• Share
  • Email
  • Embed
  • Like
  • Save
  • Private Content
Soledad Quero - Acceptability of an Online Emotional Therapy System to Apply Homework Assignments in Adjustment Disorder: A Case Study
 

Soledad Quero - Acceptability of an Online Emotional Therapy System to Apply Homework Assignments in Adjustment Disorder: A Case Study

on

  • 416 views

Presentation of Workshop on Technology for Healthcare and Healthy Lifestyle 2011

Presentation of Workshop on Technology for Healthcare and Healthy Lifestyle 2011

Thursday 1st Dec 2011
Session IV

http://www.tsb.upv.es/wths2011

Statistics

Views

Total Views
416
Views on SlideShare
416
Embed Views
0

Actions

Likes
0
Downloads
1
Comments
0

0 Embeds 0

No embeds

Accessibility

Upload Details

Uploaded via as Adobe PDF

Usage Rights

© All Rights Reserved

Report content

Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
  • Full Name Full Name Comment goes here.
    Are you sure you want to
    Your message goes here
    Processing…
Post Comment
Edit your comment

    Soledad Quero - Acceptability of an Online Emotional Therapy System to Apply Homework Assignments in Adjustment Disorder: A Case Study Soledad Quero - Acceptability of an Online Emotional Therapy System to Apply Homework Assignments in Adjustment Disorder: A Case Study Presentation Transcript

    • III Workshop on Technology for Healthcare and Healthy LifestyleValencia, December 2011 Acceptability of an Online Emotional Therapy System to Apply Homework Assignments in Adjustment Disorder: A Case Study S. Quero1, M.A. Pérez-Ara1, C. Botella1, R. Herrero1, M. Molés1, S. Andreu-Mateu1 & R.M. Baños2 1Universitat Jaume I 2 Universidad de Valencia
    • INTRODUCTION• People cope with diverse stressful and difficult situations and, most of them, do this in a more o less successful way.• However, in some cases coping is not adequate. This maladaptive, more intense and prolonged than expected reaction is the base of Adjustment Disorders (AD).• AD are an important mental health problem.• However, there is no agreement concerning its diagnosis and no evidence-based assessment or treatment protocols are available.
    • ICD-10 Adjustment DisordersNeurotic disorders,Secondary to stressful situations and somatoforms:• Phobic anxiety disorders• Other anxiety disorders• Obsessive-compulsive disorder• Reactions to severe stress and adjustment disorders – Acute stress reaction – Posttraumatic stress disorder (PTSD) – Adjustment disorders – Other reactions to severe stress – Non otherwise specified severe stress reactions• Dissociative disorders (conversion disorder)• Somatoform disorders
    • DSM-IV-TR Adjustment Disorders• The essential feature of Adjustment Disorder (AD) is the development of clinically significant emotional or behavioural symptoms in response to an identifiable stressor (APA, 2000).
    • DSM-IV-TR Adjustment Disorders• A debilitating reaction to a stressful event or situation.• When a person cant cope with a stressful event and develops emotional or behavioural symptoms• The stressful event can be anything• People with AD may have a wide variety of symptoms• Symptoms must be developed within 3 months after the onset of the stressor.
    • DSM-V Adjustment DisordersProposals:• To include the AD in the wider category of disorders related to trauma and stress.• To add 2 new subtypes:  AD with symptoms similar to PTSD  Complicated grief(http://www.dsm5.org/Pages/Default.aspx).
    • AD as an important health problem• Very common disorders, that can affect anyone, regardless of gender, age, or lifestyle.  Incidence from 5 to 21% (APA, 2000; Despland, Monod & Ferrero, 1995; Fabrega, Mezzich & Mezzich, 1987)  The most common diagnosis in primary care.• Very frequent in people who suffer from medical conditions (Strain et al., 1998)  especially if they are serious diseases (e.g., approx. 35% of oncologic patients).• Associated with:  significant impairment in social or occupational functioning  Causing a high percentage of sick leaves (Van der Klink et al., 2003).
    • AD: “Forgotten” disorders • In last 25 years, less than 30 articles (Casey, Dowrick y Wilkinson, 2001) • No present in major part of great epidemiological studies • Almost absents in handbooks and psychological guides • Leading article and 2 articles in Comprehensive Psychiatry (2008)
    • Psychological treatment of AD• In the literature we have found few studies which matched different therapeutic approaches to different types of patients (Barraza, 2004; Jojic & Leposari, 2005).• Only 4 out of 10 of these studies were published in prestigious journals with impact factor; two of them are cases studies and the other two include experimental groups.• No specific protocol exists for AD, and the majority of the studies about this issue have significant methodological problems (Casey & Bailey, 2011).
    • The use of ICTs for the treatment of AD• AD: treatment protocol based on CBT procedures and supported by the use of ICTs (specifically EMMA VR system) (Botella, Baños & Guillén, 2008).• EMMA’s World is an adaptive VR display whose content is adapted to every patient’s needs. It is a Sophisticated ICT-based system that helps to produce emotional changes in individuals who have suffered traumatic, disturbing or stressful experiences.
    • EMMA’s World EMMA uses objects and symbols to represent the negative experience that the individual needs to process:• ... In order to enhance and facilitate the process of change.• … Creating, at the same time, a protected and safe environment.
    • EMMA’s World EMMA’s “room": An architectonic structureEMMA’s “world" : 5landscapes around thearchitectonicstructure
    • No HMDRetro projected Big screen Joystick
    • The use of ICTs for the treatment of AD• This treatment protocol has already showed its efficacy in several preliminary studies with participants diagnosed of stress related disorders (including AD) (Andreu-Mateu, Botella, Quero, Guillén,& Baños, in press; Baños et al., 2008; Baños et al., 2011) and in a controlled study that compared 3 experimental conditions (Andreu-Mateu, 2011): 1. EMMA treatment condition 2. Traditional treatment condition 3. Waiting list condition• One way to enhance the efficiency of AD treatment outcomes could be by using ICTs to apply homework assignments in order to consolidate learning between therapy sessions.
    • Homework Assignments in CBT• Since the beginning of CBT the homework assignments are considered very relevant:  As a treatment component.  It’s included in the Agenda of practically all treatment sessions at the beginning and at the end: the homework assigned last week is reviewed and new homework is assigned for the next week.  They are assigned for each therapeutic component that is being introduced in the treatment program.  Traditionally they have included reading materials and writing tasks to carry out between sessions, as well as practicing in real life the different strategies that have been learned in session (e.g., exposure tasks, social skills practice).
    • The use of ICTs for the treatment of AD• Studies that examine the utility of the application of ICTs for the treatment of AD are needed.So far, the studies thatuse ICTs for psychologicaltreatments have been centred onhow to use these technologies toapply the therapy.
    • Use of ICTs to apply homework assignments• The present work pretends to go one step beyond and join:  the use of VR EMMA system within the therapy sessions and  The use of other ICTs to apply homework assignments.• To transfer the ICTs to the patient’s home: what the patient has to do in the meantime between session is also important.• First time that a homework assignments component that ca be completely self-administered over the Internet is developed: EMOTIONAL THERAPY SYSTEM ONLINE (TEO)
    • What is TEO?• It is a completely open system based on Web technology which permits in an easy and effective way to create personalized therapeutic material and to offer and present this material to the patients though the Internet.https://www.teo.uji.es• It is possible to cover different therapy needs and to optimize it.• Allows the therapist to support the patient throughout the whole therapeutic process, facilitating learning.• To use TEO system an Internet connection and a Web browser are needed.
    • What is TEO?• The use of ICTs in order to carry out therapeutic homework provides the patient and the therapist a more active role, more involvement and a higher degree of control throughout the whole treatment process• TEO system includes 2 platforms: 1. Therapist platform (administrator) 2. Patient platform (user)
    • Therapist platform• Manage and administer the database and treatment results.• Manage, organize and label the therapeutic contents based on multimedia materials (texts, videos, images and audios).• Create personalized treatment sessions and protocols with multimedia material, which can be assigned to one or several patients who will be able to visualize them online in the patient’s platform.• Assign assessment protocols that allow the monitoring or supervision of each patient.
    • TEO: Log in portal
    • Therapist platform menu
    • Therapist platform menu• Users: adding a new patient, viewing patients and users list.• Multimedia:  Administer the multimedia contents (texts, videos, images and audio)  He can add multimedia elements and view the list of elements available in the database• Sessions:  Build up by a set of multimedia contents (organized in an strategic way by the therapist) and the patient can view in his/her platform.  He can add a new session, view the list of sessions available and assign a session to a user or several users.• Treatment protocol:  Build up by a set of sessions grouped and ordered strategically according to the specific psychological problems of the patients.  He can add a new protocol, view the list of protocols and add a protocol to a user or several users.
    • Therapist platform menu• Assessment:  Build up by several predetermined instruments that assess the main clinical variables concerning AD.  2 moments of use: Pre-post session made by the user.  The therapist can view the existing assessment protocols and assign them to a patient.• Reports: the therapist has access to the download of the reports derived from all activity carried out with the following data:  List of users and sessions  Protocols contents  Sessions contents  Sessions made by the users.
    • Patient platform (user)• Main function: to receive the sessions assigned and sent by the therapist from the therapist platform.• The user access with a user an a password received by e-mail once he/she is logged in by the therapist.• The user advances in a lineal way and the system offers the different options with tutorials.
    • Patient platform (user): Pre- assessment
    • Patient platform: select the virtual environment
    • Patient platform: Select the session to visualize
    • Patient platform: Visualizing the session
    • Patient platform: walk through the virtual environment
    • Patient platform: ending the session
    • Patient platform: post assessment
    • ObjectiveThe aim of the present work is to present preliminary data about the acceptability of TEO system in a case study with AD
    • Participant• 35 year old woman, divorced with Colombian Nationality who was living in Spain for the last 2 years.• She was doing her doctorate.• She met DSM-IV-TR (2000) criteria for AD with mixed anxiety and depression mood subtype.• Stressful event: work problems.
    • Measures: pre-treatmentHomework Assignments Preferences Questionnaire1. “If you could choose between the two ways of applying the homework assignments, which one would you choose?”;2. “Which of these two ways do you consider more effective to help you overcome your problem?”;3. “Which of these two ways do you consider more aversive?” and;4. “Which of these two ways would you recommend to a friend in case that he/she had the same problem?• .
    • Measures: post-treatmentHomework Assignments Assessment Questionnaire• 2 parts: 1. Traditional method assessment:• Level of agreement from 1 (totally agree) to 5 (totally disagree) with 3 items about her opinion: – the reading materials were useful to overcome her problem – the audio recorded sessions were useful to process the negative event and, – other persons with similar problems should use this material.• An additional item assessed how often she implemented the assignments per week.
    • Measures: post-treatmentHomework Assignments Assessment Questionnaire• 2 parts: 2. TEO method assessment:• Level of agreement from 1 (totally agree) to 5 (totally disagree) with 3 items about her opinion: – the multimedia contents were useful to overcome her problem – Having available at home the symbols and lanscapes of EMMA’s World were useful to process the negative event and, – other persons with similar problems should use the system.• 5 additional usability items (e.g., easy to use, comfortable, …)• Also include an item to assess how often she implemented the assignments per week.
    • Measures: post-treatmentComparison Questionnaire of the two methods:• Assessed the participant’s preferences (TEO system versus Traditional) after treatment with 4 questions:1. “What type of application would you rather use?”2. “Which one of them was more useful to overcome your problem?”3. “Which one was more useful to process the negative event”, and4. “Which one seemed more attractive to you?”.The response scale was multiple choice with 3 alternatives: TEO, Traditional or No difference
    • Design• Case study with two treatment conditions:1. Homework assignments using TEO: • 3 therapy sessions where homework assignments were applied with TEO.2. Homework assignments in the traditional way: • 3 therapy sessions where the homework assignments were applied in the traditional way (reading materials, writing tasks and session audio records)
    • Treatment• CBT program for AD (Botella, Baños & Guillén, 2008).• Components:  Educational  Elaboration/processing of the stressful event • In vivo exposure • Positive strategies • Applied with VR (EMMA system)  Relapse prevention
    • Procedure• Screening interview• Evaluation phase:  Pre-treatment: 2 sessions (1 and a half hour each) • Homework Assignments Questionnaire  Post-treatment: • Homework Assignments Assessment Questionnaire • Comparison Questionnaire of the two Methods (Traditional versus TEO system).
    • Results obtained from the homework assignments preferences questionnaire at pre-treatment Questions Responses If you could choose between the two ways of implementing homework assignments, which TEO one would you choose? Which of these two ways do you consider was TEO more effective to overcome your problem? Which of these two ways do you consider more Traditional aversive? Which of these two treatments would you recommend to a friend in the case that he/she TEO had the same problem?
    • Results obtained from the homework assignmentsassessment questionnaire at post-treatment Item TEO Traditional It is useful to overcome the problem Totally agree (1) Agree (2) It helps to process the negative event Totally agree (1) Agree (2) Other people with similar problems Totally agree (1) Agree (2) should use this method Days of the week the homework 4-5 times per week 4-5 times per week assignments were implemented Easy to use Normal (3) Easy to learn Agree (2) Easy to follow the instructions Nor agree neither disagree (3) Comfortable Very comfortable (5) It is very attractive Totally agree (1)
    • Results obtained from the comparison questionnaire of the two methods at post-treatment Items Chosen option I prefer to use it TEO It is more useful to overcome the problem No difference It is more useful to process the negative event TEO It is more attractive TEO
    • CONCLUSIONS• Results obtained showed positive expectations towards TEO system• Participant’s opinion after treatment was, in general, very positive for both methods.• However, she reported a more positive opinion about TEO than the traditional method.• She also answered positively to the items referred to the usability of the system.• When she compared both methods, she continued to prefer the TEO system over the traditional method.• TEO is the first program developed that permits to apply the homework assignments component using a computer and in a self-applied way.
    • TEO ADVANTAGES• TEO offers a great adaptability and flexibility to adjust the therapeutic homework on every patient’s characteristics and needs, attending to the specific meaning of his/her problem.• Each session will be adapted to the patient’s needs. Furthermore, because it is based on Web it will increase the possibilities for therapy:  it can be used in blended mode (complementing the therapy), or in tele-assistance mode (being the own self-administered therapy).  It might also facilitate the patient’s treatment adherence and the therapist’s work in designing homework assignments.
    • LIMITATIONS• Uncontrolled case study• External validity is compromised• Future research with larger samples and controlled studies are needed
    • CLOSING REMARKS• The advantages and versatility of a system like TEO opens new possibilities to the clinicians:1. to design personalized homework assignments to practice at home what they have worked in the therapy sessions in a self-applied way using a computer.2. To design entire therapeutic sessions or parts of sessions that can be self-applied with a consequence of a reduction of the costs and, as a result, an improvement in the efficiency of the treatment.
    • Thank you very muchfor your attention!
    • CONCLUSIONS• La realidad virtual en la psicología. La realidad virtual en la psicología.• La realidad virtual en la psicología.• La realidad virtual en la psicología. La realidad virtual en la psicología.• La realidad virtual en la psicología.• La realidad virtual en la psicología.• La realidad virtual en la psicología.• La realidad virtual en la psicología.• La realidad virtual en la psicología.• La realidad virtual en la psicología.
    • TEO• Sistema dirigido a las emociones, algo central en el enfoque actual del tratamiento transdiagnóstico de Barlow (Barlow, Allen y Choate, 2004; Ehrenreich, Goldstein, Wrighty Barlow, 2009; Ellard, Fairholme, Boisseau, Farchione y Barlow, 2010; Brown y Barlow, 2009).• Vulnerabilidad psicológica generalizada de base que comparten grupos de trastornos como los trastornos emocionales:  TCC centrado en la regulación emocional  Uso de músicas para exponer a los pacientes a las emociones.• TEO es más potente ya que utiliza otros recursos multimedia para evocar, reflejar emociones positivas y negativas.
    • TEO• TEO puede ser de utilidad a distintos niveles:  como un laboratorio de investigación (inducción de emociones en la línea de los parques de EMMA)  para trabajar en distintos trastornos emocionales los componentes de aceptación y mindfulness y aprender a manejar las emociones y,  para desarrollar protocolos de sesiones de recordatorio de tareas para casa (aquí es por donde hemos empezado y en TA, pero también se están preparando estos protocolos para fibromialgia y para psicooncología)• EN SUMA, Con TEO podemos crear contextos emocionales relevantes desde un punto de vista de psicopatología y de tratamiento.
    • TEO• Sistema dirigido a las emociones, algo central en el enfoque actual del tratamiento transdiagnóstico de Barlow (Barlow, Allen y Choate, 2004; Ehrenreich, Goldstein, Wrighty Barlow, 2009; Ellard, Fairholme, Boisseau, Farchione y Barlow, 2010; Brown y Barlow, 2009).• Vulnerabilidad psicológica generalizada de base que comparten grupos de trastornos como los trastornos emocionales:  TCC centrado en la regulación emocional  Uso de músicas para exponer a los pacientes a las emociones.• TEO es más potente ya que utiliza otros recursos multimedia para evocar, reflejar emociones positivas y negativas.
    • Advantages and disadvantages of the two methods TEO TRAD Interactive Don’t need computer ADVANTAGES More attractive Easy to remember More immersive DISADVANTAGES Unclear interface Monotone