Week 1 Flashcards
What are the benefits of telemental health/video conference?
There are many benefits to telemental health,
(1) Extends the reach of services to people who may not assess services; due to availability, accessibility (rural), or stigma
(2) you are able to get insight into to patients living and home environment
(3) Video conference Psychotherapy (and by telephone) is equivalent in efficacy to F2F treatment, and patients find this to be an acceptable alternative to F2F treatment
(4) Video conference Psychotherapy can overcome distance and availability of services
(5) Some clients may feel safer communicating via the remote technology – reduced shame and self-consciousness – including relating to disclosing risk
Cons of telemental health/video conference psychotherapy
Cons of video conference psychotherapy
(1) Digital barriers
- VCP has greater digital barriers then F2F and telephone therapy
- There is greater infrastructure needed for people to engage in VCP
- - E.g. internet connection, device, bandwidth issues (with video)
(2) Peoples’ attitudes about seeing them in their home environment
(3) People’s ability to use technology
(4) Equipment - do they have a mic,
(5) Data security
- confidentiality
- - Do they live with house mates or family
- Third parties
- Is Zoom or Teams listening in on the conversations
In telemental health, do we get the same working alliance if the client is not in the room with us?
You do for clients
- Appears to be approximate equivalence for client measures… although one study reported high client perceptions of goals for VCP than F2F (Tracey and Kokotovich, 1989)
However, therapists report a lower therapeutic alliance during VCP
- But, this is not as important (the client matters more)
What are relational agents?
Relational agents (aka chatbots, conversational agents) are a software programs where you are interacting with a computer, but in a style where you are perceiving that you are having a conversation
Evidence to support relational agent (Fitzpatrick et al, 2017)
Method: 70 individuals (age 18-28 years) received either 2 weeks (up to 20 short sessions) of self-help content derived from CBT principles in a conversational format with a text-based conversational agent (Woebot) (n=34) or were directed to a Mental Health ebook
Results: a significant group difference on depression such that those in the Woebot group significantly reduced their symptoms of depression over the study period, while those in the information control group did not.
Conclusion: It is the same content being given, however the conversational agent might be a way an effective way of engaging people to attend therapy in an entertaining way; without involving a person
Why is Australia a world leader in the development and testing of computer based and online therapy programs
Due to our vast distances, relatively small population, and unequal distribution of healthcare workers
What are the most effective disorders to treat over Online (computer based) programs
Online programs are most effective for mood and anxiety disorders
Some problems (e.g. weight loss) may be less effectively treated over the internet than others
CBT may be more effective than other approaches when applied online
Why could this be?
May be due to more research of CBT in online programs
CBT is more of a skills based treatment (building peoples skills to magae difficulties), may be easier to translate to an online enviroment
Adding unique online tools (audio, graphics, interactivity) to present previously developed, mainly textual interventions may improve outcomes.
What is a vanishing factor
Online programs may be best for mid-aged individuals (19-39)
39 tends to be the point at which people arnt good at opparating digital technology
What makes for effective online programs?
G. Andersson, 2008
Evidence that therapist assisted more effective than self-guided – sig correlation between therapist contact and outcomes (incl dropout), although a cut off may be likely
In Internet based Psychotheraputic Interventions, therapist assisted therapy leads to better outcomes, and less likly to drop out
ANNONYMITY
Therapist assisted therapy (with minimal contact) produces strong working alliance
However, internet based therapy has slightly lower perceived treatment (tx) credibility
Even though the data suggests that they are in many cases equivilant
If you ask people, they will say F2F is more effective
Need to also consider literacy (reading, writing) and computer skills
These programs are NOT suitable for everyone
What are some cons of online programs
Need to also consider literacy (reading, writing) and computer skills
These programs are NOT suitable for everyone
Has lower perceived treatment credibility, but produces the same results as F2F therapy
May not be accessible to everyone (technology, internet connection required)
Provide one example of what an internet based therapy programs look like
Doctors Working Well
Consider the problem of stress in this population – what are the challenges for tx?
- Time for treatment
- stigma
The Doctors Working Well (DWW) program
- An initial assessment
- 6 modules – focus on building resiliency and capacity to manage stress
- Each module follows the same structure: welcome message and video; agenda; review of previous module and homework; brief self-assessment; new content consisting of didactic learning, videos, audio, interactive exercises; summary of content; quick quiz; plan for the next session
- Post and FU assessments
- The DWW does not have therapist support
Why? - it is an anonymous program given that there is high stigma within this population
What are the uses of Online Programs?
Treatment of mental disorders
Prevention of mental disorders
- Focuses on skills building, resilence, mental health literacy, emotional regulation
Allows people to access services anonymously
What are the positives and negative of a NAO Humanoid Robot
High acceptability - people enjoyed the robot and found it useful
Participants reported
Non-judgmental***
Patient and didn’t interrupt
Allowed a chance to clarify thoughts out loud
However,
Mixed results with respect to changes in activity
Some disappointment with lack of individualised responses
What are Socially assistive robots (SARS)
Socially assistive robots definition – technology platforms that are developed to interact with individuals socially while also assisting them with management of their physical and psychological wellbeing.
in comparison to mHealth interventions Socially Assisted Robots can…
in comparison to mHealth interventions SARs can:
Support patient accountability
- Similar to the role of minimal therapist support in an online program
Provide continuously tailored feedback
- By the way it monitors the person
Form a social relationship to successfully impact client wellness
- Reduce loneliness and improve welless
Do socially assistive robots (SARS) work?
What are some problems with research in this field?
According to a systematic review SARS
- increases in mood, comfort, or stress reduction, following interaction.
However,
- there is a lack of randomised control trials
- most trials have been done with elderly patients (with dementia)
- lack theory
- pilot studies
What is e-psychology/ digital mental health?
interventions designed and based on psychological practice, theory, and research delivered through digital media” (Kraft, Drozd, & Olsen, 2009)
Must be driven by theory and research about why it might enhance what we are doing or improve a service delivery
Reasons to make use of technology in psychotherapy
(1) Unmet need for mental health interventions**
- The people who need/seek support each year do NOT get treatment
(2) Increases access for people unable or unwilling to come in for F2F therapy (access and reach)
- Due to stigma, distance (rural area)
(3) Cost reduction e.g., earlier intervention
- People who seek help via digital mental health seek it at an ealier time, compared to those who wait for F2F therapy. Thus, there is a two part cost reduction…
- - The efficiency of the service
- - And when you intervene earlier the person requies less of a dose of therapy
(4) Facilitation of conventional service delivery
- - Telehealth - not changing much about the therapy but use a digital means to deliver it
- - Increases access
(5) Democratisation of healthcare and facilitation of consumer empowerment
- - People should have a choice
(6) May assist in examining change processes in therapy
(7) Rapid growth of technology – a shaping force
WHY DO WE HAVE SUCH UNMET NEED IN AUSTRALIA
One of the reasons we have such high unmet need in Australia is because we have a national shortage of health care workers
Also, we have a large landmass and small population
What happened to mental health during the Pandemic?
COVID had a detrimental effect on people mental health, as seen by the rise in mental health distress
Additionally, most countries have cut their funding to mental health (disruptions in 93% countries; WHO, 2021)
Diverted funds to other health care sevices during the pandemic (hospitals ect)
The rates of distress has gone up but the funding and resources has gone down
Why did digital mental health come around in Australia?
Digital mental health came around in Australia to adress unmet need
What is unmet need?
Unmet need may be conceptualised in terms of Barriers to Care/ Treatment
Barriers to care - any reason/factors which will prevent a person from accessing mental health care when they need it. This is specific to the individual / community
How to measure a persons barriers to care?
Mohr’s Barriers to Psychological Treatment Scale
- Scale to understand barriers to treatment
- a score of 2 or more on a scale is deemed a barrier to care
How does e-psychology fit in the health care system?
Stepped mental health care -
- - at the bottom is people who have no/minimal symptoms (going well). Preventative approaches
- Next step up - people who have mild symptoms, they may not have a disorder
- Next step up - people with moderate symptoms, and they have moderate interference with their mental health symptoms
- Top step - servere symptoms, people who have servere impact/interference from their symptoms, symptoms affect their functioning
What does stepped mental health care do?
Due to australias finite resurces, stepped care allows us to allocate resources in the best way possible
This is where digital mental health comes in
For people at the bottom step (no/minimal symptoms) they should be refered to digital mental health care
What are clients perceptions of e-psychology
Generally clients report satisfaction with use of internet mental health interventions (Christiansen, Griffiths & Evans, 2002)
- - However, those that havnt tried it are hesitant, due to preconceived ideas or concerns
some individuals may prefer the internet to other methods of delivering and receiving mental health interventions because of its anonymity
What traits do e-preferes display? (Klein and Cooke)
Klein and Cooke found that
e-preferers were sig more introverted, lower on agreeableness, emotional stability, and openness to experience.
e-preferers also reported greater internalised stigma
These may explain why they preferred online services
Therapist perceptions of Digital Mental Health
Therapist reactions are more clearly mixed (Lal & Adair, 2014)
Some concerns
- - Will it take my job?
- - Concerns it will be expensive to develop and deploy
- - That funds will be diverted from necessary & conventional services
- - How will I establish rapport with a client online?
Working alliance
- - Risk and disorder/ severity concerns
- - ”Technological phobia”
What are the barriers of e-psych?
equipment (resources),
but most concerns information and attitudes
What is one of the biggest criticisms of digital mental health?
One of the biggest criticisms of digital mental health is the lack of theory integration
What type of theory is the Theory of Planned Behaviour?
and why?
General theory, because it can be applied to any behaviour that you are interested in
What is the theory of planned behaviour?
can you draw it?
BEHAVIOUR - this could be for anything, but for this example we will do uptake of digital mental health
INTENTION - the behaviour is predicted by a behavioural intention, e.g. i intend to use my program this week
Attitiude, Subjective norm, Perceived behavioural control - intention is predicted by these,
Specifically…
attitude - is it something that is a worthwhile investment of time
Subjective norm - what does everyone else think?
Perceived behavioural control - (indirect pathway to behaviour) if i wanted to do it, can i?
Provide an example of where the theory of Planned Behaviour has been used
Study
Does the theory of planned behaviour predict client engagement in their digital mental health intervention?
Method
Participants responded to a questionnaire called the therapy attitudes and process questionair (eTAP)
results - eTAP interventions correctly predicted engagement in e-intervetions with 84% accuracy and non-engagment with 74% accuracy
Conclusion
This showed that integration of theory was helpful in being able to identify those were going to continue and those who would drop out
What is the Technology Acceptance Model?
It is a specific theory because it is just applied to technology
components….
Actual system use - the behaviour
Preceded by the intention to use
Preceded by attitude
attitude is the combination of whether or not a person perceives a system as being useful (will i get a benefit from this digital mental health) and percieved ease of use
New component
External variables - age, economic background
Other considerations of online mental health services
Other considerations of online mental health services
Privacy and Confidentiality
- Who owns the data?
- Where is it stored?
- How secure is it?
Liability
Conflict of Interest (Emmelkamp, 2005)
- Do researchers stand to benefit from using an app?
- If so, how likely are they to publish results that go against the app
- Could there be publication bias?
Where do digital mental health interventions fit in healthcare systems? (Mohr et al., 2013)
- - Are they funded?
- - What are the costing models?
- - How are people channeled into them?
- - - Will they link with electronic records for patient history?
……In digital mental health, there is no recognition of who engages in online therapy. This a GP wouldnt know if it didnt work for you, but if it was F2F a psychology would let other health professionals know
Evaluating efficacy - Research often underpowered or lacking methodological rigour
- - Traditional approaches, like randomised control trials do not fit well with the way technology advances
How do you know whether an app or an online program has good research behind it?
