Jonathan G. Perle

How Psychological Telehealth Can Alleviate Society's Mental Health Burden: A Literature Review

Mental health professionals must establish new means to reach those in need that face obstacles related to geographical location, time limitations, and health. With the high incidence of mental illness, as well as the hypothesized increase in coming years, telehealth modalities propose a novel and far-reaching alternative to traditional therapy. This article outlines the positive aspects and interdisciplinary possibilities when telehealth is incorporated into mental health practice. Novel outlets including mHealth and the utilization of computer tablets as mental health facilitators are outlined. Considerations for practice including training are discussed, as well as potential future directions for the field. Available data supports telehealth as an effective mode for the treatment of clients who are unable to pursue mental health services in their current form. However, careful consideration and training for the mental health professional is needed if telehealth is to be effectively used to alleviate the mental health burden.

Rates of Apparently Abnormal MMPI-2 Profiles in the Normal Population

MMPI-2 standardization data were re-sampled using Monte Carlo simulations to estimate the base rate of apparently abnormal scores expected by chance in the normal population when multiple scales are interpreted. 36.8% of normal adults are likely to obtain a score that would otherwise be considered clinically significant at 65T on one or more of the 10 Clinical scales. The normal incidence of at least one apparently abnormal score was 38.3% on the Content and 55.1% on the Supplementary scales. When the Clinical, Supplementary, and Content scales and subscales are interpreted together, at least three seemingly meaningful scores will be found in 47.4% of perfectly normal individuals, and five or more scales that appear to be clinically significant can be expected in 30.1% of cases that are actually unremarkable. These results imply that the number of MMPI-2 scales that can be meaningfully interpreted in clinical practice is limited, and that high T-scores are necessary for an adequate level of confidence even when interpretation is appropriately limited to the Clinical scales.

Psychologist and Physician Interest in Telehealth Training and Referral for Mental Health Services: An Exploratory Study

The current study explored psychological and medical professionals’ interest in videoconferencing telehealth training and mental health telehealth referral. An online survey assessed 782 participants comprised of 669 psychological (45% male, Mean Age = 47.01, SD = 16.82) and 113 medical professionals (58% male, Mean Age = 46.19, SD = 12.40). Z-test analyses indicated that although psychological professionals were statistically more interested in receiving telehealth training, both groups reported some interest. Ranked responses indicated efficacy data, ethical issues, and legal concerns as the most endorsed areas of training interest. Referral concerns were also found. Findings were discussed related to both statistical and clinical significance. Application of findings is discussed related to future work, practice, and program creation. The development of telehealth training programs will provide interested professionals with tools required for practice and may serve as an impetus to increase utilization and/or referral.

Rethinking ‘wait and see’ philosophies for childhood disruptive behaviour: a guide for paediatric medical providers

ABSTRACT Childhood disruptive behaviours are some of the most frequent concerns posed by families to child-focused medical providers. While prevalent and holding the potential to exacerbate into Disruptive Behaviour Disorders, some providers utilize ‘wait and see’ philosophies in the hopes that children will outgrow the concerns. Unfortunately, many do not, leading to additional problems that could have potentially been addressed more easily if the child received a more thorough evaluation and intervention when the behaviours were first suggested by a family. The purpose of this research-informed article it to not only provide a general discussion of childhood disruptive behaviours that highlights some of the possible hazards with ‘wait and see’ philosophies, but to also provide information to aid child-focused medical providers in determining normality from concerning behaviours, methods of evaluation, and the characteristics that should be sought in an evidence-based referral should a higher level of care be required.

The Conceptualization and Treatment Plan of a Child Diagnosed With Disruptive Mood Dysregulation Disorder: A Case Report

ABSTRACT One of the new diagnoses added to the Diagnostic and Statistical Manual of Mental Disorders (5th ed.), disruptive mood dysregulation disorder (DMDD), is a condition that is not currently well studied or understood. Although some work has proposed options for psychosocial and psychopharmacological intervention, very limited research exists to guide clinicians in developing an evidence-informed conceptualization and treatment for children with DMDD. The current case report details the integration of the available literature to create a conceptualization and multimodal treatment plan designed to alleviate the negative mood and disruptive behaviors associated with DMDD in an 11-year-old boy. Twenty-three sessions included components of psychoeducation, family-based behavior management training, individual cognitive-behavioral therapy techniques, and medication. From pre- to postassessment, both verbal report and rating scales suggested significant gains including improved compliance, decreased outbursts, and improved mood, despite some persisting negativistic bias. Overall, the created multimodal treatment plan demonstrated preliminary evidence for the reduction of symptoms for a child diagnosed with DMDD. Treatment complications and implications for future work are discussed.

Reaffirming normal: The high risk of pathologizing healthy adults when interpreting the MMPI-2-RF

Monte Carlo simulations were utilized to determine the proportion of the normal population expected to have scale elevations on the MMPI-2-RF when multiple scores are interpreted. Results showed that when all 40 MMPI-2-RF scales are simultaneously considered, approximately 70% of normal adults are likely to have at least one scale elevation at or above 65T, and as many as 20% will have five or more elevated scales. When the Restructured Clinical (RC) Scales are under consideration, 34% of normal adults have at least one elevated score. Interpretation of the Specific Problem Scales and Personality Psychopathology Five Scales – Revised also yielded higher than expected rates of significant scores, with as many as one in four normal adults possibly being miscategorized as having features of a personality disorder by the latter scales. These findings are consistent with the growing literature on rates of apparently abnormal scores in the normal population due to multiple score interpretation. Findings are discussed in relation to clinical assessment, as well as in response to recent work suggesting that the MMPI-2-RF’s multiscale composition does not contribute to high rates of elevated scores.

Prolonged Exposure in the Treatment of PTSD Following an Apartment Fire

Foa, Hembree, and Rothbaum’s Prolonged Exposure treatment manual has been found to be an effective treatment modality for posttraumatic stress disorder (PTSD) that is comparable with other evidence-based PTSD treatments. Although the manual details weekly 90-min sessions, this time frame is not always feasible for those clinicians who may be confined to a 50-min appointment. In addition, Foa et al.’s inclusion of audio and video for taped exposures is not always possible given some centers’ technological limitations and client finances. The current case summary details an adapted version of the manual that takes into account such limitations to treat a 26-year-old Jamaican-Canadian female who presented for treatment of PTSD following a fire destroying her home and possessions. Eighteen weekly 50- to 60-min sessions included components of psychoeducation, breathing retraining, in vivo exposures, imaginal exposures, and a trauma narrative (in replacement of audio/video exposures). From pre- to postassessment, significant gains were noted, including a reduction in intrusive thoughts and hyperarousal, and elimination of reexperiencing and sleep disturbances. At the conclusion of treatment, the client also demonstrated an ability to confront the trauma, memories, situations, activities, and places that she had avoided. Self-report measures further validated gains. Due to complicating factors, a follow-up evaluation was not able to be completed. Treatment complications, diversity factors, and implications for future work are discussed.