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What you need to know before choosing online therapy

Become an informed consumer of telepsychology services—learn factors to take into account when considering online therapy and explore additional resources.

With the click of a mouse or the tap of an app, you can have instant and inexpensive access to a therapist, or so make the claims of many new tools and technologies that want to take psychotherapy out of the therapist’s office and into whatever location you are connected to the Internet. Using the Web can be convenient for the many people who are comfortable using the Internet and looking for help.

But before you sign up, log in, and start chatting, there are points to consider about telepsychology.

Psychologists commonly refer to any therapy delivered by telecommunication tools or devices as telepsychology. You may hear it called Web therapy, phone therapy, text therapy or online therapy. Anytime you’re interacting with a psychologist using a website, a phone or a mobile app, you could be taking part in telepsychology services.

Technology can contribute to an evolution in how people receive psychotherapy or work with a psychologist. Researchers are taking great interest in telepsychology and telehealth, evaluating how well it works, especially compared to in-person, in-office psychotherapy sessions. But much like the technology, the research is still new, and there is a lot science doesn’t yet know.

There are a few points to consider before signing up for any services that are offered exclusively online or by telephone.

Why people like Web therapy
Web therapy has a lot of promise and offers benefits compared to in-person psychotherapy.

It can be convenient. Online therapy can take less time away from the office or your workday or worry about traffic. No need to travel miles to meet up with your psychologist. Dial a number or log in to a site, and the session can happen wherever you are comfortable.Compared to traditional in-person therapy, it can sometimes appear less expensive. Some apps will advertise pricing that provides unlimited use for a weekly or monthly fee. Or the online session may seem significantly lower than in-office visits. If you’re not interested in using health insurance for psychotherapy, this can be a benefit. More about insurance and online therapy is discussed in the next section.Online communication is very comfortable for many people, especially younger adults or those who use technology often. More people are using email, webinars and text messaging to communicate, and it can seem more comfortable or easier than talking to someone in person, especially when revealing personal or private information.It can provide access to those who can’t get to an office. In some rural communities, the nearest psychologist office may be an hour or two drive away. Some people with chronic illnesses or disabilities may not be able to drive or easily able to leave their home. In these situations, Web- or telephone-based therapy may be their only option for help.
What you need to think carefully about regarding Web-based therapy
Despite the potential benefits, psychologists caution that Web-therapy may not be the best option for everyone or every situation in need of professional support. Here are a few points to consider or ask before signing up:

Is this the right tool to help me? The research hasn’t yet shown that stand-alone therapy online or via texting is effective for everyone in every situation. Some sites advertise that they offer therapy, but those claims may be misleading or false. For example, the people behind the apps may not be licensed or qualified to provide therapy.Is the therapist licensed? Licensing protects you. Therapist and psychotherapist are not legally protected words in most states, meaning anyone can claim to be a therapist and offer services that may appear as therapy. It may not always be easy to know that you are receiving evidenced-based psychotherapy.

All psychologists and other professional health providers must be licensed by the state in which they practice. Licensure laws protect you by ensuring only those who are trained and qualified to practice receive a license. It also ensures that you have recourse if there are problems with your treatment. Before you sign up for any Web services, find out who you are working with, if he or she has a license, where that license is held and the license number. Most states offer an online, searchable directory of professionals licensed in their state.Is the psychologist licensed in the state you live? Licenses are granted by each state with their own laws and rules, much like each state determines what residents must know to earn a driver’s license. But unlike driver’s licenses, which allow you to legally operate a car in all states, a health care provider is limited to providing services in the state in which they are licensed. The provider must be licensed in the jurisdiction where you are located, and making that determination may be difficult to do if you don’t know where he or she is physically located.Is the site or app secure? Will the information I provide remain confidential? Psychotherapy works in part because psychologists ensure that clients have a safe, private space to share deeply personal and sometimes difficult stories, thoughts or emotions. What happens and is said in a therapy office stays there, with the exception of a few situations. The site or app you use should, at a minimum, be HIPAA-compliant and have the ability to verify your identity and your therapist’s identity.How will you pay for the service? Many insurance companies cover the treatment of mental health and substance abuse disorders—treatment that includes in-person psychotherapy. If you work with a psychologist in her office, your insurance could cover most or all of the fee, depending on whether you need to meet a deductible or have a co-pay. Psychologists will often provide an invoice that you can submit to your insurance company for reimbursement. But online therapy or web therapy services are often not covered or reimbursable by most insurance providers. If you plan to be reimbursed, check with your insurance company first. Otherwise, prepare to pay for the full cost yourself.
More psychologists are exploring online sites and apps just as more patients are interested in using them. Research does show that some technological tools can help when used in conjunction with in-office therapy.

Many psychologists and patients are finding text messages helpful for quick check-ins or reminders. Some apps can help track and log moods or thoughts. Web-conferencing and streaming in real time can offer continuity when a patient is on vacation or not able to make a regular session.

There are cases in which Web-conferencing or therapy via telephone does seem to be a viable option on its own for some people. But for now, with the current research and with the current technology, mobile apps and text messaging are best used as complementary to in-person psychotherapy.

reference: APA
Link:https://www.apa.org/topics/telehealth/online-therapy
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Traumas in children and adolescents can be treated effectively

Psychotherapeutic treatment based on trauma-focused therapy is highly effective for children and adolescents who have experienced repeated traumatic events such as sexual, physical or emotional abuse.

Around 25 percent of children and adolescents exposed to traumatic events develop post-traumatic stress disorder (PTSD). Repeated physical, sexual and emotional traumatization in childhood in particular carries a high risk of PTSD. The cases of sexual abuse in the Catholic church and the Russian war against Ukraine are two current examples that illustrate the scope of mass trauma events.

"PTDS is a serious, usually chronic, illness which creates severe functional impairment in everyday life of those affected," says Thole Hoppen who is the lead author of the study in collaboration with psychologists at the University of East Anglia (UK) and the University of Oslo (Norway).

There had previously been strong reservations in clinical practice as regards using trauma-focused psychotherapy to treat children and adolescents suffering PTSD from multiple traumas. This form of therapy aims at changing patients' patterns of thought and behavior that have arisen as a result of the trauma. The aim is to enable patients to confront the trauma they have experienced, under the supervision of a therapist, and thereby process the memories and their consequences.

"The widespread argument is that this therapy demands too much of patients, and that it is not very promising, inappropriate, or even dangerous," Hoppen comments. "Our analysis has enabled us to prove the opposite."

In a so-called meta-analysis, the researchers evaluated the results of all randomized controlled psychotherapy trials published so far relating to PTSD in children and adolescents. For the first time in a meta-analysis, the authors distinguished between individual and multiple trauma exposures in children and adolescents.

"Psychotherapy is highly effective for children and adolescents with PTSD—and not only after a single traumatisation," says Hoppen. "The evidence base shows that this is also the case for multiple traumas."

The results of the study are important not only for outpatient psychotherapy but also for inpatient treatment in psychiatric wards, as well as for the training of psychotherapists. The results provide hope and guidance for people affected, for their families and for those treating them.

link: https://medicalxpress.com/news/2023-03-traumas-children-adolescents-effectively.html
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Timely treatment of depression could reduce the risk of dementia

the course of ineffectively treated depression carries significant medical risk.

Depression has long been associated with an increased risk of dementia, and now a new study provides evidence that timely treatment of depression could lower the risk of dementia in specific groups of patients.

Over 55 million people worldwide live with dementia, a disabling neurocognitive condition that mainly affects older adults. No effective treatment for dementia exists but identifying ways to help minimize or prevent dementia would help to lessen the burden of the disease.

The study, led by Jin-Tai Yu, MD, PhD, Huashan Hospital, Shanghai Medical College, Fudan University, and Wei Cheng, PhD, Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, China, appears in Biological Psychiatry, published by Elsevier.

Professor Yu and Professor Cheng used data collected by the UK Biobank, a population-based cohort of over 500,000 participants. The current study included more than 350,000 participants, including 46,280 participants with depression. During the course of the study, 725 of the depressed patients developed dementia.

Previous studies examining whether depression therapies such as pharmacotherapy and psychotherapy could lower the risk for dementia produced mixed results, leaving the question unresolved. "Older individuals appear to experience different depression patterns over time," said Professor Yu. "Therefore, intra-individual variability in symptoms might confer different risk of dementia as well as heterogeneity in effectiveness of depression treatment in relation to dementia prevention."

To address that heterogeneity, the researchers then categorized participants into one of four courses of depression: increasing course, in which mild initial symptoms steadily increase; decreasing course, starting with moderate- or high-severity symptoms but subsequently decreasing; chronically high course of ongoing severe depressive symptoms; and chronically low course, where mild or moderate depressive symptoms are consistently maintained.

As expected, the study found that depression elevated the risk of dementia – by a striking 51% compared to non-depressed participants. However, the degree of risk depended on the course of depression; those with increasing, chronically high, or chronically low course depression were more vulnerable to dementia, whereas those with decreasing course faced no greater risk than participants without depression.

The researchers most wanted to know whether the increased risk for dementia could be lowered by receiving depression treatment. Overall, depressed participants who received treatment had reduced risk of dementia compared to untreated participants by about 30%. When the researchers separated the participants by depression course, they saw that those with increasing and chronically low courses of depression saw lower risk of dementia with treatment, but those with a chronically high course saw no benefit of treatment in terms of dementia risk.
He notes that, "in this case, symptomatic depression increases dementia risk by 51%, whereas treatment was associated with a significant reduction in this risk."

"This indicates that timely treatment of depression is needed among those with late-life depression," added Professor Cheng. "Providing depression treatment for those with late-life depression might not only remit affective symptoms but also postpone the onset of dementia."

"The new findings shed some light on previous work as well," said Professor Cheng. "The differences of effectiveness across depression courses might explain the discrepancy between previous studies."
Journal reference:
Yang, L., et al. (2022) Depression, Depression Treatments, and Risk of Incident Dementia: A Prospective Cohort Study of 354,313 Participants. Biological Psychiatry. doi.org/10.1016/j.biopsych.2022.08.026.
Link:
https://www.news-medical.net/news/20221017/Timely-treatment-of-depression-could-reduce-the-risk-of-dementia.aspx
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Digital interventions can help relieve depressive symptoms

data from smartphones and wearable devices might be used to identify people with symptoms of depression and anxiety.

With a shortage of therapists, help with mental health problems is being sought from digital interventions, where elements of psychological treatment are offered via computer programs or mobile applications. According to a study, smart devices can help identify people with symptoms of depression and anxiety.

Every year, 400 million people worldwide are affected by depression or anxiety, and the coronavirus pandemic has only increased the prevalence of mental health problems. At the same time, there is a shortage of psychotherapists. Digital interventions, where elements of psychological treatment are offered via computer programs or mobile applications, have been proposed as a solution.

In his doctoral thesis in the field of psychology, researcher Isaac Moshe investigated the effectiveness of digital interventions in treating mental health problems, with depressive symptoms in particular focus.

Tracking depression and anxiety with smart devices
One sub-study in the doctoral thesis examined whether symptoms of depression or anxiety can be identified from data collected by smartphones or wearable devices. A total of 60 adults who used an iPhone or an Oura Ring took part in the sub-study.

Based on the study, smartphone GPS data was predicted the user's depressive symptoms. Subjects who visited the same locations repeatedly had more depressive symptoms than those whose location had more variability. The data collected by smart rings indicated that the longer the person slept or spent time in bed on average, the more depressive symptoms they had. The ring data also revealed that the more frequently people woke up at night, the more symptoms of anxiety they had.
Digital interventions alleviate depressive symptoms
The most extensive sub-study of the doctoral thesis was an international collaboration that assessed the effectiveness of digital interventions in treating depression by conducting a meta-analysis of all previous studies. Digital interventions typically include videos, interactive exercises or text to deliver the core components of psychotherapy, which are then packaged into an online program or smartphone app.

The dataset was composed of 83 randomized controlled trials conducted between 1990 and 2020 involving 15,530 participants.
The findings indicate that digital interventions brought relief from depressive symptoms when they were offered in public or private healthcare settings. Digital interventions alleviated symptoms in people of all ages, regardless of depression severity or physical comorbidity.

Moshe points out that there are important caveats: in children and adolescents, digital interventions were less effective than in adults. Having human support alongside the digital interventions was also critical to people completing the programs and therefore getting the maximum benefits. Furthermore, the researchers felt that it was unclear whether digital interventions were indeed as effective as face-to-face psychotherapy, as so few comparative studies on the topic have so far been conducted.

Moshe believes that, overall, digital interventions could provide a valuable way to help meet the growing global demand for mental healthcare.

"They lower the barrier to accessing treatment, enabling anyone with a computer an internet connection to benefit from psychotherapy at a time and place that is convenient to them. Digital interventions also require much less time from therapists than traditional therapy, making it possible to shorten waiting lists and treat more people."
Source:
Helsingin yliopisto (University of Helsinki)
Link:
https://www.news-medical.net/news/20221220/Digital-interventions-can-help-relieve-depressive-symptoms.aspx
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Performing acts of kindness may help people suffering from depression or anxiety

Social connection is one of the ingredients of life most strongly associated with well-being. Performing acts of kindness seems to be one of the best ways to promote those connections.”

People suffering from symptoms of depression or anxiety may help heal themselves by doing good deeds for others, new research shows.

The study found that performing acts of kindness led to improvements not seen in two other therapeutic techniques used to treat depression or anxiety.

Most importantly, the acts of kindness technique was the only intervention tested that helped people feel more connected to others, said study co-author David Cregg, who led the work as part of his PhD dissertation in psychology at The Ohio State University.
Cregg conducted the research with Jennifer Cheavens, professor of psychology at Ohio State. Their study was published recently in The Journal of Positive Psychology.

The research also revealed why performing acts of kindness worked so well: It helped people take their minds off their own depression and anxiety symptoms.

This finding suggests that one intuition many people have about people with depression may be wrong, Cheavens said.

"We often think that people with depression have enough to deal with, so we don't want to burden them by asking them to help others. But these results run counter to that," she said.

"Doing nice things for people and focusing on the needs of others may actually help people with depression and anxiety feel better about themselves."

The study involved 122 people in central Ohio who had moderate to severe symptoms of depression, anxiety, and stress.

After an introductory session, the participants were split into three groups. Two of the groups were assigned to techniques often used in cognitive behavioral therapy (CBT) for depression: planning social activities or cognitive reappraisal.

The social activities group was instructed to plan social activities for two days a week. Another group was instructed in one of the staples of CBT: cognitive reappraisal. These participants kept records for at least two days each week that helped them identify negative thought patterns and revise their thoughts in a way that could reduce depression and anxiety.
Members of the third group were instructed to perform three acts of kindness a day for two days out of the week. Acts of kindness were defined as "big or small acts that benefit others or make others happy, typically at some cost to you in terms of time or resources."

Some of the acts of kindness that participants later said they did included baking cookies for friends, offering to give a friend a ride, and leaving sticky notes for roommates with words of encouragement.

Participants followed their instructions for five weeks, after which they were evaluated again. The researchers then checked with the participants after another five weeks to see if the interventions were still effective.

The findings showed that participants in all three groups showed an increase in life satisfaction and a reduction of depression and anxiety symptoms after the 10 weeks of the study.

"These results are encouraging because they suggest that all three study interventions are effective at reducing distress and improving satisfaction," Cregg said.

"But acts of kindness still showed an advantage over both social activities and cognitive reappraisal by making people feel more connected to other people, which is an important part of well-being," he said.

In addition, the acts of kindness group showed greater improvements than the cognitive reappraisal group for life satisfaction and symptoms of depression and anxiety, results showed.

Cheavens noted that just participating in social activities did not improve feelings of social connection in this study.

"There's something specific about performing acts of kindness that makes people feel connected to others. It's not enough to just be around other people, participating in social activities," she said.

Cregg said that while this study used techniques of CBT, it is not the same experience as going through CBT. Those who undergo the full treatment may have better results than those in this study.

But the findings also show that even the limited CBT exposure given in this study can be helpful, Cheavens said.

"Not everyone who could benefit from psychotherapy has the opportunity to get that treatment," she said. "But we found that a relatively simple, one-time training had real effects on reducing depression and anxiety symptoms."

And beyond traditional CBT, acts of kindness may have additional benefits in creating social connections, Cregg said.

"Something as simple as helping other people can go above and beyond other treatments in helping heal people with depression and anxiety," he said.

Reference:
Ohio State University

Journal reference:
Cregg, D.R., et al. (2022) Healing through helping: an experimental investigation of kindness, social activities, and reappraisal as well-being interventions. The Journal of Positive Psychology. doi.org/10.1080/17439760.2022.2154695.
Link:
https://www.news-medical.net/news/20230110/Performing-acts-of-kindness-may-help-people-suffering-from-depression-or-anxiety.aspx
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Digital interventions can help relieve depressive symptoms

Psychotherapy with Electronic , Online Intervention

With a shortage of therapists, help with mental health problems is being sought from digital interventions, where elements of psychological treatment are offered via computer programs or mobile applications. According to a study, smart devices can help identify people with symptoms of depression and anxiety.

Every year, 400 million people worldwide are affected by depression or anxiety, and the coronavirus pandemic has only increased the prevalence of mental health problems. At the same time, there is a shortage of psychotherapists. Digital interventions, where elements of psychological treatment are offered via computer programs or mobile applications, have been proposed as a solution.

In his doctoral thesis in the field of psychology, researcher Isaac Moshe investigated the effectiveness of digital interventions in treating mental health problems, with depressive symptoms in particular focus.
Tracking depression and anxiety with smart devices

One sub-study in the doctoral thesis examined whether symptoms of depression or anxiety can be identified from data collected by smartphones or wearable devices. A total of 60 adults who used an iPhone or an Oura Ring took part in the sub-study.

Based on the study, smartphone GPS data was predicted the user's depressive symptoms. Subjects who visited the same locations repeatedly had more depressive symptoms than those whose location had more variability. The data collected by smart rings indicated that the longer the person slept or spent time in bed on average, the more depressive symptoms they had. The ring data also revealed that the more frequently people woke up at night, the more symptoms of anxiety they had.
Digital interventions alleviate depressive symptoms
The most extensive sub-study of the doctoral thesis was an international collaboration that assessed the effectiveness of digital interventions in treating depression by conducting a meta-analysis of all previous studies. Digital interventions typically include videos, interactive exercises or text to deliver the core components of psychotherapy, which are then packaged into an online program or smartphone app.

The dataset was composed of 83 randomized controlled trials conducted between 1990 and 2020 involving 15,530 participants.

The findings indicate that digital interventions brought relief from depressive symptoms when they were offered in public or private healthcare settings. Digital interventions alleviated symptoms in people of all ages, regardless of depression severity or physical comorbidity.

Moshe points out that there are important caveats: in children and adolescents, digital interventions were less effective than in adults. Having human support alongside the digital interventions was also critical to people completing the programs and therefore getting the maximum benefits. Furthermore, the researchers felt that it was unclear whether digital interventions were indeed as effective as face-to-face psychotherapy, as so few comparative studies on the topic have so far been conducted.

Moshe believes that, overall, digital interventions could provide a valuable way to help meet the growing global demand for mental healthcare.

"They lower the barrier to accessing treatment, enabling anyone with a computer an internet connection to benefit from psychotherapy at a time and place that is convenient to them. Digital interventions also require much less time from therapists than traditional therapy, making it possible to shorten waiting lists and treat more people."

Reference:
Helsingin yliopisto (University of Helsinki)
Link: 
https://www.news-medical.net/news/20221220/Digital-interventions-can-help-relieve-depressive-symptoms.aspx
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