Objective: Recently, increasing attention has been given to the issue of limited access to evidence-based psychological treatments. Factors affecting access can include geographical distance from service providers, lack of trained specialists, and prohibitive costs for treatment. Videoconferencing provides a convenient, low-cost alternative to in-person psychotherapy. Although videoconferencing treatment has been trialled for a vast array of mental health problems, surprisingly little research has been conducted exploring the efficacy of videoconferencing for the treatment of anxiety disorders. Anxiety disorders are highly prevalent and disabling conditions for which effective psychological treatment exists. The aim of the present study was to determine the state of the evidence with regard to the effectiveness of videoconference-delivered treatment for anxiety disorders. Method: Using preferred reporting items for systematic reviews and meta-analyses guidelines, we conducted a systematic review of all studies that primarily recruited individuals with anxiety disorders, published between 2004 and 2014. Results: We identified 20 studies involving a total of 613 participants. Of the included studies, 50% were uncontrolled and 50% were controlled trials. The majority of studies conducted to date focused on post-traumatic stress disorder (PTSD; n = 10), followed by obsessive-compulsive disorder (n = 5), mixed anxiety and depression (n = 2), panic disorder (n = 2), and social phobia (n = 1). No studies were located that focused on investigating videoconference-delivered therapy exclusively for generalised anxiety disorder. Conclusions: Findings are discussed in terms of the accumulating evidence for the effectiveness of videoconference-delivered therapy to treat anxiety disorders and the need for more trials overall, but particularly for generalised anxiety disorder.
Background: The effectiveness of psychotherapies for social anxiety disorder (SAD) is typically evaluated using self- and clinician-reported symptom change, while biomarkers of treatment response are rarely measured. The current study aimed to compare biomarkers of response following two brief group interventions for SAD. Methods: This randomized controlled trial evaluated the effectiveness of single-session group interventions for SAD (n = 58) – imagery rescripting (IR) and verbal restructuring (VR) versus waitlist control (WC). The IR intervention guided participants to rescript autobiographical memories through visualization whilst the VR intervention focused on thought challenging. Trial outcomes included change in psychophysiological reactivity (heart rate variability (HRV) and electrodermal responding) to social stress, and symptom-based measures (social interaction anxiety, negative self-portrayal, cognitive avoidance, repetitive negative thinking, memory modification, anxious behaviors). Results: Psychophysiological reactivity was selectively attenuated following IR treatment, compared to VR and WC groups. The specific influence of the imagery-based intervention in modulating autonomic reactivity was evident across HRV parameters, including the standard deviation of intervals between heartbeats (IR vs. WC, d = 0.67, p = 0.021; IR vs. VR, d = 0.58, p = 0.041), and high frequency power – an indicator of parasympathetically mediated emotion regulation (IR vs. WC, d = 0.75, p = 0.034; IR vs. VR, d = 0.95, p = 0.006). Few group differences were observed across self-report measures. Conclusion: The current study highlights the specificity of brief imagery-based interventions in influencing psychophysiological reactivity in SAD and establishes the sensitivity of objective markers of treatment response in quantifying change over symptom-based measurements.
Objective: The Concentric Circles Therapy Training (CCTT) approach is a revised version of a previously developed interpersonal therapy training approach that primarily aims to develop therapist's awareness of interpersonal process. The CCTT approach enables students to take part in an interpersonal therapy training group both as a participant and as an observer. The aim of the study was to obtain in-depth accounts of the experience of this revised approach to interpersonal therapy training. Methods: Seven Clinical Psychology post-graduate students took part in the study, with each participant providing 6 weeks of in-depth personal reflective journals regarding their psychotherapy training experience. Thematic analysis was used to determine the predominant themes. Results: Three main themes emerged in the data: personal reflections, interpersonal reflections, and integration. Overall, participants indicated that being able to be both a participant and an observer was a unique and powerful learning experience, and all participants indicated that participation in the concentric circles training was an important part of their training to become psychotherapists. Conclusion: The CCTT approach was developed to provide a practical solution to enable interpersonal therapy training in clinical psychology courses where class sizes continue to increase. What is already known on this topic1 Effective psychotherapy relies on a blend of specific (content) and non-specific (process) factors. 2 Due to the heavy emphasis placed on the importance of teaching evidence-based therapies, clinical psychology postgraduate courses have tended to focus less attention on teaching related to the process elements of psychotherapy. 3 Innovative efforts to address this shortfall such as reflective selfpractice and interpersonal psychotherapy groups have evidence of effectiveness. What this paper adds1 Despite the challenge of larger class sizes in postgraduate clinical psychology courses, it is still possible to provide an intensive approach to teaching process aspects of psychotherapy. 2 The Concentric Circles Approach provides students with the ability to learn about interpersonal process from the perspective of both a participant and an observer. 3 Despite initial hesitations and anxieties, by the end of the sessions, students are able to integrate the experience and relate it back to their work as therapists.
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