Amount Of Therapist Contact Research Articles

Improving Cost-effectiveness and Access to Cognitive Behavior Therapy for Depression: Providing Remote-Ready, Computer-Assisted Psychotherapy in Times of Crisis and Beyond

Introduction: There is growing evidence that computer-delivered or computer-assisted forms of cognitive behavior therapy (CCBT) are helpful, but cost-effectiveness versus standard therapies is not well established. Objective: To evaluate the cost-effectiveness of a therapist-supported method for CCBT in comparison to standard cognitive behavior therapy (CBT). Methods: A total of 154 drug-free major depressive disorder outpatients were randomly assigned to either 16 weeks of standard CBT (up to twenty 50-min sessions) or CCBT using the Good Days Ahead program (including up to 5.5 h of therapist contact). Outcomes were assessed at baseline, weeks 8 and 16, and at 3 and 6 months post-treatment. Economic analyses took into account the costs of services received and work/social role impairment. Results: In the context of almost identical efficacy, a form of CCBT that used only about one third the amount of therapist contact as conventional CBT was highly cost-effective compared to conventional therapy and reduced the adjusted cost of treatment by USD 945 per patient. Conclusions: A method of CCBT that blended internet-delivered modules and abbreviated therapeutic contact reduced the cost of treatment substantially without adversely affecting outcomes. Results suggest that use of this approach can more than double the access to CBT. Because clinician support in CCBT can be provided by telephone, videoconference, and/or email, this highly efficient form of treatment could be a major advance in remote treatment delivery.

Cost-analysis of virtual reality training based on the Virtual Reality for Upper Extremity in Subacute stroke (VIRTUES) trial.

Stroke is a major cause of lasting disability worldwide. Virtual reality (VR) training has been introduced as a means of increasing the effectiveness of rehabilitation by providing large doses of task-related training with many repetitions and different modes of feedback. As VR is increasingly used in neurorehabilitation, cost considerations are important. A cost-analysis was conducted based on the Virtual Reality for Upper Extremity in Subacute stroke (VIRTUES) trial, a recent international randomized controlled observer-blind multicenter trial. Average therapist time required per therapy session may differ between VR and conventional training (CT), leading to potential cost savings due to a therapist being able to supervise more than one patient at a time. Exploratory cost analyses are presented to explore such assumptions. Based on our calculations, VR incurs extra costs as compared with CT when the same amount of therapist contact is provided, as was the case in VIRTUES. However, the exploratory analyses demonstrated that these costs may be rapidly counterbalanced when time for therapist supervision can be reduced. Extra costs for VR can be outweighed by reduced therapist time and decreasing VR system costs in the nearer future, and not least by increased patient motivation.

Online CBT I: Bridging the Gap Between Eliza and Modern Online CBT Treatment Packages

AbstractReviews have demonstrated large effect sizes when using computerised cognitive behaviour therapy (CBT) protocols for treating anxiety, depression and health related concerns. However, the amount of therapist contact per user seems to be the most significant prognostic indicator. Thus, in some ways current online interventions can be viewed primarily as an extension of one-on-one therapy. The present article provides guidelines for targeting this limitation of online psychological interventions. The goal is to mimic the therapeutic relationship using a computer, without having any therapist involved. Consequently, thousands of users would be able to receive treatment simultaneously, reaching a wider audience, which was the initial goal of the online model. The development of a treatment program using file audit data is suggested as an alternative to having an individual therapist for each user. This is done by allowing the ‘computer psychologist’ to tailor individualised treatments for each user based on their psychological profile. The user is provided with individualised corrective feedback based on a set of prewritten responses to common faulty thoughts. A new paradigm is proposed for online treatment delivery.

A small-scale study comparing the impact of psycho-education and exploratory psychotherapy groups on newcomers to a group for people with dementia

Background: The importance of providing emotional support to people newly diagnosed as having dementia is now widely recognised. However, the evidence base for this work is limited, so that it is difficult to draw conclusions either about whether this form of work is effective or which form of intervention might be most suitable for people with dementia. Objectives: This study compared the effectiveness of exploratory psychotherapy and psycho-educational group interventions for new group members. Methodology: Participants had received a diagnosis of Dementia of the Alzheimer's type or a similar form of dementia and had a mild level of cognitive impairment. Interventions occurred in ten, weekly sessions with participants attending either a psychotherapy or a psycho-educational group, each of which were facilitated by the same team of clinicians, and had the same amount of therapist contact. Data relating to levels of mood was collected at the start and at the end of the group intervention from eight participants in each arm of the study. Data collection occurred independently from the intervention by a researcher who was blind to the form of intervention. Results: There was a significant interaction between mode of therapy and levels of depression and a borderline significant interaction between therapy type and levels of anxiety. However, once the low affect level of participants in the psycho-educational groups was controlled for, differences between the interventions were non-significant. Discussion: Although the results that can be drawn from this study are limited, nevertheless it supports previous research indicating that a 10-week group psychotherapy intervention can be effective in reducing levels of depression for people with a mild level of dementia.

The efficacy of cognitive-behavioral interventions for reducing anxiety sensitivity: A meta-analytic review

The present study meta-analytically reviewed the efficacy of cognitive-behavioral therapy (CBT) vs. control conditions in the reduction of anxiety sensitivity. A computerized search was conducted to indentify CBT outcome studies that included the Anxiety Sensitivity Index as a dependent variable. Of the 989 studies that were identified, 24 randomized-controlled trials with a total of 1851 participants met inclusion criteria and were included in the analysis. Data were extracted separately for treatment-seeking (16 studies) and at-risk (eight studies) samples. Results indicated large effect sizes for treatment-seeking samples, Hedges' g=1.40, SE=0.21, 95% CI: 1.00–1.81, p<0.001, and moderate to large effect sizes for at risk samples Hedges' g=0.74, SE=0.18, 95% CI: 0.39–1.08, p<0.001. Additionally, both the amount of therapist contact and control modality (waitlist vs. psychological control) moderated the effect sizes for treatment-seeking samples. Our review indicates that CBT is efficacious in reducing anxiety sensitivity. However, more research is needed to determine the mechanisms by which CBT exert its effects on anxiety sensitivity.

Self-help and minimal-contact therapies for anxiety disorders: Is human contact necessary for therapeutic efficacy?

Self-help materials, brief therapies, and treatments involving minimal therapist contact have all been proposed as effective and low-cost interventions for anxiety disorders. However, research also suggests that the therapeutic alliance is a central predictor of therapy outcome. Interestingly, amounts of therapist contact within and across "self-help" interventions vary greatly. It is therefore unclear how much therapist contact is necessary for a positive anxiety disorder treatment outcome. The present article reviews the literature on anxiety disorder treatments using self-help, self-administered, and decreased therapist-contact interventions. Treatment studies are grouped together by anxiety diagnosis as well as amount of therapist contact. It is concluded that self-administered treatments are most effective for motivated clients seeking treatment for simple phobias. Predominantly self-help therapies are efficacious for panic disorder and mixed anxiety samples. On the other hand, minimal-contact therapies have demonstrated efficacy for the greatest variety of anxiety diagnoses.

Relaxation training for tension headache: Comparative efficacy and cost-effectiveness of a minimal therapist contact versus a therapist-delivered procedure

This study compared the clinical utility and cost-effectiveness of a standard, therapist-delivered relaxation treatment of tension headache to a comparable procedure administered with minimal therapist contact and based chiefly at home. Both procedures were highly effective and nearly equivalent for reducing headache complaints, as assessed by measures of headache index, intensity, frequency, and of medication consumption. The minimal contact, home-based treatment was shown to be more cost-effective when relating total amount of therapist contact to headache improvement. These findings suggest that the home-based relaxation treatment may constitute a viable, low-cost alternative to the more typical, but expensive, clinic-based procedures in the treatment of tension headache.

A Psychoeducational Approach to the Treatment of Unipolar Depression

This paper summarizes the results from three outcome studies. The vehicle of treatment being evaluated in each of the studies was a course consisting of 12 units-two devoted to presentation of rationale and self-change methods, eight devoted to teaching specific skills (social skills, thinking, pleasant activities, and relaxation), and two devoted to integration and maintenance. Participants were assessed on a wide range of variables at four points in time: pre- and post-treatment, one- and six-month follow up. The research was designed to contribute to three types of issues: (1) Does the amount of therapist contact and the format in which the treatment is offered (group vs. individual) affect treatment outcome? (2) Are there consistent differences between therapists in the amount of improvement they achieve with their patients? Can these differences be predicted? (3) Can improvement be predicted from pre-treatment patient characteristics?

Amount of therapist contact and outcome in a multidimensional depression treatment program.

An 8-week multidimensional program of behavioral management, cognitive restructuring, and assertiveness training was administered to depressed outpatients either individually with a single therapist (n = 12), in two small groups (n = 11), or one large group (n = 11), or as bibliotherapy (n = 12). A randomly assigned waiting list control group was also included (n = 10). Follow-up assessments were conducted at 18 weeks. Principal findings were that 1) there were no significant pretreatment differences among groups, 2) all treated groups including bibliotherapy improved substantially over the course of treatment, 3) the waiting list control group was unchanged during this same period, 4) there were no significant differences among treated groups at termination or at follow-up, nor did these groups change significantly over the period of follow-up. Thus the effectiveness of this multidimensional program was supported, but its efficacy was not systematically influenced by amount of therapist contact.

Self-help books and amount of therapist contact in smoking cessation programs.

Self-help books and amount of therapist contact in smoking cessation programs.

Self-help books and amount of therapist contact in smoking cessation programs.

Self-help books and amount of therapist contact in smoking cessation programs.

Cost effectiveness in behavioral family therapy

This report presents a multiple assessment exploration of cost effectiveness in behavioral family therapy. Thirty-six families with problem children between the ages of 4 and 12 were randomly assigned within stratified blocks to individual treatment, group treatment, or minimal contact bibliotherapy. All conditions received similar information about the behavioral management of children; only the format for therapy and the amount of therapist contact were different. Dependent variables consisted of parent attitude measures, parent-collected data on defined problems, and observational data from audio recordings made in the homes of the families. Analysis of both the parent-collected data and the home-observation data indicated the superiority of group and individual treatment conditions over the minimal contact bibliotherapy condition. Although it required less than half the amount of professional time, the group condition performed as well as the individual therapy condition. Parents in all three conditions rated the focus child as significantly improved with no differences between conditions.

Effects of a self-control manual, rapid smoking, and amount of therapist contact on smoking reduction.

Effects of a self-control manual, rapid smoking, and amount of therapist contact on smoking reduction.

Effects of a self-control manual, rapid smoking, and amount of therapist contact on smoking reduction.

Effects of a self-control manual, rapid smoking, and amount of therapist contact on smoking reduction.