Do GPs use electronic mental health resources? A qualitative study

BACKGROUNDThe Better Outcomes in Mental Health Care (BOMHC) initiative encourages general practitioners to use electronic mental health resources (EMHRs) during consultation with patients requiring psychological assistance. However, there is little data on GPs&rsquo; acceptance and use of EMHRs.METHODSemistructured interviews were conducted with 27 GPs to determine their attitude toward EMHRs, and their use during consultation with patients.RESULTSFew GPs reported frequently using EMHRs in consultation. Identified barriers to use included lack of familiarity with information technology, and insufficient knowledge of available resources. Identified advantages of electronic resources included high patient acceptance, time efficiency, and improved quality of information.DISCUSSIONGeneral practitioners recognise several advantages of utilising electronic resources for managing patients with mental illness. However, GPs are not sufficiently familiar with electronic resources to use them effectively. This could be overcome by education.<br /

Internet-based treatment for panic disorder : does frequency of therapist contact make a difference?

Internet-based interventions with therapist support have proven effective for treating a range of mental health conditions. This study examined whether frequency of therapist contact affected treatment outcomes. Fifty-seven people with panic disorder (including 32 with agoraphobia) were randomly allocated to an 8-week Internet-based cognitive behavioural treatment intervention (Panic Online) with either frequent (three e-mails per week) or infrequent (one e-mail per week) support from a psychologist. Posttreatment, intention-to-treat analyses revealed that both treatments were effective at improving panic disorder and agoraphobia severity ratings, panicrelated cognitions, negative affect, and psychological and physical quality of life domains, with no differences between conditions. High end-state functioning was achieved by 28.6% of the frequent and infrequent participants, respectively. Therapist alliance, treatment credibility, and satisfaction also did not differ between groups, despite significantly greater therapist time invested in the frequent contact condition. The results provide evidence that the effectiveness of Internet-based mental health interventions may be independent of the frequency of therapist support and may, therefore, be more cost-effective than previously reported.<br /

The relative contributions of negative cognitions and self-efficacy to severity of panic attacks in panic disorder

The aim of this study was to determine the degree to which fearful and catastrophic cognitions, and self-efficacy for managing panic predicted various panic attack characteristics in panic disorder. The cognitive variables consisted of anxiety sensitivity, the frequency of fearful agoraphobic cognitions and measures of catastrophic misinterpretation of symptoms. The panic parameters were number and severity of panic symptoms, distress associated with panic attacks, worry about future panics, duration of panic disorder, and life interference due to panic disorder. These variables were measured in 40 people with panic disorder, 31 of whom also had significant agoraphobia. The frequency of fearful agoraphobic cognitions was the strongest predictor of panic attack symptomatology, predicting number of symptoms, symptom severity and degree of anticipatory fear of panic. Catastrophic misinterpretation of symptoms and anxiety sensitivity did not independently predict any panic parameters. Only self-efficacy for managing the rapid build-up of panic symptoms was specifically related to panic severity. The results therefore suggest that cognitive behaviour therapy for panic symptoms in panic disorder should reduce fearful cognitions rather than focus on panic coping strategies. The results offer little support for the contribution of the expectancy or catastrophic misinterpretation theories to the maintenance of panic disorder

The relative contributions of negative cognitions and self-efficacy to severity of panic attacks in panic disorder

Copyright © 2002 RMIT PublishingThe aim of this study was to determine the degree to which fearful and catastrophic cognitions, and self-efficacy for managing panic predicted various panic attack characteristics in panic disorder. The cognitive variables consisted of anxiety sensitivity, the frequency of fearful agoraphobic cognitions and measures of catastrophic misinterpretation of symptoms. The panic parameters were number and severity of panic symptoms, distress associated with panic attacks, worry about future panics, duration of panic disorder, and life interference due to panic disorder. These variables were measured in 40 people with panic disorder, 31 of whom also had significant agoraphobia. The frequency of fearful agoraphobic cognitions was the strongest predictor of panic attack symptomatology, predicting number of symptoms, symptom severity and degree of anticipatory fear of panic. Catastrophic misinterpretation of symptoms and anxiety sensitivity did not independently predict any panic parameters. Only self-efficacy for managing the rapid build-up of panic symptoms was specifically related to panic severity. The results therefore suggest that cognitive behaviour therapy for panic symptoms in panic disorder should reduce fearful cognitions rather than focus on panic coping strategies. The results offer little support for the contribution of the expectancy or catastrophic misinterpretation theories to the maintenance of panic disorder.Richards Jeffrey, Richardson Vanessa and Pier Ciara

Does GPs' use of an internet-based treatment protocol in CBT for panic disorder lead to positive patient outcomes?

International research suggests that GPs trained in CBT do not significantly improve outcomes for people with mental disorders. Over the past seven years we have developed and established the efficacy of an internet-delivered CBT program (PANIC ONLINE) for people with panic disorder (PD). This study aimed to investigate whether GPs could use PANIC ONLINE to deliver effective face-to-face CBT to their patients. Outcomes from 20 patients with PD seen by their GP were compared to those from a matched cohort of people with PD who received internet therapy from our research team. All patients participated in a clinical diagnostic interview and completed online questionnaires measuring panicrelated variables, levels of negative affect and quality of life before and after 12 weeks of treatment. As well as accessing PANIC ONLINE, all GPs had previously had at least 20 hours of training in nonpharmacological therapies. Both types of treatment significantly reduced the severity of panic-related variables, improved negative affect and improved quality of life. There were no significant differences between the effects of the two treatments. Therefore CBT delivered by the GPs using PANIC ONLINE as the basis was as effective as internet therapy delivered by our research team

Enhancing the health of medical students : outcomes of an integrated mindfulness and lifestyle program

Medical students experience various stresses and many poor health behaviours. Previous studies consistently show that student wellbeing is at its lowest pre-exam. Little core-curriculum is traditionally dedicated to providing self-care skills for medical students. This paper describes the development, implementation and outcomes of the Health Enhancement Program (HEP) at Monash University. It comprises mindfulness and ESSENCE lifestyle programs, is experientially-based, and integrates with biomedical sciences, clinical skills and assessment. This study measured the program&rsquo;s impact on medical student psychological distress and quality of life. A cohort study performed on the 2006 first-year intake measured effects of the HEP on various markers of wellbeing. Instruments used were the depression, anxiety and hostility subscales of the Symptom Checklist-90-R incorporating the Global Severity Index (GSI) and the WHO Quality of Life (WHOQOL) questionnaire. Pre-course data (T1) was gathered mid-semester and post-course data (T2) corresponded with pre-exam week. To examine differences between T1 and T2 repeated measures ANOVA was used for the GSI and two separate repeated measures MANOVAs were used to examine changes in the subscales of the SCL-90-R and the WHOQOL-BREF. Follow-up t-tests were conducted to examine differences between individual subscales. A total of 148 of an eligible 270 students returned data at T1 and T2 giving a response rate of 55%. 90.5% of students reported personally applying the mindfulness practices. Improved student wellbeing was noted on all measures and reached statistical significance for the depression (mean T1 = 0.91, T2 = 0.78; p = 0.01) and hostility (0.62, 0.49; 0.03) subscales and the GSI (0.73, 0.64; 0.02) of the SCL-90, but not the anxiety subscale (0.62, 0.54; 0.11). Statistically significant results were also found for the psychological domain (62.42, 65.62; p &lt; 0.001) but not the physical domain (69.11, 70.90; p = 0.07) of the WHOQOL. This study is the first to demonstrate an overall improvement in medical student wellbeing during the pre-exam period suggesting that the common decline in wellbeing is avoidable. Although the findings of this study indicate the potential for improving student wellbeing at the same time as meeting important learning objectives, the limitations in study design due to the current duration of follow-up and lack of a control group means that the data should be interpreted with caution. Future research should be directed at determining the contribution of individual program components, long-term outcomes, and impacts on future attitudes and clinical practice.<br /

Reflections on internet-therapy : past, present and beyond

The New Year provides us with an ideal opportunity to reflect on how far we have come and what we would like to achieve in the future. For many in the psychology community 2005 was marred with the sad loss of our colleague, mentor and friend, Professor Jeff Richards. Amongst Jeff's many achievements was his pioneering role in the development of internet-delivered psychological interventions. This paper is inspired by the work of Jeff and his contemporaries and is intended to review progress, discuss the major clinical and research issues related to internet-based psychological interventions and explore some of the challenges that lie ahead