Suitability of text-based communications for the delivery of psychological therapeutic services to rural and remote communities : scoping review

Background: People living in rural and remote areas have poorer access to mental health services than those living in cities. They are also less likely to seek help because of self-stigma and entrenched stoic beliefs about help seeking as a sign of weakness. E-mental health services can span great distances to reach those in need and offer a degree of privacy and anonymity exceeding that of traditional face-to-face counseling and open up possibilities for identifying at-risk individuals for targeted intervention. Objective: This scoping review maps the research that has explored text-based e-mental health counseling services and studies that have used language use patterns to predict mental health status. In doing so, one of the aims was to determine whether text-based counseling services have the potential to circumvent the barriers faced by clients in rural and remote communities using technology and whether text-based communications, in particular, can be used to identify individuals at risk of psychological distress or self-harm. Methods: We conducted a comprehensive electronic literature search of PsycINFO, PubMed, ERIC, and Web of Science databases for articles published in English through November 2020. Results: Of the 9134 articles screened, 70 met the eligibility criteria and were included in the review. There is preliminary evidence to suggest that text-based, real-time communication with a qualified therapist is an effective form of e-mental health service delivery, particularly for individuals concerned with stigma and confidentiality. There is also converging evidence that text-based communications that have been analyzed using computational linguistic techniques can be used to accurately predict progress during treatment and identify individuals at risk of serious mental health conditions and suicide. Conclusions: This review reveals a clear need for intensified research into the extent to which text-based counseling (and predictive models using modern computational linguistics tools) may help deliver mental health treatments to underserved groups such as regional communities, identify at-risk individuals for targeted intervention, and predict progress during treatment. Such approaches have implications for policy development to improve intervention accessibility in at-risk and underserved populations

Using Conversation Topics for Predicting Therapy Outcomes in Schizophrenia

Previous research shows that aspects of doctor-patient communication in therapy can predict patient symptoms, satisfaction and future adherence to treatment (a significant problem with conditions such as schizophrenia). However, automatic prediction has so far shown success only when based on low-level lexical features, and it is unclear how well these can generalize to new data, or whether their effectiveness is due to their capturing aspects of style, structure or content. Here, we examine the use of topic as a higher-level measure of content, more likely to generalize and to have more explanatory power. Investigations show that while topics predict some important factors such as patient satisfaction and ratings of therapy quality, they lack the full predictive power of lower-level features. For some factors, unsupervised methods produce models comparable to manual annotation

Practitioner Perspectives on Evidence-Based Practice: Toward a Model for Designing, Evaluating, and Disseminating Treatments with Research Support

The widespread implementation of evidence-based practices (EBPs) into mental health settings will require a thorough understanding of the factors influencing practitioner adoption of these approaches. This project reports on the results of a series of empirical studies investigating practitioner attitudes toward EBP, preferences for treatment characteristics, predictors of EBP use, and preferences for treatment research dissemination outlets. The first study explored community mental health practitioner attitudes toward EBP using a focus group methodology and found that these practitioners (N = 19) indicated a number of challenges in implementing EBPs in their clinical work. Using a national survey of mental health practitioners (N = 206), the second study investigated practitioner preferences for various treatment characteristics and found that practitioners are more likely to use treatments that are flexible, supported in "real world" research studies, and are recommended by respected colleagues. Using the same sample, the third study examined potential predictors of practitioner use of EBPs, and aspects of practitioner training, clinical setting, and attitudes toward treatment research were found to be significant predictors. The fourth study asked practitioners to indicate where they obtain information about treatments and found that professional colleagues and supervisors were the most common sources of this information. Finally, the results of these studies are considered together and a model for designing, evaluating, and disseminating treatments with research support is presented. The proposed model highlights practitioner perspectives on EBP and attempts to integrate these perspectives into recommendations aimed at increasing the use of treatments with research support in applied settings

The Relationship Between Frequency of Yoga and Meditation on PTSD Symptoms in Individuals Who Have Experienced Intimate Partner Violence

Intimate partner violence (IPV) has become a growing phenomenon in the United States, affecting nearly 13% of the population. The adverse mental health outcomes from people who experience IPV are prevalent and more than half have a diagnosis of posttraumatic stress disorder (PTSD). Therefore, therapeutic techniques for PTSD appear to be feasible for IPV survivors and their mental health issues. Complementary and alternative medicine has become a widely accepted approach for PTSD. Being two complementary and alternative medicine techniques, yoga and meditation are effective forms of therapy in many diagnoses, including PTSD. This study utilized a not-for-profit organization called the Purple Dot Yoga Project that helps individuals who suffer from IPV with yoga and meditation techniques. The researcher utilized their resources and collected survey information on 52 individuals who had experienced some form of IPV in their lifetime. The two hypotheses that were tested were whether higher use of yoga predicted lower PTSD scores on a PTSD Checklist in individuals who survived IPV and whether higher use of meditation predicted lower PTSD scores on a PTSD Checklist in individuals who survived IPV. Results from this study found that greater use of yoga and meditation were better predictors of lower PTSD scores in individuals who experienced IPV

The Double-edged Sword: A Mixed Methods Study of the Interplay between Bipolar Disorder and Technology Use

Human behavior is increasingly reflected or acted out through technology. This is of particular salience when it comes to changes in behavior associated with serious mental illnesses including schizophrenia and bipolar disorder. Early detection is crucial for these conditions but presently very challenging to achieve. Potentially, characteristics of these conditions\u27 traits and symptoms, at both idiosyncratic and collective levels, may be detectable through technology use patterns. In bipolar disorder specifically, initial evidence associates changes in mood with changes in technology-mediated communication patterns. However much less is known about how people with bipolar disorder use technology more generally in their lives, how they view their technology use in relation to their illness, and, perhaps most crucially, the causal relationship (if any exists) between their technology use and their disease. To address these uncertainties, we conducted a survey of people with bipolar disorder (N = 84). Our results indicate that technology use varies markedly with changes in mood and that technology use broadly may have potential as an early warning signal of mood episodes. We also find that technology for many of these participants is a double-edged sword: acting as both a culprit that can trigger or exacerbate symptoms as well as a support mechanism for recovery. These findings have implications for the design of both early warning systems and technology-mediated interventions

Quality of Life and Mental Health Outcomes in Implanted Cardioverter Defibrillator Treatment: Potential Effects of Informational Media History and Treatment Knowledge

Social workers in all care venues are increasingly responsible for clinical and case management services for people being treated with sophisticated medical interventions. Unfortunately, opportunities to aid in the promotion of quality of life (QOL), mental health, and informed consent are often not understood by social workers, other care providers, or patients. These missed opportunities may lead to attenuated effectiveness of medical interventions and negative impact on patients\u27 QOL. One such technological treatment is the implantable cardioverter defibrillator (ICD), a lifesaving therapy which carries risk to patients\u27 QOL. Moreover, patients frequently do not accurately understand the benefits, limitations, and possible risks associated with ICD therapy. A small body of literature exists addressing experimental and demographic groups at risk of QOL decrements among the ICD patient population, including those who have been shocked more than five times, older adults, female patients, and those who have experienced a life threatening cardiac event. A much more limited body of literature addresses the quality of some forms of patient educational activities and materials. No research to date has attempted to characterize potential relationships between patient information acquisition, treatment knowledge, and QOL/mental health outcomes in this patient group. Using a cross-sectional survey of ICD patients being treated at the University of Colorado Hospital (UCH), this dissertation project uses a social-ecological approach to describe the media through which ICD patients learn about device therapy, how well they understand their treatment, QOL and mental health outcomes, and any relationships between these constructs. The project was conducted in iterative phases, including the creation of two new measures assessing patient informational media history and ICD treatment knowledge, a pilot survey of 100 randomly selected patients to assess the quality of the new measures, and a larger survey of the remaining 655 potential ICD patient participants. A total of 205 ICD patients responded to the survey, with a mean age of 60.7 years (sd=14.53), 34.1% of whom identified as female, 10.2% of whom are African American, and 37.5% of whom live in a household with an annual income of less than $40,000. Findings from survey responses revealed both the viability of the new informational media history and ICD treatment knowledge measures, as well as broad use of a number of specific forms of media to learn about treatment. Older adult patients illustrated significantly lower treatment knowledge and use of fewer forms of informational media than their younger counterparts. Multiple regression analyses revealed significant relationships between patient history of having been shocked, health related depression, and QOL, but failed to replicate earlier findings linking these problems to demographic indicators. Each of these findings highlight opportunities for improved social work research and practice with ICD patients, including the need for improved patient education processes for older adults with these devices, and the importance of mental health status, particularly depression, to patient QOL

Adolescent and Emerging Adult Help Seeking Using Anonymous Telephone and Live Chat Technology

Kids Help Phone is an on-demand, single-session, bilingual, free, and confidential service for young people in Canada who seek help for mental health issues and problems of daily living. 232 telephone clients and 230 Live Chat clients responded to the Counselling Client Questionnaire 2 (CCQ-2) to provide a demographic description of the youth who access this anonymous service, and assess and compare the effectiveness of telephone and text-based counselling. Transcripts of counselling sessions were analyzed using the Evidence of Mental Health Symptoms Scale for Adolescents (EMHSS-A) to describe the nature and level of risk associated with the situations clients brought to counselling, particularly as they related to mental health problems. 465 adolescents waiting in queue to access chat counselling responded to the Youth Self Report (YSR) to provide a description of the mental health symptoms of chat clients. Chat transcripts were further analyzed using the Collaborative Interactions Scale (CIS) to assess what works in terms of supporting the therapeutic relationship in time-synchronous text-to-text counselling. More clients had sexual and cultural minority identities than expected given their proportion in the population. 29% and 26% of clients were dealing with high- and medium-risk situations. According to the YSR, 64% of clients scored in the clinical range for affective problems, 56% for obsessive compulsive problems, and 51% for post-traumatic stress problems. Phone and chat clients reported decreased distress and perceived difficulty of their problems, and increased problem clarity, self-efficacy, and hope. Suggestions for how chat counsellors can manage ruptures and repairs in the therapeutic relationship are provided. Keywords: telephone counselling, e-counselling, computer-mediated communication, help-seeking, adolescenc