Exploring the Potential for Use of Virtual Reality Technology in the Treatment of Severe Mental Illness Among Adults in Mid-Norway: Collaborative Research Between Clinicians and Researchers.

BACKGROUND: Virtual reality (VR) technology is not currently used in the treatment of severe mental health illness in Norway. OBJECTIVE: We aimed to explore the potential of VR as a treatment for severe mental health illness in Norway, through collaborative research between clinicians and researchers. METHODS: A collaborative research team was established, comprising researchers, the manager at a district psychiatric center, and the manager of the local municipal mental health service. An all-day workshop with eight clinicians-four from specialist mental health services and four from municipal mental health services-was conducted. The clinicians watched three different VR movies and after each one, they answered predefined questions designed to reflect their immediate thoughts about VR's potential use in clinical practice. At the end of the workshop, two focus group interviews, each with four clinicians from each service level, were conducted. RESULTS: VR technology in specialist services might be a new tool for the treatment of severe mental health illness. In municipal mental health services, VR might particularly be useful in systematic social training that would otherwise take a very long time to complete. CONCLUSIONS: We found substantial potential for the use of VR in the treatment of severe mental health illness in specialist and municipal mental health services. One of the uses of VR technology with the greatest potential was helping individuals who had isolated themselves and needed training in social skills and everyday activity to enable them to have more active social lives. VR could also be used to simulate severe mental illness to provide a better understanding of how the person with severe mental illness experiences their situation.

Does the working alliance mediate the effect of routine outcome monitoring (ROM) and alliance feedback on psychotherapy outcomes? A secondary analysis from a randomized clinical trial.

Little is known about the mechanisms through which routine outcome monitoring (ROM) influences psychotherapy outcomes. In this secondary analysis of data from a randomized clinical trial (Brattland et al., 2018), we investigated whether the working alliance mediated the effect of the Partners for Change Outcome Monitoring System (PCOMS), a ROM system that provides session-by-session feedback on clients' well-being and the alliance. Adult individuals (N = 170) referred for hospital-based outpatient mental health treatment were randomized to individual psychotherapy either with the PCOMS ROM system, or without (treatment as usual [TAU]). Treatment was provided by the same therapists (N = 20) in both conditions. A multilevel mediation model was developed to test if there was a significant indirect effect of ROM on client impairment at posttreatment through the alliance at 2 months' treatment controlled for first-session alliance. Alliance ratings increased more from session 1 to 2 months' treatment in the ROM than TAU condition, and alliance increase was associated with less posttreatment impairment. A significant indirect effect of ROM on treatment outcomes through alliance increase (p = .043) explained an estimated 23.0% of the effect of ROM on outcomes. The results were consistent with a theory of the alliance as one mechanism through which ROM works. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

The effects of routine outcome monitoring (ROM) on therapy outcomes in the course of an implementation process: A randomized clinical trial.

This study investigated the effects of the Partners for Change Outcome Management System (PCOMS) in adult outpatient treatment at a hospital-based mental health clinic. It also investigated whether the effects differed with the timing of the treatment within a 4-year implementation period, with clients' initial distress levels, and between therapists. Adult clients (N = 170) were randomized to treatment as usual (TAU) or routine outcome monitoring (ROM). Twenty therapists provided therapy in both conditions. Therapy outcome was measured by the Behavior and Symptoms Identification Scale (BASIS-32). Data were analyzed in a series of multilevel models (MLMs). Clients in the ROM condition were 2.5 times more likely to demonstrate improvement than those in the TAU condition. Controlling for therapist variability, the overall effect size (ES) in favor of ROM was small (d = 0.26, p = .037). The superiority for ROM over TAU increased significantly over the duration of the study. ROM effects were not moderated by clients' initial distress levels. Differences between therapists accounted for 9%-10% of the variability in outcomes, and there were no significant differences in ROM effects between therapists. ROM was associated with better treatment outcomes independent of clients' initial distress levels. Clients treated later in the study benefitted more from ROM than those treated earlier. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Learning from clients: A qualitative investigation of psychotherapists' reactions to negative verbal feedback.

OBJECTIVE: To explore how therapists experience, react to, and learn from negative feedback from their clients. METHOD: Eighteen experienced therapists' written descriptions of episodes where they had received negative verbal feedback from clients were analyzed according to the Consensual Qualitative Research methodology. RESULTS: Receiving feedback was experienced as challenging, but educational. Learning was manifested in different ways: (a) Immediately Applied Learning-therapists improved the following therapy process by changing their behavior with the client, (b) Retrospectively Applied Learning-therapists made changes in their way of working with subsequent clients, and (c) Non-Applied Learning-new ideas generated by the experience had not been translated into behavior. We compared cases describing these manifestations of learning and found differences in the nature of the feedback and how therapists understood, reacted, and responded to it. CONCLUSIONS: The therapists benefitted from obtaining and being open to specific feedback from their clients, regulating their own emotional reactions, accommodating dissatisfied clients, and considering how they themselves contributed to negative therapy processes.

[Applied suicide intervention skills training workshop]. / Kurset Førstehjelp ved selvmordsfare.

This article discusses the benefits and limitations of applied suicide intervention skills training (ASIST), a two-day intensive, interactive and practice-dominated workshop designed to help caregivers recognise and estimate risk and learn how to intervene in case of immediate risk of suicide. It could appropriately be compared to training in cardiopulmonary resuscitation. The workshop sensitises participants to attitudes and presents a model for suicide intervention; it is flexible and employs learning aids and audiovisual material in order to encourage a high level of involvement. A growing body of evidence from assessments suggests that the workshop enhances caregivers' sense of readiness for suicide intervention and their actual level of skills for that role. ASIST is a standardized learning experience that uses an effective implementation strategy through which local professionals are trained as instructors. It was developed by LivingWorks Education in Canada in the 1980s. In Norway, Vivat, a training programme originating in the National Suicide Prevention Plan, is in charge of implementation of the workshop and training of instructors.

[Applied suicide intervention--an evaluation]. / Førstehjelp ved selvmordsfare--en evaluering.

BACKGROUND: The department of psychiatry of the University Hospital of North Norway in Tromsø sought to improve suicide prevention skills among medical students through a workshop on applied suicide intervention skills training (ASIST). MATERIAL AND METHODS: Over the course of the academic year 1998/99, 76 medical students attended workshops. Results were assessed through focus group interviews. RESULTS: By the end of the workshop, students reported more professional confidence and better skills in suicide intervention. They found it very useful to get this opportunity to role-play situations and receive feedback on their own behaviour. Working with suicidal patients is a great and challenging responsibility and students were well aware of the importance of paying attention to the boundaries between one's professional and one's private life. They reported that they saw the benefits of working with caregivers from other professions. CONCLUSION: The workshop appears to enhance suicide intervention skills and will continue to be a part of the clerkship in psychiatry at the University of Tromsø.