online emreg - nashia denver 2015 - tsa · ea thank you! [email protected] 33...
TRANSCRIPT
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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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1 2 3 4 5 6 7
Series1
Results
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93
79.5
72.3
95.2
7
20.5
27.7
4.8
0
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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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0
1
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3
4
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SkillAcquisiFon GeneralizaFon
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2
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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!
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