The Complexities Of E-Therapy

E-Therapy Complexities

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E-Therapy Complexities

E-therapy is the use of internet services to deliver mental health counseling. It has an advantage because a client can access the counseling service from a far distance through a website. This type of counseling uses variety of network mediums such as apps, video chatting, text and audio messaging. It is useful in a way that it supplements in-office therapy. Most of the people who cannot make time to get the service from the office gets an option that enables them to consult a counselor.

Several studies have explored the role of technology-enabled therapies in the prevention of psychiatric illness. One RCT (Randomized Controlled Trials) tested the efficacy of unassisted E-Therapy in preventing depression in 163 university students who were randomly assigned to either five weeks of unassisted E-Therapy or a waitlist control. Subjects who received unassisted E-Therapy had significantly less depressive symptoms and improved literacy about depression at study end. The dropout rate, however, was significantly higher within the unassisted E-Therapy group compared to the control group (46.9 vs. 28.0%) (Lintvedt, Griffiths ,& Sørensen K, 2013).

Multiple studies provide evidence in support of VRET (Virtual Reality Exposure Therapy) in the treatment of social anxiety disorder and public speaking anxiety. In a study of 41 subjects with social anxiety disorder, subjects participated in four sessions of cognitive restructuring, followed by four virtual sessions that targeted particular feared social settings (e.g., conference room, classroom, and large auditorium). The study provided evidence that environments that better mimicked the feared scenario outperformed those that did not (Price, Mehta,& Tone, 2011). A similar outcome was observed in a controlled trial that compared VRET to conventional CBT in the treatment of public speaking anxiety in a total of eight subjects. Participants were asked to deliver a speech before a real-life audience of five to nine individuals before and after completing four VRET sessions. All participants reported subjective improvement in public speaking anxiety immediately following, and several months after, the intervention (Anderson, Zimand,& Hodges, 2007).

Text messaging, or short message service (SMS), has been used as an m-Therapy intervention that allows for the immediate delivery of interventional messages and reminders of health goals, appointments and therapy homework (Klasnja,& Pratt, 2012). Preliminary studies have investigated it in the treatment of conditions such as major depression and psychotic disorders.

A study in 54 subjects with major depression and comorbid alcohol use disorder randomly assigned participants to either receiving twice-daily supportive text messages (N=26), or to a waitlist group where participants received “thank you” text messages once every 14 days (N=28). Subjects were followed for up to three months. Results, as assessed by the Beck Depression Inventory, showed a statistically significant difference in favor of text messaging when compared to the waitlist control (Agyapong, Ahern,& McLoughlin, 2012).

Voice phone calls are an older form of m-Therapy and have been used in the treatment of various psychiatric conditions, including anxiety disorders and depression. An RCT assessed phone-based psychotherapy in the reduction of suicidal ideation and self-harm by randomly assigning 68 subjects to either brief phone treatment alongside traditional face-to-face psychotherapy (N=34) or only face-to-face psychotherapy (N=34). Voice calls focused on mood assessment, provision of reassurance, problem-solving, and medication training. Assessment at six and 12 months following therapy initiation revealed that subject also receiving phone psychotherapy had significantly less suicidal ideation and other depressive symptoms (Marasinghe, Edirippulige ,& Kavanagh, 2012).

It has been estimated that up to 50% of all health care services will be conducted electronically by 2020 (Weinstein, Lopez,& Joseph, 2014). Telemental health has been an integral part of the telemedicine movement and, given the “hands off” nature of many mental health services and the reduced need for treatment tools such as physical exams, lab tests and radio imaging, it may be poised to grow even faster than other medical fields.

So far, however, the rise of telemental health has generally outpaced scientific research, which limits the ability to make strong recommendations, especially when the substitution of online platforms for conventional care is being considered. Randomized clinical trials of adequate size and representation are clearly needed in order to establish the efficacy, safety and treatment adherence of available interventions, as well as to test some woefully understudied ones, such as Internet-enabled psychopharmacological care.

Reference

Agyapong, V. I., Ahern S., McLoughlin, D. M., et al. (2012) Supportive text messaging for depression and comorbid alcohol use disorder: single-blind randomized trial. J Affect Disorder; 141:168–76.

Anderson, P. L., Zimand, E., Hodges, L. F., et al. (2007). Cognitive behavioral therapy for public-speaking anxiety using virtual reality for exposure. Depress Anxiety; 22:156–8.

Klasnja, P., Pratt, W. (2012). Healthcare in the pocket: mapping the space of mobile-phone health interventions. J Biomed Inform; 45:184–98.

Lintvedt, K., Griffiths, M., Sorensen, K, et al. (2013). Evaluating the effectiveness and efficacy of unguided internet-based self-help intervention for the prevention of depression: a randomized controlled trial. Clin Psychol Psychother.

Marasinghe, R. B., Edirippulige, S., Kavanagh, D, et al. (2012). Original article of mobile phone-based psychotherapy in Q Effect suicide prevention: a randomized controlled trial in Sri Lanka. J Telemed Telecare; 18:151–5.

Price, M., Mehta, N., Tone, E. B, et al. (2011). Does engagement with exposure yield better outcomes? Components of presence as a predictor of treatment response for virtual reality exposure therapy for social phobia. J Anxiety Disord; 25:763–70.

Weinstein, R. S., Lopez, A. M., Joseph, B. A, et al. (2014). Telemedicine, telehealth, and mobile health applications that work: opportunities and barriers. Am J Med; 127:183–7.

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