Digital Mental Health - Computers for Therapy

Describe the history of telemental health

• Dates back to 1879 when an article in the Lancet suggested that doctors consult patients via telephone to reduce unnecessary home visits

• In the 1920s, telephones were used to deliver advice from health practitioners to rural and ship based clinics, where they could not reach their patients in person

• In the 1950s, NASA used telephones to provide healthcare to astronauts

When did research into telemental health treatments emerge?

The 1950s

What did early telemental health treatments consist of?

Patients had to travel to a health clinic and consult with practitioners using technology at the clinic

What is the most widely used form of telemental health treatment?

Crisis intervention

Think: Suicide hotlines

Describe the findings from Day and Scheider’s study

They tested 4 different treatment groups; face to face, videoconference, audio only and WLC to see which had the best treatment effects

• All 3 conditions performed better than WLC with no significant differences in efficacy

• Client participation was higher in the distance treatment groups than face to face

  • This meant they made more of an effort to communicate and took more responsibility in the distance condition than face to face

  • Distance may have made openness feel safer

Therefore, despite common perceptions that face to face therapy is better, distance therapy may actually make people more inclined to participate in the therapy process.

How do the conversational dynamics differ between F2F and telemental therapy?

There is less emphasis on non-verbal information and greater emphasis on turn-taking

Therapy sessions are also often shorter

Videoconferencing

A digital mental health service that provides counselling or psychotherapy using a digital device equipped with a camera, to incorporate the visual aspects of therapy

• Extends breadth of services to be able to give access to clients to who may in remote areas, cannot travel to a clinic, or who face stigma

• Has become a standard aspect of care since the pandemic

How does videoconferencing compare to face to face therapy in terms of efficacy?

Evidence suggests they are equivalent

• A metaanalysis (k = 42) found that VC had similar outcomes to F2F when:

  • Delivered in a range of formats, including individual, group and family

  • Using a range of therapeutic approaches (CBT, ACT, interpersonal therapy, etc)

  • In diverse client backgrounds and difficulties (age, ethnic background, psychopathology, etc)

  • Client satisfaction

However, clients sometimes report internet connection difficulties, but these do not effect client satisfaction and they tend to roll with it

Note that the research area lacks RCTs with WLC groups! (quality of research could be stronger)

What does the research of videoconferencing therapy primarily focus on?

Individual therapy for adults presenting with anxiety or depression using a CBT approach

• So whilst meta-analyses do use some studies from other applications/groups, the majority was as above

• However, this is also the most common thing seen in a clinic too

• Just be careful when making a blanket statement across all populations and therapeutic modalities

Benefits of videoconferencing vs face to face

• Improves reach and accessibility of therapy services, including to those who cannot travel to a clinic, live in remote or rural areas, or who feel stigmatised by attending a clinic

• Can give insight into home and living context that you would not get in a therapists office

Describe the acceptance of videoconferencing amongst consumers

A study investigated this and found that when people were asked which mode of therapy they would prefer - face to face or videoconferencing - most preferred face to face (77%)

However, only 9% said they would refuse it

• Demonstrates that there is still a place for face to face therapy, but videoconferencing remains a viable and effective option for consumers

What are some barriers to care in any therapy context?

• Distance

• Service availability

• Technological barriers (i.e. poor internet access, lack of suitable devices, bandwidth issues)

• Financial barriers

What are the cons of videoconferencing therapy?

• Greater infrastructure and resources are required to engage in videoconferencing therapy

• You need good bandwidth (i.e. when too many people are online and the internet is overloaded)

• Some people feel more anxious about giving the therapist insight into the home environment

• Technological literacy

• Creating a confidential environment for the client both as the therapist, and for them to access one (i.e. discussing DV with the partner in the other room)

• Ensuring data security (i.e. you have to enter a third party, like Zoom, into the equation)

• Some assessments and activities may not be practical online

Think: You need a laptop or phone with a camera built in, rather than just a telephone

Reflective Question: Is equivalence in efficacy between F2F therapy and videoconferencing really needed?

Not necessarily

• If the intervention provides positive treatment outcomes, the client is satisfied with the mode of delivery or the treatment would have been otherwise inaccessible, then this is still positive

• Videoconferencing is not here to replace F2F therapy, but rather be additive to improve reach, access and choice

• Shows that perhaps the literature focusses too much on equivalence

How does videoconferencing influence the working alliance?

It does not negatively influence it, as many preconceptions suggest

• Evidence shows that ratings of the working alliance are somewhat equivalent between VC and F2F

• One study found that clients reported higher perception of GOALS in VC than F2F

• VC may even enhance communication with increased focus on turn-taking, social cues, slower pace and clarity and signs of emotionality

  • These can improve the processing of information in therapy, and generally you will actually get through less content, but this limits overload

• Some clients may feel safer communicating via remote technology as it offers a greater sense of anonymity and reduces shame and self-consciousness

• Makes them more likely to disclose information, including risk

However, therapists generally report a lower working alliance

What are the 3 components of the working alliance

• Bond

• Goals

• Tasks

What is the best predictor of therapeutic outcomes? Client or therapist perceptions of the working alliance?

What does this mean for the efficacy of videoconferencing?

Client

• Clients generally report higher scores of working alliance than therapists in videoconferencing

• This means the outcomes are more likely to be positive

UP TO THE PARAGRAPH UNDER VCP MINI LECTURE