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Web-based bereavement care
(2020)
Background:
Web-based interventions have been introduced as novel and effective treatments for mental disorders and, in recent years, specifically for the bereaved. However, a systematic summary of the effectiveness of online interventions for people experiencing bereavement is still missing.
Objective:
A systematic literature search was conducted by four reviewers who reviewed and meta-analytically summarized the evidence for web-based interventions for bereaved people.
Methods:
Systematic searches (PubMed, Web of Science, PsycInfo, PsycArticles, Medline, and CINAHL) resulted in seven randomized controlled trials (N= 1,257) that addressed adults having experienced bereavement using internet-based interventions. We used random effects models to summarize treatment effects for between-group comparisons (treatmentvs.control at post) and stability over time (postvs.follow-up).
Results:
All web-based interventions were based on cognitive behavioral therapy (CBT). In comparison with control groups, the interventions showed moderate (g= .54) to large effects (g= .86) for symptoms of grief and posttraumatic stress disorder (PTSD), respectively. The effect for depression was small (g= .44). All effects were stable over time. A higher number of treatment sessions achieved higher effects for grief symptoms and more individual feedback increased effects for depression. Other moderators (i.e.dropout rate, time since loss, exposure) did not significantly reduce moderate degrees of heterogeneity between the studies.
Limitations:
The number of includable studies was low in this review resulting to lower power for moderator analyses in particular.
Conclusions:
Overall, the results of web-based bereavement interventions are promising, and its low-threshold approach might reduce barriers to bereavement care. Nonetheless, future research should further examine potential moderators and specific treatment components (e.g.exposure, feedback) and compare interventions with active controls.
We evaluated the effectiveness and acceptability of metacognitive interventions for mental disorders. We searched electronic databases and included randomized and nonrandomized controlled trials comparing metacognitive interventions with other treatments in adults with mental disorders. Primary effectiveness and acceptability outcomes were symptom severity and dropout, respectively. We performed random-effects meta-analyses. We identified Metacognitive Training (MCTrain), Metacognitive Therapy (MCTherap), and Metacognition Reflection and Insight Therapy (MERIT). We included 49 trials with 2,609 patients. In patients with schizophrenia, MCTrain was more effective than a psychological treatment (cognitive remediation, SMD = -0.39). It bordered significance when compared with standard or other psychological treatments. In a post hoc analysis, across all studies, the pooled effect was significant (SMD = -0.31). MCTrain was more effective than standard treatment in patients with obsessive-compulsive disorder (SMD = -0.40). MCTherap was more effective than a waitlist in patients with depression (SMD = -2.80), posttraumatic stress disorder (SMD = -2.36), and psychological treatments (cognitive-behavioural) in patients with anxiety (SMD = -0.46). In patients with depression, MCTherap was not superior to psychological treatment (cognitive-behavioural). For MERIT, the database was too small to allow solid conclusions. Acceptability of metacognitive interventions among patients was high on average. Methodological quality was mostly unclear or moderate. Metacognitive interventions are likely to be effective in alleviating symptom severity in mental disorders. Although their add-on value against existing psychological interventions awaits to be established, potential advantages are their low threshold and economy.
With the growth of information technology, patient attitudes are shifting – away from passively receiving care towards actively taking responsibility for their well- being. Handling doctor-patient relationships collaboratively and providing patients access to their health information are crucial steps in empowering patients. In mental healthcare, the implicit consensus amongst practitioners has been that sharing medical records with patients may have an unpredictable, harmful impact on clinical practice. In order to involve patients more actively in mental healthcare processes, Tele-Board MED (TBM) allows for digital collaborative documentation in therapist-patient sessions. The TBM software system offers a whiteboard-inspired graphical user interface that allows therapist and patient to jointly take notes during the treatment session. Furthermore, it provides features to automatically reuse the digital treatment session notes for the creation of treatment session summaries and clinical case reports. This thesis presents the development of the TBM system and evaluates its effects on 1) the fulfillment of the therapist’s duties of clinical case documentation, 2) patient engagement in care processes, and 3) the therapist-patient relationship. Following the design research methodology, TBM was developed and tested in multiple evaluation studies in the domains of cognitive behavioral psychotherapy and addiction care. The results show that therapists are likely to use TBM with patients if they have a technology-friendly attitude and when its use suits the treatment context. Support in carrying out documentation duties as well as fulfilling legal requirements contributes to therapist acceptance. Furthermore, therapists value TBM as a tool to provide a discussion framework and quick access to worksheets during treatment sessions. Therapists express skepticism, however, regarding technology use in patient sessions and towards complete record transparency in general. Patients expect TBM to improve the communication with their therapist and to offer a better recall of discussed topics when taking a copy of their notes home after the session. Patients are doubtful regarding a possible distraction of the therapist and usage in situations when relationship-building is crucial. When applied in a clinical environment, collaborative note-taking with TBM encourages patient engagement and a team feeling between therapist and patient. Furthermore, it increases the patient’s acceptance of their diagnosis, which in turn is an important predictor for therapy success. In summary, TBM has a high potential to deliver more than documentation support and record transparency for patients, but also to contribute to a collaborative doctor-patient relationship. This thesis provides design implications for the development of digital collaborative documentation systems in (mental) healthcare as well as recommendations for a successful implementation in clinical practice.
There is increasing interest in improving psychotherapy training using evidence-based supervision. One approach is live supervision (LS), in which the supervisor offers immediate feedback to the trainee (e.g., via microphone, text messages) during the session. This review summarizes the research on LS and its main results. The databases Web of Science Core Collection, PsycArticles, PsycBooks, PsycInfo, PSYNDEX, Psychology and Behavioral Sciences Collection, and PubMed were searched from inception to January 23, 2020 (including a backward search) and updated November 15, 2020. The inclusion criteria (i.e., main focus on LS, immediate feedback from a present supervisor, psychological setting) were met by k = 138 publications, including k = 8 randomized controlled trials (RCTs; N = 339). Two reviewers independently evaluated the RCTs' risk of bias using the revised Cochrane Risk-of-Bias Tool. Most publications had a family therapy background (59%), were categorized as nonempirical (55%), aimed primarily at describing or comparing specific LS methods (35%), and displayed positive views on LS (87%). Based on the RCTs, LS was superior to no-supervision in 78% of all comparisons, but only in 13% of the cases compared to a delayed supervision (DS) condition (i.e., regarding trainee skills, patient outcomes, or other variables). These results somewhat contradict the overall favorable views in the literature. However, the generalizability is limited due to a lack of high-quality studies and substantial heterogeneity in terms of LS methods, concepts, outcomes, and measurements. Ideas for more systematic research on LS regarding objectives and methods are proposed. <br /> Public Significance Statement This review summarizes research on live supervision (LS). LS is a form of supervision in psychotherapy training in which the supervisor observes the trainee's therapy session and provides immediate feedback. The review concludes that LS is probably as effective as delayed supervision (DS), although more high-quality research is needed.
This study examined the effectiveness of psychological interventions for severe health anxiety (SHA) regarding somatic symptoms (SS) and health anxiety (HA). The databases Web of Science, EBSCO, and CENTRAL were searched on May 15, 2019, May 16, 2019, and August 5, 2019, respectively. Eighteen randomized controlled trials (N = 2,050) met the inclusion criteria (i.e., hypochondriasis, illness anxiety disorder or somatic symptom disorder with elevated HA being assessed with validated interviews: use of standardized outcome measures). Two reviewers independently evaluated the studies' risk of bias using the Revised Cochrane Risk-of-Bias Tool for randomized trials (RoB-2) tool. Overall, psychological interventions were significantly more effective than waitlist, treatment-as-usual, or placebo post-treatment (g(SS) = 0.70, g(HA) = 1.11) and at follow-up (g(SS) = 0.33, g(HA)= 0.70). CBT outperformed other psychological interventions or pharmacotherapy for HA post- treatment (Hedge's g(HA) = 0.81). The number of sessions did not significantly predict the effect sizes. In sum, psychological interventions were effective for SHA, but the generalizability of the results for SS is limited, because only two high-quatity trials contributed to the comparison.
Assessments of psychotherapeutic competencies play a crucial role in research and training. However, research on the reliability and validity of such assessments is sparse. This study aimed to provide an overview of the current evidence and to provide an average interrater reliability (IRR) of psychotherapeutic competence ratings. A systematic review was conducted, and 20 studies reported in 32 publications were collected. These 20 studies were included in a narrative synthesis, and 20 coefficients were entered into the meta-analysis. Most primary studies referred to cognitive-behavioral therapies and the treatment of depression, used the Cognitive Therapy Scale, based ratings on videos, and trained the raters. Our meta-analysis revealed a pooled ICC of 0.82, but at the same time severe heterogeneity. The evidence map highlighted a variety of variables related to competence assessments. Further aspects influencing the reliability of competence ratings and regarding the considerable heterogeneity are discussed in detail throughout the manuscript.
Hintergrund: Im Rahmen des reformierten Psychotherapeutengesetzes wird eine starkere Praxisorientierung in der klinisch-psychologischen Lehre und in der Prufung psychotherapeutischer Kompetenzen verankert. Hierbei sollen Studierende durch die Interaktion mit standardisierten Patient*innen (SP) therapeutische Kompetenzen erwerben und demonstrieren. Fragestellung: Das Ziel des vorliegenden Beitrags ist es, eine evidenzbasierte Umsetzung dieser neuen Lehr- und Prufungsformate zu unterstutzen, indem bisherige Forschungsbefunde zum Einsatz von SP dargestellt und Bereiche, in denen weitere Forschung notwendig ist, aufgezeigt werden. Ergebnisse: Empirische Befunde zeigen, dass SP psychische Storungen authentisch darstellen konnen. Voraussetzung dafur sind beispielsweise die Auswahl geeigneter SP, detaillierte Rollenanleitungen, spezifisches Training, Feedback und Nachschulungen. Auch wenn einige Forschungsfragen, wie zur vergleichenden Wirksamkeit des Einsatzes von SP, noch unbeantwortet sind, lassen sich praktische Implikationen fur SP-Programme in Lehre, Prufung und Forschung ableiten, die in einem Ablaufschema dargestellt werden. Schlussfolgerungen: Der Einsatz von SP bietet gro ss es Potenzial fur die klinisch-psychologische Lehre und Ausbildungsforschung. Um den Einsatz von SP an anderen Standorten zu unterstutzen, werden Beispielmaterialien (z.B. Rollenanleitung) in den elektronischen Supplementen (siehe www.karger.com/doi/10.1159/000509249 fur alle Supplemente) zum Artikel zur Verfugung gestellt.
Theoretischer Hintergrund:Supervision spielt eine zentrale Rolle zum Wissens- und Kompetenzerwerb sowie in der Qualitätssicherung.
Fragestellung:Ziel war es, den aktuellen Forschungsstand zur Supervision im Rahmen der kognitiven Verhaltenstherapie abzubilden, um daraus Schlussfolgerungen für die zukünftige Forschung abzuleiten.
Methode:Zur Evidenzsynthese wurde ein Scoping Review durchgeführt, das die Darstellung zentraler Konzepte, aktueller Evidenz und möglicher Forschungsbedarfe ermöglichte. Neben einer systematischen Literaturrecherche wurden Vorwärts- und Rückwärtssuchstrategien eingesetzt.
Ergebnisse:Eingeschlossen wurden zwölf Publikationen basierend auf zehn empirischen Studien. Alle Studien beschrieben Ausbildungssettings, aber nur wenige untersuchten übende Interventionen (z. B. Rollenspiele). Häufig wurden Effekte subjektiv erfasst, die methodische Qualität der Begleitstudien variierte.
Schlussfolgerungen:Notwendig sind weitere methodisch hochwertige Studien, experimentell orientiert oder in der klinischen Praxis, die die Supervisionsforschung bereichern können.
Purpose: The acquisition of skills is essential to the conceptualization of cognitive-behavioural therapy. Yet, what experiences are encountered and what skills actually learned during therapy, and whether patients and therapists have concurrent views hereof, remains poorly understood.
Method: An explorative pilot study with semi-structured, corresponding interview guides was conducted. Pilot data from our outpatient unit were transcribed and content-analyzed following current guidelines.
Results: The responses of 18 participants (patients and their psychotherapists) were assigned to six main categories. Educational and cognitive aspects were mentioned most frequently and consistently by both groups. Having learned Behavioural alternatives attained the second highest agreement between perspectives.
Conclusions: Patients and therapists valued CBT as an opportunity to learn new skills, which is an important prerequisite also for the maintenance of therapeutic change. We discuss limitations to generalizability but also theoretical and therapy implications.
Purpose: The acquisition of skills is essential to the conceptualization of cognitive-behavioural therapy. Yet, what experiences are encountered and what skills actually learned during therapy, and whether patients and therapists have concurrent views hereof, remains poorly understood. Method: An explorative pilot study with semi-structured, corresponding interview guides was conducted. Pilot data from our outpatient unit were transcribed and content-analyzed following current guidelines. Results: The responses of 18 participants (patients and their psychotherapists) were assigned to six main categories. Educational and cognitive aspects were mentioned most frequently and consistently by both groups. Having learned Behavioural alternatives attained the second highest agreement between perspectives. Conclusions: Patients and therapists valued CBT as an opportunity to learn new skills, which is an important prerequisite also for the maintenance of therapeutic change. We discuss limitations to generalizability but also theoretical and therapy implications.