Roseanne Dobkin and her colleagues (e.g., Dobkin, Interian, Durland, Gara, Menza, 2018) have developed a 10-session, individual cognitive-behavioral treatment (CBT) program for treating depression in individuals with Parkinson’s disease (dPD). The program has been found to yield statistically and clinically significant success in both uncontrolled group trial designs and randomized clinical trials—originally in a face-to-face version, and then in a telehealth version, using telephone therapy sessions and guided self-help materials for patients. This latter version is herein called "Teleheath Guided Self-Help for dPD," or "TH-GSH-dPD," for short. Applying Fishman, Messer, Edwards, and Dattilio’s (2017) "case studies within psychotherapy trials" methodological model, the present research was designed to complement the group research findings by my conducting systematic, pragmatic case studies (Fishman, 2013) with four patients representative of those in the telehealth studies, given the names of "Alice" (and her caregiver husband "Bob"); "Carl" (and his caregiver wife "Doris"); "Ethan" (and his caregiver wife, "Fay"); and "Gary" (and his caregiver mother, not named). Specifically, Alice and Carl were representative of those patients in the group studies with positive, responsive outcomes; and Ethan and Gary were representative of those patients in the group studies with negative, nonresponsive outcomes. Each case combines (a) quantitative data, comprised of demographic information, psychiatric diagnostic data, neurocognitive data, caregiver distress, and treatment outcome measures; and (b) qualitative data, consisting of recordings of the telephone therapy sessions, my treatment notes, my observations as the therapist, and systematic, post-treatment "Exit Interviews" I conducted with each of the patients and their caregivers about their therapy experience. Each of the four case studies aims (a) to provide a detailed, thickly described portrait of the TH-GSH-dPD treatment process; and (b) to explore the presence and influence of barriers and facilitators of treatment in an idiographic context. Regarding point (b), the following variables that cut across the case studies are explored as appearing to be particularly impactful: patients’ worldviews, patients’ cognitive functioning, caregiver involvement, and homework adherence.
Although millions of individuals suffer from mental health problems worldwide, only a small fraction receives adequate treatment. The high prevalence of depression and anxiety observed worldwide, in conjunction with very low rates of treatment utilization, are of great clinical significance, as these psychiatric conditions are two of the most important determinants of quality of life (QoL). Telehealth interventions have been touted as potential solutions to these mental health care disparities, with great interest and utility demonstrated across a diverse array of medical and psychiatric populations. Telehealth interventions may be clinic-based or homebased. The primary objective of this paper is to highlight the extent to which telehealth-to-home interventions positively impact multiple facets of QoL for individuals with depression and anxiety disorders, including those with comorbid medical conditions. While QoL outcomes are important to consider in any assessment of treatment effectiveness, QoL enhancement has received limited attention in the telemental health literature to date. All studies included in the present review evaluate telehealth-to-home treatments, assess QoL outcomes, and incorporate some degree of live, synchronous therapist-patient contact. Recommendations to advance the application of telehealth-to-home approaches are proposed and include: additional research on video-to-home telehealth platforms, strategies to increase the adoption of telehealth-to-home interventions amongst mental health treatment providers, national legislative reform to establish fair and appropriate reimbursement parameters for telehealth-to-home care, standardized definitions of telehealth-to-home services to facilitate provider engagement and reimbursement, and systematic approaches for measuring the cost-effectiveness of telehealth-to-home treatments.
My current clinical practice has been shifted to a telehealth format for the last three months due to the COVID-19 pandemic, and it seems an apt moment to reexamine my participation in Dr. Roseanne Dobkin’s research on manualized telehealth therapy for depression in Parkinson’s disease patients (dPD), using a protocol titled "Teleheath Guided Self-Help for dPD," or "TH-GSH-dPD," for short (Dobkin et al., 2020). My participation involved, in part, being the therapist in four case studies I have written about with "Alice," "Carl," "Ethan," and "Gary" (Durland, 2020). In these case studies, a subset of those in Dr. Dobkin’s group studies, I explored my clinical decision-making, seeking insight into how best to flexibly apply the dPD protocol to meet the needs of a heterogeneous clinical population. Here, my aim is to recontextualize and expand on the conclusions of my four case studies, based on my dissertation and conducted over three years ago (Durland, 2017), in light of both my recent experience providing mental health services and the Commentaries on the four case studies so perceptively contributed by Dr. Dobkin and her colleagues (Mann, Miller, St. Hill, Dobkin, 2020) and by Liza Pincus (2020). In particular, I will focus first on (a) continuing the analysis of clinical decision-making involved in the case studies described in my earlier article (Duland, 2020); and then on (b) general issues related to the delivery of telehealth treatment.
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