online emreg - nashia denver 2015 - tsa · ea thank you! theodore.tsaousides@mountsinai.org 33...

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IncreasingAccesstoCare:

OnlineTraininginEmo5onalRegula5on

forIndividualswithTrauma5cBrainInjury

TheoTsaousides,Ph.D.,ABPP

AdjunctAssistantProfessorIcahnSchoolofMedicineatMountSinai

NewYork,NY

ThisresearchwasfundedbyNaFonalInsFtuteonDisabilityandRehabilitaFonResearch(grantsH133P100016andH133A070033)

BarrierstoTreatment▶  SystemicBarriers

–  LimitedproximitytooutpaFenttreatmentandmedicalcenters–  Scarcityofadequatelytrainedprofessionals–  LimitedtransportaFonopFons

▶  IndividualBarriers–  Physicalproblems–  Sensoryproblems–  CogniFveproblems–  Financialconstraints

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Telerehabilita5on▶  TelerehabilitaFon

–  Thedeliveryofrehabilita0onservicesviainforma0onandcommunica0ontechnologies…thatincludeassessment,monitoring,preven0on,interven0on,supervision,educa0on,consulta0on,andcounseling…byabroadrangeof[rehabilita0on]professionals(Brennanetal.,2011)

▶  Advantages–  Increasedaccess–  ReducedtransportaFonFme–  Reducedcost

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TBITelerehabilita5on▶  Treatmentdelivery

–  InteracFve•  Telephone;InstantMessage;Screensharing;Videoconference

–  Self-guided•  Web-basedtrainingprograms

–  Hybrid▶  Treatmenttargets

–  Depression•  Bombardier2009;Topolovec-Vranic2010

–  EmoFonaldistress•  Arundine2012;Bradbury2008

–  CogniFveskills•  Bergquist2009;Soong2005;Wilson2005

–  Socialproblemsolving•  Man2006;Wade2011

–  Independentlivingskills•  Schoenberg2008

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Videoconference▶  Videoconference

–  SimultaneousaudiovisualinteracFonbetweentherapist&paFent–  Inthepast:specializedequipment–  Now:severalapplicaFons(e.g.,Skype,Google+)

▶  Innon-TBIsamples–  Depression,anxiety,addicFons,eaFngdisorders(Backhaus2011)

▶  InTBIsamples–  Socialproblemsolving(Wade2006,2011)–  HybridintervenFon

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OnlineGroupTreatment

Isitpossible?

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Onlinegrouptreatment▶  BenefitsofFTFGroupTreatmentsfollowingTBI(Cicerone2011;Malec2006)

–  Increasedawareness–  Sharedlearning–  Feedback–  EmoFonalsupport

▶  RemoteGroupTreatmentinnon-TBIsamples–  Angermanagement(Morland2010)–  Substanceuse(King2009)

▶  InnovaFon–  NeverbeforeatrialofonlinegrouptreatmentwithsimultaneousaudiovisualinteracFonofenFregroup

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Onlinegrouptreatment

▶  MediumselecFon

–  GoToMeeFng™–  Web-based–  EasyinstallaFon–  EncrypFon/security–  Excellentinterface

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Onlinegrouptreatment

▶  TreatmentselecFon

–  EmoFonalRegulaFonTraining(EmReg™)–  Grouptreatment–  InstrucFonal/ExperienFal–  Familiarity–  Recenttrials

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EmpiricalStudiesofEmReg™▶  Pastresearch

–  RCTforPost-TBIDepression•  Completed2004-2010•  Ashmanetal.(2014)

–  RCTforPost-TBIExecuFveDysfuncFon(ExecPlus)•  Completed2004-2010•  PublicaFonexpected

–  RCTforPost-TBIExecuFveDysfuncFon(STEP)•  Completed2007-2012•  Cantoretal.(2014)

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Descrip5onofEmReg™▶  CBTIntervenFontargeFng

–  EmoFonalAwareness–  Self-monitoring–  Self-regulaFon

▶  DidacFcandexperienFal

▶  Individualized&Contextualized

▶  IndividualorGroupDelivery

▶  Separateorcombinedwithproblem-solving

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TheEmo5onalCycle

sensaFons

emoFonstrigger behaviors

thoughts

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TheFeasibilityStudy

Spring-Summer2012

Objec5ve

▶  AssessthefeasibilityofdeliveringEmReg™toagroupofindividualswithTBIsimultaneouslyusingweb-basedvideoconference

▶  ResearchQuesFons

–  AreparFcipantsabletoengageintreatment?

–  AreparFcipantsabletocompleteoutcomemeasuresremotely?

–  DoparFcipantsreportsaFsfacFonwithtreatmentdelivery?

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Par5cipants

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▶  N=7

▶  Age:23–63

▶  Gender:F=6

▶  Race:C=3,A/A=3,Other1

▶  Severity:Mild=5,Severe=2

▶  EFology:MVA=6,Fall=1

▶  Timesinceinjury:.5yr–13yrs(2yrs)

▶  IQ=90–130

▶  Employment:No:5,P/T:1,School:1

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Measures▶  Treatmentengagement

–  Therapistchecklist–  Exitinterview

▶  SaFsfacFonwithtreatment–  SaFsfacFonwithTherapistandTherapyScale(Oei&Shullewood,1999)

▶  EmoFonalRegulaFon–  DeficitsinEmoFonRegulaFonScale(Gratz&Roemer,2004)–  BrainInjuryRehabilitaFonTrustRegulaFonofEmoFonsQuesFonnaire(Calranetal.2011)–  ProblemSolvingInventory(Heppner&Petersen,1982)–  Socialproblemsolvinginventory(D’Zurillaetal.,2002)

▶  AssessmentTimeline–  2weekbaseline,8weekacFvetreatment,4weekfollow-up

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Procedure▶  Videoconference

–  PracFcesessionbeforefirstsession–  Emailpriortoeachsession–  NeFquele–  Contactbefore/during/aoersessionfortechnicalproblems

▶  IntervenFon–  1660-minutesessions,2xweek,8weeks–  Sessions1-8didacFc/interacFve;sessions9-16applicaFon/interacFve–  2groups(4and3parFcipants)

▶  Assessment–  TC–attheendofeachsession–  EmReg–onceaweek,onlinesurvey–  Exitinterviewattheendoftreatmentbyresearchassistant

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Results

▶  ResearchquesFons

–  Arepar5cipantsabletoengageintreatment?

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Results▶  Alendance:93.8%(8/112,oncewithoutpriornoFce)

▶  Lateness:7/104

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0

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1 2 3 4 5 6 7

Series1

Results

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93

79.5

72.3

95.2

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20.5

27.7

4.8

0

10

20

30

40

50

60

70

80

90

100

Homework ParFcipaFon Interpersonal EaseofUse

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2

1

0

Results

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5

6

2

1

0

1

2

3

4

5

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SkillAcquisiFon GeneralizaFon

3

2

1

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Results

▶  ResearchquesFons

–  AreparFcipantsabletoengageintreatment?

–  Arepar5cipantsabletocompleteoutcomemeasuresremotely?

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Results

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63.30%

73.30%

60.00%

96.70% 96.00%100%

92.00%

0.00%

10.00%

20.00%

30.00%

40.00%

50.00%

60.00%

70.00%

80.00%

90.00%

100.00%

1 2 3 4 5 6 7

%CompletedSurveys

%CompletedSurveys

SurveycompleFon=82.6%completedEqualproporFonbetweentreatmentandfollow-upLongertocompleteatfollow-up(2.2vs.3.2days)

Results

▶  ResearchquesFons

–  AreparFcipantsabletoengageintreatment?

–  AreparFcipantsabletocompleteoutcomemeasuresremotely?

–  Dopar5cipantsreportsa5sfac5onwithtreatment?

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Results

▶  SaFsfacFonwithtreatment:

–  Therapy:5.3/6

–  Therapist:5.9/6.0

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Results

▶  NoChangesinEmoFonalRegulaFon L

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ExitInterviews:CommonThemes

▶  1.PosiFvesocialexperience

▶  2.Usefulskills

▶  3.Numberandlengthofsessiontooshort

▶  4.EaseofuseincreasedoverFme

▶  5.GTMeasytouse

▶  6.AugmentonlinewithFTFmeeFngs

▶  7.Drawbacks

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ConclusionsandLimita5ons

▶  Conclusion–  Onlinegrouptreatmentisfeasible!

▶  LimitaFons–  Measurement

•  NochangeinemoFonalregulaFon•  Otherrelevantvariables

–  Eligibility•  Noclinicalcut-offforinclusion•  Self-report

–  SubjectselecFon:•  HighlymoFvatedvolunteers•  FamiliarwithFTFEmReg

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What’snext?

TheCurrentStudy

2012-2017

OnlineEmo5onalRegula5onGroupTreatment

▶  FundedbyTBIMS2012-2017

▶  ExtendedFeasibilityandOutcomeStudy

▶  TargetN=80

▶  Measuresadded:PANAS,SWLS

▶  Sessionsadded:24biweekly

▶  ExtendedFmeline:4wkbaseline,12wkTx,12wkfollow-up

▶  Clinicalcut-offforparFcipaFon:DERS+1SD

▶  Groupsize:4-5 30

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OnlineEmo5onalRegula5onGroupTreatment

▶  Progresssofar…

–  RecruitmentstartedinMarch2013

–  Consented:145–  DNQ:41–  CompletedTx:73–  Completedstudy:65

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OnlineEmRegTeam

WayneGord

on

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JenniferOswald

JasonKrellman

EmilyD’Antonio

LisaSpielman

VladimiraVarbanova

WilliamLu

NicoleMurray

ColeleSeter

MariaKajankova

EricaKaplan

MelissaShuman

GabrielleGuela

Thankyou!

theodore.tsaousides@mountsinai.org

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