Post on 11-Jul-2018
transcript
Computerised therapy for young people: maintaining the therapeutic relationship
Dr Conal TwomeyPsychologist in Clinical Training, UCD/HSE
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Acknowledgement: some slides kindly provided by Prof Gary O’Reilly (UCD)
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Scenic route
HDip + Research masters
AP roles
PhD (Soton)
Clinical Psychologist in Training
Lecturing
A bit about me…
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Structure
Maintaining the
relationship
Examples
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Introduction to computerised therapy
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Psychological therapy is effective but difficult to access
Bower & Gilbody (2005). Stepped care in psychological therapies: access, effectiveness and efficiency. Narrative literature review.
British Journal of Psychiatry 186, 11-17.
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Up to 80% of children and adolescents with mental health needs receive no treatment
Ebert et al. (2015) Internet and Computer-Based Cognitive Behavioral Therapy for Anxiety and Depression in Youth: A Meta-Analysis
of Randomized Controlled Outcome Trials. PLOS ONE 10(3): e0119895.
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One way of increasing access is to deliver the therapeutic content remotely, via the Internet
Andrews, G., Cuijpers, P., Craske, M.G., McEvoy, P., Titov, N., 2010. Computer therapy for the anxiety and depressive disorders is
effective, acceptable and practical health care: a meta-analysis. PLoS One 5 (10), e13196.
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Access & convenience
Complete at own pace
Privacy
Twomey, C (2013). A multi-site randomised controlled trial of the computerised CBT programme, MoodGYM. Research Masters Thesis, UCD
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Clinician time saved
Low intensity/cost
Less waiting times
Twomey, C (2013). A multi-site randomised controlled trial of the computerised CBT programme, MoodGYM. Research Masters Thesis, UCD
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computerised CBT (cCBT)
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cCBT is effective, on average, for the treatment of common mental health problems in both adults and adolescents
Andrews et al. (2010). Computer therapy for the anxiety and depressive disorders is effective, acceptable and practical health care: a
meta-analysis. PLoS One 5.
Arnberg et al. (2014). Internet-delivered psychological treatments for mood and anxiety disorders: A systematic review of their
efficacy, safety, and cost-effectiveness. PLoS One 9 (5).
Ebert et al. (2015) Internet and Computer-Based Cognitive Behavioral Therapy for Anxiety and Depression in Youth: A Meta-Analysis
of Randomized Controlled Outcome Trials. PLoS One 10 (3).
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Twomey, C (2013). A multi-site randomised controlled trial of the computerised CBT programme, MoodGYM. Research Masters Thesis, UCD
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Twomey, C (2013). A multi-site randomised controlled trial of the computerised CBT programme, MoodGYM. Research Masters Thesis, UCD
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My experiences with MoodGYM
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Developed at the Australian National University (2004), MoodGYM is a freely available cCBT programme for depression (and anxiety)
850,000 users
https://moodgym.anu.edu.au/welcome
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“Access is available to individuals for $39(AUD) for 1 year's access.” It used to be free!
19Twomey & O’Reilly (2016). Effectiveness of a freely available computerised cognitive behavioural therapy programme (MoodGYM) for depression: meta-analysis. Australian & New Zealand
Journal of Psychiatry, 51(3), 260-269.
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Evaluations of MoodGYM
Twomey, C., O' Reilly, G., Byrne, M., Bury, M., White, A., Kissane, S., McMahon, A and Clancy, N (2014). A
randomized controlled trial of the computerized CBT programme, MoodGYM, for public mental health service
users waiting for interventions. British Journal of Clinical Psychology, 53 (4), 433-50.
MoodGYM 850,000 registered users
6 site RCT
3 Urban: Ballymun, Coolock,
Dun Laoghaire
3 Rural: Wexford, Kildare
Roscommon
Depression, Anxiety & Stress
Scale (DASS-21)
Work & Social Adjustment Scale
201 public mental health
service users currently on a
waiting list.
101 assigned to MoodGym
100 assigned to waiting list
DASS total improvement
DASS Stress improvment
Large drop-out (56.3%)
RCT of MoodGYM within HSE servicesClinical Academic
Twomey, C., & O’Reilly, G. (2016). Effectiveness of a freely available computerised cognitive behavioural therapy programme
(MoodGYM) for depression: meta-analysis. Australian & New Zealand Journal of Psychiatry, 51(3), 260-269.
MoodGYM 850,000 registered users
11 RCT studies demonstrated
MoodGYM’s effectiveness for
depression symptoms at post-
intervention, with a small effect
size (g=0.36).
6 RCT studies demonstrated
MoodGYM’s effectiveness for
anxiety symptoms at post-
intervention, with a medium
effect size (g=0.57)
6 RCT studies did not yield
significance for MoodGYM’s
effectiveness for general
psychological distress symptoms
Works in clinic + community
Local origin works better
Best when therapist assistedDrop-Out rates 0-73%
Meta-analysis of MoodGYM
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Twomey, C (2013). A multi-site randomised controlled trial of the computerised CBT programme, MoodGYM. Research Masters Thesis, UCD
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Guided cCBT
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Can we save clinician time (cCBT) while maintaining the therapeutic relationship?
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cCBT
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cCBT
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cCBT
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Mindful Gnats App free from the iTunes store or Google Play
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Can we save clinician time (cCBT) while maintaining the therapeutic relationship?
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Guided cCBT saves (some) clinician time while maintaining the therapeutic relationship (somewhat)
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In session cCBT
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Will not save much clinician time; but this is not the intention…
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3. Young person & therapist work together apply that CBT concept
to young person
4. Young person transfers that learning to their home, school &
community with a between session task
2. An in-provides a social model of how that
CBT concept applied to them
In-session computer game features
1. A game character defines a single CBT concept in each level
Visit our website: www.PeskyGnats.com
Follow us on Twitter: @peskygnats
Please share your knowledge about our work with other people…
Find us on Youtube
45https://sparx.org.nz/
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In-session computer games can improve the young person’s experience and understanding of therapeutic principles in a fun way!
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Summary
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Enhance TR
Self-help cCBT
Lose TR: Dropout!
Guided cCBT
In session cCBT
Maintain TR
Clinician time involved
Computerised therapy for young people: maintaining the therapeutic relationship
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Finally…a future direction
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Individually-tailored cCBT
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http://www.deprexis.com/index.html
Behavioural activation
Cognitive Modification
Relaxation & healthy lifestyle
Acceptance & mindfulness
Problem-solving
Childhood experiences
Interpersonal skills
Positive Psychology
Dream work
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Choice of modules in Deprexis
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“the…. dropout rate for participants allocated to Deprexis treatment arms in included studies (26.5%)…was markedly lower than the corresponding rate in the MoodGYM meta-analysis (41.3%) (Twomey and O’Reilly, 2016). The lower dropout rates may also reflect the greater acceptability of Deprexis, perhaps owing to its tailoring of content to the unique situation of the user. Indeed, meta-analyses indicate that tailored computerised interventions for various health behaviours are, on average, more effective than standardised interventions (Krebs et al., 2010; Lustria et al., 2013)”
Twomey, C., O’Reilly, G. & Meyer, B. (2017). Effectiveness of an individually-tailored computerised cognitive behavioural therapy
programme (Deprexis) for depression: meta-analysis. Psychiatry Research, 256, 371-377.
Meta-analysis of Deprexis
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Thank you!
conal.twomey.1@ucdconnect.iehttps://www.researchgate.net/profile/Conal_Twomey@C_2me
Conal TwomeyPsychologist in Clinical Training, HSE/UCD