TELEPSYCHOLOGY FOR THE PSYCHOLOGIST IN PRIVATE PRACTICE

Transcription

1 TELEPSYCHOLOGY FOR THE PSYCHOLOGIST IN PRIVATE PRACTICE Dr. Madalina Sucala Icahn School of Medicine at Mount Sinai Department of Oncological Sciences

2 OUTLINE Video conferencing as a delivery method Assessment Intervention Depression Anxiety Anger Integrated Care Therapeutic Alliance Supervision & training

3 TELEPSYCHOLOGY - VIDEO CONFERENCING The delivery of mental health services via telecommunication technologies Video conferencing Internet text-based Telephone Apps

4 TELEPSYCHOLOGY Video conferencing is the real-time, synchronous transmission of digital images and audio signals between individuals or groups for the purpose of delivering clinical and educational services Video conferencing allows the clinician to observe the patient s appearance, including the choice of clothing and attire, facial expression, and bodily movement and to use these visual cues to inform clinical diagnosis and treatment recommendations Myers & Turvey, 2013; Nelson, Bui, & Velasquez, 2011; Nelson & Vasquez, 201

5 TELEPSYCHOLOGY The real-time quality of video conferencing make it an attractive alternative to other technologies when assessing or intervening in mental health settings APA (2010) report: Psychologists use of video conferencing has increased from 2% in 2000 to 10% in 2008 American Psychological Association, Center for Workforce Studies.(2010).

6 EVIDENCE-BASED TELEPSYCHOLOGY A growing body of scientific evidence, coupled with expanding implementation, is demonstrating that video-delivery of psychological services is a viable option for providing care to individual patients Psychologists are moving the point of care delivery into patients living environments The real-time quality of video conferencing make it an attractive alternative to other technologies when assessing or intervening in mental health settings Gros et al., 2013

7 EVIDENCE-BASED TELEPSYCHOLOGY Despite the myth that face-to-face is superior to telepsychology, there is considerable research that establishes equivalency in terms of consumer satisfaction and outcomes The use of tele-mental health via videoconferencing has been widely embraced as a cost-efficient and effective service particularly for those facing access-to-care barrier Antonacci, Bloch, Saeed et al., 2008; McGinty et al., 2006; Norman, 2006; Shore & Manson, 2005

8 TELEPSYCHOLOGY One of the most frequently cited meta-analysis comprised over 90 studies investigating tele-psychology, involving a total of 9764 patients, treated through various telepsychology for a variety of problems The overall mean weighted effect size was 0.53 (medium effect size), which means that 70 % of the treatment group was above the mean of the control group; which is quite similar to face-to-face interventions d =0.53 Barak et al., 2008

9 ASSESSMENT There is strong evidence for the reliability of video conferencing clinical assessments relative to face-to-face assessments Several studies have investigated the intraclass correlations (ICCs) for clinical interviews conducted by video and in person. Intraclass Correlation Coefficient (ICC) is a measure of the reliability of measurements or ratings e.g., ICCC: ~.89 (psychiatric interviews) e.g., ICCC: ~.88 (symptom rating scales) Jones et al., 2001; Lexcen et al., 2006.; Kobak, 2004; Kobak et al., 2007

10 Kobak, 2004 ASSESSMENT

11 ASSESSMENT The psychometric properties of a wide range of instruments have been deemed adequate via video conferencing: Clinical interviews Symptom rating scales Neuropsychological testing, Mental status examinations Hilty et al., 2013

12 Examples The Structured Clinical Interview for the Diagnostic and Statistical Manual (DSM) (SCID), Beck Depression Inventory II, Diagnostic Interview Schedule (DIS), The Brief Psychiatric Rating Scale (BPRS), The Scales for the Assessment of Negative and Positive Symptoms (SANS and SAPS, respectively), Hamilton Depression Rating Scale (HDRS), Hamilton Anxiety Scale (HAMA) MONTGOMERY ASBERG DEPRESSION RATING SCALE Yale-Brown Obsessive Compulsive Scale The Abnormal Involuntary Movement Scale (AIMS) National Adult Reading Test, Adult Memory and Information Processing Battery Geriatric Depression Scale (GDS) Mini-Mental Status Examination (MMSE) ASSESMENT Hilty et al., 2013

13 INTERVENTION Depression Anxiety Anger Integrated Care Therapeutic Alliance

14 INTERVENTION A systematic review of 65 studies: The results indicate that video conferencing interventions are increasingly studied Backhaus et al. (2012)

15 INTERVENTION The results of the systematic review indicated that psychotherapy video conferencing interventions: Are feasible Have good user satisfaction, Are similar clinical outcomes to traditional face-to-face psychotherapy Backhaus et al. (2012)

16 DEPRESSION Various studies investigating the efficacy of psychotherapy through video conferencing for patients with depression demonstrated clinically significant improvement in depressive symptoms. A recently published meta-analysis of 19 studies (n = 2996), revealed a moderate post-treatment pooled effect size d=0.56 Therapist support : d =0.78 Supported interventions yielded better outcomes, along with greater retention Richard & Richardson, 2012; Anderrson & Cuijpers, 2009 d=.56

17 ANXIETY Stubbings et al. (2013) - investigating the effects of video conferencing for anxiety: The program used to conduct the videoconferencing was ichat panic/agoraphobia hypochondriasis generalized anxiety and obsessive-compulsive disorder

18 ANXIETY Meta-analysis on 72 studies with 4537 participants, comparing tele-psychology with no intervention: Tele-psychology was superior to no intervention for people with anxiety (medium effect: 0.67); There were positive effects on: symptoms of anxiety, response and recovery from illness, disability, and quality of life Wilson & Montgomery, 2013

19 ANGER RCT of 125 male veterans with PTSD and Anger difficulties was conducted at 3 Veterans Affairs outpatient clinics. Participants were randomly assigned to receive anger management therapy delivered in a group setting with the therapist either in-person (n = 64) or via videoconferencing (n = 61). Participants in the videoconferencing condition demonstrated a reduction in anger symptoms similar ("non-inferior") to symptom reductions in the in-person groups. No significant between-group differences were found on process variables, including attrition, adherence, satisfaction, and treatment expectancy Morland et al., 2010

20 Morland et al., 2010 ANGER

21 INTEGRATED CARE Integrated or collaborative care = coordination of care for patients who have psychiatric disorders and general medical illness. There is a higher rate of psychiatric illness in patients with chronic medical illness; also there is a higher rate of chronic medical illness among patients with psychiatric illness! No studies yet to investigate the use of video-conferencing platforms Debate on developing integrated practices Summergrad, 2014; APA, 2012; APA, 2011

22 THERAPEUTIC ALLIANCE Systematic review on E-therapy (2012): From the 840 reviewed studies, only 11 (1.3%) investigated the therapeutic relationship. The majority of the reviewed studies were focused on the therapeutic alliance a central element of the therapeutic relationship. Although the results do not allow firm conclusions, they indicate that e- therapy seems to be at least equivalent to face-to-face therapy in terms of therapeutic alliance, and that there is a relationship between the therapeutic alliance and e-therapy outcome. Sucala et al. (2012)

23 THERAPEUTIC ALLIANCE No systematic reviews to investigate videoconferencing RCT studies: RCT for panic and agoraphobia: the differences between conditions with regards to client symptoms and quality of the working alliance was not significant (Bouchard et al., 2004). RCT for Mood and Anxiety Disorders: there were no significant differences between conditions in client ratings of the Working Alliance Inventory Short Form (t 21 = 0.63, P=.53, one-tailed, d= 0.26), nor in therapist ratings (t 22 =0.53, P=.60, one-tailed, d=0.23) (Stubbings et al., 2013) Pilot studies: Web-based family problem solving intervention: Wade and colleagues also reported in a pilot study that clients were able to build a strong relationship with the therapist via videoconferencing (Wade et al., 2004) Nonspecific symptoms: 9 out of 10 patients reported that they were able to develop a therapeutic relationship via PC-based videoconferencing (Simpson et al., 2001)

24 SUPERVISION & TRAINING Psychotherapy training via video conference in virtually all major psychotherapeutic modalities: acceptance and commitment therapy (ACT), cognitive-behavioral therapy (CBT), dialectical-behavioral therapy (DBT), emotion-focused therapy (EFT), intensive short-term dynamic psychotherapy (ISTDP), psychoanalysis, many others. Researchers are reporting high rates of satisfaction with videoconferencing for psychotherapy supervision and training Rousmaniere et al., 2014

25 SUPERVISION Clinical supervisors are quickly integrating numerous new technologies into their practice: webcams, tablet computers (e.g., the ipad), the Internet cloud, web-based software for tracking clinical outcomes, smartphone applications ( ) Rousmaniere et al., 2014

26 SUPERVISION 25 clinical research studies on technology-assisted supervision and training (TAST) have been conducted since 2000 Xavier, Shepard, and Goldstein (2007) investigated the effects of video conference supervision and training provided to a group of psycho-oncology staff. Results revealed: an increase in confidence in assessing and treating pain in people with cancer, an increase in knowledge in the field, a 25% increase in sense of effectiveness in managing psychological distress Xavier et al., 2007;

27 SUPERVISION In a study investigating face-to-face versus video conferencebased supervision (n=9), results revealed: no differences in satisfaction with both the quality of supervision and the quality of the supervisory relationship between the two conditions. the students self-efficacy in their counseling skills increased over the course of the supervision study. Reese et al., 2009 Consultation: while there are no studies yet to investigate the efficiency of the online approach, based on the supervision studies, we have reasons to believe that it could be a feasible endeavor.

28 TRAINING Meta-analysis of 201 studies on the effects of Internet-based instruction for health professions learners: The results favored Internet-based interventions: Knowledge outcomes: d=1.00 (95% confidence interval [CI], ; P <.001; n = 126 studies) Skills: d=0.85 (95% CI, ; P <.001; n = 16) Learner behaviors and patient effects: d= 0.82 (95% CI, ; P <.001; n = 32) Cook et al., 2008

29 Thank you!