Online forum on 4/3

Critically read Chapter 12 (234-242) and use your own words to describe in depth:

1. How has the doctor-patient relationship changed with the use of videoconferencing and e-therapy, and how should the practitioners deal with the change?
2. What is a virtual patient advocates (VPA) and why might it work (e.g., for children, veterans, etc.)?

Blog Post 11-Amy Spear

This week we discussed mobile psychiatric apps. These types of apps are becoming increasingly popular as our smartphone usage is increasing. These apps give patients with mental health disorders the opportunity to self assess and monitor their symptoms and well as feel as sense of empowerment by doing this.

Psychiatric apps can be used by patients with many disorders like PTSD, depression, anxiety, substance abuse, and alcoholism. Since I have had personal experience with PTSD I am very interested in apps that help PTSD patients. My grandfather is a retired army veteran who served in World War II and the Vietnam War. After returning home, he suffered from severe PTSD. He rarely sought help for his disorder. He felt embarrassed and even scared and did not want to travel to see a professional. However, If these mobile apps had been available then, they would have been very beneficial to him. These apps help eliminate the stigma that is associated with these disorders. He would have been able to monitor his symptoms and complete therapy by himself and if his symptoms increased in severity he could reach a health professional if he wanted.

There are many applications that help patients with PTSD. Some of these include PTSD Coach, Virtual Hope Box, The Objective Zero, and Mindfulness Coach. I have researched many of these apps. However, I became very familiar with PTSD Coach. This app is an excellent tool for PTSD patients because it allows them to assess and track their symptoms as well as have access to coping tools if their symptoms are triggered in everyday situations.

As a future clinician, I believe I would utilize these types of apps to educate patients and encourage them to use them to become more familiar with their disorders and symptoms. I think that these psychiatric apps could be used alone to help patients with mild forms of their disorder. However, with increasing severity of these disorders, I believe these apps would be best used in conjunction with conventional mental health therapies such as Cognitive Behavioral Therapy.

Blog Post 11 - Abbi Herrold

This week in class we discussed the use of mobile applications as an intervention for psychological disorders. Psychiatric apps offer many benefits that traditional health care does not offer such as portability, low-cost, and additional features such as notifications to record moods and triggers. However, one main limitation of these applications is that even though there is well over 5,000 of them only a few have been studied for empirical support. Some of these include: PTSD coach for helping veterans manage this disorder, Mobilyze focused on the treatment of Major Depression, and finally Step Away which is an intervention for those struggling with Alcohol Use Disorder and other Substance Use disorders.

The Anxiety and Depression Association of America (ADAA) has a webpage that anybody can visit in order to help them find a useful psychiatric application. The ADAA rates all the apps on a scale of 1 to 5 (1 being low and 5 being high) on ease of use, effectiveness, personalization, interactive/feedback, and research evidence. However, they have only just under 20 apps listed which shows just how much more research needs to be done in the effectiveness of these apps. These apps include some which have covered in class previously such as: PTSD coach, MoodTools, Moodkit & Pacifica (which I will be focusing on for my final paper. In addition to many apps in which have not yet discussed such as: What's My M3 (mood disorders), CPT coach (PTSD), Live OCD Free, Anxiety Reliever, and iCBT (cognitive behavioral therapy for multiple diagnosis).


While I am very pleased to see that markets recognize a need for these apps and are taking initiative to create them, I hope that a balance can be made between the creation of these apps and the amount of research and randomized control trials scientists are capable of doing. I would be very disappointed to see a few psychiatric apps (which are not scientifically based) gain popularity and ruin the name of effective psychiatric apps.

As an aspiring psychologist I would be willing to recommend the use of these apps, but encourage them to utilize these applications with skills taught in therapy. Additionally, I would be willing to recommend a psychiatric app which has not been thoroughly reviewed if I found it to be effective as a practicing psychologist, in addition to it being free.

https://www.adaa.org/finding-help/mobile-apps

Blog Post 10-Amy Spear

This week we focused on Cognitive Behavioral Therapy in web-based interventions. Cognitive behavioral therapy is one of the leading approaches to psychotherapy. It is based on the idea that our thoughts, feelings, and behaviors are constantly interacting and influencing one another. CBT helps patients manage issues by allowing them recognize then alter the way they think and behave. It also helps change negative ways of thinking overgeneralizing and blaming one’s self for things that aren't their fault.

Computerized CBT is becoming more widely used and has been shown to help treat mental health problems. Specifically they have been seen to  significantly reduce  anxiety and depression. There are many advantages to computerized CBT including its increased availability, anonymity, accessibility, and flexibility.  There are many computerized CBT programs being developed. For my article presentation, I researched a specific computerized CBT program called Camp Cope-A-Lot. This intervention utilizes CD software to deliver activities and education combined with CBT to treat children with anxiety. This program integrates sessions completed by the child and then sessions that are guided by a therapist. I believe this is a great way to combine new technological treatment methods with traditional methods. These types of programs have been shown to been effective in creating great gains in reducing childhood anxiety. I believe as a clinician one day, I would integrate these types of programs to supplement traditional treatment methods. The child could meet periodically with a mental health care professional and can be concurrently treating their disorder at home with these programs as well. These types of programs are also a great way to reduce the anxiety that comes along with multiple doctors visits. Using these programs could eliminate the time needed to be in person with a physician.

Therefore, I think that the increased use of computerized CBT programs will be beneficial and can help transform the mental health field.

Blog Post 10-Abbi Herrold

This week in class we discussed cognitive behavioral therapy and computer-based cognitive therapy (CCBT). Cognitive Behavioral Therapy has seen a vast increase in recent years and is currently considered the most popular form of therapy used among clinicians. Cognitive Behavioral Therapy is a combination of cognitive (thought) therapy and behavioral (behaviors) therapy. This specific integration focuses on how thoughts, behaviors, and emotions all influence each other in treatments. For example: Being late to work (situation/trigger) may cause one to feel anxious (emotion) and think that they will not be able to complete the rest of the day's tasks successfully (thought). As a result of this they may avoid doing the rest of the day's activities (behavior). CBT could train one to recognize that although they are late to work and they feel anxious, they still have control over the situation and can work on other tasks in order to make the rest of the day successful (instead of giving up or avoiding these tasks).

Computerized Cognitive Behavioral Therapy (CCBT) is very similar to how regular CBT works however it may be more self-guided. CCBT often consists of psychoeducation, feedback and change monitoring, creating action plans, identifying goals, change techniques (such as redirecting thoughts), and putting things into practice via "homework" and worksheets. CCBT is often used as a low-intensity treatment for depression and anxiety disorders, with weekly support sessions from a trained clinician. CCBT is extremely successful and more affordable as it can be completed via tablet, computer, smartphone, etc.

Additionally, since CBT is a very skill focused form of therapy you can find worksheets and training sessions online for free from various sources with a quick google search! The website psychologytools.com offers over a dozen free worksheets (as pictured below) to help train an individual in the skills developed through CBT.

I feel as if cognitive behavioral therapy is an intervention I would definitely use with patients as a future intervention for depression and possibly anxiety as well. I feel as if CCBT is a great way to keep track of and practice the skills of CBT learned through in-person therapy. However, I believe using both traditional CBT and CCBT complement each other very well and could possibly create the most effective CBT-based treatment.

Blog Post 9- Amy Spear

In our society where technology is a large part of our everyday routine, it is common to seek medical information online. Approximately 80% of internet users seek health information online. These methods of seeking information can be very beneficial to some patients.

Internet users search for everything from diseases,medical problems, treatments, procedures, doctors, health professionals,  hospitals, medical clinics, food safety, recalls, drug safety, and pregnancy. More specifically, 66% searching for disease information and 56% searching for medical treatments. Online information can be especially helpful for patients with anxiety, depression, PTSD, patients with geographic obstacles, and poor access to care. These online resources can be used to seek support groups, share experiences, and seek health information. These online support groups are very important for individuals with rare illnesses because these patients are often socially isolated from others. These tools can be used to build a community among these small groups of individuals. Values such as anonymity and ease of access are vital in these groups and they can help increase knowledge and change attitudes towards these illnesses.

Online resources are also especially helpful for those who fear the stigma that comes along with mental illness. Many use web-based portals to remain anonymous and are more willing to receive online treatment information this way. For example, 33% of soldiers are more likely to use these therapies as well as ethnic minorities. Online information can be very important to these patients, especially if it the only outlet to care they may have.  

From experience, I can say that seeking health information online is beneficial, easy, and very commonly-used. Even working as a patient care technician, I have seen a wide variety of individuals using web-based portals to seek health information. Patients, nurses, and even physicians use these simple methods of seeking vital information.

Blog Post 9- Abbi Herrold

This week in class we discussed online and internet based services which encompasses artificial intelligence. We identified what percentage of people use the internet for medical information; mainly women and caretakers. We reviewed what type of  medical information people search for on the internet such as food & drug safety, hospitals, doctors, treatment types, etc. Finally, we reviewed how asynchronous telepsyhciatry are currently the most widely accepted uses of these programs, but how in the future many more virtual reality and avatar based treatments may be implement in mental healthcare.

I found our guest lecture to be very interesting but also kind of frightening (for lack of a better word). I think that ATP, online tool kits, and mood tracking apps can be very useful in the treatment of mental illnesses. I think many psychologists and psychiatrists are open to the idea of performing tasks or having patients perform simple tasks online that they may perform elsewhere such as clinicians keeping electronic medical records, or patients recording thoughts and triggers on a mobile app. However, I think psychologists and psychiatrists feel that there is a limit of how effectively treatment can be done without human interaction. Chien-Yi mentioned how many different departments of healthcare are interested and invested in the use of artificial intelligence, but how many mental health departments such as the American Psychological Association are not.

While some may view this as a general reluctance from Psychologists, Psychiatrists, and Counselors I think the reluctance has valid reasoning. When forming a diagnosis of a patient a Clinical Psychologist must follow the DSM-5 Criteria the criteria is systematic, empirically based, and objective. HOWEVER, deciding whether or not a patients symptoms and daily functioning is a very subjective process. Many patients may have multiple diagnosis or may not have a specific diagnosis at all, but strong thresholds for a diagnosis. These things are very difficult to assess without significant experience and a strong clinician-patient relationship. Two things which are very hard to train computer-programs or virtual reality clinicians to do. As somebody who has reasonable knowledge on the job of a mental health care professional and aspires to one day be a Clinical Psychologist, I do not think that the duties of a mental health professional can be replicated without human connection and years of experience.

I would like to add that this doesn't mean the field of mental health is completely denying the use of artificial intelligence or web-based treatments. We acknowledge its benefits but we recognize it's limits. I have attached a link that describes the research of my professor who teaches "Introduction to Clinical Psychology". He uses EEG to try to find bio-markers for depression and schizophrenia. According to the book this would be considered a use of artificial intelligence.

http://purdue.imodules.com/s/1461/alumni/feature.aspx?sid=1461&gid=1001&pgid=4184#sthash.mbepYJ5m.dpbs

Blog Post 8- Amy Spear

This week we discussed social media and how it can positively and negatively affect the relationship between clinician and patient. In our nation, social media has become a huge part of our everyday lives. Social media is also used widely throughout healthcare settings to promote and de-stigmatize mental health treatment, create connections to online support groups, and increase access to patient information.

However, with the use of technology also comes negative implications that it can have on patients and healthcare professionals. We discussed what would happen if as a clinician, a patient sent a friend request on Facebook, would you accept this request? As a professional we must first consider the implications. For example, think about how it could affect your ability and willingness to self-disclosure and how it could ultimately alter the relationship you have with patient. In my opinion, when I become a clinician, I believe I will not choose to interact with patients on social media. I believe that there are certain boundaries to maintain with patients and sometimes these can be blurred through the use of social media. For example, I thought it was very interesting to think of what would happen if a health professional became friends with a patient on a social media outlet such as Facebook and the patient posted concerning information such as thoughts of harming themselves or information regarding their disorder. Would the clinician be able to view these posts and take that into account in forming treatment for the patient? I believe in these cases it would be at the discretion of the specific clinician since everyone has specific thoughts on how these choose to connect with patients.  Therefore, it is very important that if we choose to become connected with patients through social media we must create boundaries. Then it is beneficial to express our thoughts about these boundaries with the patient before engaging in the use of social media with them.

Although the use of social media can connect us in ways other outlets cannot, it is important that we consider how we want our relationships with our patients to be before we engage with them through these various portals.

Blog Post 8- Abbi Herrold

This week in class we discussed the implications that social media can have on the patient- client relationship. This included how a provider can best protect their privacy, how to maintain professional conduct in the eye of social media, patients rights in regards to social media, and some guidance on how to react to friend requests on social media from a patient. Some of the guidelines for social media use include: follow standard privacy and confidentiality practices, maintain appropriate boundaries and be aware of information out on the internet about you (via things like self-searches), establish clear expectations about online communication (this is often done through things similar to contracts and consent forms), and discuss all of the previous mentioned things as a part of the consent process.

This chapter made a lot of important points which I had not previously considered. Since entering college I have erred on the side of caution when posting to social media platforms, especially Facebook, as many more companies are checking applicants online profiles before making a hiring decision. However, I had never considered that the things I have posted in the past, post currently, or will post in the future can be accessed by patients which I may one day treat. Additionally, I had also never considered the idea of clients looking up there therapists, psychiatrists, etc. on their personal social media. Of course from a consumer standpoint it makes sense for patients to be curious about the experience of their doctor's or physicians, but I think that searching for their personal profiles on social media platforms takes this a little too far.

An article posted on the APA's website which I have attached below suggests that it is not ethical to look at your clients social media accounts unless they have given you permission to do so, However, it should be noted that this article was published in 2010 and at the time they concluded more research should be done. I feel as if this is advisable information and that clinicians must always err on the side of caution to maintain a professional relationship with their client, and do their best to protect their own privacy on social media platforms.

http://www.apa.org/gradpsych/features/2010/client-searches.aspx