The Worker/Client Relationship in Technology-Assisted Interventions

While the effective delivery of technology-assisted interventions remains a challenge for many social workers, they can be quite helpful for clients, and it is evident that positive worker/client relationships are possible through these media. With the worldwide onset of the COVID-19 pandemic it has become almost mandatory that human service practitioners become competent in these forms of service delivery. Given the inevitability of ongoing developments in this area, social workers should embrace the opportunities afforded by online therapies. The purposes of this chapter are to review various types of distance interventions and examine their effects on the quality of worker/client relationships, including 12 recommendations for social workers to enhance those relationships.

Adaptation of Music Therapists’ Practice to the Outset of the COVID-19 Pandemic—Going Virtual: A Scoping Review

Background: In the midst of a worldwide COVID-19 pandemic, music therapists previously not involved in telehealth had to develop effective remote forms of music therapy. The objective of this review was to systematically explore how music therapists previously working in-person adapted to the transfer to remote forms of therapy in the context of the coronavirus outbreak. Methods: We searched Scopus, Web of Science Core Collection, CINAHL, Medline, ProQuest Central, PubMed, EMBASE, PsycINFO and PsyARTICLES, grey literature (to October 2020), and websites of professional organizations. We followed the JBI methodology for scoping reviews. Results: Out of the 194 screened texts, we included ten very heterogeneous articles with an overall very low quality. Most texts described remote therapy in the form of synchronous video calls using the Internet, one paper described a concert in a patio of a residential home. We report the authors’ experience with the adaptation and activities, challenges and benefits of remote forms of therapy, recommendations of organizations, and examples and tips for online therapies. Conclusions: Music therapists have adapted the musical instruments, the hours, the technology used, the therapeutic goals, the way they prepared their clients for sessions, and other aspects. They needed to be more flexible, consult with colleagues more often, and mind the client-therapist relationship’s boundaries. It seems, when taken as a necessary short-term measure, online music therapy works sufficiently well. The majority of papers stated that benefits outweighed the challenges, although many benefits were directly linked with the pandemic context.

COVID-19, Isolation, Quarantine: On the Efficacy of Internet-Based Eye Movement Desensitization and Reprocessing (EMDR) and Cognitive-Behavioral Therapy (CBT) for Ongoing Trauma

Literature points to cognitive-behavioural therapy (CBT) and eye movement desensitization and reprocessing (EMDR) as evidence-based therapies for trauma-related disorders. Treatments are typically administered in a vis-à-vis setting with patients reporting symptoms of a previously experienced trauma. Conversely, online-therapies and ongoing trauma have not received adequate attention. This study aimed to compare the efficacy of two brief treatments for health professionals and individuals suffering from the circumstances imposed by the coronavirus disease 2019 (COVID-19) pandemic. The EMDR and the trauma focused-CBT were administered online during the earliest stage of distress to manage the ongoing trauma associated to quarantine or disease. Thirty-eight patients satisfying the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria for acute stress disorder were randomly assigned to the EMDR or CBT treatment. Both groups received a 7-session therapy, and psychometric tests were administered before, after the treatment and at one-month follow-up to assess traumatic symptoms, depression and anxiety. Results revealed that both treatments reduced anxiety by 30%, and traumatic and depressive symptoms by 55%. Present findings indicate the internet-based EMDR and CBT as equally effective brief treatments, also suggesting a maintenance of the effects as indicated by the follow-up evaluation. The EMDR and CBT might be considered as first line therapies to treat the ongoing trauma and to prevent the sensitization and accumulation of trauma memories.

Internet and Computer-Based Treatments for the Management of PTSD

A rapid expansion in the development of telehealth treatments has occurred during the past several decades, with a growing body of evidence supporting online therapies for behavioral health disorders. These online interventions have focused primarily on the treatment of depression, panic disorder, social phobia, and generalized anxiety disorder. More recently, and with the relative success of the previous Web-based treatments, several online treatments for posttraumatic stress disorder (PTSD) have emerged. An overview of Internet and computer-based treatments (ICTs) for PTSD is presented, including a general discussion of computerized treatments followed by a review of specific ICTs that have been developed and tested for PTSD. Some of the critical issues surrounding ICTs are then explored, and an example of how online treatments can be incorporated into a larger care model is presented. The discussion ends with a brief description of the use of mobile health applications to augment treatment.

Access to Psychotherapy in the Era of Web 2.0 – New Media, Old Inequalities? / Zugang zur Psychotherapie in der Ära des Web 2.0 – Neue Medien, Alte Ungleichheiten?

Background: Currently, the debate on regional and socio-structurally related treatment gaps in psychotherapeutic care increases the interest in e-mental health interventions such as the Internet-based psychotherapy, online self-help and new approaches for self-empowerment. Thus, health professionals could support informed decision-making by knowing the latest developments. However, if the ‘digital revolution’ fails to reach patients not familiar with Web 2.0, access to psychotherapies is unlikely to improve. Therefore, the objective of this review is to clarify whether online therapies should be recommended as an effective alternative to conventional psychotherapy in primary care.Methods: To investigate the research evidence of online therapies in adults within the last decade (2004-2014), a rapid review of literature was conducted by using electronic databases (i.e. Medline/PubMed, PubMed Central, Cochrane Library) to find systematic reviews, meta-analysis and clinical trials. Furthermore, a hand search in journals and grey literature was undertaken.Results: A search in PubMed for clinical trials on ‘online psychotherapy’ resulted in a total number of 245 publications. So, eight reviews and several clinical trials were chosen. Overall, mostly positive findings on the effectiveness and acceptance of online psychotherapy, primarily in the treatment of depression and anxiety disorders, were identified.Discussion: In sum, Internet-based psychotherapies have been effective in reducing symptoms of mood and anxiety disorders in clinical trials. However, due to the limited range of treatable disorders and non-representative samples (young female college graduates), external validity remains insufficient. Thus, further research is needed to determine if online therapies will be capable of improving access to psychotherapy.

Evidence-Based Treatment for the Eating Disorders

This chapter comprises a focused review of the best available evidence for psychological and pharmacological treatments of choice for anorexia nervosa (AN), bulimia nervosa (BN), binge eating disorder (BED), and other specified and unspecified feeding and eating disorders (OSFED and UFED), discusses the role of primary care and online therapies, and presents treatment algorithms. In AN, although there is consensus on the need for specialist care that includes nutritional rehabilitation in addition to psychological therapy, no single approach has yet been found to offer a distinct advantage. In contrast, manualized cognitive behavior therapy (CBT) for BN has attained “first-line” treatment status with a stronger evidence base than other psychotherapies. Similarly, CBT has a good evidence base in treatment of BED and for BN, and BED has been successfully adapted into less intensive and non-specialist forms. Behavioral and pharmacological weight loss management in treatment of co-morbid obesity/overweight and BED may be helpful in the short term, but long-term maintenance of effects is unclear. Primary care practitioners are in a key role, both with regard to providing care and with coordination and initiation of specialist care. There is an emerging evidence base for online therapies in BN and BED where access to care is delayed or problematic.