Download - “Talk to me”: A Self-applied Telepsychology Programme for Treatment of Fear of Public Speaking
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Improving Mental Health Care: an
Internet Delivered Program for the
Treatment of Social Phobia
C. Botella
Director of the Clinical Psychology Area
Universitat Jaume I (Spain)
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Mental Disorders
INTRODUCTION
CBT
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INTRODUCTION
Social Anxiety Disorder (SAD) has a high prevalence
between 7% and 13% (Furmark, 2002; Andrews,
Henderson & Hall, 2001; Kessler, Berglund, Demler, Jin &
Walters, 2005).
SAD is usually associated to school phobia, separation
anxiety, and shyness.
If it’s not correctly treated, the development of the disorder
can be chronic and produce important problems in the life of
the person.
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INTRODUCTION
Currently we have evidence based psychological
treatments (EBT) for SAD. Nevertheless:
- less of the 50% of people receive a correct treatment
- the cost and the time that require the treatment
- the lack of well prepared professionals.
- many patients decide do to not seek for help
That is, efficacious psychological treatments are not
available for both, practitioners and patients.
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NEW WAYS OF DELIVERY CBT
One important challenge is to design new and more
cost-effective ways of delivering CBT
Reducing the contact between the patient and the
therapist by using self-help procedures
Using new technologies:
Computer-aided treatments
Virtual reality
The Internet
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Internet-based programs have been successfully applied to the treatment of Social Phobia:
Botella et., (2000, 2004)
Anderson, et al., (2005, 2006)
Carlbring, et al., (2006, 2007)
Titov et al., (2008)
Berger, Hohl, & Caspar (2009)
INTERNET-BASED THERAPY
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SELF-HELP AND THE INTERNET
However, there are only 2 telepsychology programs in which the whole
treatment is self-administered:
“TALK TO ME”
Fear of Public Speaking
The feared scenarios are real
videotaped audiences.
Its efficacy has been proven in:
a case study (Botella,
Hoffmann & Moscovitch, 2004)
a series of 12 cases (Botella,
Guillén et al., 2007)
“WITHOUT FEAR”
Small Animal Phobia The feared scenarios consist of a virtual environment. Its efficacy has been proven in:
a case study (Botella, Quero et al., in press), a series of 12 cases (Botella, Quero et al., in press).
In this presentation we will focus on TALK TO ME
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Objective
To compare the efficacy of a self-administered internet-
based program for the treatment of Social Phobia versus
the same program applied by the therapist.
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SOCIAL PHOBIA
77 participants
16 male (20.8%) and 61 female (79.2%)
Mean age was 24.40 (SD=5.78) ranging from 18 to 48
Educational level:
73 university students (94.8%)
3 went to high school (3.9%)
1 went to primary school (1.3%)
Method: Sample
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Diagnosis: All participants met DSM-IV (APA, 1994, 2002) criteria for Social
Phobia.
Exclusion criteria: Current alcohol or drug dependence
Being in treatment for the same psychological problems
Primary diagnosis of major depression
Psychotic disorder
Subtype of social phobia: Specific social phobia: 29 participants (37.7%)
Non generalized social phobia: 31 participants (40.3%)
Generalized social phobia: 17 participants (22.1%)
Method: Sample
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Between-group design
Participants were randomly assigned to one of the following experimental conditions:
1. Therapist Administered (N=22)
2. Self-administered (N=30)
3. Waiting List (N=25)
Experimental Conditions
Method: Design
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Anxiety Disorders Interview Schedule for Social Phobia (ADIS-IV; Brown, DiNardo, & Barlow, 1994)
Target behaviours: Fear, Avoidance, and Belief in the negative thought
Brief version of the Fear of Negative Evaluation Scale (BFNE; Leary, 1983)
Social Avoidance and Distress Scale (SAD; Watson & Friend, 1969)
Fear of Public Speaking Questionnaire (FPSQ; Bados, 1986).
Method: Measures
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“Talk to Me”: a CBT Program Treatment
Psychoeducation
Cognitive restructuring
Exposure:
Scenarios
• The oral presentation in front of a class
• The oral test
• The job interview
• The oral presentation at work
• The conference
• The wedding
Modulators: gender, number of people
Relapse prevention
Method: system description
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Trust and rapport
“Talk to Me” introduces itself and states that its role is to
assess, guide and offer help
The program has an assistant: Dr. Net
Method: system description
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Assessment
Method: system description
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“Talk to Me”: a CBT Program Treatment
Treatment components:
1.-Psychoeducation
Method: system description
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“Talk to Me”: a CBT Program Treatment
Treatment components:
2.-Cognitive Therapy
Method: system description
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Treatment components: Exposure “The class”
Method: system description
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Treatment components: Exposure “The Conference”
Method: system description
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Treatment components: Exposure “The oral test”
Method: system description
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Treatment components: Exposure “Project Presentation”
Method: system description
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The program has “barriers” between different parts of the
treatment: It is allowed to progress to the next task “only” if
the present task has been overcome.
“Talk to Me” assesses the patient at pre-treatment, during
the treatment and after the treatment.
Method: system description
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0
2
4
6
8
10
pre post 12-month
follow-up
Therapist Self-applied Waiting List
0123456789
pre post 12-month
follow-up
Therapist Self-applied Waiting List
FEAR
F(2,76)=30.73 p<0.001
Talk to Me
AVOIDANCE
F(2,76)= 30.02 p<0.001
0123456789
pre post 12-month
follow-up
Therapist Self-applied Waiting List
BELIEF IN CATASTROPHIC THOUGHT
F(2,76)= 28.69
p<0.001
Target Behaviours
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0
10
20
30
40
50
pre post 12 months
follow-up
Therapist Self-applied Waiting List
Social Avoidance and Distress
Scale
F(2,76)= 4.63
p<0.05
0
10
20
30
40
50
60
pre post follow up 12
months
Therapist Self-applied Waiting List
Fear of Public Speaking
Questionnaire
F(2,76)= 7.23
p<0.01
Talk to Me Self-report questionnaires
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0
2
4
6
8
10
12
14
pre post follow up 12
months
Therapist Self-applied Waiting List
Brief version of the Fear of Negative Evaluation Scale
F(2,76)= 1.35
p=0.267
Talk to Me Self-report questionnaires
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• Results offer support of the effectiveness of the Internet-administered self-help program for the treatment of social phobia.
• “Talk to me” was as effective as the same program applied by a therapist.
• The treatment conditions were more effective than a waiting list control group.
• The treatment program was effective not only at short-term (post-test), but also at long-term (12-month follow-up).
Conclusions
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Counseling/motivation
3D environments
Self-help therapy
Multimedia stimuli
Conclusions
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TELEPSYCHOLOGY AND MENTAL HEALTH:
Reduction of costs
Feared situations more available
Higher control over feared context
Possibility of overlearning
Confidentiality and privacy
A less aversive experience than in vivo exposure
New technologies, in this case the Internet, can allow a higher number of people to have access to health programs and resources:
- at home- choosing the moment they prefer- at their own pace
The future
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CAN ICTs HELP TO IMPROVE QUALITY
OF LIFE AND WELLBEING?
The future
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Assistance and care
Social inclusion
Therapy
Leisure
The Butler project
A CONSOLIDER action project
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Virtual Reality
Environments
-Induction of joyful mood state
-Relaxation
Book of life
My memories:– Images
–Sounds
The Butler project: Tools included
THERAPEUTIC APPLICATION
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“Going to a relaxing place”
“Going to a joyful place”
They allow to induce positive
mood states (relax, joy)
The individual can learn useful
techniques to reduce negative
emotional mood states
(relaxation, mindfulness…)
Therapeutic benefits
Relaxing sun rise
THERAPEUTIC APPLICATION
2 Virtual environments to induce positive mood:
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LUDIC APPLICATION
“Write a letter” “Talk to someone” “Meet new people”
The access to communication using ICTs helps to::
- Promote social support, by helping to maintain the already present relationships (family,
friends, grandchildren…)
- Promote new relationships with other users of the Butler net.
Butler: Tools included
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ETIOBE: A CIBER action
• According to the International
Obesity TaskForce (EASO,
2002) governments should act
against childhood obesity ,
improving the evidence for
treatments.
• ETIOBE is an intelligent e-
therapy system (e-TI) for the
treatment of obesity,
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ETIOBE is composed by 3 applications:
• Clinical support system (CSS)
• Home support system (HSS)
• Mobile support system (MSS)
Home support
system
Mobile support
system
Clinical support
system
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ETIOBE
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OPTIMI: Online Predictive Tools
for Intervention in Mental Illness
- Challenge 5: Towards Sustainable and Personalised Healthcare
- Objective ICT-2009.5.1: Personal Health Systems
Mental Health care represents a third of the health care to all EU nations.
Depression and Stress related disorders are the most common mental illnesses.
The OPTIMI project
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Prevention of Depression and suicide is one of the five points central focus points in the European Pact for Mental Health and Wellbeing.
OPTIMI: prediction, prevention
• is based on a PROACTIVE approach to mental health and pretends lower costs and higher levels of life quality
The OPTIMI concept
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CCBT Treatment
Beating the Blues
• Existing commercial software
approved by NICE
• Will be modified code and
content with OPTIMI
ETIOBE
• Existing e-therapy
treatment under trials in
Spain (schools, pediatric
services hospital , eating
disorder clinics)
• Will be modified code and
content with OPTIMI
The OPTIMI project
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The OPTIMI project
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This is the beginning of a new era in the
psychological treatments field: the evidence-
based CBT programs delivered using the
Internet.
At the present moment it is possible to
conclude that Internet-delivered CBT is useful
for the treatment of different disorders (at least
for some patients
FUTURE PERSPECTIVES
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The prediction seems to be that the
Internet has come, and is going to stay,
and grow, and improve, more and
more in the coming years, helping us
to improve health care.
FUTURE PERSPECTIVES