ABSTRACT
Mental health disorders such as depression and anxiety affect one in five adults in the United States. According to the 2019 National Survey on Drug Use and Health (NSDUH), non-serious mental illnesses are found in 30.6% of young adults aged 18-25 years old and 25.3% of adults aged 26-49 years old. In 2020, the NSDUH found that only 44.8% of all adults living with non-serious mental illnesses sought treatment. In 2020 and 2021 with the rise of the COVID-19 pandemic, 41.5% of US adults reported to have been struggling symptoms of an anxiety of depressive disorder. With this added burden, the increase in social isolation during the pandemic, and unknown long term psychological effects of the past year and a half, the need for an effective remote psychotherapy treatment is even more evident. The objective of this research is to address the growing need for a remote psychotherapy solution that is both accessible for isolated patients and effective. One approach to therapeutic healing that is standard in counseling psychology is the use of psychotherapy based on common factors theory. This theory poses that there are several common factors that need to be addressed for healing to occur. This research focuses on two of the common factors that are most difficult to reproduce in remote psychotherapy: the therapeutic alliance and the therapeutic environment. We hypothesize that the use of a virtual reality (VR) and neurofeedback based psychotherapy system specifically designed based on common factors theory will lead to better performance in the therapeutic alliance between therapists and patients and ultimately, better outcomes for remote psychotherapy patients. The following specific aims address this hypothesis:Specific Aim 1: Design and Develop a Common Factors Based Virtual Reality Therapy for Remote Psychotherapy Applications. A full common factors based VR psychotherapy system was developed using Unity3D, Autodesk Maya, and MATLAB. Key components of the design include three virtual environments designed based on key elements of restorative environments (Forest World, Log Cabin, and Freud Therapist Office), two therapist avatars based on Jungian archetypes for healing (Woman Healer, Sage), a neurofeedback system using electroencephalography (EEG), a therapist interface, and a patient interface. Success was measured based on the prototype's ability to be a fully functional remote psychotherapy treatment, its adherence to restorative environments design elements, and its adherence to Jungian archetypes design elements.Specific Aim 2: Determine the functionality and usability of the novel common factors based VR therapy system for therapists. The first step to determining the efficacy of a novel treatment system in psychotherapy is to analyze the functionality and usability of the treatment for therapists. Specifically, this study examined if therapists are able to effectively use this system for the remote treatment of depression and general anxiety. A proof of concept study was conducted with 21 observing counselors in training to examine the functionality and usability of the VR enhanced therapy system for therapists. The session was conducted with a professional therapist and a patient using the VR system in another room. Measures from this study will include the 1. Client Reactions Systems, 2. Perceived Restorative Scale, 3. Session Evaluation Questionnaire, and 4. Presence Questionnaire. Success will be determined by examining the neutral score for each these metrics, and comparing the scores received by therapists to the average. The treatment was considered successful if the novel VR treatments preforms as well or better than the average across all metrics.Specific Aim 3: Determine the functionality and usability of the novel common factors based VR therapy system for patients. (PsycInfo Database Record (c) 2023 APA, all rights reserved)
ABSTRACT
Introduction: Informal caregivers offer continuous unpaid support to loved ones who are unable to live independently. Providing care can be a very burdensome commitment, that heavily impacts informal caregivers' mental health. eMental health is a possible, yet challenging, solution to improve caregivers' mental health and their overall experience of caregiving. In fact, eMental health technologies often face challenges of implementation. The present work gathers knowledge on how to best deal with these challenges by collecting testimonies of implementation experts of eight eMental health technologies for informal caregivers with the aim of comparing them and extracting lessons learned. Methods: For this multiple case study, technologies were selected (through informal suggestions and independent search) according to the following inclusion criteria: they were intended for informal caregivers as main user group, were aimed at improving informal caregivers' mental wellbeing and caregiving experience and were available and running in real life settings in Europe. Ten interviews were conducted (two pilots and eight included cases). The interviewees were asked to provide a description of the technology and its aims and their implementation approach, method and frameworks used. Finally, determinants of implementation, the influence of the Covid-19 pandemic on implementation processes and lessons learned were investigated. Results: The results highlight key differences between technologies developed within academia and the industry regarding efficacy testing and use and use and choice of frameworks. Also, similarities in terms of recognized barriers such as financing are illustrated. Discussion: Possible ways to overcome main barriers and examples of best practices, such as structuring a business model and discussing tool maintenance and long-term hosting in advance, are discussed.
ABSTRACT
Evidence demonstrates that psychoeducation interventions have clinical and recovery-related benefits for people experiencing psychosis and their family members. The EOLAS programmes are one example of recovery-oriented psychoeducation programmes for psychosis. They differ from other programmes in that they are co-designed and co-facilitated (peer and clinician) group programmes. Due to the COVID-19 pandemic, EOLAS went online using a videoconferencing platform. The study examined the feasibility, acceptability and usefulness of EOLAS-Online and explored whether some of the positive recovery outcomes reported by attendees regarding the in-person programmes were replicated online. Data were collected through an online survey and semi-structured interviews. Quantitative data were analysed using descriptive statistics. Thematic analysis was used for qualitative data. Fifteen attendees (40% of attendees) completed the surveys and eight participated in interviews. A total of 80% were satisfied/very satisfied with the programme. The programme was rated highly for increased knowledge of mental health, coping strategies, and engaging with peers. The use of technology was mostly unproblematic, although some audio and video-related challenges were identified. Engaging with the online programme was experienced positively, including facilitator support to engage. The overall findings indicate that EOLAS-Online is feasible, acceptable and useful in supporting attendees' recovery journeys.
Subject(s)
COVID-19 , Psychotic Disorders , Humans , Pandemics , Psychotic Disorders/psychology , Mental Health , FamilyABSTRACT
As a consequence of the outbreak of the COVID-19 global pandemic in the spring of 2020, large-scale social distancing measures were implemented, resulting in the forced adoption of online or digital forms of psychological treatment. This sudden transition to digital care offered a unique opportunity to investigate if and how this experience impacted mental healthcare professionals' perceptions and use of Digital Mental Health tools. The current paper presents findings of a repeated cross-sectional study consisting of three iterations of a national online survey in the Netherlands. This survey contained open and closed questions on professionals' adoption readiness, frequency of use, perceived competency, and perceived value of Digital Mental Health collected in 2019 (before the pandemic), in 2020 (after the first wave), and in 2021 (after the second wave). The inclusion of data gathered prior to the COVID-19 pandemic offers a unique window to assess how professionals' adoption has developed through this transition from voluntary to mandatory use of Digital Mental Health tools. Our study also re-assesses the drivers, barriers, and needs of mental healthcare professionals after having gained experience with Digital Mental Health. In total, 1,039 practitioners completed the surveys (Survey 1: n = 432, Survey 2: n = 363, and Survey 3: n = 244). Results indicate that compared to the period before the pandemic, there was a particularly large increase in use, competency, and perceived value regarding videoconferencing. Small differences were also found for some other basic tools that were crucial to ensure the continuation of care, such as e-mail, text messaging, and online screening, but not for more innovative technologies, such as virtual reality and biofeedback. Many practitioners reported to have gained skills regarding Digital Mental Health and experienced several benefits of it. They expressed the intention to continue with a blended approach, using Digital Mental Health tools in combination with face-to-face care, focused on situations in which they found it to have specific added value, such as when clients are unable to travel. Others were less satisfied with the technology-mediated interactions and remained more reluctant to future use of DMH. Implications for broader implementation of Digital Mental Health and future research are discussed.
ABSTRACT
Studies on practitioners' perceptions of eMental Health repeatedly report experienced difficulties in establishing empathic interactions when communicating with their clients online - a fact that plays an important role in the adoption, or lack thereof, of technology-mediated treatments. Especially now, in times when social distancing and lockdown measures are effectuated globally to combat the COVID-19 pandemic, the need for high-quality online formats of mental health care has become more urgent than ever. To increase our understanding of the process of achieving empathic interactions in technology-mediated communication, the current paper presents an online survey study using open questions on practitioners' experiences of establishing empathy in online therapeutic interactions (n = 363). Responses were analyzed using thematic analysis. From the derived themes, a conceptual model was built showing several properties of online communication that influence empathy and ways in which these properties affect the therapeutic interaction on emotional, conversational, and relational levels. Additionally, our findings highlight the behavioral strategies practitioners employ to find workarounds to manage these effects and attempt to (re)connect with their clients. Our findings thus provide experience-based insights into the process of building empathy in online treatments - insights that can be used to improve current and future eMental Health technologies, enabling practitioners to reach the desired level of empathic understanding during remote therapeutic interactions. (PsycInfo Database Record (c) 2022 APA, all rights reserved)
ABSTRACT
Despite the use of digital communication technologies in neurocognitive rehabilitation has been widely used in face-to-face interventions, the difficulties of using ICT-based tools to provide rehabilitation services and the unfamiliarity of the neuropsychologists with internet interventions limited the use of these kinds of interventions in their clinical practices. The lockdown and mitigating measures associated with the COVID-19 pandemic, on the other hand, forced the use of at-distance and online interventions as a means to mitigate the impact of those measures on the mental health and rehabilitation processes of people with neurological disorders. Overall, little is known about the perspectives of patients with acquired neurological conditions about rehabilitation services delivered at distance. Therefore, the main goal of this study was to explore the perceptions that patients with neurological disorders have on at-distance online neurocognitive rehabilitation, namely during the COVID-19 pandemic. Sixteen patients with acquired neurological conditions attending an online neurocognitive rehabilitation program in a Portuguese rehabilitation center filled in an online questionnaire during the mandatory lockdown. The results of this study highlight the potential of delivering rehabilitation services at distance, presenting its advantages and limitations from patients' perspectives, as well as suggestions for improving both neurorehabilitation processes and the online rehabilitation platform used.
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BACKGROUND: The implementation of eMental health interventions, especially in the workplace, is a complex process. Therefore, learning from existing implementation strategies is imperative to ensure improvements in the adoption, development, and scalability of occupational eMental health (OeMH) interventions. However, the implementation strategies used for these interventions are often undocumented or inadequately reported and have not been systematically gathered across implementations in a way that can serve as a much-needed guide for researchers. OBJECTIVE: The objective of this scoping review was to identify implementation strategies relevant to the uptake of OeMH interventions that target employees and detail the associated barriers and facilitation measures. METHODS: A scoping review was conducted. The descriptive synthesis was guided by the RE-AIM (reach, effectiveness, adoption, implementation, and maintenance) framework and the Consolidated Framework for Implementation Research. RESULTS: A total of 31 of 32,916 (0.09%) publications reporting the use of the web-, smartphone-, telephone-, and email-based OeMH interventions were included. In all, 98 implementation strategies, 114 barriers, and 131 facilitators were identified. The synthesis of barriers and facilitators produced 19 facilitation measures that provide initial recommendations for improving the implementation of OeMH interventions. CONCLUSIONS: This scoping review represents one of the first steps in a research agenda aimed at improving the implementation of OeMH interventions by systematically selecting, shaping, evaluating, and reporting implementation strategies. There is a dire need for improved reporting of implementation strategies and combining common implementation frameworks with more technology-centric implementation frameworks to fully capture the complexities of eHealth implementation. Future research should investigate a wider range of common implementation outcomes for OeMH interventions that also focus on a wider set of common mental health problems in the workplace. This scoping review's findings can be critically leveraged by discerning decision-makers to improve the reach, effectiveness, adoption, implementation, and maintenance of OeMH interventions.
Subject(s)
Occupational Health , Telemedicine , Data Collection , Humans , WorkplaceABSTRACT
Objectives: The impact of the COVID-19 pandemic on population mental health has highlighted the potential for digital mental health to support the needs of those requiring care. This study sought to understand the digital mental health experiences and priorities of Canadians affected by mental health conditions (i.e. seekers, patients, and care partners). Methods: A national cross-sectional electronic survey of Canadians was administered through a market research firm's survey panel. Seekers, patients, and care partners were asked about their digital mental health experiences (e.g. uptake, barriers to access) and priorities. Survey responses were summarized using descriptive statistics. Results: Overall, 1003 participants completed the survey. 70.2% of participants routinely use digital mental health supports to support themselves or those they care for; however, only 28.6% of participants are satisfied with the available digital mental health supports. Most participants (73.3%) have encountered some barriers when accessing digital mental health supports. Awareness of digital mental health supports was a top barrier identified by participants. The top digital mental health priorities consisted of digital mental health curation, navigation, and a digital mental health passport. Conclusions: Most participants use digital mental health supports for themselves or others, however, many are unaware of digital mental health supports available. Efforts to improve navigating access to digital and in-person mental health services are seen as a top priority, highlighting the need to enable seekers, patients, and care partners to find the appropriate support and make decisions on how to best improve their mental health.
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BACKGROUND: In Egypt, the shortage of mental health services, particularly for adolescents and young adults, is apparent. Electronic mental health (EMH) has been proposed as a solution to bridge the gap and better address the needs of young people. However, EMH is new to Egypt and its acceptability among target populations is crucial to its implementation and success. OBJECTIVE: The objective of this study is to explore the interest of Egyptian youth in EMH, identify perceived barriers to EMH, and inform the design of EMH tools to best address the needs of youth. METHODS: A web-based cross-sectional survey was distributed among medical students at Tanta University in Egypt. Chi-square and one-way analysis of variance tests were performed for inferential analyses using a significance level of .05. RESULTS: Of the 707 individuals who completed the survey (90.9% response rate), 60.5% (428) were female, 62% (438) lived in urban and suburban areas, and the mean age of the sample was 20.5 (SD 1.8) years. The vast majority of participants (522/707, 73.8%) had already used the internet to find information about mental health problems, but the information was unsatisfactory for about half of them (386/707, 54.6%). Almost all students reported that they would prefer web-based therapy if EMH were available through a trustworthy national web-based platform for youth mental health (601/707, 85%). Students believed that emotional difficulties, social support, and coping strategies were the main topics that EMH should help with. The most common perceived barriers for EMH use in Egypt were concerns about privacy (382/707, 54%) and a lack of technology literacy and unfamiliarity with EMH (352/707, 50%). CONCLUSIONS: EMH is a promising strategy for addressing gaps in the mental health care for young people. To construct and implement a digital system of care that addresses the unique needs and preferences of youth, adolescents and young adults should be involved in the co-development and design.
ABSTRACT
COVID-19 mitigation measures present unprecedented challenges in mental healthcare delivery, posing high risk to the mental health of at-risk populations, namely patients diagnosed with COVID-19, frontline healthcare providers, and those submitted to quarantine or isolation measures, as well as the general population. Ensuring safe and equitable access to mental healthcare by these groups entails resorting to innovative psychosocial intervention strategies, such as digital mental health. In this perspective piece, we describe the impact of COVID-19 on the Portuguese population's mental health, present an overview on initiatives developed to address the challenges currently faced by the Portuguese mental healthcare system, and discuss how the timely implementation of a comprehensive digital mental health strategy, coupling research, education, implementation, and quality assessment initiatives, might buffer COVID-19's impact on the Portuguese society.