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      The Possible Role of Internet-Delivered Psychological Interventions in Relation to the COVID-19 Pandemic


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          Multidisciplinary research priorities for the COVID-19 pandemic: a call for action for mental health science

          Summary The coronavirus disease 2019 (COVID-19) pandemic is having a profound effect on all aspects of society, including mental health and physical health. We explore the psychological, social, and neuroscientific effects of COVID-19 and set out the immediate priorities and longer-term strategies for mental health science research. These priorities were informed by surveys of the public and an expert panel convened by the UK Academy of Medical Sciences and the mental health research charity, MQ: Transforming Mental Health, in the first weeks of the pandemic in the UK in March, 2020. We urge UK research funding agencies to work with researchers, people with lived experience, and others to establish a high level coordination group to ensure that these research priorities are addressed, and to allow new ones to be identified over time. The need to maintain high-quality research standards is imperative. International collaboration and a global perspective will be beneficial. An immediate priority is collecting high-quality data on the mental health effects of the COVID-19 pandemic across the whole population and vulnerable groups, and on brain function, cognition, and mental health of patients with COVID-19. There is an urgent need for research to address how mental health consequences for vulnerable groups can be mitigated under pandemic conditions, and on the impact of repeated media consumption and health messaging around COVID-19. Discovery, evaluation, and refinement of mechanistically driven interventions to address the psychological, social, and neuroscientific aspects of the pandemic are required. Rising to this challenge will require integration across disciplines and sectors, and should be done together with people with lived experience. New funding will be required to meet these priorities, and it can be efficiently leveraged by the UK's world-leading infrastructure. This Position Paper provides a strategy that may be both adapted for, and integrated with, research efforts in other countries.
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            The COVID-19 pandemic: The ‘black swan’ for mental health care and a turning point for e-health

            In February 2020, Duan and Zhu (2020) stressed the need for a solid Chinese evidence-based mental health care system in times of public health emergencies such as the outbreak of the Coronavirus disease-2019 (COVID-19). That would enable treatment of people who suffer from mental health problems in relation to the epidemic. The WHO has meanwhile labelled the Coronavirus a pandemic, and it is now hitting Europe, the USA, and Australia hard as well. In an attempt to reduce the risk of infections, many mental health care providers in afflicted countries are currently closing their doors for patients who need ambulatory face-to-face therapy. They are simultaneously trying to replace some of these contacts with digital therapies. Most probably, European mental health care institutions have yet to experience the full impact of the coronavirus crisis. At the same time, the demand for mental health care among infected patients and their relatives is expected to rise (Blumenstyk, 2020). Levels of anxiety will increase, both through direct causes including fears of contamination, stress, grief, and depression triggered by exposure to the virus, and through influences from the consequences of the social and economic mayhem that is occurring on individual and societal levels. We expect that this “black swan” moment (Blumenstyk, 2020) - an unforeseen event that changes everything - will lead to a partly, though robust, shift in mental health care provision towards online prevention, treatment, and care in the near future. We also need to consider the role of psychological processes and fear that may cause further harm on top of the pandemic (Asmundson and Taylor, 2020). The obvious solution to continue mental health care within a pandemic is to provide mental health care at a ‘warm’ distance by video-conferencing psychotherapy and internet interventions. A systematic review showed that videoconferencing psychotherapy show promising results for anxiety and mood disorders (Berryhill et al., 2019), and the evidence-base for therapist-guided internet interventions is even stronger (Andersson, 2016). Yet, despite two decades of evidence-based e-mental health services, numerous barriers have stalled the overall implementation in routine care thus far (Vis et al., 2018; Tuerk et al., 2019). One of the most important barriers highlighted, however, has been that e-mental health has not been integrated as a normal part of routine care practice due to the lack of acceptance by health professionals themselves (Topooco et al., 2017). Myths on telehealth such as “the therapeutic alliance can only be established face-to-face” have dominated the field, in spite of research showing the opposite (Berger, 2017). In that sense, learning curves in the adoption of new e-mental health technologies by both patients and psychologists have progressed far more slowly than initially expected, thus tallying with the estimate that it takes on average16 years for a health care innovation to be implemented (Rogers et al., 2017). There are however exceptions in the world but progress is still slow. In the Netherlands and elsewhere, we are now witnessing a phenomenon whereby the outbreak of COVID-19 is hastening managers, ICT-staff, and clinicians to overcome all such barriers overnight, from a pragmatic standpoint seldom seen before. The virus seems a greater catalyst for the implementation of online therapy and e-health tools in routine practice than two decades of many brilliant, but failed, attempts in this domain (Mohr et al., 2018). After all, since predictions about COVID-19 are largely unclear as of yet, it is now time to create a longer-term solution to the problem of heterogeneous patient populations, such as those still active in the community and those that are house-bound or isolated in hospitals. Videoconferencing and internet interventions could therefore be very helpful in mental health care, as well as in physical care and can be easily upscaled to serve isolated regions and reach across borders. Thus, the “black swan virus” has already enabled wide-scale acceptance of videoconferencing by health professionals and patients alike – creating a win-win situation for both. We should stress that e-mental health applications hold value far beyond the provision of videoconferencing psychotherapy in the current situation of crisis. Countries hit by the Corona virus may also consider adopting a wider public e-mental health approach, which would focus additionally on prevention and on reaching people at risk for mental health disorders. In this respect, not only guided but also fully self-guided interventions, such as self-help apps or online therapeutic modules, could also be applied in settings and countries with scarce mental health resources (Christiani and Setiawan, 2018). We should also consider the need for treatment development (for the psychological problems caused by corona virus isolation), which is by far more rapid in the field of internet interventions than in traditional psychotherapy (Andersson et al., 2018). It is likely that the response to this emergency will be more than a temporary increase in online work (Blumenstyk, 2020). Once mental health care institutions have developed the capabilities of serving their patients via videoconferencing and other digital technologies, there is little reason for them to give these up, in view of the many advantages (Blumenstyk, 2020; Tuerk et al., 2019). This black swan should be a call for action by encouraging providers to move more rapidly towards blended care models (van der Vaart et al., 2014; Kooistra et al., 2019). Agility, flexibility, and resilience are essential skills for 21-st-century institutions, particularly when unforeseen disruptive viruses and devastating events driven by climate change are likely to be increasingly common (Blumenstyk, 2020). We urge practitioners to promptly start adopting e-mental health care applications, both as methods to continue their care to current patients in need and as interventions to cope with the imminent upsurge in mental health symptoms due to the coronavirus. Uncited reference Karyotaki et al., 2018
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              Internet‐delivered psychological treatments: from innovation to implementation

              Internet interventions, and in particular Internet-delivered cognitive behaviour therapy (ICBT), have existed for at least 20 years. Here we review the treatment approach and the evidence base, arguing that ICBT can be viewed as a vehicle for innovation. ICBT has been developed and tested for several psychiatric and somatic conditions, and direct comparative studies suggest that therapist-guided ICBT is more effective than a waiting list for anxiety disorders and depression, and tends to be as effective as face-to-face CBT. Studies on the possible harmful effects of ICBT are also reviewed: a significant minority of people do experience negative effects, although rates of deterioration appear similar to those reported for face-to-face treatments and lower than for control conditions. We further review studies on change mechanisms and conclude that few, if any, consistent moderators and mediators of change have been identified. A recent trend to focus on knowledge acquisition is considered, and a discussion on the possibilities and hurdles of implementing ICBT is presented. The latter includes findings suggesting that attitudes toward ICBT may not be as positive as when using modern information technology as an adjunct to face-to-face therapy (i.e., blended treatment). Finally, we discuss future directions, including the role played by technology and machine learning, blended treatment, adaptation of treatment for minorities and non-Western settings, other therapeutic approaches than ICBT (including Internet-delivered psychodynamic and interpersonal psychotherapy as well as acceptance and commitment therapy), emerging regulations, and the importance of reporting failed trials.

                Author and article information

                Clin Psychol Eur
                Clin Psychol Eur
                Clinical Psychology in Europe
                September 2020
                30 September 2020
                : 2
                : 3
                : e3941
                [a ]Department of Behaviorial Sciences and Learning, Linköping University , Linköping, Sweden
                [b ]Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit , Amsterdam, the Netherlands
                [c ]Department of Research and Innovation, GGZ in Geest/Amsterdam University Medical Center, VU University Medical Center , Amsterdam, the Netherlands
                [d ]The Hebrew University of Jerusalem, Mount Scopus, Jerusalem, Israel
                [e ]MindSpot Clinic, Macquarie University , Sydney, Australia
                [f ]eCentreClinic, Department of Psychology, Macquarie University , Sydney, Australia
                Author notes
                Gerhard Andersson, Department of Behavioural Sciences and Learning, Linköping University, SE-581 83 Linköping, Sweden. Tel: ++46 13 28 587 40. Fax: ++46 13 28 21 45. Gerhard.Andersson@ 123456liu.se
                Copyright @ 2020

                This is an open-access article distributed under the terms of the Creative Commons Attribution (CC BY) 4.0 License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                The authors have no funding to report.


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