How the COVID-19 pandemic reshaped telepsychology: Insights from an Italian survey.

The coronavirus disease 2019 (COVID-19) pandemic rapidly boosted the introduction of certain changes in mental healthcare services, consequently driving up the adoption of remote care delivery options. We conducted an online Italian survey to evaluate telepsychology use, attitudes, acceptance, and training needs, as well as to understand patient-professional interactions in video-consultations, aiming to inform future mental healthcare practices and policies. The current study's survey responses were collected using an anonymous, self-reported questionnaire on the 'REDCap' platform from 25 October 2022 to 26 July 2023. In total, 128 mental health professionals and 113 patients completed the survey. In our sample, 69 % of patients and 79.7 % of mental health professionals reported having used telepsychology during COVID-19 pandemic; in particular, 84.6 % of patients and 95.1 % of professionals selected video-consultation modality. Data showed that participants expressed high satisfaction with this communication tool. The increase in satisfaction was directly proportional to increase in the quality of interactions and in relation to the quality of the experiences. The critical factors influencing the video-consultation experience include communication style, information completeness, patient-centredness, and the comfort underscoring the central role of the professional-patient relationship, which, substantially, remains a key element in the psychological treatment process. These findings reinforce the need for continued refinement and expansion of telepsychology services, thus highlighting the potential for integrating innovative technologies into mental health practise.

Telepsychology revolution in the mental health care delivery: a global overview of emerging clinical and legal issues.

Since the outbreak of the COVID-19 pandemic, remote healthcare delivery by technological devices has become a growing practice. It represented an unprecedented change in personal and professional activities, allowing health specialists to continue working online by assisting their patients from home. Psychological practice greatly benefited from this innovation, guaranteeing diagnostic and therapeutic effectiveness through cyber counseling. However, in many countries there have been no enactments of specific laws nor adaptations of the professional deontological code aimed at regulating this new psychological practice dimension, generally defined as telepsychology. This article aims to briefly review the scientific literature on this tool's effectiveness and especially analyze the legal and operational framework in which telepsychology has been to date practiced in Italy and other national realities, thus providing a global overview that may be useful to understand how to improve this valuable but still immature practice. Key points: The coronavirus pandemic exposed to short- and long-term increase in psychological and psychiatric imbalances.Cyber counseling has been proven to be effective to treat a wide range of psychological disorders.Many of the current national and international legislations concerning the telepsychology practice are still immature. Ad hoc legal frameworks are required for each national context to guarantee a safe and effective cyber counseling delivery.

Innovative technology and mental health care. Survey on the usage of WhatsApp among Argentinian psychiatrists and psychologists / Nuevas tecnologías y atención en Salud Mental. Encuesta a psiquiatras y psicólogos de Argentina sobre el uso del WhatsApp.

OBJECTIVE: Communication between patients and mental health professionals by means of messaging platforms in the interval between synchronous encounters became a kind of asynchronous teleconsultation (AT) whose usefulness and effect on providers' workload have not been explored. Method: Mental health providers working in Argentina were invited to answer a survey exploring the intensity and usefulness of AT, and the resulting overload. RESULTS: A total of 527 responses from professionals working throughout the country were received. As much as 69% of respondents exchanged messages with a mean of 1-10 patients/day and 31% with more than 10 patients/day; 75% answered messages over mobile phones on weekends. While 68% rated these interactions as positive for clinical follow-up, 47% considered them as a source of work overload. CONCLUSIONS: The generalized adoption of AT may require additional self-regulation by clinicians and regular monitoring of overload levels (particularly, among psychiatrists) to make their daily clinical practice efficient and sustainable.

OBJETIVOS: La comunicación entre pacientes y profesionales de la salud mental mediante plataformas de mensa- jería en el intervalo entre encuentros presenciales o virtuales se convirtió en una modalidad de teleconsulta asincrónica (TA) cuya utilidad y efecto en la carga de trabajo de los profesionales de salud mental no se han explorado. Método: Profesionales del campo de la salud mental que trabajan en Argentina fueron invitados a responder a una encuesta que exploraba la intensidad y utilidad de la TA, y la sobrecarga resultante. RESULTADOS: Se recibieron un total de 527 respuestas de profesionales que trabajan en todo el país. El 69 % de los encuestados mensajes con un promedio de 1-10 pacientes/día y el 31 % con más de 10 pacientes/día; el 75 % respondió mensajes por teléfono móvil los fines de semana. Mientras que el 68 % calificó estas interacciones como positivas para  el seguimiento clínico, el 47 % las consideró una fuente de sobrecarga laboral. CONCLUSIONES: La adopción generalizada de la TA puede requerir una autorregulación adicional por parte de los profesionales y un seguimiento regular de los niveles de sobrecarga (especialmente, entre los psiquiatras) para que su práctica clínica diaria sea eficiente y sostenible.

Education and training of telemental health providers: a systematic review.

Objective: To conduct a systematic literature review of education and training (E&T) programs for telemental health (TMH) providers in the past 10 years to qualitatively clarify field offerings and methodologies, as well as identify areas for future growth. Methods: We searched five major electronic databases: PubMed, PsycINFO, Scopus, CINAHL, and Web of Science for original publications on TMH E&T from January 2013 to May 2023. We extracted information from each publication and summarized key features of training programs including setting, target group, study aims, training modality, methods of assessing quality, and outcomes. Results: A total of 20 articles were selected for the final review. Articles meeting inclusionary criteria were predominantly comprised of case studies and commentaries, focused on a TMH service/practice for a specific region/population, and were performed after 2020. All of the selected studies demonstrated a significant increase in the measured knowledge, skills, and abilities of the participants after TMH training. Nevertheless, there remains a lack of standardization of training methodologies, limited sample sizes and demographics, variability in study methodologies, and inconsistency of competency targets across studies. Conclusion: This systematic review highlighted the diversity of methods for TMH E&T. Future research on this topic could include more varied and larger-scale studies to further validate and extend current findings, as well as explore potential long-term effects of TMH training programs on both provider attitudes and patient outcomes.

Provision of Telepsychological Care Via Email during COVID-19 Confinement: An Exploratory Study.

Within teletherapy, email interventions have been studied scarcely. For this reason, this exploratory study aims to characterize the assistance provided by email in a university telepsychology service and to compare the data with the assistance provided by telephone in the same service and period. For this purpose, the records of 81 users assisted via email during the COVID-19 pandemic lockdown in Spain were analyzed. The data were compared with those of the 338 users assisted by telephone in the same period. Despite its many limitations, results indicate high satisfaction with the email modality. Users express that they prefer a preference for using email when they do not feel safe in other ways. We found a lot of variation between the number of emails exchanged and the days that each case was active. Additionally, differences were found with telephone users in aspects such as age (email users being younger) and in a depression screening (email users scoring more positively). This study concludes on the high potential of this channel for the application of certain techniques (e.g., psychoeducation) or for people with certain characteristics.

Transdiagnostic Unified Protocol for Women with Breast Cancer: A Preliminary Study

This article aimed to explore the feasibility and clinical utility of the online Unified Protocol to improve emotional regulation with women diagnosed with breast cancer. Method. Research with a quantitative, exploratory, descriptive, and interactive approach, with a quasi-experimental design, pre-posttest for paired samples. Nine women with an average age of 53 years (SD= 9.5; range from 41 to 71) participated in a psychological intervention of 12 weekly 90-minute sessions. A statistically significant change (p < 0.05) between pre and post-test measurements in Anxiety (t= 2.777; p=.024), Quality of life (Z= -2.670; p=.008), Optimism (t= -2.785; p= .024) and Positive Affect (t= -3.834; p=.005) were found. The size of the effect was moderate in Optimism and big in Anxiety, Quality of life and Positive Affect. High levels of treatment satisfaction were found. The intervention was useful to improve the emotional regulation of women with a medical condition in a pandemic context. (AU)

Psychologists' experiences with telepsychology during the COVID-19 pandemic in South Africa.

Background: During the COVID-19 pandemic, South African psychologists started to use telepsychology to continue providing services. However, diverse factors may influence psychologists' decisions regarding the use of telepsychology. Aim: To investigate South African psychologists' experiences with using telepsychology during the COVID-19 pandemic. Setting: Health Professions Council of South Africa (HPCSA)-registered psychologists practising in South Africa. Methods: A quantitative, cross-sectional study was conducted. Psychologists were invited to complete an online survey on the REDCap platform. Convenience sampling was used for respondent selection (n = 179). The study explored demographic variables, telepsychology use, changes in psychotherapy format, guidelines, ethical considerations, training, socio-economic factors, and individual patient and psychotherapist factors. Descriptive statistics, including categorical variables (frequencies and percentages) and numerical variables (medians and percentiles) were utilised for the data analysis. A bivariate analysis with backward selection was subsequently used, and significant variables were integrated into the logistic regression model. Results: Most respondents (84.8%) used telepsychology, with 72.8% considering it a positive experience. Private psychologists used electronic means for delivering services significantly more than public sector psychologists. The public sector psychologists had more challenges relating to changes in the therapeutic format, additional training requirements and technology access. Conclusion: During the COVID-19 pandemic, psychologists turned to telepsychology as a valuable tool for providing services while navigating the unique challenges it presented. Contribution: This study provides insights into the utility of telepsychology in the South African context during COVID-19. It underscores the experiences, importance of guidelines, and needs regarding training and technology access among psychologists.

Evaluation of telehealth administration of MMPI symptom validity scales.

INTRODUCTION: Telehealth assessment (TA) is a quickly emerging practice, offered with increasing frequency across many different clinical contexts. TA is also well-received by most patients, and there are numerous guidelines and training opportunities which can support effective telehealth practice. Although there are extensive recommended practices, these guidelines have rarely been evaluated empirically, particularly on personality measures. While existing research is limited, it does generally support the idea that TA and in-person assessment (IA) produce fairly equitable test scores. The MMPI-3, a recently released and highly popular personality and psychopathology measure has been the subject of several of those experimental or student (non-client) based studies; however, no study to date has evaluated these trends within a clinical sample. This study empirically tests for differences in TA and IA test scores on the MMPI-3 validity scores when following recommended administration procedures. METHOD: Data were from a retrospective chart review. Veterans (n = 550) who underwent psychological assessment in a Veterans Affairs Medical Center ADHD evaluation clinic were contrasted between in person and telehealth assessment modalities on the MMPI-2-RF and MMPI-3. Groups were compared using t tests, chi square, and base rates. RESULTS: Results suggest that there were minimal differences in elevation rates or mean scores across modality, supporting the use of TA. CONCLUSIONS: This study's findings support the use of the MMPI via TA with ADHD evaluations, Veterans, and in neuro/psychological evaluation settings more generally. Observed elevation rates and mean scores of this study were notably different from those seen in other VA service clinics sampled nationally, which is an area of future investigation.

Teletherapy Used to Breakdown Access Barriers.

The studies presented in this literature review reveal the numerous ways that teletherapy can be used to treat patients with mental health issues. The literature includes six research articles from published scientific journals that span from 2005 to 2020. The three types of telehealth therapy reviewed include mobile telehealth, telephone, and video technology. The six research articles focus on the ways that telehealth can reach communities of lower socioeconomic status (SES) and those suffering from access barriers. The benefits of teletherapy include cost savings, time efficiency, easier access, and a reduction in recidivism. Challenges include access barriers, financial difficulties, anxiety, and fear of stigmatization. Limitations of the studies presented include a lack of accessibility to internet and technology, privacy issues, and insurance coverage. Overall, results show that teletherapy provides an affordable, accessible alternative to traditional in-person mental health therapy, especially in reaching lower SES groups, Veterans, and patients with access restrictions.

Patient Perspectives on Telehealth for HIV and Mental Health Care at a Pediatric and Adolescent HIV Clinic in Washington, DC.

Despite the scale-up of telehealth for children and youth living with HIV during the COVID-19 pandemic, their experience and interest in continued telehealth use in the future is unknown. We conducted a quality improvement project to identify areas for improvement of telehealth delivery to children and youth living with HIV and evaluate youth's experiences when using telehealth for mental health services. Children and youth living with HIV (up to 24 years) seen at a specialty HIV program during 2020-2021 were surveyed regarding technology access, telehealth knowledge, barriers to telehealth use and interest in future telehealth use for HIV care. Youth (12-<24 years) who used telehealth for mental health services were surveyed regarding their experiences. Data were analyzed using descriptive statistics. Of the 170 patients in care, we surveyed 103 children and youth living with HIV (median age 17.6 years, 88.3% Black, 52.4% female, 77.7% perinatally infected), of whom 69.9% had prior telehealth use for their clinical visit. Most patients had access to a device with internet (99%) and were interested in future telehealth use for HIV care (87.4%). Reasons for not wanting to use telehealth included privacy concerns, distrust, discomfort with telehealth, preferring in-person visits, technology access issues and needing translation services. Most youth (81%) surveyed regarding telehealth for mental health services were satisfied and very likely to recommend it to others. Despite some reported barriers to telehealth, there is a high desirability for continued telehealth use among children and youth receiving HIV care.

"I miss not being able to offer my couples a box of tissues ": Couples' and therapists' perspectives on the therapeutic alliance with the transition to online couple therapy.

The purpose of this study is to advance theory concerning the experiences of couples and therapists involved in online couple therapy and the meanings they assign to them, with a particular focus on the therapeutic alliance. Using constructivist grounded theory methodology, in-depth semi-structured online interviews were conducted with 36 individuals, including 18 couples who had participated in online couple therapy via videoconference. Additionally, 15 couple and family therapists were interviewed in four online focus groups. Our analysis indicates three dimensions that impact the formation of the therapeutic alliance in online couple therapy: (1) emotional closeness, as a conduit for establishing physical or emotional space; (2) limited care, due to the therapist's difficulty providing comfort and security; and (3) body language, as reflected in the lack of physical presence and the close inspection of the face, at two opposite ends of a continuum. We discuss our findings through the lens of the closeness-distance dynamic, which posits that therapists' ability to regulate themselves depends on their clients' emotional needs. We conclude with implications for clinical practice.

A review of the reliability of remote neuropsychological assessment.

The provision of clinical neuropsychological services has predominately been undertaken by way of standardized administration in a face-to-face setting. Interpretation of psychometric findings in this context is dependent on the use of normative comparison. When the standardization in which such psychometric measures are employed deviates from how they were employed in the context of the development of its associated norms, one is left to question the reliability and hence, validity of any such findings and in turn, diagnostic decision making. In light of the current COVID-19 pandemic and resultant social distancing direction, face-to-face neuropsychological assessment has been challenging to undertake. As such, remote (i.e., virtual) neuropsychological assessment has become an obvious solution. Here, and before the results from remote neuropsychological assessment can be said to stand on firm scientific grounds, it is paramount to ensure that results garnered remotely are reliable and valid. To this end, we undertook a review of the literature and present an overview of the landscape. To date, the literature shows evidence for the reliability of remote administration and the clinical implications are paramount. When and where needed, neuropsychologists, psychometric technicians and examinees may no longer need to be in the same physical space to undergo an assessment. These findings are most relevant given the physical distancing practices because of COVID-19. And whilst remote assessment should never supplant face-to-face neuropsychological assessments, it does serve as a valid alternative when necessary.

Telemedicine in inflammatory bowel diseases: A new brick in the medicine of the future?

Inflammatory bowel disease (IBD) is a chronic digestive disease that requires continuous monitoring by healthcare professionals to determine the appropriate therapy and monitor short-term and long-term complications. The progressive development of information technology has enabled healthcare personnel to deliver care services to patients remotely. Therefore, various applications of telemedicine in IBD management have evolved, including telemonitoring, teleconsulting, teleducation, telenursing, telenutrition, and telepathology. While evidence has been provided for some telemedicine applications, targeted studies are still required. This review summarises the major studies that have evaluated telemedicine and its application in the management of IBD.

Online versus in-person delivery of cognitive behaviour therapy for obsessive compulsive disorder: An examination of effectiveness.

Cognitive behavioural therapy (CBT) including exposure and response prevention is the first-line psychological treatment for obsessive compulsive disorder (OCD). Given changes in the clinical landscape, there are increasing efforts to evaluate its effectiveness in online contexts. Mirroring the traditional in-person delivery, few studies have assessed the role of therapist-guided, manual-based CBT for OCD delivered in real-time via videoconferencing methods. The present study sought to fill this gap by comparing in-person and online delivery of group-based CBT for the treatment of OCD. A convenience sample of participants with moderate to severe OCD (n = 144) were recruited from a naturalistic database from two large OCD specialty assessment and treatment centres. Patients received group-based CBT that was provided in-person (pre-COVID-19 pandemic; March 2018 to March 2020) or online via videoconferencing (during the COVID-19 pandemic; March 2020 to April 2021). In both delivery methods, treatment consisted of 2-h weekly sessions led by trained clinicians. Analyses revealed that, regardless of treatment modality, both in-person and online groups demonstrated significant, reliable, and statistically equivalent improvements in OCD symptoms post-treatment. Videoconferenced, clinician-led CBT may be a promising alternative to in-person delivery for those with moderate to severe OCD symptoms.

Study protocol: A multimethod psychophysiological randomized controlled trial of a couple therapy for post-traumatic stress disorder.

Posttraumatic stress disorder (PTSD) sequelae often have ripple effects on victims' families and spouses. Yet there has been a lag in the development and study of couple therapy for PTSD. To fill this gap, we present here a protocol for a study examining the efficacy of Cognitive Behavioral Conjoint Therapy (CBCT), a 15- session couple therapy protocol meant to alleviate PTSD and improve relationship satisfaction, in the Israeli context. The study will be a randomized controlled trial examining outcomes and processes of change via self-report questionnaires, qualitative interviews, and physiological measures (e.g., both partners' heart rate variability and electrodermal activity). We will employ a modified remote treatment protocol via video conferencing. The study will examine whether there is a reduction in couples' levels of symptomatic, emotional, and behavioral difficulties following CBCT and whether relationship satisfaction and couples' physiological synchrony increases. The study will also examine physiological and psychological change mechanisms in CBCT. Sixty Israeli couples (n = 120) will be randomly assigned to either a CBCT group or a wait-list control group. Outcomes will be assessed at four timepoints: before treatment, during treatment, post-treatment, and four months after treatment. The proposed study has the potential to shed light on the unique psychological and physiological mechanisms underlying CBCT and will be the first RCT study to employ this unique methodology in CBCT research, particularly in a video conferencing setting. This study may increase our ability to offer effective, cost-efficient, and attainable treatments for patients with PTSD and their spouses.

Telepsychology: Clinical Utility of the Transdiagnostic Unified Protocol with University Students

This study examined the content validity and consumer satisfaction of a newly developed forensic interviewing protocol and accompanying barriers screen. Results suggest content experts rated the protocol as acceptable and that subjects rated the protocol slightly more favorably than the Forensic Experiential Trauma Interview. Further, although only a minority of subjects did not like the alternative hypotheses component, this component did not significantly decrease subjects’ favorable attitudes towards the protocol, suggesting that incorporating this element may not be as controversial as previously assumed. Last, providing resources to the victim via the barriers screen was rated favorably by participants, suggesting that this might be a useful tool to improve victim’s sense of support, overall satisfaction and possible willingness to pursue prosecution post-assault (AU)

Stepping up to COVID-19: A Clinical Trial of a Telepsychology Positive Parenting Program Targeting Behavior Problems in Children With Neurological Risk.

OBJECTIVE: To evaluate the feasibility, acceptability, and preliminary efficacy of a stepped-care parenting program implemented during COVID-19 among families of behaviorally at-risk children with neurological or neurodevelopmental disorders aged 3-9 years. METHODS: Stepped-care I-InTERACT-North increased psychological support across 3 steps, matched to family needs: (1) guided self-help (podcast), (2) brief support, and (3) longer-term parent support. The intervention was provided by clinicians at The Hospital for Sick Children. Recruitment occurred via hospital and research cohort referral. A single-arm trial using a pragmatic prospective pre-post mixed-method design was utilized to assess accrual, engagement, acceptability, and preliminary efficacy. RESULTS: Over 15 months, 68 families enrolled (83% consent rate) and 56 families completed stepped-care (Step 1 = 56; Step 2 = 39; Step 3 = 28), with high adherence across Steps (100%, 98%, and 93%, respectively). Parents reported high acceptability, reflected in themes surrounding accessibility, comprehension, effectiveness, and targeted care. Positive parenting skill increases were documented, and robust improvement in child behavior problems was apparent upon Step 3 completion (p =.001, d = .390). Stepped-care was as effective as traditional delivery, while improving consent and completion rates within a pandemic context. CONCLUSIONS: This stepped-care telepsychology parenting program provides a compelling intervention model to address significant gaps in accessible mental health intervention while simultaneously balancing the need for efficient service. Findings inform program scalability beyond COVID-19 and emphasize the value of stepped-care intervention in delivering and monitoring mental health treatment.

Attitudes of Mental Health Professionals towards Telepsychology during the Pandemic: A Pilot Study.

OBJECTIVE: This pilot study investigated mental health professionals' attitudes towards remote psychological consultations and internet-based interventions. METHODS: An online survey in Italian and English was administered to a sample of 191 psychologists and psychotherapists to collect detailed information about their professional experience providing online psychological interventions a year and a half after the beginning of the SARS-CoV-2 pandemic. RESULTS: The results did not reveal a statistically significant association between the participants' theoretical approaches and the number of patients treated via the online modality. Overall, most of the participants found advantages to the online setting but also noted critical issues regarding privacy and the ease of integrating new technology into their clinical practice. CONCLUSIONS: According to the participants, despite the challenges that must be addressed, telehealth is a viable psychological therapeutic option that is destined to grow in importance in the near future.

A Primer for Understanding and Utilizing Telesupervision with Healthcare Trainees.

Clinical supervision remains a core component of healthcare education. While traditionally conducted face-to-face, the use of telesupervision, or supervision from a distance via technology, has exhibited rapid expansion across healthcare specialties. Although the literature has showcased preliminary empirical support for various methods of implementing telesupervision, limited consolidated works detail the real-world utility and considerations for healthcare supervisors. To address this gap, the current brief discussion aims to provide a primer for the use of telesupervision through a detailing of considerations relevant to telesupervisor practices, including methods of providing telesupervision, the known benefits associated with telesupervision, differences and challenges of telesupervision as compared to face-to-face methods, qualities of effective telesupervisors, and training considerations to foster the effective qualities.