Patient perspectives of Internet-delivered cognitive behavior therapy for psychosocial issues post spinal cord injury.

Abstract

Purpose: Many individuals with a spinal cord injury (SCI) report significant symptoms of depression and/or anxiety post-SCI; however, access to mental health services can be limited. The purpose of this study was to evaluate patient perspectives on the acceptability of an 8-week guided Internet-delivered cognitive behavior therapy (ICBT) course (Chronic Conditions Course) for people with SCI. In particular, we sought to understand patient perceptions of facilitators and barriers of engaging in ICBT and strengths and weaknesses of ICBT program content. Method: Semistructured interviews were conducted with 8 SCI patients after completion of the ICBT course. The interviews were audio-recorded, transcribed verbatim, and examined by means of thematic analysis by 2 coders. Results: Eight participants (mean age ϭ 53.2 years; males ϭ 50%; paraplegia ϭ 67.5%) were interviewed. Four major themes emerged when examining facilitators to completing the program: accessibility, flexibility, motivation, and guided support. Barriers to completing the program included course timeframe and physical health. Strengths of the course included effective skill development and mental health prioritization. Suggested changes to the course included improved breadth of case stories, development of extra resources, adjusting the course timeframe to account for the SCI, and more support from the guide. Conclusions: ICBT was overall highlighted as an acceptable method of receiving care for people with SCI. The study provides direction for improving delivery of ICBT to ensure this method of treatment meets the needs of individuals with SCI. Impact and ImplicationsA limited number of studies have evaluated the efficacy of internet-delivered cognitive behavior therapy (ICBT) among persons with spinal cord injury (SCI). The current study is the first to provide insight into the barriers and facilitators of implementing ICBT in this population. The results from the current study confirm the acceptability of ICBT among those with SCI. It also provides guidance for further tailoring ICBT to meet the needs of those with SCI. Due to lack of mental health resources and access to specialists, the study demonstrates the potential of ICBT to improve access to mental health care among those with SCI.

Factors Affecting the Delivery and Acceptability of the ROWTATE Telehealth Vocational Rehabilitation Intervention for Traumatic Injury Survivors: A Mixed-Methods Study

“…Several key facilitators were identified corroborating previous studies, including reduced travel time [ 10 , 12 , 13 , 15 , 38 , 39 , 40 ], improved access and geographical reach [ 10 , 15 , 38 , 39 , 40 , 41 ], positive patient experiences of telerehabilitation [ 10 , 15 , 39 , 41 , 42 , 43 , 44 ], increased flexibility in service delivery associated with remote delivery [ 10 , 38 , 40 , 42 , 44 ] and enhanced communication and teamworking between health care providers [ 15 ]. Patients felt that receiving remote therapy in the comfort of their own home helped them to engage in sessions, for example, because they felt less conscious about injuries than in a face-to-face meeting.…”

“…Patients felt that receiving remote therapy in the comfort of their own home helped them to engage in sessions, for example, because they felt less conscious about injuries than in a face-to-face meeting. Other studies have also reported that patients preferred remote delivery because they felt more comfortable at home [ 44 ], liked the anonymity it afforded or because it reduced stigma, avoided triggers for post-traumatic stress disorder or avoided travel-related anxiety [ 39 ]. To our knowledge, our finding that therapists who had received training and used remote delivery started to incorporate it into their professional role or identity has not been reported by other studies.…”

Mental Health and Spinal Cord Injury: Clinical Considerations for Rehabilitation Providers

“…It is important for providers to assess and monitor mood and psychological distress following injury, as untreated mental health conditions can impact pain levels, self-management, goal achievement during rehabilitation, length of hospitalization, and overall health and life satisfaction [ 18 ]. Rehabilitation psychologists who are embedded in rehabilitation teams are able to provide patients with support, assist with emotional and cognitive adaptation, encourage motivation and participation in therapies, and promote strengths and positive coping skills during acute rehabilitation, which can lead to improved emotional and physical health.…”

“…Research indicates that many people with SCI face new challenges after discharge [ 2 ], and express interest in post-discharge follow-up from mental health providers to assist with coping and adaptation [ 52 ]. However, fewer than half of individuals with SCI are engaged in appropriate services to address their mental health needs, both during and after initial rehabilitation [ 18 ]. Telepsychology and other internet-delivered psychotherapies have been well received within the SCI population and can mitigate some of the challenges in access to mental healthcare, specifically transportation, cost, and access to a rehabilitation psychologist [ 18 ].…”

“…However, fewer than half of individuals with SCI are engaged in appropriate services to address their mental health needs, both during and after initial rehabilitation [ 18 ]. Telepsychology and other internet-delivered psychotherapies have been well received within the SCI population and can mitigate some of the challenges in access to mental healthcare, specifically transportation, cost, and access to a rehabilitation psychologist [ 18 ]. The rise in telemedicine practices across disciplines, including telerehabilitation, due to the COVID-19 pandemic has helped PWD access needed healthcare services, while mitigating many barriers to appropriate care [ 58 ].…”