Despite the increasing use of teletherapy, it remains unclear if client outcomes differ between remote and in-person settings and, if they do differ, what factors might contribute to these ...differences. The current study synthesized findings on the comparison between teletherapy and in-person therapy using a meta-analytic approach. All known RCTs comparing teletherapy (telephone and videoconferencing therapy) to in-person therapy were identified via bibliographic database search (PsycINFO, Medline, and Cochrane database), manual searches of previously published meta-analyses, and expert contact. We identified 1,393 studies in the initial search, 20 of which satisfied study inclusion criteria. No significant difference was found between teletherapy and in-person therapy in treatment outcomes at posttreatment (g = −0.043) or follow-up (g = −0.045) or in attrition rates (RR = 1.006). Trainee therapists experienced greater client attrition rates in teletherapy than did licensed therapists. Videoconferencing therapy was at greater risk for client attrition than telephone therapy. Within-group findings showed that teletherapy produced a symptom reduction of a large magnitude at posttreatment (g = 1.026) and follow-up (g = 1.021). These findings provide empirical support for the practice of teletherapy and that client outcomes in teletherapy do not differ from in-person versions of treatments.
Public Health Significance StatementsTeletherapy produces comparable outcome to in-person therapy. Trainee therapists are at greater risk of client dropout in teletherapy than licensed therapists.
The coronavirus disease (COVID-19) pandemic has resulted in a rapid transition from in-person therapy to teletherapy. This study examined mental health providers' perceptions of the differences ...between in-person therapy and teletherapy in common therapeutic attributes and identified therapist characteristics that predicted differences. A sample of 440 therapists and trainees completed an online survey that assessed their provision of clinical services since the outbreak of COVID-19. Therapists provided ratings for having used 28 therapeutic attributes (e.g., empathy, emotional expression) and skills for in-person therapy and teletherapy. Those attributes were clustered into three factors via exploratory factor analysis (EFA) and confirmatory factor analysis (CFA): common therapeutic skills (e.g., warmth), extra-therapeutic influence (e.g., providing resources), and perceived outcome (e.g., symptom reductions). Therapists perceived poorer common therapeutic skills, decreased outcomes, and reduced extra-therapeutic influence when conducting teletherapy compared to in-person therapy. Therapists who reported poorer common therapeutic skills in teletherapy tended to be male, younger, utilize experience-based and relational therapies, have smaller caseloads, and had little training and no prior experience in teletherapy. Additionally, being male, utilizing experience-based and relational therapies, and having no training in teletherapy were associated with therapists' perception of reduced outcome in teletherapy. More intensive training and support in these attributes/skills are needed to improve therapists' confidence and ability to use therapeutic skills during teletherapy and ultimately improve the quality of psychological services in the era of teletherapy.
Clinical Impact Statement
Question:
How do therapists perceive telepsychology differently from face-to-face therapy during the COVID-19 pandemic?
Findings:
Therapists felt less skilled in most therapeutic attributes when conducting teletherapy compared to face-to-face therapy.
Meaning:
Training and support are needed to improve therapists' abilities to use therapeutic skills in telepsychology, particularly those therapists who have little experience with and training in telepsychology.
Next Steps:
It is important to examine whether and how therapists being less skilled in teletherapy versus face-to-face therapy may result in diminished client outcomes.
Psychotherapy at a Distance Markowitz, John C; Milrod, Barbara; Heckman, Timothy G ...
The American journal of psychiatry,
03/2021, Letnik:
178, Številka:
3
Journal Article
Recenzirano
Odprti dostop
The 2020 COVID-19 pandemic has abruptly overwhelmed normal life. Beyond the fear and fatality of the virus itself comes a likely wave of psychiatric disorders. Simultaneously, social distancing has ...changed overnight how psychiatrists and other mental health professionals must treat patients. Telepsychotherapy, until now a promising but niche treatment, has suddenly become treatment as usual. This article briefly reviews the limited clinical evidence supporting different modes of telepsychotherapy, then focuses on how remote therapy affects clinicians and their patients.
Purpose
In the United States, approximately 45% of persons living with HIV (PLHIV) are ≥ 50 years of age. Many older PLHIV have multi-morbidities that complicate HIV infection and/or interfere with, ...or are exacerbated by, antiretroviral treatment. Physical health symptoms and psychiatric disorders, particularly depression, can worsen life quality in older PLHIV.
Methods
This study assessed associations among physical symptoms, indicators of HIV-related health status (i.e., time since diagnosis; ever diagnosed with AIDS; having attained viral suppression), depressive symptoms, and health-related quality of life (HRQoL) in older PLHIV. Regression analyses examined data from 296 PLHIV ≥ 50 years of age living in Cincinnati, OH, Columbus, OH, and New York City.
Results
Depressive symptoms and physical symptoms, particularly those related to appearance and sexual functioning, most strongly predicted HRQoL. Indicators of HIV health status did not significantly predict HRQoL. Depressive symptoms were a particularly robust predictor of HRQoL, even when accounting for physical health symptoms.
Conclusion
Findings suggest that symptom management is critical to HRQoL in older PLHIV, and symptoms related to physical appearance and sexual functioning should not be overlooked in this growing population.
Objectives: This study tested the mediating effect of resilience on the relationship between life stress and health-related quality of life (HRQoL) in older people, 50 years of age and older, living ...with HIV/AIDS (OPLWHA).
Method: Data from 299 OPLWHA were analyzed using structural equation modeling (SEM) to define a novel resilience construct (represented by coping self-efficacy, active coping, hope/optimism, and social support) and to assess mediating effects of resilience on the association between life stress and HRQoL (physical, emotional, and functional/global well-being).
Results: SEM analyses showed satisfactory model fit for both resilience and mediational models, with resilience mediating the associations between life stress and physical, emotional, and functional/global well-being.
Conclusion: Resilience may reduce the negative influence of life stress on physical, emotional, and functional/global well-being in OPLWHA. Interventions that build personal capacity, coping skills, and social support may contribute to better management of HIV/AIDS and increase HRQoL.
Depressed HIV-infected rural persons who received 9 sessions of telephone-delivered interpersonal psychotherapy (IPT) reported significantly fewer depressive symptoms than non-intervention ...participants at long-term follow-up.
Abstract
Background
Rural areas account for 5% to 7% of all HIV infections in the USA, and rural people living with HIV (PLHIV) are 1.3 times more likely to receive a depression diagnosis than their urban counterparts. A previous analysis from our randomized clinical trial found that nine weekly sessions of telephone-administered interpersonal psychotherapy (tele-IPT) reduced depressive symptoms and interpersonal problems in rural PLHIV from preintervention through postintervention significantly more than standard care but did not increase perceived social support compared to standard care.
Purpose
To assess tele-IPT’s enduring effects at 4- and 8-month follow-up in this cohort.
Methods
Tele-IPT’s long-term depression treatment efficacy was assessed through Beck Depression Inventory self-administrations at 4 and 8 months. Using intention-to-treat and completer-only approaches, mixed models repeated measures, and Cohen’s d assessed maintenance of acute treatment gains.
Results
Intention-to-treat analyses found fewer depressive symptoms in tele-IPT patients than standard care controls at 4 (d = .41; p < .06) and 8-month follow-up (d =.47; p < .05). Completer-only analyses found similar patterns, with larger effect sizes. Tele-IPT patients used crisis hotlines less frequently than standard care controls at postintervention and 4-month follow-up (ps < .05).
Conclusions
Tele-IPT provides longer term depression relief in depressed rural PLHIV. This is also the first controlled trial to find that IPT administered over the telephone provides long-term depressive symptom relief to any clinical population.
Trial Registration
ClinicalTrials.gov Identifier: NCT02299453.
Objective
Interpersonal psychotherapy (IPT) has demonstrated efficacy for the treatment of depression, yet little is known about its therapeutic mechanisms. As a specific treatment, IPT has been ...shown to directly reduce depressive symptoms, although it is unclear whether these reductions occur via interpersonal changes. Within IPT, the potential role of the working alliance, a common factor, as a predictor of depression and interpersonal changes is also unclear.
Method
Participants were 147 depressed persons living with HIV in rural communities of 28 U.S. states enrolled in a randomized clinical trial. Seventy‐five patients received up to 9 sessions of telephone‐administered IPT (tele‐IPT) plus standard care and 72 patients received standard care only. Two models were tested; one included treatment condition (tele‐IPT vs. control) and another included the working alliance as independent variables.
Results
The first model found an indirect effect whereby tele‐IPT reduced depression via decreased social avoidance. There was a direct effect between tele‐IPT and reduced depression. In the second model, the working alliance influenced depressive symptom relief via reductions in social avoidance. Both goal and task working alliance subscales were indirectly associated with reductions in depressive symptoms, also through reductions in social avoidance. There were no direct effects involving the working alliance. Tele‐IPT's influence on depressive symptom reduction was primarily through a direct effect, whereas the influence of working alliance depression was almost entirely via an indirect effect through interpersonal problems.
Conclusion
Study findings have implications for IPT when intervening with depressed rural people living with HIV/AIDS over the telephone.
Human immunodeficiency virus (HIV)-positive rural individuals carry a 1.3-times greater risk of a depressive diagnosis than their urban counterparts. This randomized clinical trial tested whether ...telephone-administered interpersonal psychotherapy (tele-IPT) acutely relieved depressive symptoms in 132 HIV-infected rural persons from 28 states diagnosed with Diagnostic and Statistical Manual of Mental Disorders-IV major depressive disorder (MDD), partially remitted MDD, or dysthymic disorder. Patients were randomized to either 9 sessions of one-on-one tele-IPT (n = 70) or standard care (SC; n = 62). A series of intent-to-treat (ITT), therapy completer, and sensitivity analyses assessed changes in depressive symptoms, interpersonal problems, and social support from pre- to postintervention. Across all analyses, tele-IPT patients reported significantly lower depressive symptoms and interpersonal problems than SC controls; 22% of tele-IPT patients were categorized as a priori "responders" who reported 50% or higher reductions in depressive symptoms compared to only 4% of SC controls in ITT analyses. Brief tele-IPT acutely decreased depressive symptoms and interpersonal problems in depressed rural people living with HIV.
Although abnormal accumulation of amyloid in the brain is an early biomarker of Alzheimer's disease (AD), wide variation in cognitive trajectories during life can be seen in the setting of brain ...amyloidosis, ranging from maintenance of normal function to progression to dementia. It is widely presumed that cognitive resilience (i.e., coping) to amyloidosis may be influenced by environmental, lifestyle, and inherited factors, but relatively little in specifics is known about this architecture. Here, we leveraged multimodal longitudinal data from a large, population-based sample of older adults to discover genetic factors associated with differential cognitive resilience to brain amyloidosis determined by positron emission tomography (PET). Among amyloid-PET positive older adults, the AD risk allele APOE ɛ4 was associated with worse longitudinal memory trajectories as expected, and was thus covaried in the main analyses. Through a genome-wide association study (GWAS), we uncovered a novel association with cognitive resilience on chromosome 8 at the MTMR7/CNOT7/ZDHHC2/VPS37A locus (p = 4.66 × 10
, β = 0.23), and demonstrated replication in an independent cohort. Post-hoc analyses confirmed this association as specific to the setting of elevated amyloid burden and not explained by differences in tau deposition or cerebrovascular disease. Complementary gene-based analyses and publically available functional data suggested that the causative variant at this locus may tag CNOT7 (CCR4-NOT Transcription Complex Subunit 7), a gene linked to synaptic plasticity and hippocampal-dependent learning and memory. Pathways related to cell adhesion and immune system activation displayed enrichment of association in the GWAS. Our findings, resulting from a unique study design, support the hypothesis that genetic heterogeneity is one of the factors that explains differential cognitive resilience to brain amyloidosis. Further characterization of the underlying biological mechanisms influencing cognitive resilience may facilitate improved prognostic counseling, therapeutic application, and trial enrollment in AD.
This clinical trial tested whether telephone-administered supportive-expressive group therapy or coping effectiveness training reduce depressive symptoms in HIV-infected older adults. Participants ...from 24 states (
N
= 361) completed the Geriatric Depression Scale at pre-intervention, post-intervention, and 4- and 8-month follow-up and were randomized to one of three study arms: (1) 12 weekly sessions of telephone-administered, supportive-expressive group therapy (tele-SEGT;
n
= 122); (2) 12 weekly sessions of telephone-administered, coping effectiveness training (tele-CET;
n
= 118); or (3) a standard of care (SOC) control group (
n
= 121). Tele-SEGT participants reported fewer depressive symptoms than SOC controls at post-intervention (M
SEGT
= 11.9, M
SOC
= 14.3) and 4- (M
SEGT
= 12.5, M
SOC
= 14.4) and 8-month follow-up (M
SEGT
= 12.7, M
SOC
= 14.5) and fewer depressive symptoms than tele-CET participants at post-intervention (M
SEGT
= 12.4, M
CET
= 13.6) and 8-month follow-up (M
SEGT
= 12.7, M
CET
= 14.1). Tele-CET participants reported no statistically significant differences from SOC controls in GDS values at any assessment period. Tele-SEGT constitutes an efficacious treatment to reduce depressive symptoms in HIV-infected older adults.
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