Rebecca's main role has included leading the development, maintenance, and/or closeout activities for multiple CTN studies, and she has played a central role in adopting novel data collection practices across several NIDA CTN studies. Dr. Greiner is an addiction psychiatrist in training and a T32 postdoctoral fellow in the Division of Substance Use Disorders at Columbia University and NYSPI. Her main research interest is in implementation and dissemination of evidence-based interventions for substance use disorders in community settings. In particular, she is interested in implementation strategies, costs associated with implementing and sustaining interventions across different organizations, and developing methodology around implementation process. Dr. Greiner will discuss the hybrid effectiveness-implementation NIDA CTN (CTN-0097) trial led by principal investigators Drs. Adam Bisaga and Edward Nunes.

Experiential Training Groups: A Comparison between Online and in Presence Setting

Introduction: Experiential training groups are a well-known training tool used in professions based on relationship, empathy and understanding of the other. These groups have different names in the literature such as "experiential training groups," "growth groups," or "personal development groups". The literature showed that experiential training groups promote the students' personal and professional development (Chang et al., 2017), increased trainees' interpersonal and communication skills, personal and interpersonal awareness and the ability to empathize with their future clients (Pamukcu, 2022;McMahon and Rodillas, 2020;Ieva et al., 2009;Smith & Davis-Gage, 2008). However, there are still few studies that have analyzed the direct experiences of individuals in this group setting and identified the salient variables that may impact participants' experience (Goodrich, 2008). Moreover, there have been many online group experiences during the COVID-19 outbreak, but few studies have evaluated its effectiveness. Method(s): This work aims to explore the experiences of 357 students (87% female, mean age=24.1 years) following a bachelor or master program in clinical psychology who participated in 22 experiential training groups as part of their degree requirements. Data were collected between 2019 and 2022 through self-reports that investigated awareness of feelings about self and others (SAQ;Grant & Franklin, 2002), capacity of mentalization (MentS;Dimitrijevi et al., 2017), student's self-disclosure and well-being (PGWBI, Lundgren-Nilsson et al., 2013). Due to the Covid-19 pandemic, 12 groups (46.9% of students) took place online;the remaining were in presence, and all groups lasted 7 sessions. Result(s): Preliminary analyses showed moderate-to-high correlations between the studied variables (.14 - .45), and pre-post comparisons showed non-significant changes in self-awareness (t=.67, p=n.s.), well-being (t=.12, p=n.s.) and mentalization (t=1.80, p=n.s.). However, a very interesting result concerns the comparison of online and face-to-face groups, since in the latter, students showed a significant increase in the ability to mentalize the other (t=2.62, p< .01) while in online groups, this change is not observed (t=.56, p=n.s.). Further results will be presented and discussed. Conclusion(s): The findings from this study highlight challenges of participation to growth groups online and the main differences between the outcomes achieved online and in face-to-face settings. The implications for training practice are discussed.

The psychological experience and intervention in post-acute COVID-19 inpatients

Purpose: COVID-19 patients faced first-hand the life-threatening consequences of the disease, oftentimes involving prolonged hospitalization in isolation from family and friends. This study aimed at describing the psychological intervention to address the psychological difficulties and issues encountered by the hospitalized post-acute COVID-19 patients in a rehabilitation setting. Patients and Methods: Patients' demographics, medical diagnosis, and neuropsychological information were collected from March 2nd to May 12th, 2020. The main psychological issues and intervention strategies were collected. Results: A total of 181 patients were hospitalized during this period. Among them, the 47.5% underwent psychological assessment (N = 86;age: 74.58 +/- 13.39;54.7% females). The most common psychological issues were acute stress disorders (18.6%), anxious and demoralization symptoms (26.7%), depression (10.5%%), and troublesome grief (8.1%). Once recovered from COVID-19, many patients were discharged home (38.4%), some received further rehabilitation in non-COVID-19 wards (41.9%), mostly due to pre-existent diseases (72.2%) rather than to COVID-19 complications (27.8%). Conclusion: A great number of the hospitalized post-acute COVID-19 patients showed psychological issues requiring psychological intervention, the most common were anxiety, demoralization, acute stress, depression, and grief. The proposed psychological treatment for hospitalized COVID-19 patients was conducted in a Cognitive Behavioral framework. In particular, during the COVID-19 pandemic, psychological intervention is an important part of rehabilitation in the post-acute phase of the illness to reduce distress symptoms and improve psychological health. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

Therapists' perceptions and acceptability of providing internet-delivered guided self-help acceptance and commitment therapy (ACT) for family carers of people with dementia (iACT4CARERS): a qualitative study

This study aimed to explore therapists' perceptions and acceptability of providing internet-delivered, therapist-guided, self-help acceptance and commitment therapy (ACT) for family carers of people with dementia (iACT4CARERS). To achieve this, a qualitative approach with semi-structured interviews was employed with eight novice therapists recruited from primary and secondary care services taking part in a feasibility study of iACT4CARERS. The interviews were audio-recorded, transcribed, and analysed using thematic analysis. Four over-arching themes were identified: (1) positive attitudes towards the intervention, (2) therapists' workload, (3) therapists' confidence to perform their role, and (4) connecting with family carers in a virtual context. Theme 1 included seeing their involvement as an opportunity for personal growth and perceiving benefits to the family carers, which contributed to greater acceptability. Theme 2 reflected that while workload and the user-friendliness of the online platform were highly acceptable among the therapists, there were also time-consuming cases that increased therapists' burden. Theme 3 revealed that practical resources provided during the training, continued supervision, and opportunities to learn from other therapists, increased therapist confidence and facilitated greater acceptability. Finally, Theme 4 highlighted that improving the connection between therapists and carers was critical in a virtual context and strategies to improve the therapist–carer relationship were recommended. The implementation of iACT4CARERS was largely acceptable for the therapists involved in the trial. Ways to strengthen the therapeutic relationship in the virtual context and practical strategies to deal with common problems may enhance therapist experience and delivery in a full-scale effectiveness trial.Key learning aims(1) To understand which factors facilitated therapists' positive perceptions and acceptability of providing internet-delivered guided self-help ACT (iACT4CARERS).(2) To understand what challenges acted as barriers to therapists' positive perceptions and acceptability of providing iACT4CARERS.(3) To learn what aspects of the training and the intervention can be refined to improve the acceptability to therapists in trials involving internet-delivered guided self-help interventions for family carers.

A case series of compulsive hair pulling (trichotillomania) in children and young people presenting at a tertiary paediatric psychodermatology clinic

Globally, 14% of 10-19 year olds experience psychological difficulties. Evidence shows that some children/young people's (CYP) psychological wellbeing has been substantially affected during the pandemic. With the prevalence of social media and necessity of online teaching, CYP self- and otherfocused awareness has increased, leading to lowered mood and potential stigmatization from peers around visible differences, including hair loss. CYP struggling with compulsive hair pulling are often referred to dermatology clinics, which can cause considerable distress for them and their families. We present a case series focusing on CYP with compulsive hair pulling who attended a tertiary paediatric psychodermatology service. Owing to the COVID-19 pandemic, this clinic was run using a hybrid model of online and face-to-face appointments. We will discuss how applying a systemic family intervention that has been implemented in the psychodermatology clinic, run by a consultant dermatologist and paediatric clinical psychologist, has enabled optimal outcomes and a reduction of distress. To date, seven CYPs have presented and most (57%) were adolescents, supporting existing literature that compulsive hair pulling arises during this time and that this is the ideal time to focus interventions on. CYPs were seen on average for three appointments (range 1-5) prior to discharge from the service and/or a positive resolution of hair pulling. Several themes have also emerged as a result of this case series and these include stress and anxiety (57%), sexuality (14%) and challenges as a result of family discord or dynamics including family communication (29%). These will be explored in greater detail, including the underlying function and consequences of hair pulling and how a systemic family-based intervention has been beneficial. This case review also highlights the importance of having a multidisciplinary approach to managing cases within paediatrics and how differential diagnoses should always be considered prior to any treatment. We found that a family model of care was successful in treatment of hair pulling and henceforth we will also discuss learning points and best practice guidance for managing such cases.

Intersession experiences and internalized representations of psychotherapy: A scoping review.

INTRODUCTION: Between-session processes outside the therapy room and beyond the direct interaction between a therapist and client can play an important role in the psychotherapeutic process and outcome. These processes are called intersession experiences and can be seen as internalized mental representations of therapy and/or therapists. Due to the COVID-19 pandemic, different digital forms of treatment have successfully been implemented and could be relevant even after the end of the COVID-19 pandemic. Therefore, patients' internalized mental representations may become highly relevant in the future. RATIONALE: The aim of this study was to conceptually delineate the current state of research on internalized mental representations of therapy or therapists in the period between sessions and to provide an overview of the evidence. In addition, we aimed to identify research gaps to provide a baseline for further research. METHODS: For this purpose, we conducted a scoping review to obtain a comprehensive overview of the evidence and to identify the relevant research gaps. We searched PsycArticles, Medline, PsycINFO, and PSYNDEX for publications on internalized mental representations. RESULTS: The final sample comprised 30 publications published from 1989 to 2021. Based on the individual study results, it can be assumed that intersession experiences are of central importance for psychotherapeutic treatment. However, the scoping review showed that there was a large gap in knowledge in the research of intersession experiences. All previous research was barely comparable, and therefore, a generalized statement is not possible. CONCLUSION: Future research should provide sufficient information about relevant aspects, such as the setting, therapists, and patients, as these factors are likely to have a significant impact on the outcome. Furthermore, better measurements for the assessment of these processes should be developed.

Resilience and Wellbeing Strategies for Pandemic Fatigue in Times of Covid-19.

The COVID-19 pandemic is truly one of the greatest collective health crises in history which have altered our life and living. For years, people have felt fatigued from following public health directives such as social distancing, wearing masks, washing hands frequently, and working or studying remotely without in-person interactions. In this paper, we explore strategies for resilience and wellbeing which can mitigate pandemic-caused stress and behavioural fatigue. We start with individual level strategies including reworking stress appraisals, the importance of psychological flexibility, reducing loneliness through adaptive online platform use, optimizing familial relationships when living in close quarters for a prolonged period, reducing symptoms of burnout and using adaptive distractions, using specific evidence-based resilience strategies. We discuss specific considerations which tap on our shared identities and shared responsibilities which can enhance a sense of community, especially for individuals from marginalized backgrounds and how suicide risks can be minimized.