SELF-HELP MANUAL-BASED COMPUTERISED OR COMPUTER-ASSISTED lecture notes (only slides, no audio).pptx

SELF-HELP MANUAL-BASED COMPUTERISED OR COMPUTER-ASSISTED lecture notes

1. , The Usefulness of Self-Help / Manual-Based & Computer-assisted Interventions Dr Maria Livanou

2. Self-help: Term does not describe a therapy, but a way of delivery W hether its manual-based, computerised or computer-assisted it is not a therapy approach per se but a mode of delivery Its content could be based on different approaches (e.g., cognitive behavioural, person-centred, etc.)

3. Main idea: Therapy is delivered by the person who needs it. Any interventions to be used, are delivered by the person without any (or with minimal) input by a practitioner or mental health professional.

4. Why include self-help under Brief Interventions (BIs)? Even though they refer to the way of delivering psychological help or support they often involve BIs (e.g., computer-assisted mindfulness , or manualised cognitive restructuring , or manualised or computerised exposure) their effectiveness needs to be considered separately even if they do involve interventions that are known to be effective (mindfulness, or cognitive restructuring or exposure), you need to consider whether there is any evidence for the efficacy of their computerised or manual-based versions their cost-effectiveness needs to be tested

5. Aims of this week’s learning Why use self-help / manual-based / computerised / computer-assisted interventions? Aims ? Contexts? Advantages and disadvantages ? Effectiveness ?

6. Context

7. Why would we need to consider self-help or manual-based or computerised therapy? Most of the people with mental health difficulties do not seek treatment ( Regier et al, 1993; Heffren and Hausdorf , 2016; Warner et al, 2012) e.g. anxiety and major depressive disorders are very prevalent (Kessler et al, 2005; Goldberg et al, 2009) but less than half the people with these problems see a physician and only about a quarter of them receive appropriate treatment (Andrews et al, 2004)

8. Basic Assumption: Psychological interventions can be Operationalised (…but can they?) Some interventions could be formulated as a standardised set of procedures that can be applied to people with similar difficulties (e.g., cognitive restructuring for people with mood difficulties, or exposure for people with phobias) But, idiographic therapies do not lend themselves to manualisation or standardised application across different people

9. Self-help: CBT evidence spreading over 40 years showing clients can apply BT and CBT by themselves, sometimes with only minimal support from therapist (see Cuijpers et al, 2010)

10. Self-Help / Manual-based Therapy What is self-help about? Any benefits in it? Any potential problems?

11. "life is difficult" and personal growth is a "complex, arduous and lifelong task." (Scott Peck)

12. What are they about? Overcoming depression, fears and anxiety, drinking problems, managing stress, recovering from trauma and PTSD, helping parents help their children who have difficulties with obsessive thoughts and compulsive behaviours, coping with negative thoughts, overcoming grief, being more assertive, etc.

13. Guided self-help versus other self-help interventions It involves some input from a professional therapist or coach, who offers the person facilitative support in the application of the manualised intervention.

14. Guided self-help vs self-help vs face-2-face Guided or not, self-help differs from face-2-face treatment in the amount of therapist time: Interaction is minimal usually by phone or email or via skype (or zoom, etc.) or may take place face-to-face but reduced in time

15. Cuijpers et al (2010) The effectiveness of Guided Self-Help Meta-analysis including 21 studies; 14 aimed at adults 6 depression, 7 panic, 3 social phobia, 2 specific phobias, 3 phobias in general Results : No differences between face-2-face treatment and guided self-help They checked comparisons at post-treatment and follow-up No significant differences in drop-out rates either

16. Criticism about Self-help Books? Many propose the obvious (recommendations can be mainly common sense or common knowledge). They propose models that oversimplify reality. When recommendations are based on the author’s assumptions (i.e. it worked for me, therefore it will work for you) it could overlook the fact that the author is often very different from the people reading the book . Absence of assessment / formulation

17. It’s not the medium that counts; it’s the intervention proposed through the medium The recommendations made in the self-help books have to be based on evidence. So, a self-help on a treatment that has been tested and found effective is likely to be helpful, whereas advice that has not been tested may ‘sound good’ but may actually be ineffective (or even harmful?) )

18. It’s not the medium that counts; it’s the intervention proposed through the medium E.g., results from a Canadian study (Wood,  Perunovic , and Lee 2009) suggested that people with low self-esteem felt worse after repeating positive statements about themselves. repeating mantras e.g. “I am a loveable person” words or sounds or phrases repeated to help concentration in meditation )

19. Conclusions about Self-help manuals Can be as useful as therapist-delivered therapy but only for some mental health problems i f they include evidence-based suggestions / recommendations

20. Computer-Assisted Therapy a “small revolution” in the delivery of mental health care (Carroll & Rounsaville , 2010) more than 100 different computer-assisted programmes (Marks et al, 2007)

21. Justification Most of the people with mental health difficulties do not seek treatment ( Regier et al, 1993; Heffren and Hausdorf, 2016; Warner et al, 2012) but a large number of people in the western world have access to PC (for example, 70% of the people in the US, according to Carroll and Rounsaville , 2010) People with mental health difficulties often prefer not to reveal their symptoms or seek treatment (Dain, 1994) PC-assisted therapy: relative anonymity, convenience for those whose problems prevent them from leaving the house (e.g., people with agoraphobia or mobility problems).

22. Repeat: computer-assisted therapy refers to The mode of delivering an existing treatment. It is not an intervention by itself. Today there is a wide range of computer-assisted therapies for various psychiatric disorders variability also in how these approaches are delivered, their effectiveness and how they compare (in terms of effectiveness) to other evidence-based treatments

23. Some are conceived as ‘online bibliotherapy’ Providing information about psychiatric disorders, treatment, resources for extra help ( eg , http://www.quitnet.com)

24. Others offer evidence-based therapy E.g. CBT with extensive use of multimedia features (e.g. videotaped examples) to demonstrate skills with interactive exercises that allow users to assess their learning and practice new strategies

25. HOW CAN THEY BE USED An adjunct to standard treatment for example, the programme CBT4CBT is used to improve outcomes for standard CBT of addiction (Carroll et al, 2008) For aftercare or continuing care to ensure that there is no relapse, once active treatment is over Early intervention (for milder problems) or prevention for non-clinical or hard-to-reach populations ( Postel et al, 2005)

26. Strengths Improves access to treatment Reduces therapist time / cost of treatment Enhances engagement with treatment process Encourages independence (via self-help) Can be useful in psychoeducation Promotes monitoring / offers feedback Can help with skills-rehearsal Assesses treatment outcome (by collecting and analysing data and displaying results graphically)

27. Ethical issues (e.g., Sampson & Pyle, 1983) Confidentiality Determination of appropriateness of the specific form of therapy Adequate introduction to the PC software to reduce anxiety about using the system Follow-up consultation with a clinician if needed Up-to-date and accurate information Well-functioning hardware and software Supervision of the treatment process by a clinician

28. UK: The first recommendation of CCBT by a government regulatory body anywhere The NICE’s reappraisal (National Institute for Health and Clinical Excellence, 2006) recommends for the NHS two Computerised CBT systems:  Beating the Blues for mild and moderate depression, and FearFighter  for phobia, panic and anxiety. In addition, NICE recognised the `absolute clinical efficacy of  OCFighter ' ( BTSteps )  for obsessive–compulsive For a review see Marks et al, 2007

29. Fear-Fighter for phobia, panic, anxiety 12 week internet-based programme based on exposure Targets anxiety / avoidance e.g. fear of traveling by bus, train, car, fear of animals or insects and avoidance of places where one worries they may have a panic an hour a week for ‘session’ and additional ‘homework’ between each session During the course of the 12 weeks, clients receive a few brief telephone calls from a mental health worker (to discuss how they are getting on with Fearfighter ); these calls are not for ‘counselling’ or ‘therapy’

30. Effectiveness of CCBT for anxiety and depression effect sizes are substantial both for the treatment of anxiety and for the treatment of depression both short term and long term benefits good adherence and client-satisfaction from CCBT, despite the significantly reduced amount of contact with the clinician But, therapy should not be considered completely computerised; most of the existing programmes involve some input by a therapist (e.g., Thase et al, 2018; Foroushani , et al., 2011; Adelman et al., 2014).

31. Summary & Conclusions Overview of self-help manuals and computerised or computer-assisted interventions They can be effective and useful Not all approaches can be manualised Important that they are based on evidence-based suggestions Important to keep in mind their limitations Hannah M (2015). How Psychology Is Adapting To The World Of Tech. Retrieved on 01/12/19 from https://techcrunch.com/2015/12/28/how-psychology-is-adapting-to-the-world-of-tech/

32. REFERENCES Adelman, C. B., Panza , K. E., Bartley, C. A., Bontempo , A., & Bloch, M. H. (2014). A meta-analysis of computerized cognitive- behavioral therapy for the treatment of DSM-5 anxiety disorders. The Journal of Clinical Psychiatry, 75(7), e695-e704. doi:10.4088/JCP.13r08894 Andrews G, Issakidis C, Sanderson K, Corry J, Lapsley H (2004) Utilising survey data to inform public policy: comparison of the cost-effectiveness of treatment of ten mental disorders. Br J Psychiatry 184: 526–533. Carroll KM, Ball SA, Martino S, et al. Computer-assisted cognitive- behavioral therapy for addiction. A randomized clinical trial of ‘CBT4CBT’. Am J Psychiatry 2008;165:881–888. [PubMed: 18450927] Carroll, K. M., & Rounsaville , B. J. (2010). Computer-assisted therapy in psychiatry: be brave-it's a new world. Current psychiatry reports, 12(5), 426–432. https://doi.org/10.1007/s11920-010-0146-2 Cuijpers P, Donker T, van Straten A, Li J, Andersson G (2010) Is guided self-help as effective as face-to-face psychotherapy for depression and anxiety disorders? A systematic review and meta-analysis. Psychological Medicine, 40, 1943–1957 Dain N. Reflections on antipsychiatry and stigma in the history of American psychiatry. Hosp Community Psychiatry 1994;45:1010–1014. [PubMed: 7829037 ] Foroushani , P.S., Schneider, J. & Assareh , N. Meta-review of the effectiveness of computerised CBT in treating depression. BMC Psychiatry 11, 131 (2011). https://doi.org/10.1186/1471-244X-11-131

33. REFERENCES Goldberg DP, Krueger RF, Andrews G, Hobbs MJ (2009) Emotional disorders: Cluster 4 of the proposed meta-structure for DSM-V and ICD-11. Psychol Med 39: 2043–2059. Kessler RC, Berglund P, Demler O, Walters EE (2005) Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey replication. Arch Gen Psychiatry 62(6): 617–621. Marks IM, Cavanagh K, Gega L. (2007). Hands on Help: Computer-Aided Psychotherapy.  Maudsley Monographs. Psychology Press. Postel MG, de Jong CA, de Haan HA. Does e-therapy for problem drinking reach hidden populations? Am J Psychiatry 2005;162:2393. Regier DA, Narrow WE, Rae DS, et al. The de facto US mental health and addictive disorders service system: Epidemiological Catchment Area prospective one-year prevalence rates of disorders and services. Arch Gen Psychiatry 1993;50:85–91. Sampson JP, Pyle KR (1983). Ethical issues involved with the use of computer-assisted counseling , testing, and guidance systems. Personnel and Guidance Journal; 61:283-287 Warner , C. H., Appenzeller, G. N., Grieger , T., Belenkiy , S., Breitbach , J., Parker, J., … Hoge, C. (2011). Importance of anonymity to encourage honest reporting in mental health screening after combat deployment. Archives of General Psychiatry, 68(10), 1065–1071. doi : 10.1001/archgenpsychiatry.2011.112