The Digital Therapeutic Alliance and Human-Computer Interaction

10.2196/21895 ◽  
2020 ◽  
Vol 7 (12) ◽  
pp. e21895
Author(s):  
Simon D'Alfonso ◽  
Reeva Lederman ◽  
Sandra Bucci ◽  
Katherine Berry

The therapeutic alliance (TA), the relationship that develops between a therapist and a client/patient, is a critical factor in the outcome of psychological therapy. As mental health care is increasingly adopting digital technologies and offering therapeutic interventions that may not involve human therapists, the notion of a TA in digital mental health care requires exploration. To date, there has been some incipient work on developing measures to assess the conceptualization of a digital TA for mental health apps. However, the few measures that have been proposed have more or less been derivatives of measures from psychology used to assess the TA in traditional face-to-face therapy. This conceptual paper explores one such instrument that has been proposed in the literature, the Mobile Agnew Relationship Measure, and examines it through a human-computer interaction (HCI) lens. Through this process, we show how theories from HCI can play a role in shaping or generating a more suitable, purpose-built measure of the digital therapeutic alliance (DTA), and we contribute suggestions on how HCI methods and knowledge can be used to foster the DTA in mental health apps.

2020 ◽  
Author(s):  
Simon D'Alfonso ◽  
Reeva Lederman ◽  
Sandra Bucci ◽  
Katherine Berry

UNSTRUCTURED The therapeutic alliance (TA), the relationship that develops between a therapist and a client/patient, is a critical factor in the outcome of psychological therapy. As mental health care is increasingly adopting digital technologies and offering therapeutic interventions that may not involve human therapists, the notion of a TA in digital mental health care requires exploration. To date, there has been some incipient work on developing measures to assess the conceptualization of a digital TA for mental health apps. However, the few measures that have been proposed have more or less been derivatives of measures from psychology used to assess the TA in traditional face-to-face therapy. This conceptual paper explores one such instrument that has been proposed in the literature, the Mobile Agnew Relationship Measure, and examines it through a human-computer interaction (HCI) lens. Through this process, we show how theories from HCI can play a role in shaping or generating a more suitable, purpose-built measure of the digital therapeutic alliance (DTA), and we contribute suggestions on how HCI methods and knowledge can be used to foster the DTA in mental health apps.


2017 ◽  
Vol 54 (4) ◽  
pp. 445-465 ◽  
Author(s):  
Gesine Sturm ◽  
Zohra Guerraoui ◽  
Sylvie Bonnet ◽  
Françoise Gouzvinski ◽  
Jean-Philippe Raynaud

This article presents the recently created intercultural consultation at the Medical and Psychological Health Care Service (CMP) of the University Hospital la Grave at Toulouse. The approach of the intercultural consultation was elaborated in response to the increasing diversity of children and families using the service in Toulouse. It is also based on local research that indicates the difficulties service providers encounter when trying to establish a solid therapeutic alliance with families with complex migration backgrounds who accumulate different disadvantaging factors. The intercultural consultation adapts existing models of culture-sensitive consultations in child mental health care in France and Canada to the local context in Toulouse. We describe the underlying principles of the intercultural consultation work, the therapeutic and mediation techniques used, and the way the work is integrated into the global service provision of the CMP. The process is illustrated with a case study followed by a discussion of the innovations.


2018 ◽  
Author(s):  
Samantha L Connolly ◽  
Christopher J Miller ◽  
Christopher J Koenig ◽  
Kara A Zamora ◽  
Patricia B Wright ◽  
...  

BACKGROUND Mental health smartphone apps provide support, skills, and symptom tracking on demand and come at minimal to no additional cost to patients. Although the Department of Veterans Affairs has established itself as a national leader in the creation of mental health apps, veterans’ attitudes regarding the use of these innovations are largely unknown, particularly among rural and aging populations who may benefit from increased access to care. OBJECTIVE The objective of our study was to examine veterans’ attitudes toward smartphone apps and to assess whether openness toward this technology varies by age or rurality. METHODS We conducted semistructured qualitative interviews with 66 veterans from rural and urban areas in Maine, Arkansas, and California. Eligible veterans aged 18 to 70 years had screened positive for postraumatic stress disorder (PTSD), alcohol use disorder, or major depressive disorder, but a history of mental health service utilization was not required. Interviews were digitally recorded, professionally transcribed, and coded by a research team using an established codebook. We then conducted a thematic analysis of segments pertaining to smartphone use, informed by existing theories of technology adoption. RESULTS Interviews revealed a marked division regarding openness to mental health smartphone apps, such that veterans either expressed strongly positive or negative views about their usage, with few participants sharing ambivalent or neutral opinions. Differences emerged between rural and urban veterans’ attitudes, with rural veterans tending to oppose app usage, describe smartphones as hard to navigate, and cite barriers such as financial limitations and connectivity issues, more so than urban populations. Moreover, rural veterans more often described smartphones as being opposed to their values. Differences did not emerge between younger and older (≥50) veterans regarding beliefs that apps could be effective or compatible with their culture and identity. However, compared with younger veterans, older veterans more often reported not owning a smartphone and described this technology as being difficult to use. CONCLUSIONS Openness toward the use of smartphone apps in mental health treatment may vary based on rurality, and further exploration of the barriers cited by rural veterans is needed to improve access to care. In addition, findings indicate that older patients may be more open to integrating technology into their mental health care than providers might assume, although such patients may have more trouble navigating these devices and may benefit from simplified app designs or smartphone training. Given the strong opinions expressed either for or against smartphone apps, our findings suggest that apps may not be an ideal adjunctive treatment for all patients, but it is important to identify those who are open to and may greatly benefit from this technology.


2018 ◽  
Vol 21 (3) ◽  
pp. 116-119 ◽  
Author(s):  
John Torous ◽  
Jennifer Nicholas ◽  
Mark E Larsen ◽  
Joseph Firth ◽  
Helen Christensen

The potential of smartphone apps to improve quality and increase access to mental health care is increasingly clear. Yet even in the current global mental health crisis, real-world uptake of smartphone apps by clinics or consumers remains low. To understand this dichotomy, this paper reviews current challenges surrounding user engagement with mental health smartphone apps. While smartphone engagement metrics and reporting remains heterogeneous in the literature, focusing on themes offers a framework to identify underlying trends. These themes suggest that apps are not designed with service users in mind, do not solve problems users care most about, do not respect privacy, are not seen as trustworthy and are unhelpful in emergencies. Respecting these current issues surrounding mental health app engagement, we propose several solutions and highlight successful examples of mental health apps with high engagement. Further research is necessary to better characterise engagement with mental health apps and identify best practices for design, testing and implementation.


Nursing ◽  
2021 ◽  
Vol 51 (10) ◽  
pp. 56-60
Author(s):  
Angel Johann Solorzano Martinez

Author(s):  
Sree T. Sucharitha ◽  
Aravind Manoharan ◽  
Velusamy Dhanuraja ◽  
Arunadevi Kasi ◽  
Suganya Ezhilarasan

Background: Globally, depressive disorders are ranked as the single largest contributor to non-fatal health loss (7.5% of all years lost due to disability-YLD). In India, provision of quality mental health care services remains a challenge due to severe deficiency of qualified care givers. Harnessing the potential of digital technologies and smart phone apps need to be explored to address the existing gaps in mental health care services. This study aims to describe the awareness, attitudes and user experiences of mental health apps among professional course students.Methods: A mixed-methods study methodology was adapted involving medical professional students of a tertiary teaching hospital in South India. A web-based survey assessed the awareness, attitudes and usage of mental health apps. Further, in-depth interviews (30) were conducted among selective app users (20) and non-users (10) to gain insights about the user experiences.  Results: Among 898 respondents for the web-based survey, majority were female (513,57.1%), aged between 18-25 years (801,89.2%) undergraduates (673,74.9%), undertaking professional courses in medicine and allied health sciences (633,70.6%). 273 (30.4%) respondents were aware of apps and 86 (9.6%) were ever users. Novel interactive platforms, privacy and agency for self-care are the major factors for using the apps however data confidentiality and authenticity of the app-based information were identified as major concerns limiting app usage.Conclusions: The study found the utilization of mental health apps as self-management tool for depression gaining slow traction among professional course students.


2021 ◽  
Vol 9 (1) ◽  
Author(s):  
Tinashe Dune ◽  
Peter Caputi ◽  
Beverly M. Walker ◽  
Katarzyna Olcon ◽  
Catherine MacPhail ◽  
...  

Abstract Background The development of cultural competence is central to the therapeutic alliance with clients from diverse backgrounds. Given that the majority of Australia’s population growth is due to migration, mental health practitioner construing of non-White and White people has a significant role and impact on client engagement. Method To examine the impact of mental health practitioner construing on their strategies for cultural competence and the therapeutic alliance, 20 White and non-White mental health practitioners and trainees providing mental health services were purposively sampled and interviewed face-to-face or via videoconferencing. Data was analysed thematically and the impact of construing on practitioner cultural competence and the therapeutic alliance were interpreted using Personal Construct Psychology. Results Practitioners demonstrated cultural competence in their acknowledgement of the impact of negative construing of ethnic, cultural, religious, social, racial and linguistic diversity on client wellbeing. Practitioners sought to address these negative impacts on clients by drawing on the client-practitioner relationship to improve the therapeutic alliance. Conclusions The results reinforce the need for mental health care workers to develop cultural competence with a focus on developing awareness of the impact of frameworks of Whiteness on the experiences of non-White people. This is central to the development of a therapeutic alliance where clients feel understood and assured that their mental health concerns will not be constructed (and treated) through a framework that constrains both White and non-White people’s opportunities for improved mental health and wellbeing.


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