Delivery Of Psychological Interventions Research Articles

An open trial of the feasibility of brief internet-delivered acceptance and commitment therapy (iACT) for chronic anxiety and depression

Anxiety and depressive disorders are common, often chronic and result in significant disability and distress. The delivery of psychological interventions via the internet is now recognised to be a safe and effective way to treat these disorders. The predominant therapeutic model in clinical trials and in routine care has been cognitive-behavioural therapy (CBT), which helps patients identify and modify unhelpful thoughts and behaviours. However, other models of treatment for anxiety and depression, such as acceptance and commitment therapy (ACT), which uses the examination of both positive and negative experiences in the service of living a personally meaningful and values-based life, have been developed and tested, although most of these interventions are long and require more clinician support to ensure adherence and achieve positive outcomes. The aim of the present study was to examine the feasibility of a new brief, clinician supported transdiagnostic internet-delivered (iACT) program, designed to treat symptoms of both anxiety and depression and improve social function. A single-group open trial was conducted on 24 adults with long-term symptoms of anxiety and depression. The course is comprised of five online modules delivered over 8 weeks either self-guided or with support from a clinician. There was a high course completion rate (70 %) and a high level of satisfaction with the course (94 % satisfied or very satisfied). Significant clinical improvement in our primary outcome measures (within-group Cohen's d) of anxiety (d ≥ 0.62), depression (d ≥ 0.63), disability (d ≥ 0.43) and quality of life (d ≥ −0.57) were observed at posttreatment. Relatively little clinician time was required per participant (M = 30.6 min, SD = 5.7). The findings of the current study support the feasibility and potential of a transdiagnostic iACT treatment for adults experiencing long-term symptoms of anxiety and depression, including those patients who have not derived benefit from other treatments.

A single-blind, parallel-group randomised trial of a Technology-assisted and remotely delivered Cognitive Behavioural Therapy intervention (Tech-CBT) versus usual care to reduce anxiety in people with mild cognitive impairment and dementia: study protocol for a randomised trial

BackgroundAnxiety is commonly experienced by people living with mild cognitive impairment (MCI) and dementia. Whilst there is strong evidence for late-life anxiety treatment using cognitive behavioural therapy (CBT) and delivery via telehealth, there is little evidence for the remote delivery of psychological treatment for anxiety in people living with MCI and dementia. This paper reports the protocol for the Tech-CBT study which aims to investigate the efficacy, cost-effectiveness, usability and acceptability of a technology-assisted and remotely delivered CBT intervention to enhance delivery of anxiety treatment for people living with MCI and dementia of any aetiology.MethodsA hybrid II single-blind, parallel-group randomised trial of a Tech-CBT intervention (n = 35) versus usual care (n = 35), with in-built mixed methods process and economic evaluations to inform future scale-up and implementation into clinical practice. The intervention (i) consists of six weekly sessions delivered by postgraduate psychology trainees via telehealth video-conferencing, (ii) incorporates voice assistant app technology for home-based practice, and (iii) utilises a purpose-built digital platform, My Anxiety Care. The primary outcome is change in anxiety as measured by the Rating Anxiety in Dementia scale. Secondary outcomes include change in quality of life and depression, and outcomes for carers. The process evaluation will be guided by evaluation frameworks. Qualitative interviews will be conducted with a purposive sample of participants (n = 10) and carers (n = 10), to evaluate acceptability and feasibility, as well as factors influencing participation and adherence. Interviews will also be conducted with therapists (n = 18) and wider stakeholders (n = 18), to explore contextual factors and barriers/facilitators to future implementation and scalability. A cost-utility analysis will be undertaken to determine the cost-effectiveness of Tech-CBT compared to usual care.DiscussionThis is the first trial to evaluate a novel technology-assisted CBT intervention to reduce anxiety in people living with MCI and dementia. Other potential benefits include improved quality of life for people with cognitive impairment and their care partners, improved access to psychological treatment regardless of geographical location, and upskilling of the psychological workforce in anxiety treatment for people living with MCI and dementia.Trial registrationThis trial has been prospectively registered with ClinicalTrials.gov: NCT05528302 [September 2, 2022].

A Systematic Review of the Impact of Personal Therapy on Therapists

Despite the high prevalence of therapists receiving personal therapy to aid in the competent delivery of psychological treatment to clients, the understanding of its impact is limited [1]. A comprehensive review by Macran & Shapiro [2] reported methodological shortcomings in earlier research literature, preventing the researchers from establishing their conclusions with certainty. This paper systematically reviewed the research literature on this topic since the work by Macran & Shapiro [2] to examine new evidence of its impact. A total of sixteen studies were identified for this review. The paper found common professional and personal benefits consistently reported across the studies, but the evidence on the effects of personal therapy on client outcomes were inconclusive. Some therapists also reported perceiving negative experiences from personal therapy. A closer examination of the studies identified in the paper indicated that they continued to possess significant weaknesses in their research methodology. The paper then proceeded to propose how the commonly reported benefits can be organized into a preliminary model that can be utilized to guide future efforts in understanding the impacts of personal therapy

A Stage 1 Pilot Cohort Exploring the Use of EMDR Therapy as a Videoconference Psychotherapy During COVID-19 With Frontline Mental Health Workers: A Proof of Concept Study Utilising a Virtual Blind 2 Therapist Protocol.

ObjectiveThe COVID-19 pandemic has had a major impact on the delivery of psychological treatment. Due to social distancing requirements, the provision moved to videoconferencing psychotherapy (VCP). There is a paucity of empirical data supporting the efficacy of EMDR therapy as a VCP. This stage 1 pilot study tested an EMDR therapy scripted protocol, such as Virtual Blind 2 Therapist (VB2Tr), on frontline mental health workers as a VCP regarding fitness for purpose, distinctiveness, relevance, and efficiency.MethodsA total of 24 participants were recruited for the study. The design included a one-session treatment intervention with pre, post, 1-month, and 6-month follow-up (FU) measurements. This treatment session used a “Blind 2 Therapist” EMDR therapy scripted protocol as videoconference psychotherapy that involves non-disclosure of traumatic memory. The research explored the treatment effect on the core characteristics of trauma memory, including subjective disturbance, belief systems, memory intensity (MI), vividness, and levels of emotionality. Additionally, the research explored participants’ experiences of adverse and benevolent childhood experiences (ACEs/BCEs) during their childhood.ResultsRegarding the four tests, namely, fitness for purpose, distinctiveness, relevance, and efficiency, results are favourably suggesting potential clinical benefits of using EMDR as videoconference psychotherapy. Although this is a proof-of-concept study showing positive results, no clinical population or control group was used. The purpose of the study is to explore the potential for scalability toward a larger clinical trial. The treatment intervention was achieved irrespective of either ACEs/BCEs during childhood.ConclusionThe research tentatively supports the case for EMDR therapy as a credible treatment when used as video conference psychotherapy and in using the Blind 2 Therapist protocol. However, more research is needed to scale toward a clinical trial.Clinical Trial RegistrationClinical Trial Registration: https://www.isrctn.com/ISRCTN12099530, identifier ISRCTN12099530.

Technology-assisted peer therapy: a new way of delivering evidence-based psychological interventions

In low-income settings, ninety percent of individuals with clinical depression have no access to evidence-based psychological interventions. Reasons include lack of funds for specialist services, scarcity of trained mental health professionals, and the stigma attached to mental illness. In recent years there have been many studies demonstrating effective delivery of psychological interventions through a variety of non-specialists. While these interventions are cost-effective and less stigmatising, efforts to scale-up are hampered by issues of quality-control, and what has been described by implementation scientists as ‘voltage-drop’ and ‘programme-drift.’ Using principles of Human Centred Design in a rural setting in Pakistan, we worked with potential users to co-design a Tablet or Smartphone-based App that can assist a lay-person deliver the Thinking Healthy Programme, a World Health Organization-endorsed evidence-based intervention for perinatal depression. The active ingredients of this cognitive-therapy based intervention are delivered by a virtual ‘avatar’ therapist incorporated into the App which is operated by a ‘peer’ (a woman from the neighbourhood with no prior experience of healthcare delivery). Using automated cues from the App, the peer reinforces key therapeutic messages, helps with problem-solving and provides the non-specific but essential therapeutic elements of empathy and support. The peer and App therefore act as co-therapists in delivery of the intervention. The peer can deliver the intervention with good fidelity after brief automated in-built training. This approach has the potential to be applied to other areas of mental health and help bridge the treatment gap, especially in resource-poor settings. This paper describes the process of co-development with end-users and key features of the App.

A brief transdiagnostic psychological intervention for Afghan asylum seekers and refugees in Austria: a randomized controlled trial

ABSTRACT Background: Afghan refugees often face hardship and traumatic experiences before, during, and after migration and frequently suffer from mental health burdens. Evidence based psychological treatments for refugees mostly focus on symptoms of posttraumatic stress disorder (PTSD), however, refugees often suffer from a variety of general health problems as well as depression and anxiety. We thus aimed to evaluate the effectiveness of a transdiagnostic psychological intervention. Objective: To investigate the effectiveness of an adapted version of Problem Management Plus (aPM+) delivered by mental health professionals to adult Afghan refugees and asylum seekers. Methods: We randomly allocated 88 Afghan refugees either to aPM+ in addition to treatment as usual (aPM+/TAU) or TAU alone. APM+ comprises of six weekly 90-minute individual sessions including strategies of stress management, problem solving, behavioural activation, strengthening social support and either anger regulation or increasing self-efficacy. The primary outcome was general health (GHQ-28) post intervention. Secondary outcome measures included distress by PMLD, Complex PTSD symptoms, quality of life, self-identified problems, and integration. Results: Attrition was high: 42% of the randomized participants did not participate in the post-treatment assessment. A repeated measures per-protocol (completers only) ANCOVA evidenced a significant group × timepoint interaction for GHQ total scores [F(1, 47) = 14.80, p < .001, partial η2 = 0.24]. Post-hoc analyses showed significantly lower symptoms in the aPM+/TAU arm (n = 26) as compared to the TAU arm (n = 25) for the GHQ total scores (dz = 1.04). Most secondary outcomes significantly improved in the aPM+/TAU arm, but not in the TAU arm. Conclusion: APM+ was effective in reducing general health problems in Afghan refugees and might be considered as a first-line intervention. High drop-out rate limit the interpretations of our results, where future investigations should focus on possibilities to reduce these rates. Trial registration: Uniform Trial Number identifier: U1111-1226-3285. HIGHLIGHTS Refugees’ mental health can be strengthened with a brief psychological intervention that also focuses on skills in the context of post-migration stressors. High drop-out rates are a major challenge for future research and delivery of psychological interventions as part of health care systems to refugees and asylum seekers.

Scaling up psychological treatments: Lessons learned from global mental health.

Evidence-based psychological treatments are among the most effective interventions in medicine and are recommended as the first line of treatment to address the significant burden of depression, anxiety, and stress-related disorders worldwide. Despite this evidence, these treatments remain inaccessible for the great majority of the world's population. Global Mental Health (GMH) is an evolving discipline of research and practice that places a priority on improving mental health and achieving equity in mental health for all people worldwide. Equity is a driving principle, and this recognizes that inequalities exist within all nations and between nations. At the heart of this equity, there is the need for person-centered care. This essay discusses how GMH has sought to address a range of barriers to scale up the delivery of psychological treatments for common mental disorders. While the initial focus of the field has been to address access to quality care in low- and middle-income countries, this article also draws attention to how similar strategies are being implemented at scale in some high-income countries, with appropriate modifications to suit the context. In considering some of these evidence-based, contextually driven strategies, psychological communities have potential to address the growing burden of depression and anxiety worldwide. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Review article: current and future treatment approaches for pain in IBS.

Abdominal pain is a core symptom of IBS and a primary driver of care seeking. Visceral hypersensitivity is a key pathophysiological mechanism and therapeutic target for pain in IBS, with components of peripheral and central sensitisation and psychological factors. To review current and future treatment approaches specifically for the pain component of IBS. Pubmed search terms included combinations of irritable bowel, pain, visceral hypersensitivity, novel, new, emerging, future and advances. Established non-pharmacological treatments for IBS pain include the low FODMAP diet, probiotics and psychological interventions, especially hypnotherapy. Tricyclics remain the best evidenced pharmacological approach with GCC agonists, tenapanor, lubiprostone, eluxadoline and 5HT3 antagonists second line according to patient characteristics and availability. Less well-evidenced current options include anti-spasmodics, peppermint oil, SSRIs, SNRIs, alpha 2 delta ligands, melatonin and histamine antagonists. Patients are vulnerable to iatrogenesis and harmful approaches to be avoided include opioids and unwarranted surgical interventions. For severe pain, the concept of augmentation with combined gut-brain neuromodulators and psychotherapy in a multi-disciplinary setting is considered. A plethora of molecular targets and ligands are emerging from pre-clinical studies, together with early clinical evidence for a range of pharmacological, dietary, neurostimulation and novel psychological treatment delivery methods which are reviewed. The history of such emerging approaches, however, merits both caution and optimism in equal measure. Despite good in-roads and emerging options, the management of abdominal pain remains one of the biggest challenges and research priorities for patients with IBS.

Spanish-Speaking Therapists Increasingly Switch to Telepsychology During COVID-19: Networked Virtual Reality May Be Next.

Background: Social distancing restrictions imposed due to the Novel Coronavirus 2019 (COVID-19) pandemic resulted in a rapid shift in the delivery of psychological interventions from in-person to telehealth. Much of the research on this transition has been conducted with English-speaking mental health providers, leaving a gap in understanding related to how this shift has impacted Spanish-speaking treatment providers. Methods: Fifty non-U.S. Spanish-speaking therapists completed a survey related to their use of telecommunication modalities; client population characteristics; professional, ethical, and legal/regulatory issues; and telehealth training and practice. Participants completed the survey at one time point and retrospectively described their use of telehealth both pre-pandemic and during the pandemic. Results: Most of the 50 Spanish-speaking therapists surveyed reported using telepsychology 58% before COVID-19 versus 84% during the COVID-19 pandemic (χ2 = 5.76, p < 0.05). Compared with pre-pandemic, the number of hours therapists spent using telepsychology per week increased significantly for early adopter therapists (those who began using telehealth before the pandemic began) (Z = -3.18, p = 0.001) and also for late adopter therapists who only began using telehealth during the pandemic (Z = -3.74, p < 0.001). Many therapists reported equity issues. Most participants also reported ethical and regulatory concerns regarding security/confidentiality or Health Insurance Porability and Accountability Act. Conclusions: The rapid adoption of technology to deliver therapy during COVID-19 has spurred growing pains for Spanish-speaking therapists and their underserved clients, and more research is needed to better understand and improve the therapists' adoption of these technologies with diverse patient populations.

Understanding psychological treatment barriers, preferences and histories of individuals with clinically significant depressive symptoms in Australia: a preliminary study

ABSTRACT Objective: Depressive symptoms are common, yet many individuals in Australia do not seek treatment. The aim of this study was to explore 1) psychological treatment barriers, 2) psychological treatment delivery preferences, 3) predictors of psychological help-seeking intention, and 4) treatment histories of individuals with clinically significant depressive symptoms in Australia. Method: One hundred and eighty-two individuals (Mage = 36.77, SD = 11.94; range 18-73; 92.3% female) were included in the study. Data was collected online from a community sample of individuals with clinically significant depressive symptoms. Results: The most frequently endorsed barrier to seeking psychological treatment was cost (66.5%). Participants generally preferred standard face-to-face treatment (58.8%). Participant age, number of barriers, depression severity and self-stigma explained 32% of the variance in future psychological help-seeking intention. Sixty-one percent of participants indicated receiving cognitive-behaviour therapy in the past, but less than one in five received a likely best-practice treatment according to expert consensus guidelines. Conclusions: Many Australians require more cost-effective treatments, as well as treatments using remote delivery approaches. Funders may need to assess fidelity to evidence-based interventions. Key Points (1) Cost is a significant barrier to accessing treatment for individuals with depressive symptoms. (2) Patients with depressive symptoms prefer face-to-face treatment over other treatment approaches. (3)Less than one in five patients receives best-practice treatment for their depressive symptoms.

Utilizing passive sensing data to provide personalized psychological care in low-resource settings.

Background: With the growing ubiquity of smartphones and wearable devices, there is an increased potential of collecting passive sensing data in mobile health. Passive data such as physical activity, Global Positioning System (GPS), interpersonal proximity, and audio recordingscan provide valuable insight into the lives of individuals. In mental health, these insights can illuminate behavioral patterns, creating exciting opportunities for mental health service providers and their clients to support pattern recognition and problem identification outside of formal sessions. In the Sensing Technologies for Maternal Depression Treatment in Low Resource Settings (StandStrong) project, our aim was to build an mHealth application to facilitate the delivery of psychological treatments by lay counselors caring for adolescent mothers with depression in Nepal. Methods: This paper describes the development of the StandStrong platform comprising the StandStrong Counselor application, and a cloud-based processing system, which can incorporate any tool that generates passive sensing data. We developed the StandStrong Counselor application that visualized passively collected GPS, proximity, and activity data. In the app, GPS data displays as heat maps, proximity data as charts showing the mother and child together or apart, and mothers' activities as activity charts. Lay counselors can use the StandStrong application during counseling sessions to discuss mothers' behavioral patterns and clinical progress over the course of a five-week counseling intervention. Achievement Awards based on collected data can also be automatically generated and sent to mothers. Additionally, messages can be sent from counselors to mother's personal phones through the StandStrong platform. Discussion: The StandStrong platform has the potential to improve the quality and effectiveness of psychological services delivered by non-specialists in diverse global settings.

Utilizing passive sensing data to provide personalized psychological care in low-resource settings

Background: With the growing ubiquity of smartphones and wearable devices, there is an increased potential of collecting passive sensing data in mobile health. Passive data such as physical activity, Global Positioning System (GPS), interpersonal proximity, and audio recordings can provide valuable insight into the lives of individuals. In mental health, these insights can illuminate behavioral patterns, creating exciting opportunities for mental health service providers and their clients to support pattern recognition and problem identification outside of formal sessions. In the Sensing Technologies for Maternal Depression Treatment in Low Resource Settings (StandStrong) project, our aim was to build an mHealth application to facilitate the delivery of psychological treatments by lay counselors caring for adolescent mothers with depression in Nepal. Methods: This paper describes the development of the StandStrong platform comprising the StandStrong Counselor application, and a cloud-based processing system, which can incorporate any tool that generates passive sensing data. We developed the StandStrong Counselor application that visualized passively collected GPS, proximity, and activity data. In the app, GPS data displays as heat maps, proximity data as charts showing the mother and child together or apart, and mothers’ activities as activity charts. Lay counselors can use the StandStrong application during counseling sessions to discuss mothers’ behavioral patterns and clinical progress over the course of a five-week counseling intervention. Achievement Awards based on collected data can also be automatically generated and sent to mothers. Additionally, messages can be sent from counselors to mother’s personal phones through the StandStrong platform. Discussion: The StandStrong platform has the potential to improve the quality and effectiveness of psychological services delivered by non-specialists in diverse global settings.

Acceptability of psychologically-based pain management and online delivery for people living with HIV and chronic neuropathic pain: a qualitative study.

Chronic neuropathic pain is common in people living with HIV. Psychological treatments can improve quality of life for people with chronic pain in general, and online delivery can increase access to these treatments. However, the acceptability of psychological treatment and online delivery have not been investigated in-depth in people living with HIV and chronic neuropathic pain. Therefore, a qualitative study was undertaken to explore views about a psychological treatment for pain management in this population and to investigate the acceptability of online treatment delivery. Qualitative interviews were conducted and analysed using inductive thematic analysis, adopting a critical realist perspective. Twenty-six people living with HIV and chronic neuropathic pain completed semi-structured interviews. Their views about a psychological treatment for pain management and online delivery were explored in-depth. Three themes and 12 subthemes were identified. Theme one represents a desire for a broader approach to pain management, including not wanting to take more pills and having multidimensional goals that were not just focussed on pain relief. Theme two includes barriers to online psychologically-based pain management, including concerns about using the Internet and confidentiality. Theme three describes treatment facilitators, including accessibility, therapist support, social connection, and experiencing success. A psychological treatment for chronic neuropathic pain management appears acceptable for people living with HIV. Therapist-supported online delivery of cognitive-behavioural pain management may be acceptable for people living with HIV given appropriate development of the treatment to address identified barriers to engagement. These data can inform developments to enhance engagement in online psychologically-informed pain management in people living with HIV and more broadly in remote delivery of psychological treatments.

Treatment barriers, preferences and histories of individuals with symptoms of body dysmorphic disorder.

Individuals with mental health concerns face many barriers when accessing psychological treatment. Even when patients overcome these barriers, they often do not receive an evidence-based treatment. Although the current literature highlights these issues clearly across psychological disorders, the research is limited in relation to body dysmorphic disorder (BDD). The aim of this study was to examine psychological treatment barriers, treatment delivery preferences and treatment histories of individuals with symptoms of BDD. A total of 122 participants with clinically significant BDD symptoms (94% female; mean age = 34.19 years, SD = 10.86) completed the cross-sectional study. The most frequently reported barriers to accessing psychological treatment for individuals with BDD symptoms were the cost of treatment (41%) and the belief that the symptoms did not warrant treatment (36%). Although 69% of treatment-seeking participants reported previously receiving cognitive behavioural therapy (CBT) for BDD, only 13% of participants appeared to receive best-practice CBT. The preferred modality of future psychological treatment delivery was face-to-face treatment with a therapist once a week (63%), rather than accelerated or remote treatment approaches. The study suggests that there are significant barriers to accessing CBT for BDD. Reducing these barriers, as well as increasing consumer mental health literacy, is required to improve treatment access and treatment outcomes for individuals with BDD.

Utilizing passive sensing data to provide personalized psychological care in low-resource settings

Background: With the growing ubiquity of smartphones and wearable devices, there is an increased potential of collecting passive sensing data in mobile health. Passive data such as physical activity, Global Positioning System (GPS), interpersonal proximity, and audio recordings can provide valuable insight into the lives of individuals. In mental health, these insights can illuminate behavioral patterns, creating exciting opportunities for mental health service providers and their clients to support pattern recognition and problem identification outside of formal sessions. In the Sensing Technologies for Maternal Depression Treatment in Low Resource Settings (StandStrong) project, our aim was to build an mHealth application to facilitate the delivery of psychological treatments by lay counselors caring for adolescent mothers with depression in Nepal. Methods: This paper describes the development of the StandStrong platform comprising the StandStrong Counselor application, and a cloud-based processing system, which can incorporate any tool that generates passive sensing data. We developed the StandStrong Counselor application that visualized passively collected GPS, proximity, and activity data. In the app, GPS data displays as heat maps, proximity data as charts showing the mother and child together or apart, and mothers’ activities as activity charts. Lay counselors can use the StandStrong application during counseling sessions to discuss mothers’ behavioral patterns and clinical progress over the course of a five-week counseling intervention. Awards based on collected data also can be automatically generated and sent to mothers. Additionally, messages can be sent from counselors to mother’s personal phones through the StandStrong platform. Discussion: The StandStrong platform has the potential to improve the quality and effectiveness of psychological services delivered by non-specialists in diverse global settings.

Prevalence and predictors of psychopathology in the war-afflicted Syrian population.

Research on the psychological impact of war on affected populations is important for the planning and provision of interventions. However, most studies that address the effects of political violence have been restricted to Western countries, and even after six years of civil war in Syria, there has been no study addressing its psychological impact on the general population. The present study used an online survey to examine the level of psychological symptoms and correlates of distress in a sample of 387 subjects from different areas of Syria. We used t-tests to compare symptoms across zones with different levels of war activity, and multiple regression models to identify predictors of distress. Results indicate a high level of psychological distress indicative of psychopathology in all regions across the country. Rates were higher in areas with more intensive exposure ('hot' zones). Greater symptom severity was associated with living in a hot zone, female gender, older age, the number of potentially traumatic events, daily stressors, and (low) perceived feeling of safety; whereas social support, religiosity, and religious coping were associated with lower levels of symptoms. The elevated levels of mental health problems and direct relation between the level of exposure to violence and poorer mental health point to the need for mental health services. Reducing daily stressors and ensuring safety could contribute significantly to better mental health, although this does not replace the need for evidence-based psychotherapy. The planning and delivery of psychological interventions by NGOs should be informed by issues related to stigma, lack of understanding and acceptance of psychological care.

Developing an automated VR cognitive treatment for psychosis: gameChange VR therapy

The automated delivery of psychological treatment using virtual reality (VR) has the potential to revolutionise patient access to evidence-based care. VR creates immersive, interactive computer simulations, which elicit responses similar to the real world. VR simulations provide an ideal opportunity for the experimentation and experiential learning that are key to successful cognitive therapy. If automated, and using the latest consumer kit, VR treatment can substantially scale-up the delivery of psychological therapy. However, the successful application of automated VR to mental health difficulties requires precise treatment targets linked to the right psychological theory and techniques. This paper describes the process of development of an automated VR cognitive therapy targeting anxious avoidance of everyday social situations by patients with psychosis. In the gameChange project, a person-centered design process was used involving people with lived experience of psychosis, clinical psychologists, designers, and software developers. The six-session gameChange VR therapy consists of six everyday scenarios: a street, a bus, a café, a pub, a doctor's waiting room, and a shop. Each scenario has five levels of difficulty. Every level provides an opportunity to test out fearful cognitions while limiting the use of safety-seeking behaviours, allowing patients to build confidence in their ability to cope. Learning is facilitated by a virtual coach and therapeutic gaming elements are included. Data from user testing indicates that the gameChange VR therapy is easy to use and engaging. The clinical effectiveness of gameChange VR therapy is now being tested in a randomised controlled trial with several hundred patients with psychosis.

Can a motivational letter increase attendance to psychological treatment for gambling disorder?

High rates of treatment refusal and dropout have complicated the delivery of psychological treatment for gambling disorder, which continues accumulating evidence for efficacy. Incorporating motivational interviewing and addressing outcome expectations into psychological treatments has been shown to increase overall attendance. However, no studies have investigated whether motivational interviewing and outcome expectations can increase attendance at the initial and subsequent sessions of psychological treatment for gambling disorder. Participants were 69 prospective clients who contacted an outpatient training clinic requesting treatment services for gambling-related problems. They were randomly assigned to receive a mailed letter that incorporated principles of motivational interviewing and addressed outcome expectancies plus a telephone reminder call or to receive a telephone reminder call only. Clients who received the letter plus reminder call were more likely to attend the initial session than were clients who received the reminder call only. Clients receiving the letter were also more likely to reschedule their initial session and less likely to not show up than were clients receiving the reminder call only. There was no significant difference in attendance at subsequent sessions. These results suggest that mailing a similar letter to prospective clients of psychological treatment for gambling disorder is worthwhile, given the associated ease and low cost. Future investigations should further investigate the value of strengthening the motivation of prospective clients and clinics before initial treatment sessions, and they should investigate the distinction between clients who reschedule versus not show up. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Delivery of Psychological Interventions in the Gastroenterology Practice: Is It Time For New Paradigms to Define the Figure of the Psychogastroenterologist?

Delivery of Psychological Interventions in the Gastroenterology Practice: Is It Time For New Paradigms to Define the Figure of the Psychogastroenterologist?

Resolving the paradox of increased mental health expenditure and stable prevalence.

A doubling of Australian expenditure on mental health services over two decades, inflation-adjusted, has reduced prevalence of neither psychological distress nor mental disorders. Low rates of help-seeking, and inadequate and inequitable delivery of effective care may explain this partially, but not fully. Focusing on depressive disorders, drawing initially on ideas from the work of philosopher and socio-cultural critic Ivan Illich, we use evidence-based medicine statistics and simulation modelling approaches to develop testable hypotheses as to how iatrogenic influences on the course of depression may help explain this seeming paradox. Combined psychological treatment and antidepressant medication may be available, and beneficial, for depressed people in socioeconomically advantaged areas. But more Australians with depression live in disadvantaged areas where antidepressant medication provision without formal psychotherapy is more typical; there also are urban/non-urban disparities. Depressed people often engage in self-help strategies consistent with psychological treatments, probably often with some benefit to these people. We propose then, if people are encouraged to rely heavily on antidepressant medication only, and if they consequently reduce spontaneous self-help activity, that the benefits of the antidepressant medication may be more than offset by reductions in beneficial effects as a consequence of reduced self-help activity. While in advantaged areas, more comprehensive service delivery may result in observed prevalence lower than it would be without services, in less well-serviced areas, observed prevalence may be higher than it would otherwise be. Overall, then, we see no change. If the hypotheses receive support from the proposed research, then implications for service prioritisation and delivery could include a case for wider application of recovery-oriented practice. Critically, it would strengthen the case for action to correct inequities in the delivery of psychological treatments for depression in Australia so that combined psychological therapy and antidepressant medication, accessible and administered within an empowering framework, should be a nationally implemented standard.