Practitioners' perspectives on preparing for and delivering remote psychological support in Nepal, Perú and the United States during COVID-19.

INTRODUCTION: The COVID-19 pandemic has propelled a global paradigm shift in how psychological support is delivered. Remote delivery, through phone and video calls, is now commonplace around the world. However, most adoption of remote delivery methods is occurring without any formal training to ensure safe and effective care. OBJECTIVE: The purpose of this applied qualitative study was to determine practitioners' experiences of rapidly adapting to deliver psychological support remotely during COVID-19. DESIGN: We used a pragmatic paradigm and applied approach to gain perspectives related to the feasibility and perceived usefulness of synchronous remote psychological support, including views on how practitioners can be prepared. METHODS: Key informant interviews were conducted remotely with 27 specialist and non-specialist practitioners in Nepal, Perú and the USA. Interviewees were identified through purposeful sampling. Data were analysed using framework analysis. RESULTS: Respondents revealed three key themes: (i) Remote delivery of psychological support raises unique safety concerns and interference with care, (ii) Remote delivery enhances skills and expands opportunities for delivery of psychological support to new populations, and (iii) New training approaches are needed to prepare specialist and non-specialist practitioners to deliver psychological support remotely. CONCLUSIONS: Remote psychological support is feasible and useful for practitioners, including non-specialists, in diverse global settings. Simulated remote role plays may be a scalable method for ensuring competency in safe and effective remotely-delivered care.

Identifying Core Competencies for Remote Delivery of Psychological Interventions: A Rapid Review.

OBJECTIVE: The COVID-19 pandemic led to a rapid shift toward remote delivery of psychological interventions and transition to voice-only and video communication platforms. However, agreement is lacking on key competencies that are aligned with equitable approaches for standardized training and supervision of remote psychological intervention delivery. A rapid review was conducted to identify and describe competencies that could inform best practices of remote services delivery during and after the COVID-19 pandemic. METHODS: Scopus, MEDLINE, and PsycINFO were searched for literature published in English (2015-2021) on competencies for synchronous, remote psychological interventions that can be measured through observation. RESULTS: Of 135 articles identified, 12 met inclusion criteria. Studies targeted populations in high-income countries (11 in the United States and Canada, one in Saudi Arabia) and focused on specialist practitioners, professionals, or trainees in professional or prelicensure programs working with adult populations. Ten skill categories were identified: emergency and safety protocols for remote services, facilitating communication over remote platforms, remote consent procedures, technological literacy, practitioner-client identification for remote services, confidentiality during remote services, communication skills during remote services, engagement and interpersonal skills for remote services, establishing professional boundaries during remote services, and encouraging continuity of care during remote services. CONCLUSIONS: These 10 skills domains can offer a foundation for refinement of discrete, individual-level competencies that can be aligned with global initiatives promoting use of observational competency assessment during training and supervision programs for psychological interventions. More research is needed on identification of and agreement on remote competencies and on their evaluation.

Maternal Perceptions of Infant Behavior as a Potential Indicator of Parents or Infants in Need of Additional Support and Intervention.

The goal of the present study is to examine the relationship between early infant behaviors, which can be easily reported by parents, with parent-infant bonding and maternal mental health. It has long been established that child characteristics and behaviors have a significant impact on parent well-being and how parents respond to their infants. Examining parent perceptions of challenging infant behaviors may help health professionals identify high risk infants in need of intervention and mothers in need of additional support. Mothers of 73 infants between the ages of 3.5 weeks and 6 months filled out questionnaires. Infant stomach issues were positively correlated with bonding issues, maternal anxiety and maternal depression. Infant crying issues were also positively correlated with bonding issues, maternal anxiety and maternal depression. Potential clinical and research applications of the instrument include early identification of caregivers in need of support and screening for further clinical assessment and care.

Autobiographical Memory and Future Thinking Specificity and Content in Chronic Pain.

Chronic pain is associated with high levels of mental health issues and alterations in cognitive processing. Cognitive-behavioral models illustrate the role of memory alterations (e.g., autobiographical memory and future thinking) in the development and maintenance of chronic pain as well as in mental health disorders which frequently co-occur with chronic pain (e.g., anxiety and mood disorders). This study aims to expand our understanding of specific cognitive mechanisms underlying chronic pain which may in turn shed light on cognitive processes underlying pain-related psychological distress. Individuals (N = 84) who reported a history of chronic pain and individuals who reported no history of chronic pain (N = 102) were recruited from MTurk to complete an online survey including standardized measures of anxiety and depression and two sentence completion tasks that assessed autobiographical memory and future thinking specificity and content. Chi square analyses revealed that participants who endorsed experiencing chronic pain were significantly more likely to recall at least one painful and negative event and to imagine at least one anticipated painful event in their future. Two ANCOVAs were performed to examine the degree to which chronic pain endorsement influenced specificity in memory and future imagining. Individuals with a history of chronic pain and higher levels of depression symptom severity generated autobiographical memories with significantly less specificity; whereas, individuals with a history of chronic pain also generated future autobiographical events with significantly less specificity. In addition, individuals with a history of chronic pain were more likely to generate episodes related to pain when asked to recall the past or imagine the future. Further research is needed to improve our understanding of the etiology of autobiographical memory and future thinking specificity and content in the pathogenesis of mental health conditions in the context of chronic pain.

Hurts so good: Pain as an emotion regulation strategy.

In the field of emotion regulation studies, cognitive reappraisal has been established as the preferred strategy for coping with painful negative feelings. For some, however, asking them to think more about an already distressing situation can be quite literally "like pulling teeth." Indeed, many people voluntarily cause themselves physical pain during upsetting situations (e.g., getting a deep tissue massage after a stressful week or hitting a punching bag when angry); however, there is currently little empirical evidence of the relative effectiveness of such behaviors. The present study tested two primary hypotheses: (a) some people will choose to inflict pain to regulate negative emotional states; and (b) pain provides effective short-term relief from negative emotion. The findings from these two studies demonstrate that, given the opportunity, participants will choose to use physical pain in addition to other strategies, like reappraisal or distraction, to cope with various sources of negative emotion. We further show that physical sensation in general, and pain in particular, are equally effective in coping with negative emotion. These results suggest a reconsideration of the dominance of cognitively based emotion regulation. We discuss the implication that benign physical pain may be a broadly effective and underrecognized coping strategy. (PsycInfo Database Record (c) 2020 APA, all rights reserved).