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2.
Ann Palliat Med ; 10(10): 10591-10599, 2021 10.
Article in English | MEDLINE | ID: covidwho-1515698

ABSTRACT

BACKGROUND: During the epidemic, the mental health of college students was generally poor, especially anxiety and depression, which should be treated using counseling and intervention. This study aimed to observe the influence of dialectical behavior therapy on the anxiety and depression of medical students during the normalization of the prevention and control of the COVID-19 epidemic. METHODS: A total of 26 medical students (experimental group) were treated with dialectical behavior therapy intervention for 4 weeks. Changes in depression, anxiety, and stress levels were assessed by the Patient Health Questionnaire (PHQ-9), the Generalized Anxiety Disorder (GAD-7) scale, the Somatic Self-rating Scale (SSS), and the Perceived Stress Scale (PSS-10). This group was compared with 26 medical students (control group) without intervention. RESULTS: The value-added scores of the PHQ-9 (t=2.543, P=0.014) and GAD-7 scales (t=3.790, P=0.000) in the experimental group were significantly higher than those in the control group, while in the SSS scale, the value-added score of the depressive symptoms subscale (t=2.234, P=0.030) in the experimental group was significantly higher than that of the control group. For the total score of the PSS-10 scale (t=2.435, P=0.018), the value-added score of the experimental group was significantly higher than that of the control group. CONCLUSIONS: The intervention of dialectical behavior therapy can effectively alleviate the depression and anxiety of medical students during the normalization of epidemic prevention and control. TRIAL REGISTRATION: Chinese Clinical Trial Registry ChiCTR2100048784.


Subject(s)
COVID-19 , Dialectical Behavior Therapy , Epidemics , Psychotherapy, Group , Students, Medical , Anxiety/prevention & control , Anxiety Disorders/prevention & control , Humans , SARS-CoV-2
3.
Eur J Psychotraumatol ; 12(1): 1991651, 2021.
Article in English | MEDLINE | ID: covidwho-1510838

ABSTRACT

Background: The COVID-19 pandemic has resulted in increased anxiety and depression around the world. Refugees may be particularly vulnerable to the mental health effects of the pandemic because of their higher rates of mental health disorders, trauma histories, and daily stressors. Objectives: This study used data from a controlled trial of a brief behavioural intervention for psychological distress in Syrian refugees living in Azraq Camp in Jordan to examine the psychological effects of the pandemic on refugee mental health. Method: A total of 410 participants were randomized to either the intervention or control arms of the trial and were assessed at baseline and 3-month follow-up. Half the sample (199; 48.5%) completed their 3-month follow-up assessment after the pandemic restrictions began in Jordan and 211 (51.5%) completed the assessment prior to the pandemic. Refugees were independently assessed for symptoms of PTSD, anxiety, and depression at baseline and follow-up, and pandemic-related worries were assessed at follow-up for those who completed their assessment during the pandemic. Results: The most commonly reported worries were economic difficulties (82.4%), shortage of essential supplies (71.3%), and infecting others (59.7%) or themselves (51.9%). Refugees who were assessed during the pandemic had less severe PTSD symptoms than those assessed prior to the pandemic. Significant predictors of pandemic-related worries were lower levels of depression prior to the pandemic and greater anxiety during the pandemic. Conclusion: These findings highlight the specific needs of refugees during the pandemic and suggest that pre-existing mental health issues may not necessarily be the key risk factors for who will experience major mental health issues or worries during the pandemic.


Antecedentes: La ansiedad y la depresión alrededor del mundo se han incrementado como consecuencia de la pandemia por la COVID-19. Los refugiados pueden ser particularmente vulnerables a los efectos de la pandemia sobre la salud mental a sus tasas más altas de trastornos de salud mental, de antecedentes de trauma y de estresores diarios.Objetivos: Este estudio empleó los datos del ensayo controlado de una intervención conductual breve para la angustia psicológica en refugiados sirios que vivían en el campo Azraq en Jordania. Se buscó evaluar los efectos psicológicos de la pandemia sobre la salud mental de los refugiados.Método: Un total de 410 participantes fueron asignados aleatoriamente, bien al grupo de intervención o bien al grupo de control del ensayo, y fueron evaluados al inicio y a los 3 meses de seguimiento. La mitad de la muestra (199; 48,5%) completó la evaluación a los 3 meses de seguimiento después de que comenzaran las restricciones de la pandemia en Jordania, mientras que 211 (51,5%) completaron esta evaluación antes de la pandemia. Los refugiados fueron evaluados de forma independiente para detectar síntomas del TEPT, de la ansiedad y de la depresión al inicio y en el seguimiento. Las preocupaciones relacionadas a la pandemia se evaluaron durante el seguimiento en aquellos que completaron su evaluación durante la pandemia.Resultados: Las preocupaciones más comúnmente reportadas fueron las dificultades económicas (82,4%), la escasez de suministros esenciales (71,3%) y la infección de otros (59,7%) o de ellos mismos (51,9%). Los refugiados que fueron evaluados durante la pandemia tenían síntomas de TEPT menos severos que aquellos que fueron evaluados antes de la pandemia. Los predictores significativos de las preocupaciones relacionados con la pandemia fueron niveles más bajos de depresión antes de la pandemia y mayor ansiedad durante la pandemia.Conclusiones: Estos hallazgos destacan las necesidades especificas de los refugiados durante la pandemia y sugieren que los problemas de salud mental preexistentes no necesariamente pueden ser los factores de riesgo clave para aquellos que experimentarán los principales problemas de salud mental o preocupaciones durante la pandemia.背景: COVID-19 疫情导致全世界的焦虑和抑郁增加。难民可能特别容易受到疫情的心理健康影响, 因为他们的精神健康障碍, 创伤史和日常应激因素的发生率较高。目的:本研究使用了一项来自居住在约旦 Azraq 难民营的叙利亚难民心理困扰的简短行为干预对照试验的数据, 以考查疫情对难民心理健康的心理影响。方法:总共 410 名参与者被随机分配到试验干预组或对照组, 并在基线和 3 个月的随访中进行评估。一半的样本 (199; 48.5%) 在约旦开始疫情限制后完成了其 3 个月的随访评估, 211 (51.5%) 在疫情之前完成了评估。在基线和随访时独立评估难民的 PTSD, 焦虑和抑郁症状, 并在随访时评估那些在疫情期间完成评估者的疫情相关担忧。结果:最常报告的担忧是经济困难 (82.4%), 必需品短缺 (71.3%), 和感染他人 (59.7%) 或自己 (51.9%)。疫情期间评估的难民的 PTSD 症状不如疫情之前评估的人严重。疫情相关担忧的显著预测因素是疫情之前较低的抑郁程度和疫情期间的较高的焦虑水平。结论:这些发现强调了疫情期间难民的特定需求, 表明先前存在的心理健康问题可能不一定是谁将在疫情期间遇到重大心理健康问题或担忧的关键风险因素。.


Subject(s)
COVID-19 , Mental Health , Psychotherapy, Group , Refugees , Adult , Anxiety/epidemiology , Depression/epidemiology , Humans , Jordan/epidemiology , Psychological Distress , Refugees/psychology , Refugees/statistics & numerical data , Stress Disorders, Post-Traumatic , Syria/ethnology
4.
BMJ Open ; 11(9): e050259, 2021 09 06.
Article in English | MEDLINE | ID: covidwho-1394117

ABSTRACT

BACKGROUND: Substance use disorder (SUD) is a leading contributor to the global burden of disease. In Indonesia, the availability of formal treatment for SUD falls short of the targeted coverage. A standardised therapeutic option for SUD with potential for widespread implementation is required, yet evidence-based data in the country are scarce. In this study, we developed a cognitive behavioural therapy (CBT)-based group telemedicine model and will investigate effectiveness and implementability in a multicentre randomised controlled trial. METHODS: A total of 220 participants will be recruited from the social networks of eight sites in Indonesia: three hospitals, two primary healthcare centres and three rehabilitation centres. The intervention arm will participate in a relapse prevention programme called the Indonesia Drug Addiction Relapse Prevention Programme (Indo-DARPP), a newly developed 12-week module based on CBT and motivational interviewing constructed in the Indonesian context. The programme will be delivered by a healthcare provider and a peer counsellor in a group therapy setting via video-conferencing, as a supplement to participants' usual treatments. The control arm will continue treatment as usual. The primary outcome will be the percentage increase in days of abstinence from the primarily used substance in the past 28 days. Secondary outcomes will include addiction severity, quality of life, motivation to change, psychiatric symptoms, cognitive function, coping, and internalised stigma. Assessments will be performed at baseline (week 0), post-treatment (week 13), and 3 and 12 months post-treatment completion (weeks 24 and 60). Retention, participant satisfaction, and cost-effectiveness will be assessed as the implementation outcomes. ETHICS AND DISSEMINATION: The study protocol was reviewed and approved by the Ethics Committees of Universitas Indonesia and Kyoto University. The results will be disseminated via academic journals and international conferences. Depending on trial outcomes, the treatment programme will be advocated for adoption as a formal healthcare-based approach for SUD. TRIAL REGISTRATION NUMBER: UMIN000042186.


Subject(s)
Psychotherapy, Group , Substance-Related Disorders , Cost-Benefit Analysis , Humans , Indonesia , Multicenter Studies as Topic , Quality of Life , Randomized Controlled Trials as Topic , Secondary Prevention , Substance-Related Disorders/prevention & control
5.
Psychosomatics ; 61(6): 662-671, 2020.
Article in English | MEDLINE | ID: covidwho-1386490

ABSTRACT

BACKGROUND: Patients with psychiatric illnesses are particularly vulnerable to highly contagious, droplet-spread organisms such as SARS-CoV-2. Patients with mental illnesses may not be able to consistently follow up behavioral prescriptions to avoid contagion, and they are frequently found in settings with close contact and inadequate infection control, such as group homes, homeless shelters, residential rehabilitation centers, and correctional facilities. Furthermore, inpatient psychiatry settings are generally designed as communal spaces, with heavy emphasis on group and milieu therapies. As such, inpatient psychiatry services are vulnerable to rampant spread of contagion. OBJECTIVE: With this in mind, the authors outline the decision process and ultimate design and implementation of a regional inpatient psychiatry unit for patients infected with asymptomatic SARS-CoV-2 and share key points for consideration in implementing future units elsewhere. CONCLUSION: A major takeaway point of the analysis is the particular expertise of trained experts in psychosomatic medicine for treating patients infected with SARS-CoV-2.


Subject(s)
Asymptomatic Infections , Coronavirus Infections/complications , Hospital Design and Construction/methods , Hospital Units , Hospitalization , Infection Control/methods , Mental Disorders/therapy , Personnel Staffing and Scheduling/organization & administration , Pneumonia, Viral/complications , Betacoronavirus , COVID-19 , Humans , Involuntary Commitment , Mental Disorders/complications , Pandemics , Personal Protective Equipment , Psychiatric Department, Hospital , Psychotherapy, Group/methods , Recreation , SARS-CoV-2 , Ventilation/methods , Visitors to Patients
7.
Am J Addict ; 30(5): 445-452, 2021 09.
Article in English | MEDLINE | ID: covidwho-1360443

ABSTRACT

BACKGROUND AND OBJECTIVES: The rapid scale-up of telehealth services for substance use disorders (SUDs) during the COVID-19 pandemic presented a unique opportunity to investigate patient experiences with telehealth. This study examined patient perceptions of telehealth in an outpatient SUD treatment program offering individual therapy, group therapy, and medication management. METHODS: Two hundred and seventy adults receiving SUD outpatient treatment were eligible to complete a 23-item online survey distributed by clinicians; 58 patients completed/partially completed the survey. Data were summarized with descriptive statistics. RESULTS: Participants were predominately male, White, and well-educated. The majority (86.2%) were "very satisfied" or "satisfied" with the quality of telehealth care. "Very satisfied" ratings were highest for individual therapy (90%), followed by medication management (75%) and group therapy (58%). Top reasons for liking telehealth included the ability to do it from home (90%) and not needing to spend time commuting (83%). Top reasons for disliking telehealth were not connecting as well with other members in group therapy (28%) and the ability for telehealth to be interrupted at home or work (26%). DISCUSSION AND CONCLUSIONS: Telehealth visits were a satisfactory treatment modality for most respondents receiving outpatient SUD care, especially those engaging in individual therapy. Challenges remain for telehealth group therapy. SCIENTIFIC SIGNIFICANCE: This is the first study examining patients' perceptions of telehealth for outpatient SUD treatment during the COVID-19 pandemic by treatment service type. Importantly, while many participants found telehealth more accessible than in-person treatment, there was variability with respect to the preferred mode of treatment delivery.


Subject(s)
Ambulatory Care , COVID-19 , Outpatients , Pandemics , Patient Satisfaction , Substance-Related Disorders , Telemedicine , Adult , Ambulatory Care/methods , COVID-19/epidemiology , Female , Health Care Surveys , Humans , Male , Outpatients/psychology , Outpatients/statistics & numerical data , Patient Satisfaction/statistics & numerical data , Psychotherapy, Group , Substance-Related Disorders/therapy
8.
PLoS Med ; 18(6): e1003621, 2021 06.
Article in English | MEDLINE | ID: covidwho-1315878

ABSTRACT

BACKGROUND: Globally, 235 million people are impacted by humanitarian emergencies worldwide, presenting increased risk of experiencing a mental disorder. Our objective was to test the effectiveness of a brief group psychological treatment delivered by trained facilitators without prior professional mental health training in a disaster-prone setting. METHODS AND FINDINGS: We conducted a cluster randomized controlled trial (cRCT) from November 25, 2018 through September 30, 2019. Participants in both arms were assessed at baseline, midline (7 weeks post-baseline, which was approximately 1 week after treatment in the experimental arm), and endline (20 weeks post-baseline, which was approximately 3 months posttreatment). The intervention was Group Problem Management Plus (PM+), a psychological treatment of 5 weekly sessions, which was compared with enhanced usual care (EUC) consisting of a family psychoeducation meeting with a referral option to primary care providers trained in mental healthcare. The setting was 72 wards (geographic unit of clustering) in eastern Nepal, with 1 PM+ group per ward in the treatment arm. Wards were eligible if they were in disaster-prone regions and residents spoke Nepali. Wards were assigned to study arms based on covariate constrained randomization. Eligible participants were adult women and men 18 years of age and older who met screening criteria for psychological distress and functional impairment. Outcomes were measured at the participant level, with assessors blinded to group assignment. The primary outcome was psychological distress assessed with the General Health Questionnaire (GHQ-12). Secondary outcomes included depression symptoms, posttraumatic stress disorder (PTSD) symptoms, "heart-mind" problems, social support, somatic symptoms, and functional impairment. The hypothesized mediator was skill use aligned with the treatment's mechanisms of action. A total of 324 participants were enrolled in the control arm (36 wards) and 319 in the Group PM+ arm (36 wards). The overall sample (N = 611) had a median age of 45 years (range 18-91 years), 82% of participants were female, 50% had recently experienced a natural disaster, and 31% had a chronic physical illness. Endline assessments were completed by 302 participants in the control arm (36 wards) and 303 participants in the Group PM+ arm (36 wards). At the midline assessment (immediately after Group PM+ in the experimental arm), mean GHQ-12 total score was 2.7 units lower in Group PM+ compared to control (95% CI: 1.7, 3.7, p < 0.001), with standardized mean difference (SMD) of -0.4 (95% CI: -0.5, -0.2). At 3 months posttreatment (primary endpoint), mean GHQ-12 total score was 1.4 units lower in Group PM+ compared to control (95% CI: 0.3, 2.5, p = 0.014), with SMD of -0.2 (95% CI: -0.4, 0.0). Among the secondary outcomes, Group PM+ was associated with endline with a larger proportion attaining more than 50% reduction in depression symptoms (29.9% of Group PM+ arm versus 17.3% of control arm, risk ratio = 1.7, 95% CI: 1.2, 2.4, p = 0.002). Fewer participants in the Group PM+ arm continued to have "heart-mind" problems at endline (58.8%) compared to the control arm (69.4%), risk ratio = 0.8 (95% CI, 0.7, 1.0, p = 0.042). Group PM+ was not associated with lower PTSD symptoms or functional impairment. Use of psychosocial skills at midline was estimated to explain 31% of the PM+ effect on endline GHQ-12 scores. Adverse events in the control arm included 1 suicide death and 1 reportable incidence of domestic violence; in the Group PM+ arm, there was 1 death due to physical illness. Study limitations include lack of power to evaluate gender-specific effects, lack of long-term outcomes (e.g., 12 months posttreatment), and lack of cost-effectiveness information. CONCLUSIONS: In this study, we found that a 5-session group psychological treatment delivered by nonspecialists modestly reduced psychological distress and depression symptoms in a setting prone to humanitarian emergencies. Benefits were partly explained by the degree of psychosocial skill use in daily life. To improve the treatment benefit, future implementation should focus on approaches to enhance skill use by PM+ participants. TRIAL REGISTRATION: ClinicalTrials.gov NCT03747055.


Subject(s)
Depression/therapy , Mental Health , Natural Disasters , Problem Solving , Psychotherapy, Brief , Psychotherapy, Group , Relief Work , Stress Disorders, Post-Traumatic/therapy , Stress, Psychological/therapy , Adaptation, Psychological , Adolescent , Adult , Aged , Aged, 80 and over , Depression/diagnosis , Depression/etiology , Depression/psychology , Female , Functional Status , Humans , Male , Middle Aged , Nepal , Stress Disorders, Post-Traumatic/diagnosis , Stress Disorders, Post-Traumatic/etiology , Stress Disorders, Post-Traumatic/psychology , Stress, Psychological/diagnosis , Stress, Psychological/etiology , Stress, Psychological/psychology , Time Factors , Treatment Outcome , Young Adult
9.
Am J Orthopsychiatry ; 91(2): 171-180, 2021.
Article in English | MEDLINE | ID: covidwho-1226414

ABSTRACT

Evidence from multiple samples of trauma-exposed populations across the globe suggests that intergenerational trauma constitutes a biopsychological risk factor which manifests itself throughout the life cycle of offspring of trauma survivors. Prior empirical studies have shown that adult children of Holocaust survivors (OHS, also referred to in select quotes as 2G for "Second Generation") are vulnerable to life-threatening situations. This study aimed to examine the reactions of OHS to the COVID-19 pandemic, which posed a serious threat to the lives of many, in particular to older adults. As they enter middle age, OHS were observed to have more medical health issues and less positive perceptions of their own aging relative to peers. Less positive subjective aging was associated with more negative psychiatric symptoms in relation to Covid-19-related loneliness, further suggesting that OHS are a group of aging adults with particular vulnerabilities to negative mental health effects of the pandemic and of the social distancing and isolation it imposed. This study is a qualitative report of experiences expressed by over 1,200 participants in several web-based interactive webinars for OHS during the period of "shelter at home" in March and April 2020. It is proposed that this format of "web-based, second-best" way of being together, an intervention that emerged spontaneously in response to the coronavirus and social distancing, offers a novel, nonpathologizing, effective form of supportive psychosocial intervention uniquely suited to the unprecedented challenges experienced during times requiring social distancing. (PsycInfo Database Record (c) 2021 APA, all rights reserved).


Subject(s)
COVID-19/psychology , Holocaust/psychology , Psychotherapy, Group/methods , Survivors/psychology , Adult Children/psychology , Anxiety/etiology , Anxiety/therapy , COVID-19/therapy , Humans , Internet , Siblings/psychology
10.
Bull Menninger Clin ; 85(3): 283-297, 2021.
Article in English | MEDLINE | ID: covidwho-1211728

ABSTRACT

The coronavirus disease (COVID-19) has impacted life for people throughout the world, especially for those in health care who experience unique stressors. To support the psychological needs of staff, faculty, and learners at a biomedical sciences university, faculty at Baylor College of Medicine created a mental health and wellness support program consisting of multiple behavioral health care pathways, including phone support, a self-guided mental health app, a coping skills group, and individual therapy services. The authors present this program as a model for academic institutions to support the well-being of faculty, staff, and learners.


Subject(s)
COVID-19/psychology , Faculty/psychology , Mental Disorders/therapy , Psychotherapy/methods , Students, Medical/psychology , Telemedicine/methods , Academic Medical Centers , Adaptation, Psychological , Humans , Mental Disorders/psychology , Mental Health , Mobile Applications , Psychotherapy, Group , SARS-CoV-2 , Stress, Psychological
11.
Int J Eat Disord ; 54(7): 1316-1322, 2021 07.
Article in English | MEDLINE | ID: covidwho-1204690

ABSTRACT

Reduced exposure to social reward during the COVID-19 pandemic may result in both reduced reward response to day-to-day life activities and elevated reward response to substances or naturally rewarding stimuli (e.g., food). The combined hypo- and hyper-reward responses results in a reward imbalance, which has been noted as a relevant maintenance factor for eating disorders (EDs) characterized by binge eating. This registered report describes the protocol for a pilot randomized controlled trial (RCT) comparing supportive therapy to a novel treatment targeting reward imbalance (Reward Re-Training; RRT) for individuals with binge eating. Aims of the current study include to confirm feasibility and acceptability of RRT, to evaluate the ability of RRT to engage critical targets, and to provide preliminary estimates of efficacy in reducing ED symptoms at both posttreatment and 3-month follow-up. Sixty participants will be randomized to either RRT or supportive therapy. For both conditions, treatment will be delivered in 10 weekly group outpatient therapy sessions conducted remotely using videoconferencing software. Assessments will be conducted at baseline, mid-treatment, posttreatment, and 3-month follow-up to measure feasibility, acceptability, critical treatment targets (i.e., reward to day-to-day life activities, reward to palatable foods, social isolation, and loneliness), and ED symptoms.


Subject(s)
Binge-Eating Disorder/therapy , COVID-19/psychology , Pandemics , Psychotherapy, Group/methods , Reward , Adolescent , Adult , Aged , Binge-Eating Disorder/epidemiology , Binge-Eating Disorder/psychology , COVID-19/epidemiology , Clinical Protocols , Feasibility Studies , Female , Humans , Male , Middle Aged , Pilot Projects , Treatment Outcome , Videoconferencing , Young Adult
12.
Am J Psychother ; 74(2): 83-88, 2021 Jun 01.
Article in English | MEDLINE | ID: covidwho-1059457

ABSTRACT

Although telepsychiatry is not new, the COVID-19 pandemic has dramatically boosted and legitimized it, especially in the field of group therapy. Group therapists have been forced to move online without enough training in leading online groups. Online groups are not the same as meeting in person and present specific obstacles and challenges that should either be compensated for or acknowledged as losses. In this article, the author summarizes these obstacles, identifying factors in group therapy, such as body-to-body interaction, that are absent online and suggesting ways to compensate for other differences, such as the therapist's reduced control over the setting. Surprisingly, some group members may benefit from online groups more than from in-person ones, but the online format is not for everyone. Research on online therapy has already shown this format's effectiveness, and the therapeutic alliance that is positively correlated with outcome seems to be achievable online as well. However, more research is needed, especially on cohesion in online groups, which seems to develop slower online.


Subject(s)
COVID-19 , Psychotherapy, Group , Humans , Pandemics , Professional-Patient Relations , Psychotherapy , SARS-CoV-2
13.
Semin Perinatol ; 44(7): 151279, 2020 11.
Article in English | MEDLINE | ID: covidwho-1044689

ABSTRACT

The pandemic, and the associated changes to pregnancy and postpartum experiences, can lead to profound psychological reactions including panic, hyperarousal, sleep disturbance, anxiety, depression, and traumatic stress disorders. Providers face compassion fatigue and shared trauma. In this article, we describe the mental health outcomes known to date in regard to the novel coronavirus disease 2019 pandemic for obstetric patients and their providers as well as therapeutic approaches, including our novel embedded mental health service, to address these mental health needs.


Subject(s)
COVID-19 , Compassion Fatigue/psychology , Obstetrics , Physicians/psychology , Pregnancy Complications/psychology , Pregnant Women/psychology , Psychological Trauma/psychology , Anxiety/psychology , Anxiety/therapy , Compassion Fatigue/therapy , Depression/psychology , Depression/therapy , Female , Humans , Mental Health , Mental Health Services , Organizational Policy , Pregnancy , Pregnancy Complications/therapy , Psychological Trauma/therapy , Psychotherapy , Psychotherapy, Group , SARS-CoV-2 , Sleep Wake Disorders , Stress Disorders, Post-Traumatic/psychology , Stress Disorders, Post-Traumatic/therapy , Stress Disorders, Traumatic, Acute/psychology , Stress Disorders, Traumatic, Acute/therapy , Telemedicine , Visitors to Patients
14.
Early Interv Psychiatry ; 15(6): 1595-1601, 2021 12.
Article in English | MEDLINE | ID: covidwho-991348

ABSTRACT

AIM: The COVID-19 pandemic has introduced many mental health professionals to therapy via videoconferencing. Mostly individual teletherapy has been offered and studied, although group therapy is often offered in clinics. In fact, little is known regarding group therapy's acceptability, feasibility, and potential impact when offered via videoconferencing. METHODS: This pilot study offered group cognitive-behavioural therapy for psychosis via videoconferencing to 14 individuals with early psychosis either living in remote areas or confined during the pandemic. RESULTS: The rate of consenting to the study (79%) and actual participation rates were acceptable (18.5 sessions out of 24). Although some technological obstacles were encountered, solutions offered allowed the videoconferencing group to be considered feasible for most participants and therapists. Prepost results on symptoms and self-esteem were comparable to those of other studies using the same group treatment but in-person. Alliance scores seemed similar as well. CONCLUSIONS: More studies are warranted on the efficacy of group therapy via videoconferencing. This pilot study does offer promising results, suggesting that a wider range of people with early psychosis can be reached and benefit from the advantages of receiving an evidence-based group intervention.


Subject(s)
COVID-19 , Psychotherapy, Group , Psychotic Disorders , Feasibility Studies , Humans , Pandemics , Pilot Projects , Psychotic Disorders/therapy , SARS-CoV-2 , Videoconferencing
15.
Prim Care Companion CNS Disord ; 22(6)2020 Nov 05.
Article in English | MEDLINE | ID: covidwho-916456

ABSTRACT

Objective: To report the clinical characteristics and transmission rate of coronavirus disease 2019 (COVID-19) in a community inpatient long-term care psychiatric rehabilitation facility designed for persons with serious mental illness to provide insight into transmission and symptom patterns and emerging testing protocols, as well as medical complications and prognosis. Methods: This study examined a cohort of 54 residents of a long-term care psychiatric rehabilitation program from March to April 2020. Baseline demographics, clinical diagnoses, and vital signs were examined to look for statistical differences between positive versus negative severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) groups. During the early phase of the pandemic, the facility closely followed the local shelter-in-place order (starting March 19, 2020) and symptom-based testing. Results: Of the residents, the primary psychiatric diagnoses were schizoaffective disorder: 28 (51.9%), schizophrenia: 21 (38.9%), bipolar I disorder: 3 (5.5%), and unspecified psychotic disorder: 2 (3.7%). Forty (74%) of 54 residents tested positive for SARS-COV-2, with a doubling time of 3.9 days. There were no statistical differences between the positive SARS-COV-2 versus negative groups for age or race/ethnicity. Psychiatric and medical conditions were not significantly associated with contracting SARS-COV-2, with the exception of obesity (n = 17 [43%] positive vs n = 12 [86%] negative, P = .01). Medical monitoring of vital signs and symptoms did not lead to earlier detection. All of the residents completely recovered, with the last resident no longer showing any symptoms 24 days from the index case. Conclusion: Research is needed to determine optimal strategies for long-term care mental health settings that incorporate frequent testing and personal protective equipment use to prevent rapid transmission of SARS-COV-2.


Subject(s)
Coronavirus Infections/epidemiology , Pneumonia, Viral/epidemiology , Psychotic Disorders/rehabilitation , Rehabilitation Centers , Schizophrenia/rehabilitation , Adult , African Americans , Asian Americans , Betacoronavirus , Bipolar Disorder/epidemiology , Bipolar Disorder/rehabilitation , COVID-19 , COVID-19 Testing , California/epidemiology , Clinical Laboratory Techniques , Comorbidity , Coronavirus Infections/diagnosis , Coronavirus Infections/physiopathology , Coronavirus Infections/transmission , Diabetes Mellitus/epidemiology , Gastroesophageal Reflux/epidemiology , Humans , Hyperlipidemias/epidemiology , Hypertension/epidemiology , Hypothyroidism/epidemiology , Infection Control , Long-Term Care , Mass Screening , Middle Aged , Obesity/epidemiology , Pandemics , Pneumonia, Viral/diagnosis , Pneumonia, Viral/physiopathology , Pneumonia, Viral/transmission , Psychiatric Rehabilitation , Psychotherapy, Group , Psychotic Disorders/epidemiology , Recreation , Rehabilitation, Vocational , SARS-CoV-2 , Schizophrenia/epidemiology , Smoking/epidemiology , Visitors to Patients
16.
Mayo Clin Proc ; 95(12): 2709-2718, 2020 12.
Article in English | MEDLINE | ID: covidwho-885378

ABSTRACT

During the current coronavirus disease 2019 epidemic, many outpatient chemical dependency treatment programs and clinics are decreasing their number of in-person patient contacts. This has widened an already large gap between patients with substance use disorders (SUDs) who need treatment and those who have actually received treatment. For a disorder where group therapy has been the mainstay treatment option for decades, social distancing, shelter in place, and treatment discontinuation have created an urgent need for alternative approaches to addiction treatment. In an attempt to continue some care for patients in need, many medical institutions have transitioned to a virtual environment to promote safe social distancing. Although there is ample evidence to support telemedical interventions, these can be difficult to implement, especially in the SUD population. This article reviews current literature for the use of telehealth interventions in the treatment of SUDs and offers recommendations on safe and effective implementation strategies based on the current literature.


Subject(s)
Substance-Related Disorders/therapy , Telemedicine/methods , COVID-19 , Humans , Pandemics , Psychotherapy, Group/instrumentation , SARS-CoV-2
17.
Psychol Psychother ; 94(2): 382-389, 2021 06.
Article in English | MEDLINE | ID: covidwho-880927

ABSTRACT

Digital health has emerged in recent years as a tool to optimize care delivery and promote treatment adherence among individuals with first-episode psychosis (FEP). Recent mandates for social distancing and sheltering in place due to the COVID-19 pandemic have catapulted efforts to provide ongoing coordinated specialty care (CSC) on virtual platforms. While prior evidence provides support for the general implementation of virtual individual therapy, there is limited guidance and evidence for the adoption of group teletherapy. Here we describe our efforts to implement group teletherapy for two small cohorts of individuals with FEP receiving care in a coordinated specialty care clinic using methods adopted from Acceptance and Commitment Therapy. We observed high adherence with group visits as well as client satisfaction across groups. Based on our results, we have taken efforts to implement virtual group therapy more permanently in our clinic. Our experience provides guidance and a model for integration of virtual group therapy within CSC. PRACTITIONER POINTS: In-person group therapy can be adapted as an online treatment modality for individuals with first-episode psychosis (FEP). Group teletherapy is both accessible and satisfactory to individuals with FEP. Group teletherapy has potential as a more standard and widespread treatment modality within coordinated specialty care for FEP.


Subject(s)
Acceptance and Commitment Therapy , COVID-19 , Delivery of Health Care, Integrated , Process Assessment, Health Care , Psychotherapy, Group , Psychotic Disorders/therapy , Telemedicine , Adult , Cohort Studies , Humans , Patient Compliance , Patient Satisfaction , Pilot Projects
19.
J Pediatr Psychol ; 45(9): 983-989, 2020 10 01.
Article in English | MEDLINE | ID: covidwho-780412

ABSTRACT

OBJECTIVE: We recently transitioned from in-person delivery of a brief behavioral parent intervention to telepsychology delivery to meet families' needs during the COVID-19 pandemic. In this topical review, we describe how we used treatment fidelity as a guiding principle to orient adaptations for telepsychology, as well as preliminary findings and early lessons learned in this implementation. Methods: Using rapid-cycle quality improvement methods, we adapted a brief parent training group (Bootcamp for Attention-Deficit/Hyperactivity Disorder; BC-ADHD) to three groups of caregivers (i.e., 5-7 families) of school-aged children with ADHD (n = 20; 85% males). Families were from the following ethnic backgrounds: 75% White non-Hispanic, 15% White Hispanic, and 10% Black. Clinicians completed measures on their implementation experience. Observers completed measures on content/process fidelity and attendance. Caregivers completed measures on demographics, treatment satisfaction, and telepsychology experience. RESULTS: Telepsychology BC-ADHD can be implemented with comparably high levels of content and process fidelity and treatment satisfaction to in-person groups; and it appears to be feasible and acceptable to caregivers. Caregiver and clinician qualitative feedback revealed themes of appreciating the convenience of telepsychology, while experiencing some challenges in relating to others and sharing over video. CONCLUSIONS: When treatment fidelity is used as a guiding tool, telepsychology parent training groups can be delivered with high fidelity and appear to be acceptable and feasible to caregivers and clinicians. Future research using larger and more diverse samples, multimethod and multi-informant measurement approaches, and controlled designs is needed to further assess the generalizability and efficacy of telepsychology parent training groups.


Subject(s)
Attention Deficit Disorder with Hyperactivity/therapy , Behavior Therapy/methods , Betacoronavirus , Coronavirus Infections/prevention & control , Pandemics/prevention & control , Parents/psychology , Pneumonia, Viral/prevention & control , Psychotherapy, Group/methods , Telemedicine/methods , Attention Deficit Disorder with Hyperactivity/psychology , COVID-19 , Caregivers/psychology , Child , Child, Preschool , Female , Humans , Male , SARS-CoV-2
20.
Clin Child Psychol Psychiatry ; 25(3): 672-686, 2020 Jul.
Article in English | MEDLINE | ID: covidwho-620478

ABSTRACT

The impact of COVID-19 has challenged the long accepted 'norm' in delivery of psychological therapy. Public policies designed to reduce transmission have made it extremely difficult to meet with service-users safely in the traditional face-to-face context. E-therapies have existed in theory and practice since technological progress has made them possible. They can offer a host of advantages over face-to-face equivalents, including improved access, greater flexibility for service-users and professionals, and cost savings. However, despite the emerging evidence and anticipated positive value, implementation has been slower than anticipated. Concerns have been raised by service-users, clinicians, and public health organisations, identifying significant barriers to the wide spread use of e-therapies. In the current climate, many clinicians are offering e-therapies for the first time, without prior arrangement or training, as the only viable option to continue to support their clients. This paper offers a clinically relevant review of the e-therapies literature, including effectiveness and acceptability dilemmas and challenges that need to be addressed to support the safe use and growth of e-therapies in psychology services. Further research is needed to better understand what might be lost and what gained in comparison to face-to-face therapy, and for which client groups and settings it might be most effective.


Subject(s)
Attitude of Health Personnel , Coronavirus Infections/epidemiology , Patient Acceptance of Health Care , Pneumonia, Viral/epidemiology , Psychiatry , Psychology , Telemedicine , Adult , Betacoronavirus , COVID-19 , Child , Humans , Pandemics , Psychotherapy, Group , SARS-CoV-2 , Telephone , Treatment Outcome , Videoconferencing
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