Bonnie A. Clough

Technological adjuncts to increase adherence to therapy: a review

This paper identified and reviewed technological adjuncts to increase client adherence to therapy. Three areas of adherence were identified, namely treatment dropout and non-attendance, engagement during and between therapy sessions, and aftercare. Database searches were conducted in each of these areas to identify relevant studies published between the years of 1990 and 2010. Adjuncts designed to replace or reduce direct therapist contact, change the medium of communication between the client and therapist, or alter the content or style of the therapy were not included in this review. Adjuncts were reviewed in light of theories of adherence, including Self Determination Theory, the Transtheoretical Model, and the Theory of Planned Behaviour. Adjuncts reviewed included appointment reminders, exercises and monitoring delivered by mobile phone, and exercises and data collection delivered by computer. Limitations and directions for future research were addressed and discussed.

Technological adjuncts to enhance current psychotherapy practices: A review

Although there are several of reviews of technology in psychology, none to date has focused on technological adjuncts for improving traditional face to face therapy. However, examination of response, adherence, and dropout rates suggests there is considerable scope for improving traditional face to face services. The purpose of this paper was to examine technological adjuncts used to enhance psychotherapy practice. This review focused only on those technologies designed to supplement or enhance traditional therapy methods. Adjuncts designed to reduce direct therapist contact or change the medium of communication were not included. Adjuncts reviewed were mobile phones, personal digital assistants, biofeedback and virtual reality. Limitations in the current literature and directions for future research were identified and discussed. This review provides a comprehensive examination of the way in which adjunctive technologies may be incorporated into face to face therapy.

Measuring mental health literacy – a review of scale-based measures

Abstract Background: Mental Health Literacy (MHL) has become an important concept in the literature; however, quantitative research on MHL methodology has been limited. Aims: This review identified peer-reviewed papers investigating MHL, assessed psychometric attributes of scale-based measures of MHL, and the extent that studies assessed the attributes that define MHL. Method: A comprehensive review of the literature was conducted to identify measures which generate a total MHL or subscale score was also conducted. A total of 13 studies were identified and their psychometric attributes determined using the Consensus-based Standards for the Selection of Health Measurement Instruments (COSMIN). The extent to which each measure assessed the attributes of MHL was also determined. Results: Results showed that included studies failed to report detailed information about the sample, measure development and testing to demonstrate the psychometric properties of their tool. Conclusion: There are substantial limitations in current ability to measure MHL and there is significant scope for the development and evaluation of psychometrically robust measures that assess the relevant attributes of MHL. Further research could also focus on the adequacy of the current definition of MHL.

The Impact of Information on Attitudes Toward E-Mental Health Services

E-mental health services are Internet-based treatment options for mental illness. There has been a proliferation of these services in recent years, with online programs now available for the treatment of mood, anxiety, eating, adjustment, and substance use disorders. (1) E-mental health services allow for greater dissemination of psychological treatments, are cost effective, and may overcome a number of client barriers to care. (1) However, the limited research available indicates that attitudes about e-mental health services are less than optimal. Past research has found that providing information about services can improve attitudes. This study investigated the relationship between knowledge of e-mental health services and attitudes toward e-mental health services. The attitudes examined were the perceived helpfulness of e-mental health services and the likelihood of using the services. Participants (N=217) were randomly assigned to one of three conditions: provision of e-mental health information by means of film; provision of e-mental health information by text; or provision of no e-mental health information. Results indicated that participants perceived online programs without therapist assistance as being significantly less helpful, and reported reduced likelihood of engaging in these programs when compared to other e-mental health services. Participants in the text intervention group reported higher likelihood of e-mental health use in the future, whereas there were no effects for the film group. Results indicate that participants perceive important differences between types of e-mental health services, and that a brief text intervention can improve attitudes toward these services. Limitations of the present study and directions for future research are discussed.

Therapy on the Move: The Development of a Therapeutic Smartphone Application

The present research investigated the use of a Smartphone App as an adjunct in the treatment of a range of anxiety disorders. The primary aim of the App was to increase client adherence to between session therapy tasks, involving homework practice of a range of skills and tasks known to be associated with successful treatment of anxiety disorders. Homework is an important component of many therapeutic approaches, allowing clients to practise therapeutic skills between sessions, as well as providing continuity between sessions (Freeman & Rosenfield, 2002). Greater client adherence to homework tasks has been associated with improved treatment outcomes, and may be particularly important for reducing the risk of relapse (Scheel, Hanson, & Razzhavaikina, 2004). However, despite the benefits of engagement with homework tasks, client adherence to these activities can often be a significant barrier to treatment (Addis & Jacobson, 2000; Burns & Nolenhoeksema, 1991; Detweiler & Whisman, 1999; Detweiler-Bedell & Whisman, 2005). It is also one area in which the use of adjunctive technologies may have the greatest impact. The aim of this paper was to describe the development and pilot testing of a therapeutic Smartphone application, namely, PsychAssist. This application was designed as an adjunct to face-to-face therapy in the treatment of anxiety disorders among adults. The App was developed with the purpose of enhancing client engagement and adherence to between session (homework) tasks to improve maintenance and generalization of therapeutic behaviours.

Using SMS reminders in psychology clinics: A cautionary tale

BACKGROUND As healthcare services become progressively more stretched, there is increasing discussion of ways in which technological adjuncts may be used to deliver more cost-efficient services. Before widespread implementation, however, the use of these adjuncts requires proper scrutiny of their effects on psychological practice. AIMS This research examined the effectiveness of SMS reminders on client appointment attendance and dropout in a psychological treatment setting. It was predicted that the reminders would result in increased initial appointment attendance, increased total appointment attendance, and decreased client dropout. METHOD A randomized controlled trial investigated the impact of SMS appointment reminders (two levels: present or absent) on client attendance (three levels: attended, rescheduled, or did not attend) and dropout (two levels: completed treatment or terminate early). Participants (N = 140) at an outpatient psychology clinic were randomly allocated to either receive an SMS appointment reminder one day before their scheduled appointment, or to receive no reminder. RESULTS No significant differences were found between the SMS and no SMS conditions in relation to appointment attendance. There were more client dropouts in the SMS compared to the no SMS condition. CONCLUSIONS The SMS appointment reminders were not effective at increasing appointment attendance. The current research suggests that there is more to client non-attendance in psychological settings than the simple forgetting of appointments. Technological adjuncts may be useful in increasing the cost-efficiency of current services; however, this research highlights the importance of understanding the effects of technology before widespread implementation.

Comparison of Perceived Barriers and Treatment Preferences Associated with Internet-Based and Face-to-Face Psychological Treatment of Depression

One of the major reasons that internet-based psychological treatments are strongly advocated is the belief that they may enable consumers to overcome many of the barriers to treatment otherwise encountered in seeking face to face treatment. A corollary to this belief is the assumption that many consumers may then be more likely to prefer to receive treatment via the internet because of the reduced barriers to care offered by internet-based treatments. However, there has been no formal examination of the barriers perceived by consumers to internet-based treatments in comparison to face to face treatment to ascertain whether these hypothesized differences impact on treatment preferences. This study compared consumer perceptions of barriers to treatment for both internet and face-to-face psychological treatments for depression. Of interest was whether consumers continue to report a preference for face-to-face treatment over internet-based treatment, even if perceptions of barriers to care were deemed greater for traditional than internet based delivery of services. Potential consumers of a structured online psychological program for workplace depression were targeted. An online survey was accessed by fifty-three employed individuals (female = 35, male = 18) with ages ranging from 18 to 60 (M = 35.57, SD = 12.15). Results indicated that participants perceived that internet-based treatment was associated with fewer barriers than face-to-face treatment for depression. Participants perceived that time constraints and participation restrictions would make it more difficult to access face-to-face treatment than internet-based treatment. However, the participants reported that they would be more likely to access face-to-face treatment for depression than internet-based treatment. These results suggest that there is a need to further investigate ways in which consumers can be encouraged to consider engaging in internet-based treatment.

Protocols for Protection of Human Participants: A Comparison of Five Countries

Research ethics protocols relating to human participants were compared across five countries, namely, Australia, Azerbaijan, Iran, the Philippines, and South Africa. These countries were considered to be geographically and culturally diverse, as well as representing both developed and developing countries. The extent to which the research participant is protected across cultures and countries was investigated, with particular focus on the use of informed consent procedures. It was argued that current ethical guidelines and practices fail to ensure the protection of the most vulnerable participants within these cultures. Informed consent mechanisms also often fail to consider cultural differences in self-concept, understanding of research methods, and power differences between researchers and participants. Discussion of these ethical challenges and recommendations for research ethics development within these cultures and countries are discussed.

A randomized controlled trial of mindfulness to reduce stress and burnout among intern medical practitioners

Abstract Introduction: Stress and burnout are highly prevalent among medical doctors, and are associated with negative consequences for doctors, patients, and organizations. The purpose of the current study was to examine the effectiveness of a mindfulness training intervention in reducing stress and burnout among medical practitioners, by means of a Randomised Controlled Trial design. Methods: Participants were 44 intern doctors completing an emergency department rotation in a major Australian hospital. Participants were randomly assigned to either an active control (one hour extra break per week) or the 10-week mindfulness training intervention. Measures of stress and burnout were taken pre-, mid- and post intervention. Results: Participants undergoing the 10-week mindfulness training program reported greater improvements in stress and burnout relative to participants in the control condition. Significant reduction in stress and burnout was observed for participants in the mindfulness condition. No such reductions were observed for participants in the control condition. Conclusions: Mindfulness interventions may provide medical practitioners with skills to effectively manage stress and burnout, thereby reducing their experience of these symptoms. It is likely that doctors would benefit from the inclusion of such a training program as a part of their general medical education.

Development of the SOSS-D: a scale to measure stigma of occupational stress and burnout in medical doctors

Abstract Background: Occupational stress and burnout are highly prevalent among doctors, with stigma identified as a barrier to help-seeking in this population. However, there has been a lack of a standardised tool to measure stigma of occupational stress and burnout among doctors. Aims: The aim of the current study was to develop and investigate the psychometric properties of the Stigma of Occupational Stress Scale for Doctors (SOSS-D). Method: An online questionnaire package was completed by 200 (38 male, 162 female) doctors. Participants completed measures relating to help-seeking intentions, general stigma, and the SOSS-D. Results: Exploratory Factor Analysis was used to refine the scale to an 11-item version. The analysis revealed a three-factor structure, which explained 63.4% of variance. Factors related to perceived structural stigma, personal stigma and perceived other stigma. The internal consistency, convergent, discriminant and criterion validity of the scale were supported. Conclusions: The SOSS-D may assist educators and mental health professionals in measuring and assessing the efficacy of interventions designed to reduce stigma. As such, it is anticipated that the SOSS-D will be a useful instrument for understanding and addressing stigma of occupational stress and burnout among medical doctors, to improve help-seeking behaviours in this population.