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Improving Mental Health Care: an
Internet Delivered Program for the
    Treatment of Social Phobia

                 C. Bo...
Who we are


PSYCHOLOGY                         TECHNOLOGY




             ITC applications in
                Psychology
INTRODUCTION


Mental Disorders




             CBT
INTRODUCTION


   Social Anxiety Disorder (SAD) has a high prevalence
    between 7% and 13% (Furmark, 2002; Andrews,
   ...
INTRODUCTION


   Currently we have evidence based psychological
    treatments (EBT) for SAD. Nevertheless:
     - less ...
NEW WAYS OF DELIVERY CBT


One important challenge is to design new and more
 cost-effective ways of delivering CBT

Redu...
INTERNET-BASED THERAPY


   Internet-based programs have been successfully applied to
    the treatment of Social Phobia:...
SELF-HELP AND THE INTERNET


   However, there are only 2 telepsychology programs in which the whole
    treatment is sel...
Objective



 To compare the efficacy of a self-administered internet-
  based program for the treatment of Social Phobia...
Method: Sample

SOCIAL PHOBIA

   77 participants
   16 male (20.8%) and 61 female (79.2%)
   Mean age was 24.40 (SD=5....
Method: Sample

    Diagnosis:
       All participants met DSM-IV (APA, 1994, 2002) criteria for Social
        Phobia.
...
Method: Design


   Between-group design
   Participants were randomly assigned to one of the
    following experimental...
Method: Measures


   Anxiety Disorders Interview Schedule for Social
    Phobia (ADIS-IV; Brown, DiNardo, & Barlow, 1994...
Method: system description

“Talk to Me”: a CBT Program Treatment
   Psychoeducation
   Cognitive restructuring
   Expo...
Method: system description

Trust and rapport
   “Talk to Me” introduces itself and states that its role is to
    assess...
Method: system description

Assessment
Method: system description

“Talk to Me”: a CBT Program Treatment
Treatment components:

1.-Psychoeducation
Method: system description

“Talk to Me”: a CBT Program Treatment
Treatment components:
2.-Cognitive Therapy
Method: system description

Treatment components: Exposure “The class”
Method: system description

Treatment components: Exposure “The Conference”
Method: system description

Treatment components: Exposure “The oral test”
Method: system description

Treatment components: Exposure “Project Presentation”
Method: system description


 The program has “barriers” between different parts of the
  treatment: It is allowed to pro...
Talk to Me                                                           Target Behaviours


                     FEAR        ...
Talk to Me                                         Self-report questionnaires


     Social Avoidance and Distress        ...
Talk to Me                     Self-report questionnaires


     Brief version of the Fear of Negative Evaluation Scale
  ...
Conclusions

•   Results offer support of the effectiveness of the Internet-
    administered self-help program for the tr...
Conclusions
Counseling/motivation                 Self-help therapy




   3D environments                    Multimedia s...
The future

TELEPSYCHOLOGY AND MENTAL HEALTH:
 Reduction of costs
 Feared situations more available
 Higher control ove...
The future




CAN ICTs HELP TO IMPROVE QUALITY
     OF LIFE AND WELLBEING?
The Butler project

Assistance and care                Therapy




    Social inclusion               Leisure



     A CO...
THERAPEUTIC APPLICATION



The Butler project: Tools included


 Virtual Reality
 Environments
    -Induction of joyful mo...
THERAPEUTIC APPLICATION
    2 Virtual environments to induce positive mood:


  Therapeutic benefits


“Going to a relaxin...
LUDIC APPLICATION


 Butler: Tools included




   “Write a letter”             “Talk to someone”            “Meet new peo...
ETIOBE: A CIBER action


• According to the International
  Obesity TaskForce (EASO,
  2002) governments should act
  agai...
ETIOBE is composed by 3 applications:

             • Clinical support system (CSS)
             • Home support system (HS...
ETIOBE
The OPTIMI project


OPTIMI: Online Predictive Tools
for Intervention in Mental Illness

- Challenge 5: Towards Sustainabl...
The OPTIMI concept


 Prevention of Depression and suicide is one of the
  five points central focus points in the Europe...
The OPTIMI project

CCBT Treatment
Beating the Blues
• Existing commercial software
  approved by NICE
    • Will be modif...
The OPTIMI project
FUTURE PERSPECTIVES

This is the beginning of a new era in the
psychological treatments field: the evidence-
based CBT pr...
FUTURE PERSPECTIVES



The prediction seems to be that the
Internet has come, and is going to stay,
and grow, and improve...
“Talk to me”: A Self-applied Telepsychology Programme for Treatment of Fear of Public Speaking
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“Talk to me”: A Self-applied Telepsychology Programme for Treatment of Fear of Public Speaking

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“Talk to me”: A Self-applied Telepsychology Programme for Treatment of Fear of Public Speaking. Botella C. eHealth week 2010 (Barcelona: CCIB Convention Centre; 2010)

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Transcript of "“Talk to me”: A Self-applied Telepsychology Programme for Treatment of Fear of Public Speaking"

  1. 1. Improving Mental Health Care: an Internet Delivered Program for the Treatment of Social Phobia C. Botella Director of the Clinical Psychology Area Universitat Jaume I (Spain)
  2. 2. Who we are PSYCHOLOGY TECHNOLOGY ITC applications in Psychology
  3. 3. INTRODUCTION Mental Disorders CBT
  4. 4. INTRODUCTION  Social Anxiety Disorder (SAD) has a high prevalence between 7% and 13% (Furmark, 2002; Andrews, Henderson & Hall, 2001; Kessler, Berglund, Demler, Jin & Walters, 2005).  SAD is usually associated to school phobia, separation anxiety, and shyness.  If it’s not correctly treated, the development of the disorder can be chronic and produce important problems in the life of the person.
  5. 5. INTRODUCTION  Currently we have evidence based psychological treatments (EBT) for SAD. Nevertheless: - less of the 50% of people receive a correct treatment - the cost and the time that require the treatment - the lack of well prepared professionals. - many patients decide do to not seek for help That is, efficacious psychological treatments are not available for both, practitioners and patients.
  6. 6. NEW WAYS OF DELIVERY CBT One important challenge is to design new and more cost-effective ways of delivering CBT Reducing the contact between the patient and the therapist by using self-help procedures Using new technologies:  Computer-aided treatments  Virtual reality  The Internet
  7. 7. INTERNET-BASED THERAPY  Internet-based programs have been successfully applied to the treatment of Social Phobia:  Botella et., (2000, 2004)  Anderson, et al., (2005, 2006)  Carlbring, et al., (2006, 2007)  Titov et al., (2008)  Berger, Hohl, & Caspar (2009)
  8. 8. SELF-HELP AND THE INTERNET  However, there are only 2 telepsychology programs in which the whole treatment is self-administered: “TALK TO ME” “WITHOUT FEAR”  Fear of Public Speaking  Small Animal Phobia  The feared scenarios are real  The feared scenarios consist of videotaped audiences. a virtual environment.  Its efficacy has been proven in:  Its efficacy has been proven in:  a case study (Botella, Quero  a case study (Botella, et al., in press), Hoffmann & Moscovitch, 2004)  a series of 12 cases  a series of 12 cases (Botella, (Botella, Quero et al., in Guillén et al., 2007) press).  In this presentation we will focus on TALK TO ME
  9. 9. Objective  To compare the efficacy of a self-administered internet- based program for the treatment of Social Phobia versus the same program applied by the therapist.
  10. 10. Method: Sample SOCIAL PHOBIA  77 participants  16 male (20.8%) and 61 female (79.2%)  Mean age was 24.40 (SD=5.78) ranging from 18 to 48  Educational level:  73 university students (94.8%)  3 went to high school (3.9%)  1 went to primary school (1.3%)
  11. 11. Method: Sample  Diagnosis:  All participants met DSM-IV (APA, 1994, 2002) criteria for Social Phobia.  Exclusion criteria:  Current alcohol or drug dependence  Being in treatment for the same psychological problems  Primary diagnosis of major depression  Psychotic disorder Subtype of social phobia:  Specific social phobia: 29 participants (37.7%)  Non generalized social phobia: 31 participants (40.3%)  Generalized social phobia: 17 participants (22.1%)
  12. 12. Method: Design  Between-group design  Participants were randomly assigned to one of the following experimental conditions: Experimental Conditions 1. Therapist Administered (N=22) 2. Self-administered (N=30) 3. Waiting List (N=25)
  13. 13. Method: Measures  Anxiety Disorders Interview Schedule for Social Phobia (ADIS-IV; Brown, DiNardo, & Barlow, 1994)  Target behaviours: Fear, Avoidance, and Belief in the negative thought  Brief version of the Fear of Negative Evaluation Scale (BFNE; Leary, 1983)  Social Avoidance and Distress Scale (SAD; Watson & Friend, 1969)  Fear of Public Speaking Questionnaire (FPSQ; Bados, 1986).
  14. 14. Method: system description “Talk to Me”: a CBT Program Treatment  Psychoeducation  Cognitive restructuring  Exposure: Scenarios • The oral presentation in front of a class • The oral test • The job interview • The oral presentation at work • The conference • The wedding Modulators: gender, number of people  Relapse prevention
  15. 15. Method: system description Trust and rapport  “Talk to Me” introduces itself and states that its role is to assess, guide and offer help The program has an assistant: Dr. Net
  16. 16. Method: system description Assessment
  17. 17. Method: system description “Talk to Me”: a CBT Program Treatment Treatment components: 1.-Psychoeducation
  18. 18. Method: system description “Talk to Me”: a CBT Program Treatment Treatment components: 2.-Cognitive Therapy
  19. 19. Method: system description Treatment components: Exposure “The class”
  20. 20. Method: system description Treatment components: Exposure “The Conference”
  21. 21. Method: system description Treatment components: Exposure “The oral test”
  22. 22. Method: system description Treatment components: Exposure “Project Presentation”
  23. 23. Method: system description  The program has “barriers” between different parts of the treatment: It is allowed to progress to the next task “only” if the present task has been overcome.  “Talk to Me” assesses the patient at pre-treatment, during the treatment and after the treatment.
  24. 24. Talk to Me Target Behaviours FEAR AVOIDANCE 9 9 8 8 7 7 6 6 5 5 4 4 3 3 2 2 1 1 0 0 pre post 12-month pre post 12-month follow-up follow-up Therapist Self-applied Waiting List Therapist Self-applied Waiting List F(2,76)=30.73 p<0.001 F(2,76)= 30.02 p<0.001 BELIEF IN CATASTROPHIC THOUGHT 10 8 6 F(2,76)= 28.69 4 2 p<0.001 0 pre post 12-month follow-up Therapist Self-applied Waiting List
  25. 25. Talk to Me Self-report questionnaires Social Avoidance and Distress Fear of Public Speaking Scale Questionnaire 50 60 40 50 40 30 30 20 20 10 10 0 0 pre post 12 months pre post follow up 12 follow-up months Therapist Self-applied Waiting List Therapist Self-applied Waiting List F(2,76)= 4.63 F(2,76)= 7.23 p<0.05 p<0.01
  26. 26. Talk to Me Self-report questionnaires Brief version of the Fear of Negative Evaluation Scale 14 12 10 8 6 4 2 0 pre post follow up 12 months Therapist Self-applied Waiting List F(2,76)= 1.35 p=0.267
  27. 27. Conclusions • Results offer support of the effectiveness of the Internet- administered self-help program for the treatment of social phobia. • “Talk to me” was as effective as the same program applied by a therapist. • The treatment conditions were more effective than a waiting list control group. • The treatment program was effective not only at short-term (post-test), but also at long-term (12-month follow-up).
  28. 28. Conclusions Counseling/motivation Self-help therapy 3D environments Multimedia stimuli
  29. 29. The future TELEPSYCHOLOGY AND MENTAL HEALTH:  Reduction of costs  Feared situations more available  Higher control over feared context  Possibility of overlearning  Confidentiality and privacy  A less aversive experience than in vivo exposure New technologies, in this case the Internet, can allow a higher number of people to have access to health programs and resources: - at home - choosing the moment they prefer - at their own pace
  30. 30. The future CAN ICTs HELP TO IMPROVE QUALITY OF LIFE AND WELLBEING?
  31. 31. The Butler project Assistance and care Therapy Social inclusion Leisure A CONSOLIDER action project
  32. 32. THERAPEUTIC APPLICATION The Butler project: Tools included Virtual Reality Environments -Induction of joyful mood state -Relaxation Book of life My memories: – Images –Sounds
  33. 33. THERAPEUTIC APPLICATION 2 Virtual environments to induce positive mood: Therapeutic benefits “Going to a relaxing place” “Going to a joyful place” They allow to induce positive mood states (relax, joy) The individual can learn useful techniques to reduce negative emotional mood states Relaxing sun rise (relaxation, mindfulness…)
  34. 34. LUDIC APPLICATION Butler: Tools included “Write a letter” “Talk to someone” “Meet new people” The access to communication using ICTs helps to:: - Promote social support, by helping to maintain the already present relationships (family, friends, grandchildren…) - Promote new relationships with other users of the Butler net.
  35. 35. ETIOBE: A CIBER action • According to the International Obesity TaskForce (EASO, 2002) governments should act against childhood obesity , improving the evidence for treatments. • ETIOBE is an intelligent e- therapy system (e-TI) for the treatment of obesity,
  36. 36. ETIOBE is composed by 3 applications: • Clinical support system (CSS) • Home support system (HSS) • Mobile support system (MSS) Home support system Clinical support system Mobile support system
  37. 37. ETIOBE
  38. 38. The OPTIMI project OPTIMI: Online Predictive Tools for Intervention in Mental Illness - Challenge 5: Towards Sustainable and Personalised Healthcare - Objective ICT-2009.5.1: Personal Health Systems  Mental Health care represents a third of the health care to all EU nations.  Depression and Stress related disorders are the most common mental illnesses.
  39. 39. The OPTIMI concept  Prevention of Depression and suicide is one of the five points central focus points in the European Pact for Mental Health and Wellbeing.  OPTIMI: prediction, prevention • is based on a PROACTIVE approach to mental health and pretends lower costs and higher levels of life quality
  40. 40. The OPTIMI project CCBT Treatment Beating the Blues • Existing commercial software approved by NICE • Will be modified code and content with OPTIMI ETIOBE • Existing e-therapy treatment under trials in Spain (schools, pediatric services hospital , eating disorder clinics) • Will be modified code and content with OPTIMI
  41. 41. The OPTIMI project
  42. 42. FUTURE PERSPECTIVES This is the beginning of a new era in the psychological treatments field: the evidence- based CBT programs delivered using the Internet. At the present moment it is possible to conclude that Internet-delivered CBT is useful for the treatment of different disorders (at least for some patients
  43. 43. FUTURE PERSPECTIVES The prediction seems to be that the Internet has come, and is going to stay, and grow, and improve, more and more in the coming years, helping us to improve health care.
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