scholarly journals Transitioning Transdiagnostic CBT from Face-to-Face to Telephone Delivery During the Coronavirus Pandemic: A Case Study

2021 ◽  
pp. 153465012110182
Author(s):  
Jess Saunders ◽  
Chris Allen
Keyword(s):  
Mental Health ◽  
Mental Health Services ◽  
Health Services ◽  
Behavioral Therapy ◽  
Self Report ◽  
Health Conditions ◽  
Face To Face ◽  
Clinically Significant ◽  
Digital Exclusion

The coronavirus pandemic led to worldwide disruption in the delivery of face-to-face mental health services. This impact was marked for individuals with long-term health conditions and comorbid depression and anxiety. Many face-to-face mental health services switched to remote delivery or paused therapeutic input entirely, despite the lack of research on the efficacy of switching between modalities mid-therapy or having breaks in therapy. This paper presents the case of a patient with long-term health conditions who experienced both breaks in therapy and a switch in modalities from face-to-face to telephone delivery. The intervention used was based on transdiagnostic cognitive behavioral therapy and self-report measures were completed at the beginning and end of the twelve sessions. Despite the shift in modalities, the patient experienced clinically significant recovery on all measures, indicating the efficacy of therapy was not greatly affected by the shift in modalities. Long breaks in therapy were linked to deterioration in mental health, although this could be due to the deterioration in physical health that necessitated these breaks. This case highlights the benefits and challenges of a shifting modality of therapy during treatment and in response to a pandemic for a shielding population. From the work presented here, it seems beneficial for services to be able to work across multiple modalities to suit the needs of the patients and ensure continuity of treatment. It also indicates that pauses in therapy may risk deterioration. Further work is needed to prevent digital exclusion of patients.

Transdiagnostic versus Diagnosis-Specific Group Cognitive Behavioral Therapy for Anxiety Disorders and Depression: A Randomized Controlled Trial

2021 ◽  
pp. 1-14
Author(s):  
Nina Reinholt ◽  
Morten Hvenegaard ◽  
Anne Bryde Christensen ◽  
Anita Eskildsen ◽  
Carsten Hjorthøj ◽  
...  
Keyword(s):  
Mental Health ◽  
Mental Health Services ◽  
Health Services ◽  
Behavioral Therapy ◽  
Controlled Trial ◽  
Well Being ◽  
Major Depressive ◽  
Outpatient Mental Health ◽  
End Of Treatment

<b><i>Introduction:</i></b> The Unified Protocol for Transdiagnostic Treatment of Emotional Disorders (UP) delivered in a group format could facilitate the implementation of evidence-based psychological treatments. <b><i>Objective:</i></b> This study compared the efficacy of group UP and diagnosis-specific cognitive behavioral therapy (dCBT) for anxiety and depression in outpatient mental health services. <b><i>Methods:</i></b> In this pragmatic, multi-center, single-blinded, non-inferiority, randomized controlled trial (RCT), we assigned 291 patients with major depressive disorder, social anxiety disorder, panic disorder, or agoraphobia to 14 weekly sessions in mixed-diagnosis UP or single-diagnosis dCBT groups. The primary test was non-inferiority, using a priori criteria, on the World Health Organisation 5 Well-Being Index (WHO-5) at the end of the treatment. Secondary outcomes were functioning and symptoms. We assessed outcomes at baseline, end-of-treatment, and at a 6-month follow-up. A modified per-protocol analysis was performed. <b><i>Results:</i></b> At end-of-treatment, WHO-5 mean scores for patients in UP (<i>n</i> = 148) were non-inferior to those of patients in dCBT (<i>n</i> = 143; mean difference –2.94; 95% CI –8.10 to 2.21). Results were inconclusive for the WHO-5 at the 6-month follow-up. Results for secondary outcomes were non-inferior at end-of-treatment and the 6-month follow-up. Client satisfaction and rates of attrition, response, remission, and deterioration were similar across conditions. <b><i>Conclusions:</i></b> This RCT demonstrated non-inferior acute-phase outcomes of group-delivered UP compared with dCBT for major depressive disorder, social anxiety disorder, panic disorder, and agoraphobia in outpatient mental health services. The long-term effects of UP on well-being need further investigation. If study findings are replicated, UP should be considered a viable alternative to dCBT for common anxiety disorders and depression in outpatient mental health services.

scholarly journals Stigmatization Toward Patients with Mental Health Diagnoses: Tehran’s Stakeholders’ Perspectives

2020 ◽  
Vol 14 (3) ◽  
Author(s):  
Zahra Farsi ◽  
Arsia Taghva ◽  
Samantha C Butler ◽  
Hanif Tabesh ◽  
Yavar Javanmard ◽  
...  
Keyword(s):  
Mental Health ◽  
Mental Health Services ◽  
Mental Disorders ◽  
Health Services ◽  
Negative Consequences ◽  
Stigma Reduction ◽  
Written Narratives ◽  
Face To Face ◽  
Mental Health Diagnoses ◽  
To Receive

Background: The stigma associated with mental health disorders has an enormous impact on decisions concerning receiving mental health services. Objectives: The current qualitative study aimed to describe the stigma toward mental disorders in Tehran, Iran. Methods: The current grounded theory study conducted from 2013 to 2016 in Tehran (Iran). Fourteen participants were sampled using purposive and theoretical sampling techniques. Data were collected through face-to-face interviews, focused groups, and written narratives. The Corbin and Strauss coding paradigm (2008) was used to analyze data. Results: Three main categories of stigmatization toward patients with mental health diagnoses were extracted: (1) barriers to stigma reduction; (2) strategies to reduce stigma; and (3) outcomes of stigma reduction such as negative consequences of stigma toward mental disorders and positive impacts of stigma reduction toward mental disorders. Conclusions: To improve mental health services for patients in Tehran (Iran), it is imperative to reduce the stigma toward mental disorders, educate the community, including the general population and healthcare professionals, and remove existing barriers to receive mental health services.

Mental Health Services

2005 ◽  
Author(s):  
Scott Bloom
Keyword(s):  
Mental Health ◽  
Mental Health Services ◽  
Health Services ◽  
Family Counseling ◽  
Her Family ◽  
Social And Emotional ◽  
School Based ◽  
Counseling Group ◽  
Teachers And Parents

Mental health problems in children are a major deterrent to learning. Yet the President’s New Freedom Commission on Mental Health in 2002 pointed out that mental health services for children are so fragmented as to be ineffective in major ways. The commission’s report emphasizes the importance of using the school system as the means of delivering such services. The school-based approach to mental health helps accomplish several goals: • Minimizing barriers to learning • Overcoming stigma and inadequate access to care • Providing comprehensive on-site counseling services • Creating a school climate that promotes students’ social and emotional functioning • Promoting healthy psychological and social development This chapter will describe the mental health services at the Children’s Aid Society (CAS) community schools, focusing on staffing, structure, and strategies and describing the clinic at one school in greater detail. Questions of space, accountability, and funding will be explored, and some conclusions based on our work will be discussed. CAS’s school-based clinics, located in elementary and middle schools, provide individual and family counseling, group therapy, in-depth assessments and referrals, and crisis intervention for students and their family members. Referrals to the clinic are made by students, teachers, and parents. Assessment and intervention plans include the active participation of the child, his or her family, school staff, and anyone else who can help in understanding the child’s needs. Based on the assessment, the child and/or family are engaged in shortor long-term individual, group, or family counseling aimed at ameliorating the problems that precipitated the referral. An in-depth psychosocial assessment is the first step in developing a comprehensive treatment plan that includes short- and long-term goals. Psychological and psychiatric evaluations are scheduled as appropriate. Clinicians (social workers with M.S.W. or C.S.W. degrees) generally have caseloads of 18–22 students, with enough room in their schedules to see walk-ins and emergencies. Problems that have been successfully treated include suicide ideation, physical and sexual abuse, drug and alcohol use, disruptive school behaviors, academic delays, hyperactivity, family and peer conflicts, and depression.

29 Symptoms of PTSD in a Burn Outpatient Clinic: Prevalence and Engagement Challenges for the Burn Team

2020 ◽  
Vol 41 (Supplement_1) ◽  
pp. S21-S22
Author(s):  
Andrew McAleavey ◽  
Mariel Emrich ◽  
Adina R Jick ◽  
Collette L McGuire ◽  
JoAnn Difede
Keyword(s):  
Mental Health ◽  
Psychological Distress ◽  
Mental Health Services ◽  
Health Services ◽  
Outpatient Clinic ◽  
Stress Disorder ◽  
Psychological Trauma ◽  
Self Report ◽  
Outpatient Mental Health ◽  
Contact Information

Abstract Introduction Psychological distress, including posttraumatic stress disorder, acute stress disorder, and depressive disorders, are common after burn injury. These conditions are major determinants of long-term quality of life and productivity loss among burn patients, yet are generally under treated. Among the many reasons for limited treatment are lack of accessible quality care, limited clinical staff expertise in assessing these conditions, and patient avoidance of effective services. Methods During December 2018 to September, 2019, patients awaiting outpatient visits at an urban burn center were asked to complete brief standardized self-report questionnaires assessing symptoms of posttraumatic distress, anxiety, and depression. Using pre-defined criteria, we attempted to reach individuals with greater than moderate distress using contact information provided voluntarily and engage these patients in outpatient mental health services. Results 747 questionnaires were completed by 511 individuals in the assessment period, and of these 98 (19.2%) individuals had a likely PTSD diagnosis. Visual analog scale assessments for current anxiety, depression and stress all suggested high average distress in the overall group. Using pre-defined criteria to identify potential distress, we identified 195 people (38.2%) to whom we would proactively offer services. Only 159 provided contact information, and several more were not eligible for available clinical services so were not contacted. We called 128 individuals (81%). This led to direct communication with 48 patients (37.5% of those contacted), but only 22 individuals (17.2% of all those contacted) still endorsed distress at the time of the phone call (which was planned to occur within one week of the patients’ report) and 11 individuals were interested in seeking mental health services. Of these, 4 were referred to other services, 3 declined specific offers of service, 4 were scheduled for appointments and only 2 individuals attended appointments with the in-hospital psychological trauma group. Conclusions Psychological distress is highly prevalent in the burn outpatient clinic, with roughly one in five patients likely meeting criteria for PTSD. However, engaging patients in psychological and psychiatric treatment remains a major challenge for the effective care in this population. We discuss strategies tried here and systemic barriers to overcome in future research and care. Applicability of Research to Practice High prevalence of PTSD in outpatient burn clinics and difficulty engaging patients in separate outpatient mental health services suggest co-located and collaborative care models would be highly helpful in this population.

Mental Health Services for Syrian Refugees in Lebanon: Perceptions and Experiences of Professionals and Refugees

2020 ◽  
Vol 30 (6) ◽  
pp. 849-864
Author(s):  
Hala Kerbage ◽  
Filippo Marranconi ◽  
Yara Chamoun ◽  
Alain Brunet ◽  
Sami Richa ◽  
...  
Keyword(s):  
Mental Health ◽  
Mental Health Services ◽  
Health Services ◽  
Health Conditions ◽  
Adaptive Mechanism ◽  
Syrian Refugees ◽  
Health Practice ◽  
Short Term ◽  
Mental Health Practice ◽  
Depth Interviews

We applied semi-structured and in-depth interviews to explore the perceptions and experiences of 60 practitioners/policymakers and 25 Syrian participants involved in mental health services for refugees in Lebanon. Refugees were found to view their distress as a normal shared reaction to adversity while professionals perceived it as symptomatic of mental illness. Practitioners viewed Syrian culture as an obstacle to providing care and prioritized educating refugees about mental health conditions. Policymakers invoked the state of crisis to justify short-term interventions, while Syrian refugees requested community interventions and considered resettlement in a third country the only solution to their adverse living conditions. The therapeutic relationship seems threatened by mistrust, since refugees change their narratives as an adaptive mechanism in response to the humanitarian system, which professionals consider manipulative. We discuss the implications of our findings for mental health practice in humanitarian settings.

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