Organizational and Policy Barriers to the Use of Digital Mental Health by Mental Health Professionals.

Background: Digital mental health (DMH) provides effective methods of overcoming issues of time constraints, accessibility, and availability of mental health care. They can provide a valuable means to deliver mental health care in the present pandemic. However, adoption of these methods has been slow. Mental health professional (MHP) concerns at the organizational and policy level that influence this slow adoption need to be examined. Materials and Methods: A narrative review was conducted to identify the barriers. Searches using the databases Scopus, Embase, and PubMed were conducted to identify research focused on barriers reported by MHPs to use DMH. Results: The search resulted in 356 unique citations, and 21 papers met the inclusion and exclusion criteria. Forward and backward sampling resulted in identifying an additional 19 relevant papers. Discussion: Unmet needs for information, training, and infrastructure, challenges to the workflow and excessive workloads, and ambiguous policies serve as barriers to DMH use. This article recommends strategies for researchers, organizations, DMH designers, and governmental institutions to ensure efficient utilization of DMH. Conclusions: Concerted efforts at individual, organizational, and governmental levels are essential to ensure efficient utilization of DMH.

Development of a measure of stigma towards occupational stress for mental health professionals.

PURPOSE: Stigma is a common barrier to mental health professionals (MHPs) seeking help for occupational stress and burnout, although there is a lack of psychometrically sound tools to measure this construct. The current study aimed to develop and validate a scale (the Mental Health Professional Stigma Scale; MHPSS) for this purpose. METHODS: The MHPSS and related measures were completed by 221 Australian MHPs via online survey, with a subsample completing the MHPSS again 2 weeks after initial completion. RESULTS: Exploratory factor analysis revealed a four-factor solution, comprising of 13 items and accounting for 50.16% of variance. Factors were Perceived Other Stigma, Perceived Structural Stigma, Personal Stigma, and Self stigma. The internal consistency, test-retest reliability, and validity of the scale were supported. CONCLUSIONS: The MHPSS has utility to capture stigmatising attitudes and beliefs related to occupational stress and burnout among MHPs. It may be used to assist in the development and evaluation of initiatives to reduce stigma and increase help-seeking among MHPs.

Investigative interviewing of youth with ADHD - recommendations for detective training.

Attention deficit hyperactivity disorder (ADHD) in youth can lead to a trajectory of early and repeated contact with the criminal justice system (CJS), where such youth face significant challenges due to the nature of their diagnosis and the lack of specialized detective training in this area. This article reviews Australian detectives' perceptions regarding contact with ADHD-affected youth, ongoing contact of such youth with the CJS, and the impact of ADHD on interviewing time efficiency and quality of information gathered. It explores detectives' perceived impact of ADHD on components of the Cognitive Interview (CI). It overviews detectives' perceptions regarding their own skill/ability, training availability and future training preferences regarding the interviewing of ADHD-affected youth. The authors highlight best practice in specialized detective training, as well as in working with ADHD-affected youth. Recommendations are made regarding the design features of a potential specialized training programme for detectives interviewing ADHD-affected youth.

Going global: do consumer preferences, attitudes, and barriers to using e-mental health services differ across countries?

BACKGROUND: e-Mental health services have the capacity to overcome barriers to care and reduce the unmet need for psychological services, particularly in developing countries. However, it is unknown how acceptable e-mental health interventions may be to these populations. AIMS: The purpose of the current study was to examine consumer attitudes and perceived barriers to e-mental health usage across four countries: Australia, Iran, the Philippines and South Africa. METHODS: An online survey was completed by 524 adults living in these countries, assessing previous contact with e-mental health services, willingness to use e-mental health services, and perceived barriers and needs for accessing e-mental health services. RESULTS: Although previous contact with e-mental health services was low, the majority of respondents in each sample reported a willingness to try e-mental health services if offered. Barriers toward e-mental health usage were higher among the developing countries than Australia. The most commonly endorsed barriers concerned needing information and assurances regarding the programmes. CONCLUSIONS: Across countries, participants indicated a willingness to use e-mental health programmes if offered. With appropriate research and careful implementation, e-mental health has the potential to be a valuable part of mental healthcare in developing countries.

Police perceptions of the impact that ADHD has on conducting cognitive interviews with youth.

Attention deficit hyperactivity disorder (ADHD) in youth witnesses, victims and suspects can significantly impact the investigative interviewing process. In this study, 102 Child Protection Investigation Unit (CPIU) detectives were asked to read four vignettes of adolescents being interviewed by police, two as witnesses and two as suspects, in which one witness and one suspect display ADHD-type behaviour. The detectives rated the degree to which the behaviour in each vignette would impact the interviewer's ability to use the 10 key components of the cognitive interview (CI). They perceived ADHD-type interviewee behaviour as significantly hampering the use of all 10 CI components. There is also a significant difference between the detectives' rated severity of each CI component; they rated Encourage Concentration, Mentally Recreate and Change Order as exerting the strongest impact on the interview process. Implications for police perceptions of training options, needs and preferences regarding interviewing youth with ADHD are discussed.

Internet-Based Delivery of Cognitive Behaviour Therapy Compared to Monitoring, Feedback and Support for Problem Gambling: A Randomised Controlled Trial.

The aim of this study was to investigate the efficacy of an Internet-based cognitive behavioural therapy program (I-CBT) for the treatment of problem gambling, when compared to a waitlist control and an active comparison condition consisting of monitoring, feedback, and support (I-MFS). Participants (N = 174) were randomly allocated to the three conditions. Variables of interest were gambling outcome and related mental health measures. Participants in the active conditions (I-CBT and I-MFS) completed six online modules. Both I-CBT and I-MFS conditions resulted in significant treatment gains on gambling severity. However, I-CBT was also associated with reductions in a range of other gambling-related and mental health outcomes. Compared with I-MFS, I-CBT produced greater effects across seven outcomes measures, relating to gambling urges, cognitions, stress, and life satisfaction. I-CBT participants also rated the program as significantly more satisfactory. Treatment gains observed for both active conditions were found to be stable through to 12 month follow up. The results indicate that the benefits of I-CBT were more than simply the non-specific effects of engaging in online treatment or receiving motivation, feedback, and support. Online treatments for gambling may be a valuable tool in increasing help-seeking and treatment engagement in this population, and be integrated as part of stepped care approaches to treatment.

Assessing treatment barriers in eating disorders: A systematic review.

This systematic review evaluated methods used to assess treatment barriers among individuals with eating disorders or disordered eating. A total of 11 studies were identified and evaluated according to attributes considered important in the accurate assessment of treatment barriers. The majority of studies used qualitative methods, with five studies utilizing either a checklist or scale-based instrument. Adequate psychometric investigation was lacking. This review highlights the paucity of research examining barriers to accessing and/or receiving treatment in disordered eating populations. There is a need for development of psychometrically sound instruments that assess the range and relative interference of specific barriers experienced in this population.

Using SMS reminders in psychology clinics: a cautionary tale.

BACKGROUND: As healthcare services become progressively more stretched, there is increasing discussion of ways in which technological adjuncts may be used to deliver more cost-efficient services. Before widespread implementation, however, the use of these adjuncts requires proper scrutiny of their effects on psychological practice. AIMS: This research examined the effectiveness of SMS reminders on client appointment attendance and dropout in a psychological treatment setting. It was predicted that the reminders would result in increased initial appointment attendance, increased total appointment attendance, and decreased client dropout. METHOD: A randomized controlled trial investigated the impact of SMS appointment reminders (two levels: present or absent) on client attendance (three levels: attended, rescheduled, or did not attend) and dropout (two levels: completed treatment or terminate early). Participants (N = 140) at an outpatient psychology clinic were randomly allocated to either receive an SMS appointment reminder one day before their scheduled appointment, or to receive no reminder. RESULTS: No significant differences were found between the SMS and no SMS conditions in relation to appointment attendance. There were more client dropouts in the SMS compared to the no SMS condition. CONCLUSIONS: The SMS appointment reminders were not effective at increasing appointment attendance. The current research suggests that there is more to client non-attendance in psychological settings than the simple forgetting of appointments. Technological adjuncts may be useful in increasing the cost-efficiency of current services; however, this research highlights the importance of understanding the effects of technology before widespread implementation.

Breathe Easier Online: evaluation of a randomized controlled pilot trial of an Internet-based intervention to improve well-being in children and adolescents with a chronic respiratory condition.

BACKGROUND: Chronic respiratory illnesses are the most common group of childhood chronic health conditions and are overrepresented in socially isolated groups. OBJECTIVE: To conduct a randomized controlled pilot trial to evaluate the efficacy of Breathe Easier Online (BEO), an Internet-based problem-solving program with minimal facilitator involvement to improve psychosocial well-being in children and adolescents with a chronic respiratory condition. METHODS: We randomly assigned 42 socially isolated children and adolescents (18 males), aged between 10 and 17 years to either a BEO (final n = 19) or a wait-list control (final n = 20) condition. In total, 3 participants (2 from BEO and 1 from control) did not complete the intervention. Psychosocial well-being was operationalized through self-reported scores on depression symptoms and social problem solving. Secondary outcome measures included self-reported attitudes toward their illness and spirometry results. Paper-and-pencil questionnaires were completed at the hospital when participants attended a briefing session at baseline (time 1) and in their homes after the intervention for the BEO group or a matched 9-week time period for the wait-list group (time 2). RESULTS: The two groups were comparable at baseline across all demographic measures (all F < 1). For the primary outcome measures, there were no significant group differences on depression (P = .17) or social problem solving (P = .61). However, following the online intervention, those in the BEO group reported significantly lower depression (P = .04), less impulsive/careless problem solving (P = .01), and an improvement in positive attitude toward their illness (P = .04) compared with baseline. The wait-list group did not show these differences. Children in the BEO group and their parents rated the online modules very favorably. CONCLUSIONS: Although there were no significant group differences on primary outcome measures, our pilot data provide tentative support for the feasibility (acceptability and user satisfaction) and initial efficacy of an Internet-based intervention for improving well-being in children and adolescents with a chronic respiratory condition. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry number: ACTRN12610000214033; http://www.anzctr.org.au/trial_view.aspx?ID=308074 (Archived by WebCite at http://www.webcitation.org/63BL55mXH).

A Decade in Review: A Systematic Review of Virtual Reality Interventions for Emotional Disorders.

Research is increasingly demonstrating the therapeutic benefits of virtual reality interventions for various mental health conditions, though these rarely translate from research to application in clinical settings. This systematic review aims to examine the efficacy of current virtual reality interventions for emotional disorders, with a focus on clinical and technological features that influence translation of treatments from research to clinical practice. A comprehensive systematic literature search was conducted following PRISMA guidelines, for studies including the application of a virtual reality intervention to a clinical population of adults with an emotional disorder. Thirty-seven eligible studies were identified, appraised, and assessed for bias. Treatment effects were typically large across studies, with virtual reality being considered an efficacious treatment modality for various anxiety disorders and post-traumatic stress disorder. Virtual reality interventions were typically used for delivering exposure in cognitive behavioural therapy approaches. Considerable variability was seen in cost, technological specifications, degree of therapist involvement, delivery format, dosage, duration, and frequency of treatment. Suboptimal methodological rigour was identified in some studies. Remote use of virtual reality was rare, despite increasing options for in home use. Virtual reality interventions have the potential to overcome barriers to care and better meet the needs of consumers. Future research should examine the efficacy of virtual reality for treatment of depressive disorders and obsesive compulsive disorder. Improved methodological reporting and development of transdiagnostic and remotely delivered virtual reality interventions, will likely increase the translation of this treatment modality.

Cada vez más la investigación demuestra las ventajas terapéuticas de las intervenciones mediante realidad virtual en distintos estados de salud mental, aunque esta investigación raramente se traslada a la aplicación en el contexto clínico. Esta revisión sistemática pretende analizar la eficacia de las intervenciones actuales de realidad virtual en trastornos emocionales, centrándose en las características clínicas y tecnológicas que afectan a la transferencia de los tratamientos desde la investigación hasta la práctica clínica. Se llevó a cabo una amplia búsqueda bibliográfica sistemática de acuerdo con las directrices PRISMA para estudios que abarcan la aplicación de la intervención mediante realidad virtual a población clínica adulta con trastornos emocionales. Se consideraron elegibles 37 estudios, que fueron valorados y revisados para descartar sesgos. Los efectos de los tratamientos eran normalmente grandes, siendo considerada la realidad virtual como una modalidad de tratamiento eficaz para diversos trastornos de ansiedad y el de estrés postraumático. Las intervenciones de realidad virtual normalmente se han utilizado para la exposición en los enfoques de terapia cognitivo-conductual. Se observó una considerable variabilidad en coste, especificaciones tecnológicas, grado de implicación del terapeuta, formato de presentación, dosificación, duración y frecuencia del tratamiento. En algunos estudios se observó que el rigor metodológico estaba por debajo de los niveles óptimos. La utilización remota de realidad virtual no era frecuente a pesar de las posibilidades que ofrece para usarse en casa. Las intervenciones de realidad virtual tienen el potencial de superar barreras en los cuidados y cubrir mejor las necesidades de los consumidores. La investigación futura debería analizar la eficacia de la realidad virtual para tratar los trastornos depresivos y el desorden obsesivo compulsivo. Mejorar los informes metodológicos y el desarrollo de las intervenciones mediante realidad virtual transdiagnósticas y practicadas a distancia podría facilitar la transferencia de esta modalidad de tratamiento.

Dropout from Internet-based treatment for psychological disorders.

PURPOSE: The purpose of this review was to present an in-depth analysis of literature identifying the extent of dropout from Internet-based treatment programmes for psychological disorders, and literature exploring the variables associated with dropout from such programmes. METHODS: A comprehensive literature search was conducted on PSYCHINFO and PUBMED with the keywords: dropouts, drop out, dropout, dropping out, attrition, premature termination, termination, non-compliance, treatment, intervention, and program, each in combination with the key words Internet and web. A total of 19 studies published between 1990 and April 2009 and focusing on dropout from Internet-based treatment programmes involving minimal therapist contact were identified and included in the review. RESULTS: Dropout ranged from 2 to 83% and a weighted average of 31% of the participants dropped out of treatment. A range of variables have been examined for their association with dropout from Internet-based treatment programmes for psychological disorders. Despite the numerous variables explored, evidence on any specific variables that may make an individual more likely to drop out of Internet-based treatment is currently limited. CONCLUSIONS: This review highlights the need for more rigorous and theoretically guided research exploring the variables associated with dropping out of Internet-based treatment for psychological disorders.

Effectiveness of group and individual formats of a combined motivational interviewing and cognitive behavioral treatment program for problem gambling: a randomized controlled trial.

BACKGROUND: The study aimed to assess the effectiveness of group and individual formats of a combined motivational interviewing and cognitive behavioral treatment (CBT) program for problem gamblers (PGs) using a randomized controlled design. METHOD: One hundred and two PGs were randomly assigned to individual or group CBT conditions. Twenty-eight of these participants were randomly allocated to a 6-week waitlist control condition prior to receiving the designated treatment. RESULTS: At post-treatment, there were significant improvements in all dependent variables (frequency and amount gambled, gambling urges, gambling cognitions, negative psychological states, and life satisfaction) for both the treatment conditions but not for the waitlist condition. Individuals that completed the individual (compared to group) treatment condition generally had higher effect sizes for gambling correlates. Therapeutic gains for gambling correlates were generally maintained at 6-month follow-up. CONCLUSIONS: A combined motivational interviewing and CBT program applied in group or individual format can improve PG behaviors, as well as gambling correlates.

Development of the eTAP-T: A measure of mental health professionals' attitudes and process towards e-interventions.

BACKGROUND: The development of technological applications within psychotherapy has opened up new opportunities for mental health professionals (MHPs) to address client need. Despite the clinical efficacy and utility of evidence-based electronic interventions, MHPs' engagement with these interventions remains poorly understood. OBJECTIVE: The aim of the current study was to develop and conduct a preliminary psychometric investigation of the measurement properties of the electronic-therapy attitudes and process questionnaire - therapist version (eTAP-T). Based upon the theory of planned behaviour (TPB), the eTAP-T measures factors related to MHPs' engagement with e-interventions for clients' mental health concerns. METHODS: Participants were 222 practicing MHPs who reported being in direct contact with clients. Participants completed the eTAP-T and related measures with a subsample of 40 participants completing a two-week follow up questionnaire. RESULTS: Exploratory factor analysis with item reduction resulted in a 12-item eTAP-T, with four factors accounting for 82% of variance. The four factors (subjective norms, perceived behavioural control, attitudes and intentions) were consistent with the four TPB domains. The eTAP-T demonstrated satisfactory validity and reliability as per the consensus-based standards for the selection of health measurement instruments. CONCLUSIONS: The development and preliminary psychometric investigation supported the validity and reliability of the eTAP-T. Further research is required for confirmatory analyses. The eTAP-T may be useful in identifying the training needs of MHPs and evaluating training programs. Specific areas for intervention, such as attitudes or perceived credibility may be identified and targetted, with the measure then also used to evaluate change across these domains. It is anticipated that the eTAP-T may useful tool in improving uptake of digital interventions by MHPs.

Development of the eTAP: A brief measure of attitudes and process in e-interventions for mental health.

BACKGROUND: Considerable evidence supports the efficacy of e-interventions for mental health treatment and support. However, client engagement and adherence to these interventions are less than optimal and remain poorly understood. OBJECTIVE: The aim of the current study was to develop and investigate the psychometric properties of the e-Therapy Attitudes and Process questionnaire (eTAP). Based on the Theory of Planned Behaviour (TPB), the eTAP was designed to measure factors related to client engagement in e-interventions for mental health. METHODS: Participants were 220 adults who reported current use of an e-intervention for mental health support. Participants completed the eTAP and related measures, with a subsample of 49 participants completing a one-week follow up assessment. RESULTS: A 16-item version of the eTAP produced a clear four-factor structure, explaining 70.25% of variance. The factors were consistent with the TPB, namely, Intention, Subjective Norm, Attitudes, and Perceived Behavioural Control. Internal consistency of the total and subscales was high, and adequate to good one-week test retest reliability was found. Convergent and divergent validity of the total and subscales was supported, as was the predictive validity. Specifically, eTAP Intentions correctly predicted engagement in e-interventions with 84% accuracy and non-engagement with 74% accuracy. CONCLUSIONS: The eTAP was developed as a measure of factors related to engagement and adherence with e-interventions for mental health. Psychometric investigation supported the validity and reliability of the eTAP. The eTAP may be a valuable tool to understand, predict, and guide interventions to increase engagement and adherence to e-interventions for mental health.

Measuring self-efficacy in gambling: the Gambling Refusal Self-Efficacy Questionnaire.

This paper reports on the development and psychometric properties of a Gambling Refusal Self-Efficacy Questionnaire (GRSEQ). Two hundred and ninety-seven gamblers from both normal and clinical populations completed an initial set of 31-items of which 26 were selected for inclusion in the final version of the GRSEQ. A series of factor analyses showed four clear factors accounting for 84% of the variance. These factors can be summarised as situations and thoughts associated with gambling, the influence of drugs on gambling, positive emotions associated with gambling and negative emotions associated with gambling. The GRSEQ total score and factors scores showed high internal consistency (Cronbach's alpha ranging from 0.92 to 0.98). Participants experiencing problems with gambling scored significantly lower on the GRSEQ, and discriminant analyses showed that the scale is able to correctly classify the non-problem (i.e., community and student samples) and problem gamblers (i.e., clinical sample). Furthermore, the GRSEQ showed significant negative relationships with other gambling-related variables (gambling urge and gambling-related cognitions) and negative mood states (depression, anxiety and stress) and was shown to be sensitive to change in treatment of pathological gambling. The results suggest that the GRSEQ is a useful measure of gambling refusal self-efficacy that is suitable for assessment of gamblers from both normal and clinical populations.

What do help-seeking measures assess? Building a conceptualization framework for help-seeking intentions through a systematic review of measure content.

Mental health services are underutilised by people who could benefit from treatment. Research into help-seeking intentions (HSI) is required to support interventions to increase service use. Existing HSI measures are not psychometrically robust and problems with content validity undermine research in this field. Our purpose was to create a clear conceptualization of HSI and systematically review the content of existing measures. Previous researchers had defined help-seeking and intentions separately, so the first step was to create a more comprehensive definition. Seven theoretical perspectives identified in the HSI literature were mapped onto the new definition and aggregated to form a conceptual framework that reflects expert opinion. This framework guided an analysis of item relevance and a comparison of completeness across measures. Most individual items (99.1%) were relevant, lending credibility to the proposed framework. However, no measure provided a complete assessment of the HSI construct. This study used a novel methodology to develop a definition and conceptual framework, both of which reflect sound theoretical perspectives and represent the consensus-view of experts. The current results will guide the development of stronger measures with improved construct validity and will support interventions aimed at improving help-seeking.

Can the Perceived Barriers to Psychological Treatment Scale be used to investigate treatment barriers among females with disordered and non-disordered eating behaviours?

There is a lack of psychometrically sound instruments to assess treatment barriers among individuals with disordered eating behaviours. This study examined the factor structure and psychometric properties of the Perceived Barriers to Psychological Treatment scale (PBPT; Mohr et al., 2010) among a sample of individuals with disordered eating behaviours. Participants were 708 females aged 14 years and older who completed an online survey. The sample was randomly divided in two for the conduct of exploratory (EFA) and confirmatory (CFA) factor analyses. EFA suggested a seven-factor structure retaining 24 of the original 27 items (variance explained = 60%, α = 0.91). Factors were stigma, participation restrictions, negative evaluation of treatment, lack of motivation, emotional concerns, access restrictions, and time constraints. To assess clinical sensitivity, we conducted a secondary EFA utilising only clinical cases from this sample, which supported the solution but suggested retaining 25 of the original 27 items (variance explained = 58%, α = 0.89). The 25-item, seven-factor solution was further supported by CFA with an independent sample. Construct validity was also supported. The study suggests that the instrument will provide clinicians and researchers with a valid and reliable method of assessing treatment barriers in disordered eating samples.

Psychological treatment dropout among pathological gamblers.

Premature dropout from treatments for pathological gambling is potentially of significant importance, if it occurs before substantial progress has been made in addressing the problem. A systematic review of current research on dropout from psychological treatments for pathological gambling identified 12 studies from five countries. Dropout ranged from 14% to 50%, with a median of dropout 26%. Overall, 31% of the participants dropped out of treatment. Few studies distinguish between dropouts at different stages of participation. The evidence on specific variables that predict dropout is limited or inconsistent, and is characterised by a lack of a coherent, gambling-specific model and by methodological problems. Two studies that attempted to apply motivational and compliance-enhancing techniques were found. Both showed promising effects on reduction of dropout and improvement of short-term impact of treatment, but inconsistent results on longer-term outcomes were obtained. The review highlighted a need for more rigorous investigation of the extent of dropout and of variables associated with dropout from pathological gambling treatment programs. Further research on interventions to enhance retention and reduce dropout from psychological treatment is also required.

The Therapy Attitudes and Process Questionnaire: A Brief Measure of Factors Related to Psychotherapy Appointment Attendance.

BACKGROUND: Patient non-attendance and dropout remains problematic in mental health settings. The theory of planned behavior (TPB) has proven useful in understanding such challenges in a variety of healthcare settings, but the absence of an adequate measure in mental health has hampered research in this area. OBJECTIVE: The aim of the current study was to develop and conduct an initial psychometric investigation of a brief measure, the Therapy Attitudes and Process Questionnaire (TAP), utilizing the TPB to understand factors associated with attendance in mental health settings. METHODS: We used a quantitative survey-based design and administered the TAP to 178 adult participants who were engaged in individual or group psychotherapy. A subsample also provided data to assess validity and reliability. RESULTS: A four-factor solution was revealed through exploratory factor analysis and accounted for approximately 75 % of the variance in scores. Factors corresponded to those predicted by the TPB. Analyses supported the reliability, validity, and internal consistency of the measure. CONCLUSIONS: Results suggest that the TAP may be a useful tool for examining patients' attitudes and beliefs about attending psychotherapy appointments. The TAP can be used to better understand patients' intentions, attitudes, perceptions of behavioral control, and subjective norms relating to psychotherapy attendance. This understanding may facilitate improved outcomes for patients and clinicians.

Self-injury in young people and the help-negation effect.

This study examined the relationship between self-injurious behavior and intentions to seek help from professionals, family and friends, technology based support and from no-one. Participants were 679 young people aged 14-25 years drawn from a larger internet survey (N =1463) on the basis of their reported self-injury. A help-negation effect was found only in relation to intentions to seek help from family and friends. That is, a higher extent or severity of self-injury was independently associated with lower intentions to seek help from family and friends. This effect remained after controlling for psychological distress and suicidal ideation. Establishing avenues for early intervention and providing access to a range of potential avenues for help-seeking may assist young people to seek support in relation to self-injury.