A Randomized Clinical Trial to Assess the Efficacy of Online-Treatment with Trial-Based Cognitive Therapy, Mindfulness-Based Health Promotion and Positive Psychotherapy for Post-Traumatic Stress Disorder during the COVID-19 Pandemic: A Study Protocol

Background: Research suggests the use of different forms of therapy as a way of decreasing dropout rates in the treatment of post-traumatic stress disorder (PTSD). The psychotherapies to be assessed in this study are trial-based cognitive therapy (TBCT), mindfulness-based health promotion (MBHP) and positive psychotherapy (PPT). Objectives: (1) to assess the online efficacy of TBCT compared to MBHP and PPT to reduce the symptoms of PTSD in the context of the Coronavirus Disease 2019 (COVID-19) pandemic; (2) to compare the efficacy of these psychotherapies in improving anxiety, depression, guilt and in promoting well-being; and (3) to describe how professionals perceive online treatment. Methods: A randomized, multicenter, single-blind clinical trial will be conducted, with three separate arms. An estimated sample of 135 patients will receive either TBCT, MBHP or PPT and will be treated through online, individual, weekly visits, totaling 14 sessions. The primary outcome will be CAPS-5 and secondary outcomes will be HADS and WHO-5. The variables used to mediate these outcomes will be the Trauma-Related Guilt Inventory (TRGI), Negative Core Beliefs Inventory (NCBI) and the California Psychotherapy Alliance Scale (CALPAS-P). Expected results: PTSD symptoms are expected to be reduced after TBCT, MBHP and PPT. No statistical difference is expected to be found among the three. Discussion: The present study will evaluate and contribute towards the development of new psychotherapeutic options for patients with PTSD. The results of this study will allow the dissemination of new effective and adaptable interventions for patients with PTSD.

Some issues I have encountered on my path to becoming a psychoanalyst

The author describes her personal journey in training and as a therapist. She explores the area of cultural difference and decides that the main cultural difference between now and her previous life is the advent of the new language of psycho-analysis. She explores the move to online treatment during the pandemic to arrive at a conclusion that the process of analytic therapy is paramount, overriding the superficial differences whether it is in-person or online.

Development of Telemedicine in Russia: A Consumer View

Introduction: One of the most significant trends in the global and Russian healthcare system is its digitalization. The COVID-19 pandemic has only given more importance and accelerated this process. The worldwide demand for telemedicine services has grown considerably. Yet, among Russian citizens e-health is not very popular. Besides, the use of telehealth gives rise to controversial issues as to the boundaries of its application. Objective: To analyze the attitude of various socio-demographic groups of Russian people to telemedicine and perspectives on its use. Methods: The article is based on the results of a sociological study aimed to establish the attitude of citizens to telemedicine. In order to obtain empirical information, an all-Russian sociological survey of the population representing various socio-demographic groups was carried out in April 2021. The survey method was a formalized personal interview at the place of residence of the respondents. Results: The study showed that few respondents had ever made use of telemedicine opportunities so far. At the same time, the low level of e-health use was accompanied by a very restrained attitude of the respondents to practicing it in the future. Conclusion: According to the data obtained, having a higher level of education allows citizens to integrate much more easily into innovative projects, including those in the digital space. Personal experience of using digital (e-health) technologies determines a more loyal attitude and greater interest of consumers to its potential use. The attractiveness of telemedicine opportunities is mostly attributed to complicated formal administrative procedures of obtaining medical certificates, referrals, and sick leaves offline. However, Russians are still wary of the possibilities of having the first consultation or monitoring their well-being and condition during the online treatment process. The majority of the respondents did not accept the diagnosis and the choice of treatment by means of telecommunications

COVID-19 Pandemic and Eating Disorders: What Can We Learn About Psychopathology and Treatment? A Systematic Review

Purpose of Review This systematic review aims to collect evidence regarding the impact of the SarsCov-2 pandemic on people affected by eating disorders (EDs) targeting the following variables: psychopathology changes, mechanisms of vulnerability or resilience, and perception of treatment modifications during the pandemic. Recent Findings Since the beginning of the pandemic, a mental health deterioration has been detected in the general population and especially in people affected by pre-existing psychiatric conditions. Furthermore, mental healthcare has moved toward online treatment. Summary ED people showed a trend toward worsening of ED-specific psychopathology and impairment in general psychopathology. The most common vulnerability mechanisms were social isolation and feelings of uncertainty, while heightened self-care and reduced social pressure were resilience factors. The online treatment, although raising many concerns related to its quality, was considered the best alternative to the face-to-face approach. These findings may support the idea that stressful events contribute to the exacerbation of ED psychopathology and highlight the relevance of internalizing symptoms in EDs. The identification of putative risk and resilience variables as well as of subjective factors affecting online treatment perception may inform healthcare professionals and may promote more personalized approaches.

Therapists’ Experiences With the Effectiveness and Feasibility of Videoconference-Based Eye Movement Desensitization and Reprocessing

Research on the effectiveness and applicability of eye movement desensitization and reprocessing (EMDR) via videoconference is sparse. Considering the emerging use of internet-based psychotherapy during the COVID-19 pandemic, information on videoconference-based EMDR (eEMDR) would be beneficial for many therapists. In this study, 23 therapists from the EMDR-Institute in Germany provided information about their experiences with eEMDR in a questionnaire-based survey. Information on the effectiveness and the course of 102 eEMDR sessions was recorded. Results showed the potential of eEMDR as an effective and viable method. The decrease in the subjective unit of disturbance (SUD), which is an important indicator of treatment outcome, was found to be at a similar level compared to that of previous EMDR studies that were not administered in eEMDR format. The most important predictor of the SUD decrease was the type of bilateral stimulation used in eEMDR sessions. Eye movements resulted in significantly greater SUD reductions than tapping. Perceived disadvantages and impediments for the implementation of eEMDR were mainly of bureaucratic and technical concerns. In addition, about one-third of the therapists stated that some patients were not willing to engage in eEMDR. In our study, eEMDR proved to be a practically applicable therapy method and therefore, therapists can consider using eEMDR. These findings will hopefully encourage EMDR therapists and their patients to use eEMDR due to its effectiveness and viability as an online treatment approach.

A Provably Secure Authentication and Key Agreement Protocol in Cloud-Based Smart Healthcare Environments

The wide applications of the Internet of Things and cloud computing technologies have driven the development of many industries. With the improvement of living standards, health has become the top priority of people’s attention. The emergence of the wireless body area network (WBAN) enables people to master their physical condition all the time and make it more convenient for patients and doctors to communicate with each other. Doctors can provide real-time online treatment with cloud-based smart healthcare environments for patients. In this process, patients, health records, and doctors need to maintain security and privacy. Recently, Kumari et al. proposed a secure framework for the smart medical system. However, we found that their framework cannot provide the anonymity of patients and doctors, data confidentiality, and patient unlinkability and also is subject to impersonation attacks and desynchronization attacks. In order to ensure the security and privacy of patients and doctors, we propose an authentication and key exchange protocol in cloud-based smart healthcare environments. Formal and informal security analyses, as well as performance analysis, demonstrated that our protocol is suitable for these environments.

Equity in telemedicine for older adults during the COVID-19 pandemic

The coronavirus disease 2019 (COVID-19) pandemic has spurred an unprecedented paradigm shift to telemedicine across healthcare fields in order to limit exposure to the virus. At the West China Hospital of Sichuan University, telemedicine has been used to perform COVID-19-related tele-education to health professionals and the general population, as well as tele-diagnosis, online treatment and internet-based drug prescription and delivery. However, many older adults could not make appointments with doctors due to difficulty using the internet-based platform. Careful attention needs to be paid by future researchers and policymakers in order to mitigate barriers older adults face when using telemedicine.

Contracts to Coordinate Healthcare Providers in the Telemedicine Referral System

With the help of telemedicine, healthcare providers can increase patients’ access to high-quality services while reducing the medical expenditure, especially for patients in remote areas. Once advanced care is needed, local patients will first be referred to an online health service and then be referred to the offline hospital if the online healthcare fails. In practice, local community hospitals and the advanced tertiary hospitals generally lack financial incentives to exert costly, but non-reimbursable, effort to avoid poor patient outcomes. Therefore, we build a new model to analyze the interaction between these two service providers, promoting them to exert the right effort by designing payment contracts. Our results show that neither fee-for-service nor bundled payment contracts can achieve the social optimum. Tertiary hospitals always exert less effort than the socially-optimal effort while the community hospital may exert less or more effort depending on the online treatment cost. Then, we propose a performance-based bundled payment contract that can coordinate both hospitals’ decisions to achieve socially optimal outcomes. Finally, we numerically show the impact of the referral service fee and the online treatment cost on the efficiency of these contracts.

Overcome Death Anxiety: The Development of an Online Cognitive Behaviour Therapy Programme for Fears of Death

Emerging research suggests that death anxiety is a transdiagnostic construct, which may underpin a number of mental illnesses. Although cognitive behaviour therapy (CBT) has been found to be the most effective treatment for death anxiety, no self-guided treatments for this construct exist at present. Furthermore, there is a growing need for accessible, scalable and cost-effective psychological treatments. To address these gaps, we created Overcome Death Anxiety (ODA), an online CBT-based programme which specifically targets fears of death. ODA was designed to be a fully automated, standalone, yet individualised online treatment. The present study outlines the development and structure of this programme using responses from four users to illustrate feasibility. Research is needed to examine the efficacy and usability of ODA with a larger clinical sample.