Patterns of utilization and a case illustration of an interactive text‐based psychotherapy delivery system

Nitzburg, George C.; Farber, Barry A.

doi:10.1002/jclp.22718

Cited by 13 publications

(10 citation statements)

References 34 publications

(32 reference statements)

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“…In studying use patterns, Nitzburg and Farber (2019) found that the demographic characteristics of telepsychotherapy users were consistent with findings on traditional, FtF psychotherapy. They found higher utilization ratios among clients who were female, Caucasian, college-educated, and between ages 21 to 50.…”

Section: Platform Examples: Use and Preliminary Evidencesupporting

confidence: 56%

“…Outcomes did not significantly differ across age, gender, financial status, or physical health status. Importantly, this study lacked a control group.In studying use patterns,Nitzburg and Farber (2019) found that the demographic characteristics of telepsychotherapy users were consistent with findings on traditional, FtF psychotherapy. They found higher utilization ratios among clients who were female, Caucasian, college-educated, and between ages 21 to 50.…”

supporting

confidence: 56%

“…Therapists on this site are required to hold the highest clinical license in their state of residence allowing independent practice, a minimum of three years of direct clinical experience, professional malpractice liability insurance, and can only work with clients in the state(s) where they are licensed. Nitzburg and Farber (2019) explained that therapists use this medium to conduct psychotherapy according to their preferred theoretical orientation. Therapists must respond to patient texts a minimum of twice a day within an 8-hr/day, 5-day/week timeframe.…”

Section: Platform Examples: Use and Preliminary Evidencementioning

confidence: 99%

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A narrative review of alliance formation and outcome in text-based telepsychotherapy.

Schwartzman¹,

Boswell²

2020

Practice Innovations

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The prevalence of mental health difficulties has been rising, yet the availability and use of mental health services remains low. One specific barrier to receiving mental health care is the prevailing model of treatment delivery, namely individual psychotherapy in an office setting. Multimodal digital therapy platforms that offer treatment using technology hold promise in overcoming persisting barriers to intervention access and reaching individuals in traditionally underserved groups, including elderly populations, racial and ethnic minorities, low-income individuals, those without insurance, those with physical impairments, and residents of rural areas. Yet, many researchers and mental health professionals have expressed doubt regarding the suitability and efficacy of text-based telepsychotherapy. They tend to believe that without the benefit of contextual and nonverbal cues present in a face-to-face environment, an authentic and deep relationship cannot develop. Therefore, the present article reviewed research examining alliance formation and treatment outcomes in telepsychotherapy. We discuss socioemotional theory and research studies investigating how emotions are communicated in the computer-mediated environment-an environment lacking physical presence, nonverbal cues, and visual identifiers. Multicultural considerations within this treatment modality and research area are also addressed. We conclude with implications, suggestions for clinicians, limitations of the research base, and future research directions. This knowledge may help elucidate the mechanisms of change in text-based telepsychotherapy and inform future therapist training and competency development in this area. Clinical Impact StatementText-based telepsychotherapy holds potential to mitigate barriers to access to mental healthcare (e.g., for underserved populations, for those mandated to stay home during a crisis). This article reviews the research conducted on the select telepsychotherapy feature of emotional communication through text given its transtheoretical relevance for alliance formation and successful psychotherapy outcome.

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Section: Platform Examples: Use and Preliminary Evidencesupporting

confidence: 56%

supporting

confidence: 56%

Section: Platform Examples: Use and Preliminary Evidencementioning

confidence: 99%

See 1 more Smart Citation

A narrative review of alliance formation and outcome in text-based telepsychotherapy.

Schwartzman¹,

Boswell²

2020

Practice Innovations

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“…Data from 267 users indicated that the service was predominantly accessed by females (198/267, 74.2%), aged 21-50 years (243/267, 91.0%; median 34 years), with a college education (212/267, 79.4%), living in (sub)urban locations (232/267, 86.9%). Past barriers to face-to-face treatment reported by 240 participants included cost (130/240, 54.2%), excessive time and inconvenience (101/240, 42.1%), and face-to-face therapy not being helpful (67/240, 27.9%) [32]. These findings indicate that Talkspace is effective in addressing a range of mental health issues, although the results should be interpreted with caution because the authors were affiliated with the service.…”

Section: Effectiveness Of Text-based E-mental Health Servicesmentioning

confidence: 99%

Suitability of Text-Based Communications for the Delivery of Psychological Therapeutic Services to Rural and Remote Communities: Scoping Review

Dwyer¹,

Neto²,

Estival³

et al. 2021

JMIR Ment Health

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Background People living in rural and remote areas have poorer access to mental health services than those living in cities. They are also less likely to seek help because of self-stigma and entrenched stoic beliefs about help seeking as a sign of weakness. E-mental health services can span great distances to reach those in need and offer a degree of privacy and anonymity exceeding that of traditional face-to-face counseling and open up possibilities for identifying at-risk individuals for targeted intervention. Objective This scoping review maps the research that has explored text-based e-mental health counseling services and studies that have used language use patterns to predict mental health status. In doing so, one of the aims was to determine whether text-based counseling services have the potential to circumvent the barriers faced by clients in rural and remote communities using technology and whether text-based communications, in particular, can be used to identify individuals at risk of psychological distress or self-harm. Methods We conducted a comprehensive electronic literature search of PsycINFO, PubMed, ERIC, and Web of Science databases for articles published in English through November 2020. Results Of the 9134 articles screened, 70 met the eligibility criteria and were included in the review. There is preliminary evidence to suggest that text-based, real-time communication with a qualified therapist is an effective form of e-mental health service delivery, particularly for individuals concerned with stigma and confidentiality. There is also converging evidence that text-based communications that have been analyzed using computational linguistic techniques can be used to accurately predict progress during treatment and identify individuals at risk of serious mental health conditions and suicide. Conclusions This review reveals a clear need for intensified research into the extent to which text-based counseling (and predictive models using modern computational linguistics tools) may help deliver mental health treatments to underserved groups such as regional communities, identify at-risk individuals for targeted intervention, and predict progress during treatment. Such approaches have implications for policy development to improve intervention accessibility in at-risk and underserved populations.

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“…Clients may pay for a plan with optional synchronous 1-hour sessions conducted through chat, telephone, or videoconferencing that can be either 1 or 4 times per month. Several observational studies with selected samples of Talkspace users suggest that the use of the asynchronous text-based psychotherapy plan is associated with improvement in depression symptoms over 12 to 16 weeks of treatment; however, none of these studies examined predictors of these outcomes and for whom the therapy may be most beneficial [ 15 - 18 ].…”

Section: Introductionmentioning

confidence: 99%

Predictors of Disengagement and Symptom Improvement Among Adults With Depression Enrolled in Talkspace, a Technology-Mediated Psychotherapy Platform: Naturalistic Observational Study

Darnell¹,

Pullmann²,

Hull³

et al. 2022

JMIR Form Res

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Background Depression is a common psychiatric condition with an estimated lifetime prevalence for major depression of 16.6% in the US adult population and is effectively treated through psychotherapy. The widespread availability of the internet and personal devices such as smartphones are changing the landscape of delivery of psychotherapy; however, little is known about whether and for whom this type of therapy is beneficial, and whether having synchronous video-based sessions provides additional benefits to clients above and beyond messaging-based therapy. Objective This study examined the outcomes associated with the use of a digital platform (Talkspace) for technology-mediated psychotherapy. We examined the duration of client engagement in therapy and client depression score trajectories over 16 weeks. We explored the association of client characteristics, therapist characteristics, and service plan type with time-to-disengagement and trajectories of change in depression scores. Methods This naturalistic observational study assessed data collected routinely by the platform between January 2016 and January 2018 and examined psychotherapy outcomes among a large representative sample of adult clients with clinically significant depression. Treatment disengagement was defined as a lack of client-initiated communication for more than 4 weeks. Clients completed the Patient Health Questionnaire-8 item (PHQ-8) at intake and every 3 weeks via an in-app survey. Cox regression analysis was used to examine the time until and predictors of disengagement. Changes in depression scores and predictors of change over time were examined using mixed-effects regression. Results The study included 5890 clients and 1271 therapists. Client scores on the PHQ-8 declined over time, with the average client improving from a score of 15 to below the clinical cutoff of 10 by week 6. At the same time point, 37% of clients had disengaged from the therapy. When combined into a final Cox regression model, those who were more likely to disengage were clients aged 18 to 25 years versus those aged ≥50 years (odds ratio [OR] 0.82, 95% CI 0.74-0.9; P<.001), had higher education (OR 1.14, 95% CI 1.06-1.22; P<.001), had been in therapy before (OR 1.09, 95% CI 1.02-1.17; P=.01), and were living with a partner but unmarried versus single (OR 1.14, 95% CI 1.02-1.27; P=.02). Having a therapist with >10 years of experience was related to lower odds of disengagement (OR 0.87, 95% CI 0.8-0.94; P=.01). When combined into a final regression model predicting improvement in depression scores over time, clients showing more improvement were those with an associate’s degree or higher (linear estimate=−0.07, P=.002) and higher intake PHQ-8 scores (estimate=3.73, P<.001). There were no differences based on the plan type. Conclusions Our findings add to the growing literature showing the benefits of technology-mediated psychotherapy over a relatively brief period (16 weeks).

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Patterns of utilization and a case illustration of an interactive text‐based psychotherapy delivery system

Cited by 13 publications

References 34 publications

A narrative review of alliance formation and outcome in text-based telepsychotherapy.

A narrative review of alliance formation and outcome in text-based telepsychotherapy.

Suitability of Text-Based Communications for the Delivery of Psychological Therapeutic Services to Rural and Remote Communities: Scoping Review

Predictors of Disengagement and Symptom Improvement Among Adults With Depression Enrolled in Talkspace, a Technology-Mediated Psychotherapy Platform: Naturalistic Observational Study

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