Jay Earles

The Coming of Age of Telecommunications in Psychological Research and Practice

Rapid and far-reaching technological advances are revolutionizing the ways in which people relate, communicate, and live their daily lives. Technologies that were hardly used a few years ago, such as the Internet, e-mail, and video teleconferencing, are becoming familiar methods for modern communication. Telecommunications will continue to evolve quickly, spawning telehealth applications for research and the provision of clinical care in communities, university settings, clinics, and medical facilities. The impact on psychology will be significant. This article examines the application of developing technologies as they relate to psychology and discusses implications for professional research and practice.

Psychophysiologic treatment of vocal cord dysfunction.

BACKGROUND Vocal cord dysfunction (VCD) is an obstructive upper airway syndrome that frequently mimics asthma and for which there is no empirical treatment of choice. OBJECTIVE To describe two military service members experiencing VCD who were treated with psychophysiologic self-regulation training. METHODS Both cases were active-duty military members with VCD confirmed by laryngoscopy They each received biofeedback self-regulation training to decrease tension in the extrinsic laryngeal musculature. RESULTS Both patients responded to the treatment, denied the presence of dsypnea, and had resumed military physical training. CONCLUSIONS Psychophysiologic self-regulation strategies both with and without concurrent speech therapy positively impacted VCD symptoms.

Biofeedback via telehealth : A new frontier for applied psychophysiology

Psychophysiological diagnostic and therapeutic methods, to include biofeedback, have been found to be empirically effective in the treatment of a variety of physical disorders. In many areas of the country, however, certified biofeedback practitioners are not well distributed, limiting patient access to this treatment modality. Psychologists at Tripler Army Medical Center have pioneered efforts to develop and provide these needed services via a telehealth venue. Such capability significantly improves access to care, particularly for patients located at considerable distance from the provider. As the telecommunications infrastructure in rural and remote areas is often quite basic, such a system must be capable of operating within these limited parameters. The system developed by the authors provides real-time video and audio interactivity and allows the therapist to monitor and control biofeedback equipment located at the remote site. The authors discuss the clinical applications, the technology, and relevant practical and ethical issues.

Primary Care Behavioral Health Provider Training: Systematic Development and Implementation in a Large Medical System

The expansion of integrated, collaborative, behavioral health services in primary care requires a trained behavioral health workforce with specific competencies to deliver effective, evidence-informed, team-based care. Most behavioral health providers do not have training or experience working as primary care behavioral health consultants (BHCs), and require structured training to function effectively in this role. This article discusses one such training program developed to meet the needs of a large healthcare system initiating widespread implementation of the primary care behavioral health model of service delivery. It details the Department of Defense’s experience in developing its extensive BHC training program, including challenges of addressing personnel selection and hiring issues, selecting a model for training, developing and implementing a phased training curriculum, and improving the training over time to address identified gaps. Future directions for training improvements and lessons learned in a large healthcare system are discussed.

Clinical Effectiveness of the LE3AN Program: A Military Healthy Lifestyle Program

For several decades, obesity has been a major health concern within the general population of the United States as well as within the unique military population. Unlike the civilian sector, military service requires individuals to meet weight and body fat standards. In order to assist overweight military personnel return to standards, Tripler Army Medical Center initiated the LE3AN Program. LE3AN is a one-week, day-treatment, cognitive-behavioral weight management program coupled with 12 months of weekly follow-up. Baseline data was collected on 387 consecutive participants. Despite physical fitness training and required standards in each military service, the average BMIs for men and women were in the obese range, with male participants’ BMIs significantly higher than women’s (34.3 vs 31.9, p<.005). One year outcome data was collected from 167 participants, i.e. 43.2% of treatment initiators. Among participants who completed treatment, men maintained a 6.56% loss of their initial weight while women maintained a 7.35% loss. Over a quarter, 26.6%, of those who started the program (but did not complete it) maintained at least a 5% weight loss at one year, while 61.6% of treatment completers maintained 5% weight losses.

Biofeedback using telemedicine: clinical applications and case illustrations.

Abstract Telecommunications technology is dramatically changing our world, allowing healthcare professionals to offer medical healthcare, in the form of consultation, assessment, and treatment, through the use of new communications media. In behavioral medicine, advances in telecommunications have brought about new ways of offering services by expanding healthcare to patients located all over the world and simultaneously reducing costs and improving outcome efficacy. This article describes the use of biofeedback to treat various pain and psychophysiological disorders through telemedicine technology. The authors provide a description of “off-the-shelf,” low-cost, and low-bandwidth telemedicine equipment used to deliver clinical biofeedback treatment when the patient and provider are in two different locations. In addition, the authors discuss practical issues of behavioral telehealth.