TY - JOUR AU - Mohd Kassim, Amiruddin Mohd AU - Azli Shah, Yusoff Sidi Muhammad AU - Lim, Yn Jane Tze AU - Mohd Daud, Iryani Tuti PY - 2025/4/15 TI - Online-Based and Technology-Assisted Psychiatric Education for Trainees: Scoping Review JO - JMIR Med Educ SP - e64773 VL - 11 KW - online learning KW - telepsychiatry KW - remote learning KW - virtual KW - training KW - education KW - psychiatry KW - trainees KW - residents N2 - Background: The concept of online learning in medical education has been gaining traction, but whether it can accommodate the complexity of higher-level psychiatric training remains uncertain. Objective: This review aims to identify the various online-based and technology-assisted educational methods used in psychiatric training and to examine the outcomes in terms of trainees? knowledge, skills, and levels of confidence or preference in using such technologies. Methods: A comprehensive search was conducted in PubMed, Cochrane, PsycINFO, Scopus, and ERIC to identify relevant literature from 1991 until 2024. Studies in English and those that had English translations were identified. Studies that incorporated or explored the use of online-based or technology-assisted learning as part of psychiatric training in trainees and had outcomes of interest related to changes in the level of knowledge or skills, changes in the level of preference or confidence in using online-based or technology-assisted learning, and feedback of participants were included. Studies were excluded if they were conducted on populations excluding psychiatric trainees or residents, were mainly descriptive of the concept of the intervention without any relevant study outcome, were not in English or did not have English translations, or were review articles. Results: A total of 82 articles were included in the review. The articles were divided into 3 phases: prior to 2015, 2015 to 2019 (prepandemic), and 2020 onward (postpandemic). Articles mainly originated from Western countries, and there was a significant increase in relevant studies after the pandemic. There were 5 methods identified, namely videoconference, online modules/e-learning, virtual patients, software/applications, and social media. These were applied in various aspects of psychiatric education, such as theory knowledge, skills training, psychotherapy supervision, and information retrieval. Conclusions: Videoconference-based learning was the most widely implemented approach, followed by online modules and virtual patients. Despite the outcome heterogeneity and small sample sizes in the included studies, the application of such approaches may have utility in terms of knowledge and skills attainment and could be beneficial for the training of future psychiatrists, especially those in underserved low- and middle-income countries. UR - https://mededu.jmir.org/2025/1/e64773 UR - http://dx.doi.org/10.2196/64773 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/64773 ER - TY - JOUR AU - Schwarz, Julian AU - Meier-Diedrich, Eva AU - Scholten, Matthé AU - Stephenson, Lucy AU - Torous, John AU - Wurster, Florian AU - Blease, Charlotte PY - 2025/3/18 TI - Integration of Psychiatric Advance Directives Into the Patient-Accessible Electronic Health Record: Exploring the Promise and Limitations JO - J Med Internet Res SP - e68549 VL - 27 KW - advance statements KW - advance choice documents KW - advance care planning KW - mental health KW - online record access KW - patient accessible electronic health records KW - interoperability KW - fast healthcare interoperability eesources KW - FHIR KW - self-binding directives KW - mobile phone UR - https://www.jmir.org/2025/1/e68549 UR - http://dx.doi.org/10.2196/68549 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/68549 ER - TY - JOUR AU - Kimhy, David AU - Ospina, H. Luz AU - Wall, Melanie AU - Alschuler, M. Daniel AU - Jarskog, F. Lars AU - Ballon, S. Jacob AU - McEvoy, Joseph AU - Bartels, N. Matthew AU - Buchsbaum, Richard AU - Goodman, Marianne AU - Miller, A. Sloane AU - Stroup, Scott T. PY - 2025/2/14 TI - Telehealth-Based vs In-Person Aerobic Exercise in Individuals With Schizophrenia: Comparative Analysis of Feasibility, Safety, and Efficacy JO - JMIR Ment Health SP - e68251 VL - 12 KW - schizophrenia KW - psychosis KW - exercise KW - aerobic fitness KW - VO2max KW - telehealth KW - telemedicine KW - COVID-19 KW - clinical trial KW - safety KW - maximum oxygen consumption N2 - Background: Aerobic exercise (AE) training has been shown to enhance aerobic fitness in people with schizophrenia. Traditionally, such training has been administered in person at gyms or other communal exercise spaces. However, following the advent of the COVID-19 pandemic, many clinics transitioned their services to telehealth-based delivery. Yet, at present, there is scarce information about the feasibility, safety, and efficacy of telehealth-based AE in this population. Objective: To examine the feasibility, safety, and efficacy of trainer-led, at-home, telehealth-based AE in individuals with schizophrenia. Methods: We analyzed data from the AE arm (n=37) of a single-blind, randomized clinical trial examining the impact of a 12-week AE intervention in people with schizophrenia. Following the onset of the COVID-19 pandemic, the AE trial intervention transitioned from in-person to at-home, telehealth-based delivery of AE, with the training frequency and duration remaining identical. We compared the feasibility, safety, and efficacy of the delivery of trainer-led AE training among participants undergoing in-person (pre?COVID-19; n=23) versus at-home telehealth AE (post?COVID-19; n=14). Results: The telehealth and in-person participants attended a similar number of exercise sessions across the 12-week interventions (26.8, SD 10.2 vs 26.1, SD 9.7, respectively; P=.84) and had similar number of weeks with at least 1 exercise session (10.4, SD 3.4 vs 10.6, SD 3.1, respectively; P=.79). The telehealth-based AE was associated with a significantly lower drop-out rate (telehealth: 0/14, 0%; in-person: 7/23, 30.4%; P=.04). There were no significant group differences in total time spent exercising (telehealth: 1246, SD 686 min; in-person: 1494, SD 580 min; P=.28); however, over the 12-week intervention, the telehealth group had a significantly lower proportion of session-time exercising at or above target intensity (telehealth: 33.3%, SD 21.4%; in-person: 63.5%, SD 16.3%; P<.001). There were no AE-related serious adverse events associated with either AE delivery format. Similarly, there were no significant differences in the percentage of participants experiencing minor or moderate adverse events, such as muscle soreness, joint pain, blisters, or dyspnea (telehealth: 3/14, 21%; in-person: 5/19, 26%; P>.99) or in the percentage of weeks per participant with at least 1 exercise-related adverse event (telehealth: 31%, SD 33%; in-person: 40%, SD 33%; P=.44). There were no significant differences between the telehealth versus in-person groups regarding changes in aerobic fitness as indexed by maximum oxygen consumption (VO2max; P=.27). Conclusions: Our findings provide preliminary support for the delivery of telehealth-based AE for individuals with schizophrenia. Our results indicate that in-home telehealth-based AE is feasible and safe in this population, although when available, in-person AE appears preferable given the opportunity for social interactions and the higher intensity of exercises. We discuss the findings? clinical implications, specifically within the context of the COVID-19 pandemic, as well as review potential challenges for the implementation of telehealth-based AE among people with schizophrenia. UR - https://mental.jmir.org/2025/1/e68251 UR - http://dx.doi.org/10.2196/68251 ID - info:doi/10.2196/68251 ER - TY - JOUR AU - Tay, Ling Jing AU - Qu, Yuanrong AU - Lim, Lucas AU - Puthran, Rohan AU - Tan, Robert Chye Lee AU - Rajendran, Rajkirren AU - Wei, Chiah Ker AU - Xie, Huiting AU - Sim, Kang PY - 2025/1/21 TI - Impact of a Virtual Reality Intervention on Stigma, Empathy, and Attitudes Toward Patients With Psychotic Disorders Among Mental Health Care Professionals: Randomized Controlled Trial JO - JMIR Ment Health SP - e66925 VL - 12 KW - virtual reality KW - social distance KW - stigma KW - empathy KW - mental health KW - schizophrenia KW - psychosis KW - psychotic disorder KW - mental disorder KW - healthcare professional KW - VR KW - randomized controlled trial KW - RCT KW - user satisfaction N2 - Background: Previous studies have found that psychotic disorders are among the most stigmatized mental disorders. Of note, virtual reality (VR) interventions have been associated with improvements in attitudes and empathy and reduced stigma toward individuals with psychotic disorders, especially among undergraduates, but this has not been examined among mental health care professionals. Objective: We aimed to evaluate the effectiveness of a newly developed VR intervention for mental health care professionals to improve attitudes and empathy and reduce stigma toward people with psychotic disorders. Methods: We conducted a randomized controlled trial and recruited eligible mental health care professionals from a tertiary mental health care institution. Both arms (VR intervention and VR control groups) were evaluated at baseline, postintervention, and 1-month follow up. The evaluation included outcomes related to attitudes (modified attitudes toward people with schizophrenia scale), stigma (social distance scale, personal stigma scale), and empathy (empathetic concern subscale of the Interpersonal Reactivity Index). The experience with the VR intervention was assessed using a user satisfaction questionnaire, and qualitative feedback was gathered. Results: Overall, 180 mental health care professionals participated and completed the study. Both groups showed improvements in attitude, social distance, and stigma scores but not the empathy score following the intervention. The VR intervention group had better user satisfaction than the VR control group. In addition, certain outcome measures were positively associated with specific factors including female gender, higher education level, certain job roles, years of work, and presence of loved ones with a mental disorder. Conclusions: Both the intervention and control VR groups of mental health care professionals showed improvements in attitudes, stigma, and social distance toward people with psychotic disorders. Future longitudinal studies may want to evaluate the impact of VR on caregivers and the public on these same and other outcome measures to reduce stigma and improve empathy toward individuals with psychotic disorders. Trial Registration: clinicaltrials.gov NCT05982548; https://clinicaltrials.gov/study/NCT05982548 UR - https://mental.jmir.org/2025/1/e66925 UR - http://dx.doi.org/10.2196/66925 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/66925 ER - TY - JOUR AU - Ng, Hydra Hei-Yin AU - Wu, W. Changwei AU - Hsu, Hao-Che AU - Huang, Chih-Mao AU - Hsu, Ai-Ling AU - Chao, Yi-Ping AU - Jung, Tzyy-Ping AU - Chuang, Chun-Hsiang PY - 2024/12/6 TI - Neurological Evidence of Diverse Self-Help Breathing Training With Virtual Reality and Biofeedback Assistance: Extensive Exploration Study of Electroencephalography Markers JO - JMIR Form Res SP - e55478 VL - 8 KW - biofeedback KW - virtual reality KW - breathing training KW - EEG KW - electroencephalography KW - effective connectivity N2 - Background: Recent advancements in virtual reality (VR) and biofeedback (BF) technologies have opened new avenues for breathing training. Breathing training has been suggested as an effective means for mental disorders, but it is difficult to master the technique at the beginning. VR-BF technologies address the problem of breathing, and visualizing breathing may facilitate the learning of breathing training. This study explores the integration of VR and BF to enhance user engagement in self-help breathing training, which is a multifaceted approach encompassing mindful breathing, guided breathing, and breath counting techniques. Objective: We identified 3 common breathing training techniques in previous studies, namely mindful breathing, guided breathing, and breath counting. Despite the availability of diverse breathing training methods, their varying effectiveness and underlying neurological mechanisms remain insufficiently understood. We investigated using electroencephalography (EEG) indices across multiple breathing training modalities to address this gap. Methods: Our automated VR-based breathing training environment incorporated real-time EEG, heart rate, and breath signal BF. We examined 4 distinct breathing training conditions (resting, mindful breathing, guided breathing, and breath counting) in a cross-sectional experiment involving 51 healthy young adults, who were recruited through online forum advertisements and billboard posters. In an experimental session, participants practiced resting state and each breathing training technique for 6 minutes. We then compared the neurological differences across the 4 conditions in terms of EEG band power and EEG effective connectivity outflow and inflow with repeated measures ANOVA and paired t tests. Results: The analyses included the data of 51 participants. Notably, EEG band power across the theta, alpha, low-beta, high-beta, and gamma bands varied significantly over the entire scalp (t ?1.96, P values <.05). Outflow analysis identified condition-specific variations in the delta, alpha, and gamma bands (P values <.05), while inflow analysis revealed significant differences across all frequency bands (P values <.05). Connectivity flow analysis highlighted the predominant influence of the right frontal, central, and parietal brain regions in the neurological mechanisms underlying the breathing training techniques. Conclusions: This study provides neurological evidence supporting the effectiveness of self-help breathing training through the combined use of VR and BF technologies. Our findings suggest the involvement of internal-external attention focus and the dorsal attention network in different breathing training conditions. There is a huge potential for the use of breathing training with VR-BF techniques in terms of clinical settings, the new living style since COVID-19, and the commercial value of introducing VR-BF breathing training into consumer-level digital products. Furthermore, we propose avenues for future research with an emphasis on the exploration of applications and the gamification potential in combined VR and BF breathing training. Trial Registration: ClinicalTrials.gov NCT06656741; https://clinicaltrials.gov/study/NCT06656741 UR - https://formative.jmir.org/2024/1/e55478 UR - http://dx.doi.org/10.2196/55478 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/55478 ER - TY - JOUR AU - Mikkonen, Kasperi AU - Helminen, Eeva-Eerika AU - Saarni, I. Samuli AU - Saarni, E. Suoma PY - 2024/7/29 TI - Learning Outcomes of e-Learning in Psychotherapy Training and Comparison With Conventional Training Methods: Systematic Review JO - J Med Internet Res SP - e54473 VL - 26 KW - mental health KW - psychotherapy KW - digital learning KW - Kirkpatrick model KW - e-learning KW - online health KW - psychotherapy training KW - learning outcome KW - learning outcomes KW - systematic review KW - training methods KW - mental disorders KW - mental disorder KW - accessibility KW - evidence-based KW - scalability KW - cost-effectiveness KW - internet KW - education N2 - Background: Mental disorders pose a major public health problem in most western countries. The demand for services for common mental health disorders has been on the rise despite the widespread accessibility of medication. Especially, the supply and demand for evidence-based psychotherapy do not align. Large-scale increase of modern psychotherapy is difficult with current methods of training which are often expensive, time consuming, and dependent on a small number of top-level professionals as trainers. E-learning has been proposed to enhance psychotherapy training accessibility, quality, and scalability. Objective: This systematic review aims to provide an overview of the current evidence regarding e-learning in psychotherapy training. In particular, the review examines the usability, acceptability, and learning outcomes associated with e-learning. Learning outcomes are assessed in different modalities including trainee experiences, knowledge acquisition, skill acquisition, and application of trained content in daily practice. Furthermore, the equivalence of web-based training and conventional training methods is evaluated. Methods: Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, a search from Ovid, MEDLINE, PsycINFO, and Scopus databases between 2008 and June 2022 was conducted. Inclusion criteria required studies to describe e-learning systems for psychotherapy training and assess acceptability, feasibility, or learning outcomes. The risk of bias was evaluated for both randomized and nonrandomized studies. Learning outcomes were categorized using the Kirkpatrick model. Effect sizes comparing e-learning and traditional methods were calculated. Results: The search yielded 3380 publications, of which 34 fulfilled the inclusion criteria. Positive learning outcomes are generally associated with various e-learning programs in psychotherapy training including trainee satisfaction, knowledge, and skill acquisition, and in application of trained content in clinical practice. Learning outcomes generally show equivalence between e-learning and conventional training methods. The overall effect size, indicating this disparity, was 0.01, suggesting no significant difference. This literature displays a high level of heterogeneity in e-learning solutions and assessment methods. Conclusions: e-Learning seems to have good potential to enhance psychotherapy training by increasing access, scalability, and cost-effectiveness while maintaining quality in terms of learning outcomes. Results are congruent with findings related to e-learning in health education in general where e-learning as a pedagogy is linked to an opportunity to carry out learner-centric practices. Recommendations for conducting psychotherapy training programs in blended settings supported by activating learning methods are presented. However, due to the heterogeneity and limitations in the existing literature, further research is necessary to replicate these findings and to establish global standards for e-learning, as well as for the assessment of training outcomes in psychotherapy education. Research is especially needed on the effects of training on patient outcomes and optimal ways to combine e-learning and conventional training methods in blended learning settings. UR - https://www.jmir.org/2024/1/e54473 UR - http://dx.doi.org/10.2196/54473 UR - http://www.ncbi.nlm.nih.gov/pubmed/39073862 ID - info:doi/10.2196/54473 ER - TY - JOUR AU - Fernandes, Sara AU - Brousse, Yann AU - Zendjidjian, Xavier AU - Cano, Delphine AU - Riedberger, Jérémie AU - Llorca, Pierre-Michel AU - Samalin, Ludovic AU - Dassa, Daniel AU - Trichard, Christian AU - Laprevote, Vincent AU - Sauvaget, Anne AU - Abbar, Mocrane AU - Misdrahi, David AU - Berna, Fabrice AU - Lancon, Christophe AU - Coulon, Nathalie AU - El-Hage, Wissam AU - Rozier, Pierre-Emmanuel AU - Benoit, Michel AU - Giordana, Bruno AU - Caqueo-Urízar, Alejandra AU - Yon, Keon Dong AU - Tran, Bach AU - Auquier, Pascal AU - Fond, Guillaume AU - Boyer, Laurent PY - 2024/5/16 TI - Psychometric Assessment of an Item Bank for Adaptive Testing on Patient-Reported Experience of Care Environment for Severe Mental Illness: Validation Study JO - JMIR Ment Health SP - e49916 VL - 11 KW - psychiatry KW - public mental health KW - schizophrenia KW - major depressive disorders KW - bipolar disorders KW - patient-reported experience measures KW - quality of care KW - health services research KW - computerized adaptive testing KW - real-world data N2 - Background: The care environment significantly influences the experiences of patients with severe mental illness and the quality of their care. While a welcoming and stimulating environment enhances patient satisfaction and health outcomes, psychiatric facilities often prioritize staff workflow over patient needs. Addressing these challenges is crucial to improving patient experiences and outcomes in mental health care. Objective: This study is part of the Patient-Reported Experience Measure for Improving Quality of Care in Mental Health (PREMIUM) project and aims to establish an item bank (PREMIUM-CE) and to develop computerized adaptive tests (CATs) to measure the experience of the care environment of adult patients with schizophrenia, bipolar disorder, or major depressive disorder. Methods: We performed psychometric analyses including assessments of item response theory (IRT) model assumptions, IRT model fit, differential item functioning (DIF), item bank validity, and CAT simulations. Results: In this multicenter cross-sectional study, 498 patients were recruited from outpatient and inpatient settings. The final PREMIUM-CE 13-item bank was sufficiently unidimensional (root mean square error of approximation=0.082, 95% CI 0.067-0.097; comparative fit index=0.974; Tucker-Lewis index=0.968) and showed an adequate fit to the IRT model (infit mean square statistic ranging between 0.7 and 1.0). DIF analysis revealed no item biases according to gender, health care settings, diagnosis, or mode of study participation. PREMIUM-CE scores correlated strongly with satisfaction measures (r=0.69-0.78; P<.001) and weakly with quality-of-life measures (r=0.11-0.21; P<.001). CAT simulations showed a strong correlation (r=0.98) between CAT scores and those of the full item bank, and around 79.5% (396/498) of the participants obtained a reliable score with the administration of an average of 7 items. Conclusions: The PREMIUM-CE item bank and its CAT version have shown excellent psychometric properties, making them reliable measures for evaluating the patient experience of the care environment among adults with severe mental illness in both outpatient and inpatient settings. These measures are a valuable addition to the existing landscape of patient experience assessment, capturing what truly matters to patients and enhancing the understanding of their care experiences. Trial Registration: ClinicalTrials.gov NCT02491866; https://clinicaltrials.gov/study/NCT02491866 UR - https://mental.jmir.org/2024/1/e49916 UR - http://dx.doi.org/10.2196/49916 UR - http://www.ncbi.nlm.nih.gov/pubmed/38753416 ID - info:doi/10.2196/49916 ER - TY - JOUR AU - Brown, Rushell Tashalee AU - Amir, Habiba AU - Hirsch, Drew AU - Jansen, Owens Madeline PY - 2024/4/3 TI - Designing a Novel Digitally Delivered Antiracism Intervention for Mental Health Clinicians: Exploratory Analysis of Acceptability JO - JMIR Hum Factors SP - e52561 VL - 11 KW - acceptability KW - antiracism KW - clinicians KW - intervention KW - interview study KW - mental health KW - psychiatry residents KW - racism KW - social workers KW - web-based technology N2 - Background: There is a great need for evidence-based antiracism interventions targeting mental health clinicians to help mitigate mental health disparities in racially and ethnically minoritized groups. Objective: This study provides an exploratory analysis of mental health clinicians? perspectives on the acceptability of a web-based antiracism intervention. Methods: Mental health clinicians were recruited from a single academic medical center through outreach emails. Data were collected through individual 30-minute semistructured remote video interviews with participants, then recorded, transcribed, and analyzed using content analysis. Results: A total of 12 mental health clinicians completed the study; 10 out of 12 (83%) were female candidates. Over half (7/12, 58%) of the respondents desired more robust antiracism training in mental health care. Regarding the web-based antiracism intervention, (8/12, 67%) enjoyed the digitally delivered demo module, (7/12, 58%) of respondents suggested web-based content would be further enhanced with the addition of in-person or online group components. Conclusions: Our results suggest a strong need for additional antiracist training for mental health clinicians. Overall, participants responded favorably to novel web-based delivery methods for an antiracism intervention. These findings provide important support for future development and pilot testing of a large-scale digitally enhanced antiracist curriculum targeting mental health clinicians. UR - https://humanfactors.jmir.org/2024/1/e52561 UR - http://dx.doi.org/10.2196/52561 UR - http://www.ncbi.nlm.nih.gov/pubmed/38568730 ID - info:doi/10.2196/52561 ER - TY - JOUR AU - Bilder, A. Deborah AU - Mthembu, Mariah AU - Worsham, Whitney AU - Aguayo, Patricia AU - Knight, R. Jacob AU - Deng, W. Steven AU - Singh, P. Tejinder AU - Davis, John PY - 2024/3/29 TI - Developing and Implementing a Web-Based Branching Logic Survey to Support Psychiatric Crisis Evaluations of Individuals With Developmental Disabilities: Qualitative Study and Evaluation of Validity JO - JMIR Ment Health SP - e50907 VL - 11 KW - developmental disabilities KW - disruptive behavior KW - psychiatric comorbidity KW - web-based KW - psychiatric crisis KW - disability KW - mental health KW - behavioral crises KW - intervention KW - general population KW - screening KW - accuracy KW - mood disorder KW - sources of distress KW - autism KW - intellectual disability N2 - Background: Individuals with developmental disabilities (DD) experience increased rates of emotional and behavioral crises that necessitate assessment and intervention. Psychiatric disorders can contribute to crises; however, screening measures developed for the general population are inadequate for those with DD. Medical conditions can exacerbate crises and merit evaluation. Screening tools using checklist formats, even when designed for DD, are too limited in depth and scope for crisis assessments. The Sources of Distress survey implements a web-based branching logic format to screen for common psychiatric and medical conditions experienced by individuals with DD by querying caregiver knowledge and observations. Objective: This paper aims to (1) describe the initial survey development, (2) report on focus group and expert review processes and findings, and (3) present results from the survey?s clinical implementation and evaluation of validity. Methods: Sources of Distress was reviewed by focus groups and clinical experts; this feedback informed survey revisions. The survey was subsequently implemented in clinical settings to augment providers? psychiatric and medical history taking. Informal and formal consults followed the completion of Sources of Distress for a subset of individuals. A records review was performed to identify working diagnoses established during these consults. Results: Focus group members (n=17) expressed positive feedback overall about the survey?s content and provided specific recommendations to add categories and items. The survey was completed for 231 individuals with DD in the clinical setting (n=161, 69.7% men and boys; mean age 17.7, SD 10.3; range 2-65 years). Consults were performed for 149 individuals (n=102, 68.5% men and boys; mean age 18.9, SD 10.9 years), generating working diagnoses to compare survey screening results. Sources of Distress accuracy rates were 91% (95% CI 85%-95%) for posttraumatic stress disorder, 87% (95% CI 81%-92%) for anxiety, 87% (95% CI 81%-92%) for episodic expansive mood and bipolar disorder, 82% (95% CI 75%-87%) for psychotic disorder, 79% (95% CI 71%-85%) for unipolar depression, and 76% (95% CI 69%-82%) for attention-deficit/hyperactivity disorder. While no specific survey items or screening algorithm existed for unspecified mood disorder and disruptive mood dysregulation disorder, these conditions were caregiver-reported and working diagnoses for 11.7% (27/231) and 16.8% (25/149) of individuals, respectively. Conclusions: Caregivers described Sources of Distress as an acceptable tool for sharing their knowledge and insights about individuals with DD who present in crisis. As a screening tool, this survey demonstrates good accuracy. However, better differentiation among mood disorders is needed, including the addition of items and screening algorithm for unspecified mood disorder and disruptive mood dysregulation disorder. Additional validation efforts are necessary to include a more geographically diverse population and reevaluate mood disorder differentiation. Future study is merited to investigate the survey?s impact on the psychiatric and medical management of distress in individuals with DD. UR - https://mental.jmir.org/2024/1/e50907 UR - http://dx.doi.org/10.2196/50907 UR - http://www.ncbi.nlm.nih.gov/pubmed/38551644 ID - info:doi/10.2196/50907 ER - TY - JOUR AU - Kallakuri, Sudha AU - Gara, Sridevi AU - Godi, Mahesh AU - Yatirajula, Kanaka Sandhya AU - Paslawar, Srilatha AU - Daniel, Mercian AU - Peiris, David AU - Maulik, Kumar Pallab PY - 2024/2/15 TI - Learnings From Implementation of Technology-Enabled Mental Health Interventions in India: Implementation Report JO - JMIR Med Inform SP - e47504 VL - 12 KW - mental health KW - technological interventions KW - digital health KW - community intervention KW - implementation KW - eHealth KW - India KW - Asia KW - development KW - health technology N2 - Background: Recent years have witnessed an increase in the use of technology-enabled interventions for delivering mental health care in different settings. Technological solutions have been advocated to increase access to care, especially in primary health care settings in low- and middle-income countries, to facilitate task-sharing given the lack of trained mental health professionals. Objective: This report describes the experiences and challenges faced during the development and implementation of technology-enabled interventions for mental health among adults and adolescents in rural and urban settings of India. Methods: A detailed overview of the technological frameworks used in various studies, including the Systematic Medical Appraisal and Referral Treatment (SMART) Mental Health pilot study, SMART Mental Health cluster randomized controlled trial, and Adolescents? Resilience and Treatment Needs for Mental Health in Indian Slums (ARTEMIS) study, is provided. This includes the mobile apps that were used to collect data and the use of the database to store the data that were collected. Based on the experiences faced, the technological enhancements and adaptations made at the mobile app and database levels are described in detail. Implementation (Results): Development of descriptive analytics at the database level; enabling offline and online data storage modalities; customizing the Open Medical Record System platform to suit the study requirements; modifying the encryption settings, thereby making the system more secure; and merging different apps for simultaneous data collection were some of the enhancements made across different projects. Conclusions: Technology-enabled interventions prove to be a useful solution to cater to large populations in low-resource settings. The development of mobile apps is subject to the context and the area where they would be implemented. This paper outlines the need for careful testing using an iterative process that may support future research using similar technology. Trial Registration: SMART Mental Health trial: Clinical Trial Registry India CTRI/2018/08/015355; https://ctri.nic.in/Clinicaltrials/pmaindet2.php?EncHid=MjMyNTQ=&Enc=&userName=CTRI/2018/08/015355. ARTEMIS trial: Clinical Trial Registry India CTRI/2022/02/040307; https://ctri.nic.in/Clinicaltrials/pmaindet2.php?EncHid=NDcxMTE=&Enc=&userName=CTRI/2022/02/040307 UR - https://medinform.jmir.org/2024/1/e47504 UR - http://dx.doi.org/10.2196/47504 UR - http://www.ncbi.nlm.nih.gov/pubmed/38358790 ID - info:doi/10.2196/47504 ER - TY - JOUR AU - Wislocki, Katherine AU - Jager-Hyman, Shari AU - Brady, Megan AU - Weiss, Michal AU - Schaechter, Temma AU - Khazanov, Gabriela AU - Young, Sophia AU - Becker-Haimes, Emily PY - 2023/11/3 TI - Freely Available Training Videos for Suicide Prevention: Scoping Review JO - JMIR Ment Health SP - e48404 VL - 10 KW - freely available videos KW - asynchronous training KW - suicide prevention KW - evidence-based practice KW - dissemination KW - implementation N2 - Background: Freely available and asynchronous implementation supports can reduce the resource burden of evidence-based practice training to facilitate uptake. Freely available web-based training videos have proliferated, yet there have been no efforts to quantify their breadth, depth, and content for suicide prevention. Objective: This study presents results from a scoping review of freely available training videos for suicide prevention and describes a methodological framework for reviewing such videos. Methods: A scoping review of freely available training videos (?2 minutes) for suicide prevention practices was conducted using 4 large video-sharing platforms: YouTube, Vimeo, Bing Video, and Google Video. Identified suicide prevention training videos (N=506) were reviewed and coded. Results: Most content was targeted toward gatekeepers or other lay providers (n=370) versus clinical providers (n=136). Videos most commonly provided content related to suicidal thoughts or behaviors (n=420). Many videos (n=274, 54.2%) included content designed for certain communities or organizations. Less than half (n=232, 45.8%) of training videos included formal clinical content pertaining to assessment or intervention for suicide prevention. Conclusions: Results suggested an abundance of videos providing broad informational content (eg, ?signs and symptoms of someone at risk for suicide?) and a limited portion of videos with instructional content aimed at clinical providers delivering formal evidence-based assessments or interventions for suicide prevention. Development of resources to address identified gaps may be needed. Future work may leverage machine learning techniques to expedite the review process. UR - https://mental.jmir.org/2023/1/e48404 UR - http://dx.doi.org/10.2196/48404 UR - http://www.ncbi.nlm.nih.gov/pubmed/37921847 ID - info:doi/10.2196/48404 ER - TY - JOUR AU - Cyranka, Katarzyna AU - Juza, Anna AU - Kwiendacz, Hanna AU - Nabrdalik, Katarzyna AU - Gumprecht, Janusz AU - Ma?ecki, Maciej AU - Klupa, Tomasz AU - Matejko, Bart?omiej PY - 2023/5/29 TI - Evaluation of Psychological Resources of Young Adults With Type 1 Diabetes Mellitus During the Transition From Pediatric to Adult Diabetes Clinics: Multicenter Cross-sectional Study JO - JMIR Form Res SP - e46513 VL - 7 KW - young adults KW - type 1 diabetes KW - transitioning care KW - psychological KW - diabetes KW - cross-sectional study KW - anxiety KW - socioeconomic KW - validation KW - anger KW - depression KW - outpatient KW - chronic disease KW - pediatric KW - adulthood KW - coping mechanism N2 - Background: The transition period of patients with type 1 diabetes from pediatric to adult-oriented health care is associated with poorer glycemic control and less frequent clinic attendance. Fears and anxiety about the unknown, care approach differences in adult settings, and sadness about leaving the pediatric provider all contribute to a patient?s reluctance to transition. Objective: This study aimed to evaluate the psychological parameters of young patients with type 1 diabetes transitioning to an adult outpatient clinic during the first visit. Methods: We examined 50 consecutive patients (n=28, 56% female) transitioning from March 2, 2021, to November 21, 2022, into adult care (3 diabetes centers from 3 regions in southern Poland: A, n=16; B, n=21; and C, n=13) and their basic demographic information. They completed the following psychological questionnaires: State-Trait Anxiety Inventory (STAI), Generalized Self-Efficacy Scale, Perceived Stress Scale, Satisfaction with Life Scale, Acceptance of Illness Scale, Multidimensional Health Locus of Control Scale Form C, Courtauld Emotional Control Scale, and Quality of Life Questionnaire Diabetes. We compared their data with those for the general healthy population and patients with diabetes from Polish Test Laboratory validation studies. Results: During the first adult outpatient visit, patients? mean age was 19.2 (SD 1.4) years, with a diabetes duration of 9.8 (SD 4.3) years and BMI of 23.5 (SD 3.1) kg/m2. Patients came from diverse socioeconomic backgrounds: 36% (n=18) live in villages, 26% (n=13) live in towns with ?100,000 inhabitants, and 38% (n=19) live in bigger cities. Regarding therapy type, 68% (n=34) were treated with insulin pump therapy, whereas 32% (n=16) were treated with multiple daily injections. Patients from center A had a mean glycated hemoglobin level of 7.5% (SD 1.2%). There was no difference regarding the level of life satisfaction, perceived level of stress, and state anxiety between the patients and reference populations. Patients had similar health locus of control and negative emotions control to the general population of patients with diabetes. Most patients (n=31, 62%) believe that control over their health depends on themselves, whereas 52% (n=26) believe that it depends mostly on others. Patients had higher levels of suppression of negative emotions?anger, depression, and anxiety?than the age-matched general population. Additionally, the patients were characterized by a higher acceptance of illness and higher level of self-efficacy compared to the reference populations: 64% (n=32) had a high level of self-efficacy and 26% (n=13) had a high level of life satisfaction. Conclusions: This study indicated that young patients transitioning to adult outpatient clinics have good psychological resources and coping mechanisms, which might result in adequate adaptation and adult life satisfaction including future metabolic control. These result also disprove the stereotypes that young people with chronic disease have worse life perspectives when entering adulthood. UR - https://formative.jmir.org/2023/1/e46513 UR - http://dx.doi.org/10.2196/46513 UR - http://www.ncbi.nlm.nih.gov/pubmed/37247225 ID - info:doi/10.2196/46513 ER - TY - JOUR AU - McGee-Vincent, Pearl AU - Mackintosh, Margaret-Anne AU - Jamison, L. Andrea AU - Juhasz, Katherine AU - Becket-Davenport, Colleen AU - Bosch, Jeane AU - Avery, J. Timothy AU - Glamb, Lauren AU - Hampole, Shilpa PY - 2023/1/12 TI - Training Staff Across the Veterans Affairs Health Care System to Use Mobile Mental Health Apps: A National Quality Improvement Project JO - JMIR Ment Health SP - e41773 VL - 10 KW - mental health KW - mobile apps KW - digital health KW - technology KW - veterans KW - training N2 - Background: The National Center for PTSD, within the Department of Veterans Affairs (VA), has developed a suite of free, publicly available, evidence-informed apps that can reach an increasing number of veterans and bridge gaps in care by providing resources to those who are not engaged in mental health treatment. To expand the reach of these apps, staff across VA service lines learned about these apps, their features and limitations, and how to introduce them to veterans. Objective: This study aimed to develop, disseminate, and evaluate a training for multidisciplinary staff as part of a national quality improvement project to increase the reach of mobile mental health apps as a resource for veterans. Methods: Sites from all of VA?s 18 geographic regions enrolled in this project. At each site, a minimum of 25 VA staff members who had direct contact with veterans, including staff from the mental health service line and all other service lines, were recruited to participate. Training included a 3-hour multidisciplinary core module, and a 1-hour clinical integration module designed specifically for mental health clinicians. Owing to the COVID-19 pandemic, the trainings were adapted to a live, web-based format. Pre- and posttraining surveys assessed program reach (ie, participants enrolled per site), satisfaction, and effectiveness of the training as measured by changes in knowledge, basic skills, and behavioral intentions to use apps with veterans. Results: A total of 1110 participants representing 34 disciplines at 19 VA sites completed the training. Overall, 67% (743/1109) of participants were mental health staff members. Sites averaged 58.4 participants (SD 36.49, median [IQR] 51). Most (961/1024, 93.85%) participants were satisfied with the training and reported that they (941/1018, 92.44%) would recommend it to others. App knowledge scores significantly increased from pretraining (mean 80.8% correct, SD 15.77%) to posttraining (mean 91.1% correct, SD 9.57%; P<.001). At posttraining, participants also reported greater confidence in their ability to show veterans how to download (z=?13.86; P<.001) and use VA mental health apps (z=?15.13; P<.001). There was near universal endorsement by staff for their intentions to recommend apps to veterans as well as their ability to think of at least one specific veteran to whom they could recommend an app. Staff also reported a strong motivation to encourage other VA staff to share apps with veterans. Conclusions: The training far exceeded the initial goals for staff recruitment and training for all three metrics. Overall, 33% (366/1109) of participants came from service lines outside of mental health, indicating the feasibility of introducing these mental health resources during medical appointments and in other contexts. UR - https://mental.jmir.org/2023/1/e41773 UR - http://dx.doi.org/10.2196/41773 UR - http://www.ncbi.nlm.nih.gov/pubmed/36633895 ID - info:doi/10.2196/41773 ER - TY - JOUR AU - Smith, Katharine AU - Torous, John AU - Cipriani, Andrea PY - 2022/10/14 TI - Teaching Telepsychiatry Skills: Building on the Lessons of the COVID-19 Pandemic to Enhance Mental Health Care in the Future JO - JMIR Ment Health SP - e37939 VL - 9 IS - 10 KW - mHealth KW - mental health KW - smartphones KW - telehealth KW - telepsychiatry KW - COVID-19 UR - https://mental.jmir.org/2022/10/e37939 UR - http://dx.doi.org/10.2196/37939 UR - http://www.ncbi.nlm.nih.gov/pubmed/35358948 ID - info:doi/10.2196/37939 ER - TY - JOUR AU - Mercadal Rotger, Josep AU - Cabré, Victor PY - 2022/5/2 TI - Therapeutic Alliance in Online and Face-to-face Psychological Treatment: Comparative Study JO - JMIR Ment Health SP - e36775 VL - 9 IS - 5 KW - online psychological intervention KW - therapeutic alliance KW - digital health KW - mental health KW - mental health education KW - mental health treatment KW - health interventions KW - health professional KW - online health KW - web-based health KW - intervention modality N2 - Background: Since the COVID-19 pandemic, the number of online mental health treatments have grown exponentially. Additionally, it seems inevitable that this technical resource is here to stay at health centers. However, there is still very little scholarly literature published on this topic, and therefore, the impact of the changes that have had to be dealt with in this regard has not been studied. Objective: This study aims to evaluate the differences in the establishment of the therapeutic alliance (TA) based on the intervention modality (online or face-to-face), the type of attachment, and diagnosis. Methods: A total of 291 subjects participated in the study, 149 (51.2%) of whom were men and 142 were (48.8%) women between the ages of 18 and 30 years. The instruments used were sociodemographic data, SOFTA-o (System for Observing Family Therapeutic Alliances?observational), and Relationship Questionnaire. Results: The results show that the treatments conducted face-to-face obtain significantly better scores in the creation of the TA than those conducted online (t=?42.045, df=289, P<.001). The same holds true with attachment, in that users with secure attachment show a better TA than those with insecure attachment (t=6.068, P<.001,), although there were no significant differences with the diagnosis (F=4.566, P=.44), age (r=0.02, P=.70), and sex (t=0.217, P=.33). Conclusions: We believe that professionals are not yet prepared to conduct remote treatment with a degree of efficacy similar to that of face-to-face. It is essential for professionals to receive training in this new technical resource and to understand and incorporate the variants it entails into their daily practice. UR - https://mental.jmir.org/2022/5/e36775 UR - http://dx.doi.org/10.2196/36775 UR - http://www.ncbi.nlm.nih.gov/pubmed/35499910 ID - info:doi/10.2196/36775 ER - TY - JOUR AU - Shin, Bokyoung AU - Oh, Jooyoung AU - Kim, Byung-Hoon AU - Kim, Erin Hesun AU - Kim, Hyunji AU - Kim, Suji AU - Kim, Jae-Jin PY - 2021/11/22 TI - Effectiveness of Self-Guided Virtual Reality?Based Cognitive Behavioral Therapy for Panic Disorder: Randomized Controlled Trial JO - JMIR Ment Health SP - e30590 VL - 8 IS - 11 KW - virtual reality KW - panic disorder KW - cognitive behavioral therapy KW - exposure therapy KW - intervention N2 - Background: Virtual reality (VR) is as effective a technique as traditional cognitive behavioral therapy (CBT) and a promising tool for treating panic disorder symptoms because VR exposure can be safer and has better acceptability than in vivo exposure and is more immersive than exposure through imagination. CBT techniques can be delivered more effectively using VR as well. So far, VR has required high-quality devices, but the development of mobile VR technology has improved user availability. At the same time, a well-structured form of VR can be reproduced and used anywhere. This means that VR can be used to provide a self-guided form of treatment and address the high treatment costs of evidence-based therapy and the lack of professional therapists. This study aimed to investigate the potential of self-guided VR as an alternative to high-cost treatment. Objective: The main goal of this study was to offer data about the efficacy of a mobile app-based self-led VR CBT in the treatment of panic disorder. Methods: A total of 54 subjects with panic disorder were enrolled in this study and randomly assigned to either the VR treatment group or waitlist group. The VR treatment was designed to be total 12 sessions for 4 weeks. The VR treatment consists of 4 steps in which patients are gradually exposed to phobic stimuli while learning to cope with panic symptoms in each stage. The effectiveness of treatment was assessed through the Panic Disorder Severity Scale, Hamilton Rating Scale for Depression, Body Sensations Questionnaire, Albany Panic and Phobia Questionnaire, Anxiety Sensitivity Index, State-Trait Anxiety Inventory, Hospital Anxiety and Depression Scale, Korean Inventory of Social Avoidance and Distress Scale, Korean Inventory of Depressive Symptomatology, and Perceived Stress Scale. In addition, physiological changes using heart rate variability were evaluated. Results: In within-group analyses, the VR treatment group exhibited improvements in panic disorder symptoms, anxiety, and depression after 4 weeks, while the waitlist group did not show any significant improvement. Compared to the waitlist group, the VR treatment group showed significantly greater improvements in the Panic Disorder Severity Scale in both completer analysis and intention-to-treat analysis. Heart rate variability in the VR treatment group showed improvement in normalized high frequency from baseline to postassessment with no significant differences in any outcome measure between groups. Conclusions: The self-guided, mobile app-based VR intervention was effective in the treatment of panic symptoms and restoring the autonomic nervous system demonstrating the validity of the use of VR for self-guided treatment. VR treatment can be a cost-effective therapeutic approach. Trial Registration: ClinicalTrials.gov NCT04985019; https://clinicaltrials.gov/ct2/show/NCT04985019 UR - https://mental.jmir.org/2021/11/e30590 UR - http://dx.doi.org/10.2196/30590 UR - http://www.ncbi.nlm.nih.gov/pubmed/34813486 ID - info:doi/10.2196/30590 ER - TY - JOUR AU - van der Windt, Melissa AU - Schoenmakers, Sam AU - Willemsen, Sten AU - van Rossem, Lenie AU - Steegers-Theunissen, Régine PY - 2021/9/3 TI - Optimizing the Periconception Lifestyle of Women With Overweight Using a Blended Personalized Care Intervention Combining eHealth and Face-to-face Counseling (eFUSE): Protocol for a Randomized Controlled Trial JO - JMIR Res Protoc SP - e28600 VL - 10 IS - 9 KW - eHealth KW - periconception period KW - lifestyle intervention KW - maternal and child health KW - pregnancy KW - birth outcomes KW - healthy lifestyle KW - psychotherapy KW - obesity KW - randomized controlled trial KW - behavior change N2 - Background: Maternal overweight has a substantial impact on reproductive, maternal, pregnancy, and neonatal outcomes with long-term and transgenerational health consequences. Interventions that aim to optimize periconception maternal lifestyle can improve maternal and fetal health during pregnancy and throughout the life course. However, it remains difficult to change and adopt adequate lifestyle behaviors. We hypothesize that additional psychological therapy targeting cognitive and affective factors substantially contribute to the effectiveness of these interventions. Objective: The proposed study aims to examine the feasibility and effectiveness of a blended personalized periconception lifestyle care intervention with additional psychological therapy aimed at women with a BMI?25 and who are contemplating pregnancy or are already pregnant (?12 weeks) in reducing inadequate lifestyle behaviors and improving early and late pregnancy outcome. Methods: The eHealth and Face-to-face Counseling (eFUSE) study follows a single-center two-arm randomized controlled trial design at the Erasmus MC, University Medical Center, with a multicenter regional referral. The female patients with overweight (BMI?25), together with their male partner, will be stratified by pregnancy status (preconception vs pregnant) and randomized to receive either the blended personalized periconception lifestyle care intervention with additional psychological therapy (n=313) or usual care (n=313). The primary outcome is a change in the lifestyle risk score (between baseline and 24 weeks) between the randomization arms (difference in differences). Secondary outcomes include measurements defined as most relevant by the International Consortium for Health Outcomes Measurement, including behavioral determinants, patient satisfaction, provider feasibility, and maternal pregnancy and neonatal complications. Results: The study will be open for recruitment from Fall 2021 onward. Data collection is expected to be completed by the beginning of 2023, and the results are expected to be published by Fall 2023. Conclusions: This study will evaluate the feasibility and effectiveness of a blended periconception lifestyle intervention with additional psychological therapy, aimed at women with a BMI?25. Positive results of this innovative care approach will be used for implementation in routine medical care of all women with overweight, with the ultimate aim to improve clinical outcomes of these high-risk pregnancies. Trial Registration: Netherlands Trial Register NL9264; https://www.trialregister.nl/trial/9264 International Registered Report Identifier (IRRID): PRR1-10.2196/28600 UR - https://www.researchprotocols.org/2021/9/e28600 UR - http://dx.doi.org/10.2196/28600 UR - http://www.ncbi.nlm.nih.gov/pubmed/34477561 ID - info:doi/10.2196/28600 ER - TY - JOUR AU - Dohnt, C. Henriette AU - Dowling, J. Mitchell AU - Davenport, A. Tracey AU - Lee, Grace AU - Cross, P. Shane AU - Scott, M. Elizabeth AU - Song, C. Yun Ju AU - Hamilton, Blake AU - Hockey, J. Samuel AU - Rohleder, Cathrin AU - LaMonica, M. Haley AU - Hickie, B. Ian PY - 2021/6/14 TI - Supporting Clinicians to Use Technology to Deliver Highly Personalized and Measurement-Based Mental Health Care to Young People: Protocol for an Evaluation Study JO - JMIR Res Protoc SP - e24697 VL - 10 IS - 6 KW - mental health service delivery KW - youth mental health KW - model of care coordination KW - transdiagnostic KW - health information technology KW - education KW - training KW - adoption into clinical practice KW - Kirkpatrick evaluation N2 - Background: Australia?s mental health care system has long been fragmented and under-resourced, with services falling well short of demand. In response, the World Economic Forum has recently called for the rapid deployment of smarter, digitally enhanced health services to facilitate effective care coordination and address issues of demand. The University of Sydney?s Brain and Mind Centre (BMC) has developed an innovative digital health solution that incorporates 2 components: a highly personalized and measurement-based (data-driven) model of youth mental health care and a health information technology (HIT) registered on the Australian Register of Therapeutic Goods. Importantly, research into implementation of such solutions considers education and training of clinicians to be essential to adoption and optimization of use in standard clinical practice. The BMC?s Youth Mental Health and Technology Program has subsequently developed a comprehensive education and training program to accompany implementation of the digital health solution. Objective: This paper describes the protocol for an evaluation study to assess the effectiveness of the education and training program on the adoption and optimization of use of the digital health solution in service delivery. It also describes the proposed tools to assess the impact of training on knowledge and skills of mental health clinicians. Methods: The evaluation study will use the Kirkpatrick Evaluation Model as a framework with 4 levels of analysis: Reaction (to education and training), Learning (knowledge acquired), Behavior (practice change), and Results (client outcomes). Quantitative and qualitative data will be collected using a variety of tools, including evaluation forms, pre- and postknowledge questionnaires, skill development and behavior change scales, as well as a real-time clinical practice audit. Results: This project is funded by philanthropic funding from Future Generation Global. Ethics approval has been granted via Sydney Local Health District?s Human Research Ethics Committee. At the time of this publication, clinicians and their services were being recruited to this study. The first results are expected to be submitted for publication in 2021. Conclusions: The education and training program teaches clinicians the necessary knowledge and skills to assess, monitor, and manage complex needs; mood and psychotic syndromes; and trajectories of youth mental ill-health using a HIT that facilitates a highly personalized and measurement-based model of care. The digital health solution may therefore guide clinicians to help young people recover low functioning associated with subthreshold diagnostic presentations and prevent progression to more serious mental ill-health. International Registered Report Identifier (IRRID): PRR1-10.2196/24697 UR - https://www.researchprotocols.org/2021/6/e24697 UR - http://dx.doi.org/10.2196/24697 UR - http://www.ncbi.nlm.nih.gov/pubmed/34125074 ID - info:doi/10.2196/24697 ER - TY - JOUR AU - Hilty, Donald AU - Chan, Steven AU - Torous, John AU - Luo, John AU - Boland, Robert PY - 2020/2/21 TI - A Framework for Competencies for the Use of Mobile Technologies in Psychiatry and Medicine: Scoping Review JO - JMIR Mhealth Uhealth SP - e12229 VL - 8 IS - 2 KW - apps KW - behavior KW - education KW - mobile KW - outcome KW - competency KW - technology KW - health KW - mobile phone KW - framework N2 - Background: To ensure quality care, clinicians need skills, knowledge, and attitudes related to technology that can be measured. Objective: This paper sought out competencies for mobile technologies and/or an approach to define them. Methods: A scoping review was conducted to answer the following research question, ?What skills are needed for clinicians and trainees to provide quality care via mHealth, have they been published, and how can they be made measurable and reproducible to teach and assess them?? The review was conducted in accordance with the 6-stage scoping review process starting with a keyword search in PubMed/Medical Literature Analysis and Retrieval System Online, APA PsycNET, Cochrane, EMBASE, PsycINFO, Web of Science, and Scopus. The literature search focused on keywords in 4 concept areas: (1) competencies, (2) mobile technologies, (3) telemedicine mode, and (4) health. Moreover, 2 authors independently, in parallel, screened the search results for potentially relevant studies based on titles and abstracts. The authors reviewed the full-text articles for final inclusion based on inclusion/exclusion criteria. Inclusion criteria were keywords used from concept area 1 (competencies) and 2 (mobile technologies) and either 3 (telemedicine mode) or 4 (health). Exclusion criteria included, but were not limited to, keywords used from a concept area in isolation, discussion of skills abstractly, outline or listing of what clinicians need without detail, and listing immeasurable behaviors. Results: From a total of 1232 results, the authors found 78 papers eligible for a full-text review and found 14 papers directly relevant to the 4 key concepts. Although few studies specifically discussed skills, the majority were clinical studies, and the literature included no lists of measurable behaviors or competency sets for mobile technology. Therefore, a framework for mobile technology competencies was built according to the review, expert consensus, and recommendations of the Institute of Medicine?s Health Professions Education Summit and Accreditation Council of Graduate Medical Education framework. This framework borrows from existing competency framework domains in telepsychiatry and social media (patient care, medical knowledge, practice-based learning and improvement, systems-based practice, professionalism, and interpersonal skills and communication) and added domains of mHealth clinical decision support, device/technology assessment/selection, and information flow management across an electronic health record platform. mHealth Asynchronous components require additional traditional learning, teaching, supervisory and evaluation practices. Interactive curricula with case-, problem-, and system-based teaching may help faculty focus on decision making and shape skills and attitudes to complement clinical exposure. Conclusions: Research is needed on how to customize implementation and evaluation of mHealth competencies and to ensure skill development is linked to the quality of care. This will require the management of organizational change with technology and the creation of a positive electronic culture in a complex policy and regulatory environment. UR - http://mhealth.jmir.org/2020/2/e12229/ UR - http://dx.doi.org/10.2196/12229 UR - http://www.ncbi.nlm.nih.gov/pubmed/32130153 ID - info:doi/10.2196/12229 ER - TY - JOUR AU - Muir, David Samuel AU - de Boer, Kathleen AU - Thomas, Neil AU - Seabrook, Elizabeth AU - Nedeljkovic, Maja AU - Meyer, Denny PY - 2020/1/21 TI - Videoconferencing Psychotherapy in the Public Sector: Synthesis and Model for Implementation JO - JMIR Ment Health SP - e14996 VL - 7 IS - 1 KW - implementation science KW - videoconferencing KW - psychotherapy KW - public sector KW - telemedicine KW - mental health N2 - Background: Videoconferencing psychotherapy (VCP) is a growing practice among mental health professionals. Early adopters have predominantly been in private practice settings, and more recent adoption has occurred in larger organizations, such as the military. The implementation of VCP into larger health service providers in the public sector is an important step in reaching and helping vulnerable and at-risk individuals; however, several additional implementation challenges exist for public sector organizations. Objective: The aim of this study was to offer an implementation model for effectively introducing VCP into public sector organizations. This model will also provide practical guidelines for planning and executing an embedded service trial to assess the effectiveness of the VCP modality once implemented. Methods: An iterative search strategy was employed, drawing on multiple fields of research across mental health, information technology, and organizational psychology. Previous VCP implementation papers were considered in detail to provide a synthesis of the barriers, facilitators, and lessons learned from the implementation attempts in the military and other public sector settings. Results: A model was formulated, which draws on change management for technology integration and considers the specific needs for VCP integration in larger organizations. A total of 6 phases were formulated and were further broken down into practical and measurable steps. The model explicitly considers the barriers often encountered in large organizational settings and suggests steps to increase facilitating factors. Conclusions: Although the model proposed is time and resource intensive, it draws on a comprehensive understanding of larger organizational needs and the unique challenge that the introduction of VCP presents to such organizations. UR - https://mental.jmir.org/2020/1/e14996 UR - http://dx.doi.org/10.2196/14996 UR - http://www.ncbi.nlm.nih.gov/pubmed/31961334 ID - info:doi/10.2196/14996 ER - TY - JOUR AU - Tanana, J. Michael AU - Soma, S. Christina AU - Srikumar, Vivek AU - Atkins, C. David AU - Imel, E. Zac PY - 2019/07/15 TI - Development and Evaluation of ClientBot: Patient-Like Conversational Agent to Train Basic Counseling Skills JO - J Med Internet Res SP - e12529 VL - 21 IS - 7 KW - psychotherapy training KW - interactive learning KW - conversational agents KW - deep learning N2 - Background: Training therapists is both expensive and time-consuming. Degree?based training can require tens of thousands of dollars and hundreds of hours of expert instruction. Counseling skills practice often involves role-plays, standardized patients, or practice with real clients. Performance?based feedback is critical for skill development and expertise, but trainee therapists often receive minimal and subjective feedback, which is distal to their skill practice. Objective: In this study, we developed and evaluated a patient-like neural conversational agent, which provides real-time feedback to trainees via chat?based interaction. Methods: The text?based conversational agent was trained on an archive of 2354 psychotherapy transcripts and provided specific feedback on the use of basic interviewing and counseling skills (ie, open questions and reflections?summary statements of what a client has said). A total of 151 nontherapists were randomized to either (1) immediate feedback on their use of open questions and reflections during practice session with ClientBot or (2) initial education and encouragement on the skills. Results: Participants in the ClientBot condition used 91% (21.4/11.2) more reflections during practice with feedback (P<.001) and 76% (14.1/8) more reflections after feedback was removed (P<.001) relative to the control group. The treatment group used more open questions during training but not after feedback was removed, suggesting that certain skills may not improve with performance?based feedback. Finally, after feedback was removed, the ClientBot group used 31% (32.5/24.7) more listening skills overall (P<.001). Conclusions: This proof-of-concept study demonstrates that practice and feedback can improve trainee use of basic counseling skills. UR - https://www.jmir.org/2019/7/e12529/ UR - http://dx.doi.org/10.2196/12529 UR - http://www.ncbi.nlm.nih.gov/pubmed/31309929 ID - info:doi/10.2196/12529 ER - TY - JOUR AU - Thew, R. Graham AU - Powell, LYM Candice AU - Kwok, PL Amy AU - Lissillour Chan, H. Mandy AU - Wild, Jennifer AU - Warnock-Parkes, Emma AU - Leung, WL Patrick AU - Clark, M. David PY - 2019/05/15 TI - Internet-Based Cognitive Therapy for Social Anxiety Disorder in Hong Kong: Therapist Training and Dissemination Case Series JO - JMIR Form Res SP - e13446 VL - 3 IS - 2 KW - anxiety KW - social phobia KW - internet KW - cognitive therapy KW - clinical competence KW - cross-cultural comparison KW - Hong Kong KW - benchmarking KW - psychology, clinical KW - mental health N2 - Background: Guided internet-based psychological interventions show substantial promise for expanding access to evidence-based mental health care. However, this can only be achieved if results of tightly controlled studies from the treatment developers can also be achieved in other independent settings. This dissemination depends critically on developing efficient and effective ways to train professionals to deliver these interventions. Unfortunately, descriptions of therapist training and its evaluation are often limited or absent within dissemination studies. Objective: This study aimed to describe and evaluate a program of therapist training to deliver internet-based Cognitive Therapy for social anxiety disorder (iCT-SAD). As this treatment was developed in the United Kingdom and this study was conducted in Hong Kong with local therapists, an additional objective was to examine the feasibility, acceptability, and initial efficacy of iCT-SAD in this cultural context, based on data from a pilot case series. Methods: Training in iCT-SAD was provided to 3 therapists and included practice of the face-to-face format of therapy under clinical supervision, training workshops, and treating 6 patients with the iCT-SAD program. Training progress was evaluated using standardized and self-report measures and by reviewing patient outcomes. In addition, feedback from patients and therapists was sought regarding the feasibility and acceptability of the program. Results: The training program was effective at increasing therapists? iCT-SAD knowledge and skills, resulting in levels of competence expected of a specialist Cognitive Behavioral Therapy practitioner. The 6 patients treated by the trainees all completed their treatment and achieved a mean pre- to posttreatment change of 53.8 points (SD 39.5) on the primary patient outcome measure, the Liebowitz Social Anxiety Scale. The within-group effect size (Cohen d) was 2.06 (95% CI 0.66-3.46). There was evidence to suggest that the patients? clinical outcomes were sustained at 3-month follow-up. These clinical results are comparable to those achieved by UK patients treated by the developers of the internet program. Patient and therapist feedback did not identify any major cultural barriers to implementing iCT-SAD in Hong Kong; some modest language suggestions were made to assist understanding. Conclusions: The therapist training implemented here facilitated the successful dissemination of an effective UK-developed internet intervention to Hong Kong. The treatment appeared feasible and acceptable in this setting and showed highly promising initial efficacy. A randomized controlled trial is now required to examine this more robustly. As therapist training is critical to the successful dissemination of internet interventions, further research to develop, describe, and evaluate therapist training procedures is recommended. UR - http://formative.jmir.org/2019/2/e13446/ UR - http://dx.doi.org/10.2196/13446 UR - http://www.ncbi.nlm.nih.gov/pubmed/31094320 ID - info:doi/10.2196/13446 ER - TY - JOUR AU - Lukaschek, Karoline AU - Schneider, Nico AU - Schelle, Mercedes AU - Kirk, Bak Ulrik AU - Eriksson, Tina AU - Kunnamo, Ilkka AU - Rochfort, Andrée AU - Collins, Claire AU - Gensichen, Jochen PY - 2019/04/29 TI - Applicability of Motivational Interviewing for Chronic Disease Management in Primary Care Following a Web-Based E-Learning Course: Cross-Sectional Study JO - JMIR Ment Health SP - e12540 VL - 6 IS - 4 KW - motivational interviewing KW - e-learning KW - web-based learning KW - primary care KW - health behavior change KW - disease management N2 - Background: Motivational interviewing (MI) is an established communication method for enhancing intrinsic motivation for changing health behavior. E-learning can reduce the cost and time involved in providing continuing education and can be easily integrated into individual working arrangements and the daily routines of medical professionals. Thus, a Web-based course was devised to familiarize health professionals with different levels of education and expertise with MI techniques for patients with chronic conditions. Objective: The aim of this study was to report participants? opinion on the practicality of MI (as learned in the course) in daily practice, stratified by the level of education. Methods: Participants (N=607) of the MI Web-based training course evaluated the course over 18 months, using a self-administered questionnaire. The evaluation was analyzed descriptively and stratified for the level of education (medical students, physicians in specialist training [PSTs], and general practitioners [GPs]). Results: Participants rated the applicability of the skills and knowledge gained by the course as positive (medical students: 94% [79/84] good; PSTs: 88.6% [109/123] excellent; and GPs: 51.3% [182/355] excellent). When asked whether they envisage the use of MI in the future, 79% (67/84) of the students stated to a certain extent, 88.6% (109/123) of the PSTs stated to a great extent, and 38.6% (137/355) of GPs stated to a great extent. Participants acknowledged an improvement of communication skills such as inviting (medical students: 85% [72/84]; PSTs: 90.2% [111/123]; GPs: 37.2% [132/355]) and encouraging (medical students: 81% [68/84]; PSTs: 45.5% [56/123]; GPs: 36.3% [129/355]) patients to talk about behavior change and conveying respect for patient?s choices (medical students: 72% [61/84]; PSTs: 50.0% [61/123]; GPs: 23.4% [83/355]). Conclusions: Participants confirmed the practicality of MI. However, the extent to which the practicality of MI was acknowledged as well as its expected benefits depended on the individual?s level of education/expertise. UR - http://mental.jmir.org/2019/4/e12540/ UR - http://dx.doi.org/10.2196/12540 UR - http://www.ncbi.nlm.nih.gov/pubmed/31033446 ID - info:doi/10.2196/12540 ER - TY - JOUR AU - Zaheer, Salaha AU - Garofalo, Vanessa AU - Rodie, David AU - Perivolaris, Athina AU - Chum, Jenny AU - Crawford, Allison AU - Geist, Rose AU - Levinson, Andrea AU - Mitchell, Brian AU - Oslin, David AU - Sunderji, Nadiya AU - Mulsant, H. Benoit AU - PY - 2018/12/10 TI - Computer-Aided Telephone Support for Primary Care Patients with Common Mental Health Conditions: Randomized Controlled Trial JO - JMIR Ment Health SP - e10224 VL - 5 IS - 4 KW - telemedicine KW - collaborative care KW - depression KW - anxiety KW - at-risk drinking KW - lay provider KW - family medicine KW - general practice KW - primary care psychiatry N2 - Background: Depression, anxiety, and at-risk drinking are highly prevalent in primary care settings. Many jurisdictions experience geographical barriers to accessing mental health services, necessitating the development and validation of alternative models of care delivery. Existing evidence supports the acceptability and effectiveness of providing mental health care by telephone. Objective: This analysis assesses patient?s acceptability of computer-aided telephone support delivered by lay providers to primary care patients with depression, anxiety, or at-risk drinking. Methods: The Primary care Assessment and Research of a Telephone intervention for Neuropsychiatric conditions with Education and Resources study is a randomized controlled trial comparing a computer-aided telephone-based intervention to usual care enhanced by periodic assessments in adult primary care patients referred for the treatment of depression, anxiety, or at-risk drinking; no part of the study involves in-person contact. For this analysis, the following data were obtained: reasons provided for declining consent; reasons provided for withdrawing from the study; study retention rate; and a thematic analysis of a satisfaction survey upon study completion. Results: During the consent process, 17.1% (114/667) patients referred to the study declined to participate and 57.0% of them (65/114) attributed their refusal to research-related factors (ie, randomization and time commitment); a further 16.7% (19/114) declined owing to the telephone delivery of the intervention. Among the 377 participants who were randomized to the 1-year intervention, the overall retention rate was 82.8% (312/377). Almost no participants who withdrew from the study identified the telephone components of the study as their reason for withdrawal. Analysis of a qualitative satisfaction survey revealed that 97% (38/39) of comments related to the telephone components were positive with key reported positive attributes being accessibility, convenience, and privacy. Conclusions: Our results suggest that a computer-aided telephone support is highly acceptable to primary care patients with depression, anxiety, or at-risk drinking. In particular, these patients appreciate its accessibility, flexibility, and privacy. Trial Registration: ClinicalTrials.gov NCT02345122; https://clinicaltrials.gov/ct2/show/NCT02345122 (Archived by WebCite at http://www.webcitation.org/73R9Q2cle) UR - http://mental.jmir.org/2018/4/e10224/ UR - http://dx.doi.org/10.2196/10224 UR - http://www.ncbi.nlm.nih.gov/pubmed/30530461 ID - info:doi/10.2196/10224 ER - TY - JOUR AU - Abraham, H. Traci AU - Marchant-Miros, Kathy AU - McCarther, B. Michael AU - Craske, G. Michelle AU - Curran, M. Geoffrey AU - Kearney, K. Lisa AU - Greene, Carolyn AU - Lindsay, A. Jan AU - Cucciare, A. Michael PY - 2018/08/22 TI - Adapting Coordinated Anxiety Learning and Management for Veterans Affairs Community-Based Outpatient Clinics: Iterative Approach JO - JMIR Ment Health SP - e10277 VL - 5 IS - 3 KW - therapy KW - veterans KW - depression KW - anxiety disorders KW - posttraumatic stress disorder KW - PTSD N2 - Background: A national priority at the US Department of Veterans Affairs (VA) is to increase the availability and accessibility of evidence-based psychotherapies (EBPs) across all VA medical facilities. Yet many veterans, particularly those who use remote outpatient VA clinics, still do not receive much needed evidence-based treatment. Strategies are needed for supporting mental health providers at rural VA community-based outpatient clinics (CBOCs) as they translate their clinical training to routine practice. The Coordinated Anxiety Learning Management (CALM) program is a computer-delivered program that supports the delivery of cognitive behavioral therapy (CBT) by providers in outpatient settings to patients with depression and anxiety, including posttraumatic stress disorder. Objective: The objectives of our study were to (1) adapt an existing computer-based program to rural VA CBOCs through feedback from key stakeholder focus groups; (2) develop a prototype of the adapted program; and (3) determine the adapted program?s acceptability and feasibility. Mental health stakeholders included VA leaders (n=4) in the implementation of EBPs, VA experts (n=4) in CBT, VA CBOC mental health providers (n=8), and veterans (n=8) diagnosed with a mental health condition treated using the CALM program and receiving treatment in a VA CBOC. Methods: An iterative approach comprising 3 waves of focus group discussions was used to develop a modified prototype of CALM. Following each wave of focus group discussions, template analysis was used to rapidly communicate stakeholder recommendations and feedback to the design team. The original program was first adapted through a process of data collection, design modification, and product development. Next, a prototype was developed. Finally, the redesigned program was tested for acceptability and feasibility through a live demonstration. Results: Key stakeholders suggested modifications to the original CALM program that altered its modules? appearance by incorporating veteran-centric content. These modifications likely have no impact on the integrity of the original CALM program, but have altered its content to reflect better the demographic characteristics and experiences of rural veterans. Feedback from stakeholder groups indicates that changes will help VA patients identify with the program content, potentially enhancing their treatment engagement. Conclusions: The development model was effective for economically gathering actionable recommendations from stakeholders to adapt a computer-based program, and it can result in the development of an acceptable and feasible computer-delivered intervention. Results have implications for developing computer-based programs targeting behavior change more broadly and enhancing engagement in EBP. UR - http://mental.jmir.org/2018/3/e10277/ UR - http://dx.doi.org/10.2196/10277 UR - http://www.ncbi.nlm.nih.gov/pubmed/30135051 ID - info:doi/10.2196/10277 ER - TY - JOUR AU - Gayed, Aimée AU - LaMontagne, D. Anthony AU - Milner, Allison AU - Deady, Mark AU - Calvo, A. Rafael AU - Christensen, Helen AU - Mykletun, Arnstein AU - Glozier, Nick AU - Harvey, B. Samuel PY - 2018/07/03 TI - A New Online Mental Health Training Program for Workplace Managers: Pre-Post Pilot Study Assessing Feasibility, Usability, and Possible Effectiveness JO - JMIR Ment Health SP - e10517 VL - 5 IS - 3 KW - manager; supervisor training; workplace mental health; mental health education; online intervention; knowledge; attitudes; behaviour; eHealth N2 - Background: Mental health has become the leading cause of sickness absence in high-income countries. Managers can play an important role in establishing mentally healthy workplaces and coordinating their organization?s response to a mentally ill worker. Objective: This pilot study aims to evaluate the feasibility, usability, and likely effectiveness of a newly developed online training program for managers called HeadCoach. HeadCoach aims to build managers? confidence in supporting the mental health needs of staff and promote managerial behavior most likely to result in a more mentally healthy workplace. Methods: In total, 66 managers from two organizations were invited to participate in this pre-post pilot study of HeadCoach, which was made available to managers to complete at their own pace over a 4-week period. Data were collected at baseline and post intervention via an online research platform. The difference in mean scores for each outcome between these two time points was calculated using paired samples t tests. Results: Of all the invited managers, 59.1% (39/66) participated in the trial, with complete pre?post data available for 56.4% (22/39) of the participants. The majority of respondents reported positive engagement with the program. During the study period, managers? knowledge regarding their role in managing mental health issues (P=.01) and their confidence in communicating with employees regarding mental illness (P<.001) significantly increased. In addition, a significant increase was observed from the baseline in managers? self-reported actions to use strategies to prevent and decrease stress among their team members (P=.02). Conclusions: Although caution is needed due to the absence of a control group, preliminary results of this study suggest that HeadCoach could be a feasible, acceptable, and efficient method of training managers in best workplace practices to help support the mental health needs of their staff. UR - http://mental.jmir.org/2018/3/e10517/ UR - http://dx.doi.org/10.2196/10517 UR - http://www.ncbi.nlm.nih.gov/pubmed/29970359 ID - info:doi/10.2196/10517 ER - TY - JOUR AU - O'Connor, Marianne AU - Morgan, E. Katy AU - Bailey-Straebler, Suzanne AU - Fairburn, G. Christopher AU - Cooper, Zafra PY - 2018/06/08 TI - Increasing the Availability of Psychological Treatments: A Multinational Study of a Scalable Method for Training Therapists JO - J Med Internet Res SP - e10386 VL - 20 IS - 6 KW - internet KW - web-centered KW - eating disorders KW - cognitive therapy KW - effective treatment N2 - Background: One of the major barriers to the dissemination and implementation of psychological treatments is the scarcity of suitably trained therapists. A highly scalable form of Web-centered therapist training, undertaken without external support, has recently been shown to have promise in promoting therapist competence. Objective: The aim of this study was to conduct an evaluation of the acceptability and effectiveness of a scalable independent form of Web-centered training in a multinational sample of therapists and investigate the characteristics of those most likely to benefit. Methods: A cohort of eligible therapists was recruited internationally and offered access to Web-centered training in enhanced cognitive behavioral therapy, a multicomponent, evidence-based, psychological treatment for any form of eating disorder. No external support was provided during training. Therapist competence was assessed using a validated competence measure before training and after 20 weeks. Results: A total of 806 therapists from 33 different countries expressed interest in the study, and 765 (94.9%) completed a pretraining assessment. The median number of training modules completed was 15 out of a possible 18 (interquartile range, IQR: 4-18), and 87.9% (531/604) reported that they treated at least one patient during training as recommended. Median pretraining competence score was 7 (IQR: 5-10, range: 0-19; N=765), and following training, it was 12 (IQR: 9-15, range: 0-20; N=577). The expected change in competence scores from pretraining to posttraining was 3.5 (95% CI 3.1-3.8; P<.001). After training, 52% (300/574) of therapists with complete competence data met or exceeded the competence threshold, and 45% (95% CI 41-50) of those who had not met this threshold before training did so after training. Compliance with training predicted both an increase in competence scores and meeting or exceeding the competence threshold. Expected change in competence score increased for each extra training module completed (0.19, 95% CI 0.13-0.25), and those who treated a suitable patient during training had an expected change in competence score 1.2 (95% CI 0.4-2.1) points higher than those who did not. Similarly, there was an association between meeting the competence threshold after training and the number of modules completed (odds ratio, OR=1.11, 95% CI 1.07-1.15), and treating at least one patient during training was associated with competence after training (OR=2.2, 95% CI 1.2-4.1). Conclusions: Independent Web-centered training can successfully train large numbers of therapists dispersed across a wide geographical area. This finding is of importance because the availability of a highly scalable method of training potentially increases the number of people who might receive effective psychological treatments. UR - http://www.jmir.org/2018/6/e10386/ UR - http://dx.doi.org/10.2196/10386 UR - http://www.ncbi.nlm.nih.gov/pubmed/29884606 ID - info:doi/10.2196/10386 ER - TY - JOUR AU - Cooper, Zafra AU - Doll, Helen AU - Bailey-Straebler, Suzanne AU - Bohn, Kristin AU - de Vries, Dian AU - Murphy, Rebecca AU - O'Connor, E. Marianne AU - Fairburn, G. Christopher PY - 2017/10/31 TI - Assessing Therapist Competence: Development of a Performance-Based Measure and Its Comparison With a Web-Based Measure JO - JMIR Ment Health SP - e51 VL - 4 IS - 4 KW - therapist competence KW - Web-based knowledge assessment KW - skill assessment KW - therapist training outcome KW - scalable assessment KW - eating disorders KW - cognitive-behavioral treatment N2 - Background: Recent research interest in how best to train therapists to deliver psychological treatments has highlighted the need for rigorous, but scalable, means of measuring therapist competence. There are at least two components involved in assessing therapist competence: the assessment of their knowledge of the treatment concerned, including how and when to use its strategies and procedures, and an evaluation of their ability to apply such knowledge skillfully in practice. While the assessment of therapists? knowledge has the potential to be completed efficiently on the Web, the assessment of skill has generally involved a labor-intensive process carried out by clinicians, and as such, may not be suitable for assessing training outcome in certain circumstances. Objectives: The aims of this study were to develop and evaluate a role-play?based measure of skill suitable for assessing training outcome and to compare its performance with a highly scalable Web-based measure of applied knowledge. Methods: Using enhanced cognitive behavioral therapy (CBT-E) for eating disorders as an exemplar, clinical scenarios for role-play assessment were developed and piloted together with a rating scheme for assessing trainee therapists? performance. These scenarios were evaluated by examining the performance of 93 therapists from different professional backgrounds and at different levels of training in implementing CBT-E. These therapists also completed a previously developed Web-based measure of applied knowledge, and the ability of the Web-based measure to efficiently predict competence on the role-play measure was investigated. Results: The role-play measure assessed performance at implementing a range of CBT-E procedures. The majority of the therapists rated their performance as moderately or closely resembling their usual clinical performance. Trained raters were able to achieve good-to-excellent reliability for averaged competence, with intraclass correlation coefficients ranging from .653 to 909. The measure was also sensitive to change, with scores being significantly higher after training than before as might be expected (mean difference 0.758, P<.001) even when taking account of repeated data (mean difference 0.667, P<.001). The major shortcoming of the role-play measure was that it required considerable time and resources. This shortcoming is inherent in the method. Given this, of most interest for assessing training outcome, scores on the Web-based measure efficiently predicted therapist competence, as judged by the role-play measure (with the Web-based measure having a positive predictive value of 77% and specificity of 78%). Conclusions: The results of this study suggest that while it was feasible and acceptable to assess performance using the newly developed role-play measure, the highly scalable Web-based measure could be used in certain circumstances as a substitute for the more labor-intensive, and hence, more costly role-play method. UR - http://mental.jmir.org/2017/4/e51/ UR - http://dx.doi.org/10.2196/mental.7704 UR - http://www.ncbi.nlm.nih.gov/pubmed/29089289 ID - info:doi/10.2196/mental.7704 ER - TY - JOUR AU - Cooper, Zafra AU - Bailey-Straebler, Suzanne AU - Morgan, E. Katy AU - O'Connor, E. Marianne AU - Caddy, Caroline AU - Hamadi, Layla AU - Fairburn, G. Christopher PY - 2017/10/18 TI - Using the Internet to Train Therapists: Randomized Comparison of Two Scalable Methods JO - J Med Internet Res SP - e355 VL - 19 IS - 10 KW - psychotherapy KW - training KW - Internet KW - eating disorders KW - cognitive therapy N2 - Background: One of the major barriers to the dissemination and implementation of psychological treatments is the scarcity of suitably trained therapists. The currently accepted method of training is not scalable. Recently, a scalable form of training, Web-centered training, has been shown to have promise. Objective: The goal of our research was to conduct a randomized comparison of the relative effects of independent and supported Web-centered training on therapist competence and investigate the persistence of the effects. Methods: Eligible therapists were recruited from across the United States and Canada. They were randomly assigned to 1 of 2 forms of training in enhanced cognitive behavior therapy (CBT-E), a multicomponent evidence-based psychological treatment for any form of eating disorder. Independent training was undertaken autonomously, while supported training was accompanied by support from a nonspecialist worker. Therapist competence was assessed using a validated competence measure before training, after 20 weeks of training, and 6 months after the completion of training. Results: A total of 160 therapists expressed interest in the study, and 156 (97.5%) were randomized to the 2 forms of training (81 to supported training and 75 to independent training). Mixed effects analysis showed an increase in competence scores in both groups. There was no difference between the 2 forms of training, with mean difference for the supported versus independent group being ?0.06 (95% Cl ?1.29 to 1.16, P=.92). A total of 58 participants (58/114, 50.9%) scored above the competence threshold; three-quarters (43/58, 74%) had not met this threshold before training. There was no difference between the 2 groups in the odds of scoring over the competence threshold (odds ratio [OR] 1.02, 95% CI 0.52 to 1.99; P=.96). At follow-up, there was no significant difference between the 2 training groups (mean difference 0.19, 95% Cl ?1.27 to 1.66, P=.80). Overall, change in competence score from end of training to follow-up was not significant (mean difference ?0.70, 95% CI ?1.52 to 0.11, P=.09). There was also no difference at follow-up between the training groups in the odds of scoring over the competence threshold (OR 0.95, 95% Cl 0.34 to 2.62; P=.92). Conclusions: Web-centered training was equally effective whether undertaken independently or accompanied by support, and its effects were sustained. The independent form of Web-centered training is particularly attractive as it provides a means of training large numbers of geographically dispersed therapists at low cost, thereby overcoming several obstacles to the widespread dissemination of psychological treatments. UR - http://www.jmir.org/2017/10/e355/ UR - http://dx.doi.org/10.2196/jmir.8336 UR - http://www.ncbi.nlm.nih.gov/pubmed/29046265 ID - info:doi/10.2196/jmir.8336 ER - TY - JOUR AU - Fairburn, G. Christopher AU - Allen, Elizabeth AU - Bailey-Straebler, Suzanne AU - O'Connor, E. Marianne AU - Cooper, Zafra PY - 2017/06/16 TI - Scaling Up Psychological Treatments: A Countrywide Test of the Online Training of Therapists JO - J Med Internet Res SP - e214 VL - 19 IS - 6 KW - psychotherapy KW - training KW - dissemination KW - Internet KW - eating disorders KW - cognitive behavior therapy N2 - Background: A major barrier to the widespread dissemination of psychological treatments is the way that therapists are trained. The current method is not scalable. Objective: Our objective was to conduct a proof-of-concept study of Web-centered training, a scalable online method for training therapists. Methods: The Irish Health Service Executive identified mental health professionals across the country whom it wanted to be trained in a specific psychological treatment for eating disorders. These therapists were given access to a Web-centered training program in transdiagnostic cognitive behavior therapy for eating disorders. The training was accompanied by a scalable form of support consisting of brief encouraging telephone calls from a nonspecialist. The trainee therapists completed a validated measure of therapist competence before and after the training. Results: Of 102 therapists who embarked upon the training program, 86 (84.3%) completed it. There was a substantial increase in their competence scores following the training (mean difference 5.84, 95% Cl ?6.62 to ?5.05; P<.001) with 42.5% (34/80) scoring above a predetermined cut-point indicative of a good level of competence. Conclusions: Web-centered training proved feasible and acceptable and resulted in a marked increase in therapist competence scores. If these findings are replicated, Web-centered training would provide a means of simultaneously training large numbers of geographically dispersed trainees at low cost, thereby overcoming a major obstacle to the widespread dissemination of psychological treatments. UR - http://www.jmir.org/2017/6/e214/ UR - http://dx.doi.org/10.2196/jmir.7864 UR - http://www.ncbi.nlm.nih.gov/pubmed/28623184 ID - info:doi/10.2196/jmir.7864 ER - TY - JOUR AU - Zhang, WB Melvyn AU - Cheok, CS Christopher AU - Ho, CM Roger PY - 2015/06/08 TI - Global Outreach of a Locally-Developed Mobile Phone App for Undergraduate Psychiatry Education JO - JMIR Medical Education SP - e3 VL - 1 IS - 1 KW - psychiatry KW - education KW - eLearning KW - mobile phone apps KW - mobile phones KW - feasibility KW - proof of concept N2 - Background: Over the past decade, there have been massive developments in both Web-based and mobile phone technologies. Mobile phones are well accepted by students, trainees, and doctors. A review of the current literature has identified the following specialties that have used mobile phones in education: pediatrics, ophthalmology, nephrology, plastic surgery, orthopedics, pharmacology, and urology. However, to date, there are no published papers examining the application of the latest mobile phone technologies for psychiatry education internationally. Objectives: The main objectives of this study are (1) to determine the feasibility and receptiveness of a locally-developed psychiatry mobile phone app and user perspectives (both quantitative and qualitative) towards it, and (2) to determine the receptiveness of a locally-developed app for psychiatry education internationally. Methods: A Web-based app that contained textbook contents, videos, and quizzes was developed using HTML5 technologies in 2012. Native apps were subsequently developed in 2013. Information about the apps was disseminated locally to Singaporean medical students, but the respective native apps were made available on the app stores. A user perspective survey was conducted locally to determine student?s perception of the app. Results: From the inception of the app until the time of preparation of this manuscript, there have been a cumulative total of 28,500 unique visits of the responsive HTML5 Web-based mobile phone app. There have been a cumulative total of 2200 downloads of the Mastering Psychiatry app from the Apple app store and 7000 downloads of the same app from the Android app store. The initial user perspective survey conducted locally highlighted that approximately a total of 95.2% (177/186) of students felt that having a psychiatry mobile phone app was deemed to be useful. Further chi-squared analysis demonstrated that there was a significant difference between males and females in their perception of having textbook contents in the mobile phone app (?24=12.9, P=.0012). Conclusions: To the best of our knowledge, this is the first study to demonstrate the feasibility and global acceptance of a local, self-designed educational app for psychiatry education. Whilst the current research has managed to demonstrate the feasibility and acceptance of such an app, future studies would be warranted to look, in-depth, into whether there are cultural differences in terms of perceptions towards having such an app in psychiatry and what contents different cultures and cohorts of students might want within an app. UR - https://medinform.jmir.org/2015/1/e3/ UR - http://dx.doi.org/10.2196/mededu.4179 UR - http://www.ncbi.nlm.nih.gov/pubmed/27731838 ID - info:doi/10.2196/mededu.4179 ER - TY - JOUR AU - Pantziaras, Ioannis AU - Fors, Uno AU - Ekblad, Solvig PY - 2015/02/16 TI - Training With Virtual Patients in Transcultural Psychiatry: Do the Learners Actually Learn? JO - J Med Internet Res SP - e46 VL - 17 IS - 2 KW - mental health KW - transcultural psychiatry KW - virtual systems KW - PTSD KW - medical informatics KW - education KW - patient simulation N2 - Background: The rapid increase in the number of patients with diverse ethnic backgrounds and previous exposure to severe mental trauma dictates the need for improvement in the quality of transcultural psychiatric health care through the development of relevant and effective training tools. Objective: This study aimed to evaluate the impact of training with a virtual patient on the learner?s knowledge of posttraumatic stress disorder symptoms, clinical management, and basic communication skills. Methods: The authors constructed an interactive educational tool based on virtual patient methodology that portrayed a refugee with severe symptoms of posttraumatic stress disorder and depression. A total of 32 resident psychiatrists tested the tool and completed a pre-interaction and post-interaction knowledge test, including skills, at the time and several weeks later. Results: All of the participants (N=32) completed the pre-interaction and post-interaction test, and 26 (81%) of them completed the online follow-up test. The mean pre-interaction score was 7.44 (male: 7.08, female: 7.65, no statistical significance). The mean post-interaction score was 8.47, which was significantly higher (P<.001) than the pre-interaction score (mean score 7.44). The mean score for the follow-up test several weeks later was 8.38, higher than the pre-interaction score by 0.69 points but not statistically significant. Conclusions: Our results suggest that virtual patients can successfully facilitate the acquisition of core knowledge in the field of psychiatry, in addition to developing skills such as clinical reasoning, decision making, and history taking. Repeated training sessions with virtual patients are proposed in order to achieve sustainable educational effects. UR - http://www.jmir.org/2015/2/e46/ UR - http://dx.doi.org/10.2196/jmir.3497 UR - http://www.ncbi.nlm.nih.gov/pubmed/25689716 ID - info:doi/10.2196/jmir.3497 ER -