A literature review on the potential of computer-mediated communication (CMC) as a medium for conducting psychotherapy via the Internet revealed that CMC may mediate interpersonally rich interactions if participants are allowed sufficient time and repeated opportunities (anticipate future communications) to exchange information and build relationships. To examine the extent to which the process of online therapy resembles face-to-face therapy, online therapy transcripts were examined through a molecular approach and the results were compared to the extant, psychotherapy processes literature. The participants were six dyads formed by college graduate students enrolled in a clinical practicum course and their online adolescent clients. The clients were highschool freshmen and sophomores referred by their school counselors through the Gulf Coast GEAR UP Partnership Project. Trained undergraduate psychology majors coded therapist and client online behavior according to two well established and validated coding methods, the Helping Skills System (HSS) and the Client Behavior System (CBS; Hill & O’Brien, 1999). Although levels of client overall output (grammatical units) remained fairly constant throughout the course of therapy, the ratio of productive to non-productive output per session increased as a function of number of sessions. Using hierarchical linear modeling (HLM) methodology, the results revealed that therapist facilitating skills (approval and reassurance, restatements and rephrasing, and reflection of feelings) predicted higher client productive output, whereas interpretations and informative statements predicted lower client productive output. The results confirmed that online therapy can lead to productive therapist-client interactions and that the associations between these interactions are similar to the associations found in faceto- face therapy interactions.

This study evaluated the efficacy of the From Survivor to Thriver program, an interactive, online therapist-facilitated cognitive-behavioral program for rape-related PTSD. Eighty-seven college women with rape-related PTSD were randomized to complete the interactive program (n = 46) or a psycho-educational self-help website (n = 41). Both programs led to large reductions in interview-assessed PTSD at post-treatment (interactive d = 2.22, psycho-educational d = 1.10), which were maintained at three month follow-up. Both also led to medium- to large-sized reductions in self-reported depressive and general anxiety symptoms. Follow-up analyses supported that the therapist-facilitated interactive program led to superior outcomes among those with higher pre-treatment PTSD whereas the psycho-educational self-help website led to superior outcomes for individuals with lower pre-treatment PTSD. Future research should examine the efficacy and effectiveness of online interventions for rape-related PTSD including whether treatment intensity matching could be utilized to maximize outcomes and therapist resource efficiency.

This study examined the level of satisfaction reported by participants of a technologically assisted intervention study (TAI). TAI is a type of teletherapy done through online, live video conferencing. Satisfaction was examined at three different time points, post therapy, 3-months post therapy, and 6-months post therapy. Analyses examined if there were any changes in reported satisfaction over the three time periods. Participants received cognitive behavioral therapy (CBT) targeted at reducing symptoms of mild to moderately severe depression. A satisfaction measure was developed for this study, and included quantitative and qualitative items which were analyzed to determine participants' level of satisfaction. Seventeen women residing in the Vernal and Roosevelt, Uintah Basin areas, volunteered to participate in the study that was funded by a CURI and AES grant. This study found that the women experienced a high level of satisfaction with TAI across the various dimension measured. This high level of satisfaction remained consistent across the three time periods examined. Qualitative data offered a depth of understanding regarding what particularly participants were and weren't satisfied with. (106 pages)

The efficacy of cognitive-behavioural therapy (CBT) in the treatment of child anxiety disorders has been well established in the literature, with on average, just over 50% of children becoming free of their primary anxiety diagnosis immediately following treatment (James et al., 2008). Despite the existence of these efficacious treatments, up to two thirds of children with anxiety do not receive assistance for their difficulties (Essau et al., 2002). The reasons for this are varied, and include lack of available therapists or services, long waiting lists, high therapy costs and stigma associated with therapy. Computer- and internet-based interventions represent a modern alternative for delivering CBT interventions that may be more appealing and accessible to a greater proportion of children with anxiety. Various forms of computer-assisted therapies have been investigated, including palmtop computers, desktop computers, virtual reality and online programs. Although computerised interventions have demonstrated promise in the treatment of adult anxiety, they have only recently received interest in the child literature. Specifically, there are very few controlled trials evaluating the efficacy of computer- and internet-based interventions for childhood psychological disorders, including anxiety disorders. The present research involved the initial development and subsequent testing of an entirely internet-based, CBT intervention for child anxiety disorders. BRAVE-ONLINE was developed as an internet adaptation of The BRAVE Program, a clinic-based program which has demonstrated efficacy in the treatment of childhood anxiety. The online intervention is a therapist-mediated program, in which children and parents receive email and telephone assistance from a therapist throughout treatment. BRAVE-ONLINE is an interactive program consisting of 10 child and 6 parent sessions to be completed by families in their own home. Following the development of BRAVE–ONLINE, the first study of this thesis included a randomised control trial to investigate the efficacy of the internet-based intervention (NET) compared to a waitlist control (WL). Seventy-three children aged between 7 and 12 years, diagnosed with separation anxiety disorder, social phobia, generalised anxiety disorder or specific phobia were randomly allocated to NET and WL conditions. Treatment effects were evaluated at 10-14 weeks post-assessment and 6-month follow-up, using multiple outcome measures including a diagnostic interview, clinician ratings of severity, parent and child questionnaires. Results indicated that at post-assessment, 30% of NET participants in the completer sample (22.5% in the Intent-to-Treat (ITT) sample) no longer met criteria for their primary anxiety diagnosis, compared to 10% of WL participants. Significant gains were also evident for clinician severity ratings, global assessments of functioning, and several questionnaire measures. However, results also indicated that children and parents were slow to progress through therapy, such that a large proportion of families had not completed all treatment sessions at the post-assessment point. For this reason, 6-month follow-up may present a better indication of treatment efficacy. Indeed, at 6-month follow-up, treatment gains were improved upon such that 75% of children in the completer sample (52.5% in the ITT sample) no longer met criteria for their primary anxiety disorder. Reductions in severity ratings, global assessments of functioning and child and parent self-report measures were also improved upon at 6-month follow-up. Further, the online intervention was found to be highly acceptable to families and was associated with only minimal rates of attrition. The second study of this thesis aimed to explore factors associated with treatment outcome for the online intervention. Factors of interest included demographic factors (age, gender, income and educational background), treatment expectancy, initial symptom severity, program compliance and pre-treatment diagnostic comorbidity. Specifically, this study investigated the extent to which each of these factors predicted the improvement made by children on global assessments of functioning (CGAS) at 6-month follow-up. Results indicated that only some of these factors were directly associated with treatment outcome. Although treatment expectancy predicted compliance with the program, it was not associated with treatment outcome. Baseline severity also did not predict treatment outcome. Contrary to expectation, levels of program compliance by children negatively predicted outcome, such that children who were more compliant with the program showed fewer improvements in overall functioning. Parent compliance did not predict treatment outcome. A significant relationship was evident between diagnostic comorbidity (number of pre-treatment anxiety diagnoses) and treatment outcome, such that higher baseline comorbidity predicted poorer functioning on the CGAS at 6-month follow-up. None of the demographic factors were associated with treatment outcome. Overall, the findings of this research suggest that a CBT intervention delivered entirely over the internet was associated with reductions in indicators of anxiety at post-assessment, compared to a WL control, particularly for the completer sample. Further, these reductions were improved upon at 6-month follow-up, with a substantial proportion of children becoming free of their primary anxiety diagnosis. The results also indicated that the online intervention might not be as effective for children suffering from multiple anxiety disorders. The effects of program compliance were somewhat surprising and possible explanations are offered. Although these results are promising, conclusions should be regarded as tentative until further trials are conducted and the online intervention is compared with clinic-based treatments. Limitations of this research and areas for future research are discussed.

The efficacy of cognitive-behavioural therapy (CBT) in the treatment of child anxiety disorders has been well established in the literature, with on average, just over 50% of children becoming free of their primary anxiety diagnosis immediately following treatment (James et al., 2008). Despite the existence of these efficacious treatments, up to two thirds of children with anxiety do not receive assistance for their difficulties (Essau et al., 2002). The reasons for this are varied, and include lack of available therapists or services, long waiting lists, high therapy costs and stigma associated with therapy. Computer- and internet-based interventions represent a modern alternative for delivering CBT interventions that may be more appealing and accessible to a greater proportion of children with anxiety. Various forms of computer-assisted therapies have been investigated, including palmtop computers, desktop computers, virtual reality and online programs. Although computerised interventions have demonstrated promise in the treatment of adult anxiety, they have only recently received interest in the child literature. Specifically, there are very few controlled trials evaluating the efficacy of computer- and internet-based interventions for childhood psychological disorders, including anxiety disorders. The present research involved the initial development and subsequent testing of an entirely internet-based, CBT intervention for child anxiety disorders. BRAVE-ONLINE was developed as an internet adaptation of The BRAVE Program, a clinic-based program which has demonstrated efficacy in the treatment of childhood anxiety. The online intervention is a therapist-mediated program, in which children and parents receive email and telephone assistance from a therapist throughout treatment. BRAVE-ONLINE is an interactive program consisting of 10 child and 6 parent sessions to be completed by families in their own home. Following the development of BRAVE–ONLINE, the first study of this thesis included a randomised control trial to investigate the efficacy of the internet-based intervention (NET) compared to a waitlist control (WL). Seventy-three children aged between 7 and 12 years, diagnosed with separation anxiety disorder, social phobia, generalised anxiety disorder or specific phobia were randomly allocated to NET and WL conditions. Treatment effects were evaluated at 10-14 weeks post-assessment and 6-month follow-up, using multiple outcome measures including a diagnostic interview, clinician ratings of severity, parent and child questionnaires. Results indicated that at post-assessment, 30% of NET participants in the completer sample (22.5% in the Intent-to-Treat (ITT) sample) no longer met criteria for their primary anxiety diagnosis, compared to 10% of WL participants. Significant gains were also evident for clinician severity ratings, global assessments of functioning, and several questionnaire measures. However, results also indicated that children and parents were slow to progress through therapy, such that a large proportion of families had not completed all treatment sessions at the post-assessment point. For this reason, 6-month follow-up may present a better indication of treatment efficacy. Indeed, at 6-month follow-up, treatment gains were improved upon such that 75% of children in the completer sample (52.5% in the ITT sample) no longer met criteria for their primary anxiety disorder. Reductions in severity ratings, global assessments of functioning and child and parent self-report measures were also improved upon at 6-month follow-up. Further, the online intervention was found to be highly acceptable to families and was associated with only minimal rates of attrition. The second study of this thesis aimed to explore factors associated with treatment outcome for the online intervention. Factors of interest included demographic factors (age, gender, income and educational background), treatment expectancy, initial symptom severity, program compliance and pre-treatment diagnostic comorbidity. Specifically, this study investigated the extent to which each of these factors predicted the improvement made by children on global assessments of functioning (CGAS) at 6-month follow-up. Results indicated that only some of these factors were directly associated with treatment outcome. Although treatment expectancy predicted compliance with the program, it was not associated with treatment outcome. Baseline severity also did not predict treatment outcome. Contrary to expectation, levels of program compliance by children negatively predicted outcome, such that children who were more compliant with the program showed fewer improvements in overall functioning. Parent compliance did not predict treatment outcome. A significant relationship was evident between diagnostic comorbidity (number of pre-treatment anxiety diagnoses) and treatment outcome, such that higher baseline comorbidity predicted poorer functioning on the CGAS at 6-month follow-up. None of the demographic factors were associated with treatment outcome. Overall, the findings of this research suggest that a CBT intervention delivered entirely over the internet was associated with reductions in indicators of anxiety at post-assessment, compared to a WL control, particularly for the completer sample. Further, these reductions were improved upon at 6-month follow-up, with a substantial proportion of children becoming free of their primary anxiety diagnosis. The results also indicated that the online intervention might not be as effective for children suffering from multiple anxiety disorders. The effects of program compliance were somewhat surprising and possible explanations are offered. Although these results are promising, conclusions should be regarded as tentative until further trials are conducted and the online intervention is compared with clinic-based treatments. Limitations of this research and areas for future research are discussed.

Children’s mental health is a topic of concern, not only in the escalating number of children who meet diagnostic criteria for disorders, but also for the practitioners desiring to treat them effectively. Parental involvement in treatment results in more favorable outcomes with longer treatment gains observed, thus reducing mental health issues. An additional factor in children’s mental health is the effect of levels of parental acceptance toward the child. Parental acceptance is a positive outcome that has been observed in previous studies conducted with Child-Parent Relationship Therapy (CPRT). There are many reported barriers to seeking treatment for mental health issues, including time, cost, distance, and access. Online therapies have been found to reduce or eliminate most barriers to treatment, and is a preferred format for certain populations. To date, however, there have been no studies conducted on whether CPRT is effective in increasing levels of parental acceptance in an online format. Eight participants from around the world completed the ten-week CPRT training in an online format. Levels of parental acceptance were measured by the Porter Parental Acceptance Scale (Porter, 1954; PPAS) in self-reported pre- and post-treatment assessments. A perception survey was also conducted to assess participants’ perception of the process of an online parent training format, including benefits and challenges. This mixed-methods study found that an online version of CPRT does significantly increase parental acceptance levels. Participants also reported positive perceptions of the online training format. Positive themes reported in the survey responses related to convenience, community, access, and user experience.

No description available.

CONTEXTO: O Transtorno Depressivo Maior é um grave problema de saúde pública mundial. No Brasil, 50% da população diagnosticada com esse transtorno não tem acesso a tratamento. As psicoterapias breves psicodinâmicas têm sua eficácia comprovada por revisões sistemáticas (RS) no tratamento do Transtorno Depressivo Maior e realizadas por meio de videoconferência, podem ampliar o acesso da população a essas psicoterapias baseadas em evidências. OBJETIVO: Avaliar a eficácia das psicoterapias breves psicodinâmicas realizadas pela internet, por meio de videoconferência, no tratamento de adultos com Transtorno Depressivo Maior. MÉTODO: Revisão sistemática de ensaios clínicos randomizados realizada segundo a metodologia da Colaboração Cochrane (Handbook of Systematic Reviews of Interventions). ESTRATÉGIA DE BUSCA: Os artigos foram recuperados em uma busca sensibilizada às bases de dados eletrônicas: BVS-Psi; Cochrane Library; EBSCO-CINAHL; EMBASE; LILACS; PsycNET (PsycINFO, PsycARTICLES, APABooks); Ovid MEDLINE; PubMED; Redalyc; SciELO; ScienceDirect; Scopus e Web of Science. Buscas adicionais foram realizadas no ClinicalTrials.gov e WHO (http://www.who.int/ictrp/en/), no Google Scholar e ResearchGate e na literatura cinzenta. As buscas foram realizadas em abril de 2016 e atualizadas até setembro de 2016. Não houve restrição a idiomas, datas e status de publicação. As listas de referências bibliográficas de RS e de artigos selecionados foram revisadas. Realizou-se contato com especialistas em busca de estudos em andamento. DESFECHO: Remissão sintomatológica por meio de escalas validadas e adesão ao tratamento. RESULTADOS: Dois revisores (CCAS e MNR) selecionaram de forma independente os artigos segundo os critérios de elegibilidade. Um terceiro revisor (KY) resolveu as discordâncias. Da busca inicial de 1163 artigos, 30 foram selecionados para avaliação do texto completo. Nenhum artigo contemplou os critérios de elegibilidade preconizados para esta revisão sistemática. CONCLUSÃO: Até o vii momento, não é possível afirmar se as psicoterapias breves psicodinâmicas realizadas pela internet, por meio de videoconferência, apresentam eficácia no tratamento da Depressão Maior em adultos devido à inexistência de ensaios clínicos randomizados / BACKGROUND: Major Depressive Disorder (MDD) is a major world public health problem. In Brazil, 50% of diagnosed population don´t receive treatment properly. Short-term psychodynamic psychotherapies have efficacy proved by systematic reviews of Depressions treatment and applied through videoconferencing may improve the access of population to these evidence-based psychotherapies. OBJECTIVES: To evaluate the efficacy of online videoconferencing short-term psychodynamic psychotherapies on MDDs treatment in adults. METHOD: Systematic review of randomized clinical trials following the Cochrane Collaboration Methodology (Handbook of Systematic Reviews of Interventions). SEARCH METHODS: Sensitive electronic searches were handled in the following databases: BVS-Psi; Cochrane Library; EBSCO-CINAHL; EMBASE; LILACS; PsycNET (PsycINFO, PsycARTICLES, APABooks); Ovid MEDLINE; PubMED; Redalyc; SciELO; ScienceDirect; Scopus and Web of Science. Additional searches were done in ClinicalTrials.gov and WHO (http://www.who.int/ictrp/en/), Google Scholar, ResearchGate and grey literature. Electronic searches were done in April 2016 and updated to September 2016. No restrictions on language, date and publication status were applied to the searches. References list of systematic reviews and potentially relevant papers retrieved were checked. A group of specialists was contacted in order to find ongoing studies. OUTCOME: Symptoms remission measured by validated scales and adherence to treatment. RESULTS: Two reviewers independently (CCAS e MNR) screened suitable articles according to eligibility criteria of this review. A third reviewer (KY) was consulted if two review authors could not reach consensus. From 1163 articles initially retrieved, 30 had assessed the full-text for eligibility. None article met the eligibility criteria of this systematic review. CONCLUSION: At this moment, is not possible to assure if online videoconferencing short-term psychodynamic psychotherapies are efficacious on MDDs treatment because of the absence of randomized clinical trials

Traditionally, mental health professionals have provided psychotherapeutic services through face-to-face sessions. As the Internet has become an increasingly important part of individuals' personal and professional lives, psychologists and clients have used this medium to expand access to psychotherapy. The purpose of this quantitative correlational design was to investigate whether demographic variables and the personality traits of extroversion/introversion (E/I), as assessed by the Big Five Inventory, predicted clients' preferences for a specific method of administered psychotherapy. The theoretical framework for this study was social information processing through computer-mediated communication. An online survey site was used to assist in survey design and data collection, and 301 individuals participated in the study. Results of the Pearson correlation indicated that age was negatively correlated with use of online therapy (p = .038). The variables of region, race, and E/I had no statistically significant effect on the use of online versus in-person therapy (all p values > .05). Findings reflected larger social trends that decisions to seek online therapy fall along lines of diversity related to age and technological knowledge. Recommendations include engaging older patients in opportunities for participating in online therapeutic services, as well as further research on the relationship between cultural diversity and online therapy. These results can inform practitioners and the community about the importance of expanding access to psychotherapeutic services for individuals who need them, which will in turn be an important component of positive social change.

Submitted by Renata Lopes (renatasil82@gmail.com) on 2016-04-27T13:36:16Z No. of bitstreams: 1 biancaaparecidaribeirosingulane.pdf: 1026859 bytes, checksum: 6891320e0ee0d08d8facc3e7176b9dc9 (MD5) / Approved for entry into archive by Adriana Oliveira (adriana.oliveira@ufjf.edu.br) on 2016-05-02T00:59:28Z (GMT) No. of bitstreams: 1 biancaaparecidaribeirosingulane.pdf: 1026859 bytes, checksum: 6891320e0ee0d08d8facc3e7176b9dc9 (MD5) / Made available in DSpace on 2016-05-02T00:59:28Z (GMT). No. of bitstreams: 1 biancaaparecidaribeirosingulane.pdf: 1026859 bytes, checksum: 6891320e0ee0d08d8facc3e7176b9dc9 (MD5) Previous issue date: 2016-02-22 / CAPES - Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / CNPq - Conselho Nacional de Desenvolvimento Científico e Tecnológico / Introdução: O consumo de álcool salienta-se como um grave problema de saúde pública no Brasil e no mundo. Porém, o número de usuários que procuram ajuda ou que conseguem tratamento ainda é reduzido. As terapias por computador (e-terapias) têm sido apontadas como alternativas de tratamento para diversos transtornos mentais, dentre eles o uso problemático de álcool e outras drogas. Uma preocupação importante relacionada a esta modalidade de atendimento refere-se à aliança terapêutica e a satisfação com o tratamento, condições básicas para que haja um atendimento psicoterapêutico de qualidade. Objetivo: O presente trabalho contempla objetivos de dois estudos: o primeiro pretendeu avaliar a literatura sobre aliança terapêutica nas Terapias cognitivo-comportamentais realizadas por videoconferência para diferentes transtornos mentais; e o segundo almejou avaliar a aliança terapêutica e a satisfação com o tratamento em uma psicoterapia por videoconferência para dependentes de álcool. Metodologia: No primeiro estudo foi realizada uma revisão sistemática de literatura, incluindo artigos empíricos dos últimos 11 anos, escritos nas línguas inglesa, portuguesa ou espanhola, que avaliavam a aliança terapêutica na TCC realizada por videoconferência. No segundo estudo, foi realizado um estudo de casos múltiplos, retirados de uma amostra que participou da TCC por videoconferência para dependentes de álcool. Os resultados foram analisados por meio de uma triangulação de dados, trabalhados de forma qualitativa e quantitativa. Resultados: No artigo 1 observou-se que a maioria dos estudos indicou que a aliança foi alta no decorrer das sessões de TCC por videoconferência, podendo ser comparada com a formada na psicoterapia presencial. Já os resultados do estudo 2 mostraram que, na TCC por videoconferência, houve formação de uma aliança terapêutica de qualidade e que os clientes ficaram satisfeitos com tratamento. Discussão: Apesar das limitações destes estudos, podemos inferir que há indícios tanto na revisão de literatura, quanto no estudo empírico, de que a aliança terapêutica e a satisfação com o tratamento na TCC por videoconferência pode ser comparável com os resultados encontrados na psicoterapia presencial. Assim, ela pode ser uma alternativa viável de tratamento para indivíduos com dependência de álcool. / Introduction: Alcohol consumption stands out as a serious public health problem in Brazil and worldwide. However, the number of users seeking help or who fail treatment is still low. The computer therapies (e-therapies) have been identified as alternative treatment for various mental disorders, including the abuse of alcohol and other drugs. A major concern related to this type of service refers to the therapeutic alliance and treatment satisfaction, basic conditions so that there is a psychotherapeutic care quality. Objective: This study includes two study objectives: the first aimed to evaluate the literature on therapeutic alliance in cognitive-behavioral therapies conducted by videoconference for different mental disorders; and the second craved evaluate the therapeutic alliance and treatment satisfaction in psychotherapy by videoconference to alcoholics. Methodology: In the first study was carried out a systematic review of the literature, including empirical articles from the past 11 years, written in English, Portuguese or Spanish that evaluated the therapeutic alliance in CBT held by videoconference. In the second study, we conducted a study of multiple cases, drawn from a sample of CBT participated by videoconference for alcoholics. The results were analyzed by means of a data triangulation worked qualitative and quantitative manner. Results: In Article 1 it was observed that most studies indicated that the alliance was high during the CBT sessions by videoconference and can be compared to that formed in the presence psychotherapy. Already the second study results showed that, in CBT by video conference, there is formation of a therapeutic alliance of quality and that clients were satisfied with treatment. Discussion: Despite the limitations of these studies, we can infer that there is evidence of the therapeutic alliance and treatment satisfaction in CBT by videoconference can be comparable with the results found in face psychotherapy. Thus, it can be a viable alternative treatment for patients with alcohol dependence.