BackgroundCognitive-behavioral therapy (CBT) has demonstrated efficacy and effectiveness for treating mood and anxiety disorders. Dissemination of CBT via videoconference may help improve access to treatment.ObjectiveThe present study aimed to compare the effectiveness of CBT administered via videoconference to in-person therapy for a mixed diagnostic cohort.MethodsA total of 26 primarily Caucasian clients (mean age 30 years, SD 11) who had a primary Diagnostic and Statistical Manual of Mental Disorders, 4th edition text revision (DSM-IV-TR) diagnosis of a mood or anxiety disorder were randomly assigned to receive 12 sessions of CBT either in-person or via videoconference. Treatment involved individualized CBT formulations specific to the presenting diagnosis; all sessions were provided by the same therapist. Participants were recruited through a university clinic. Symptoms of depression, anxiety, stress, and quality of life were assessed using questionnaires before, after, and 6 weeks following treatment. Secondary outcomes at posttreatment included working alliance and client satisfaction.ResultsRetention was similar across treatment conditions; there was one more client in the videoconferencing condition at posttreatment and at follow-up. Statistical analysis using multilevel mixed effects linear regression indicated a significant reduction in client symptoms across time for symptoms of depression (P<.001, d=1.41), anxiety (P<.001, d=1.14), stress (P<.001, d=1.81), and quality of life (P<.001, d=1.17). There were no significant differences between treatment conditions regarding symptoms of depression (P=.165, d=0.37), anxiety (P=.41, d=0.22), stress (P=.15, d=0.38), or quality of life (P=.62, d=0.13). There were no significant differences in client rating of the working alliance (P=.53, one-tailed, d=–0.26), therapist ratings of the working alliance (P=.60, one-tailed, d=0.23), or client ratings of satisfaction (P=.77, one-tailed, d=–0.12). Fisher’s Exact P was not significant regarding differences in reliable change from pre- to posttreatment or from pretreatment to follow-up for symptoms of depression (P=.41, P=.26), anxiety (P=.60, P=.99), or quality of life (P=.65, P=.99) but was significant for symptoms of stress in favor of the videoconferencing condition (P=.03, P=.035). Difference between conditions regarding clinically significant change was also not observed from pre- to posttreatment or from pretreatment to follow-up for symptoms of depression (P=.67, P=.30), anxiety (P=.99, P=.99), stress (P=.19, P=.13), or quality of life (P=.99, P=.62).ConclusionsThe findings of this controlled trial indicate that CBT was effective in significantly reducing symptoms of depression, anxiety, and stress and increasing quality of life in both in-person and videoconferencing conditions, with no significant differences being observed between the two.Trial RegistrationAustralian New Zealand Clinical Trials Registry ID: ACTRN12609000819224; http://www.anzctr.org.au/ACTRN12609000819224.aspx (Archived by WebCite at http://...

Client engagement is a necessary component of psychotherapy, but it can be challenging to foster in clients with severe and complex problems. Telehealth technology influences the clinical dyad in unique ways and offers new opportunities for approaching the challenge of client engagement. In this article, we present a qualitative case study of a client with severe and complex obsessive-compulsive disorder (OCD) who received 40 sessions of cognitive-behavioural-based psychotherapy administered through a mix of videoconference and text-chat. The results suggest that telehealth technology may have facilitated client engagement by helping to reduce interpersonal anxiety, thus allowing the client to continue disclosing and discussing issues that were espoused in shame, guilt, and embarrassment.

Restrictive practices are often harmful and many academics, policy-makers and clinicians agree that their use should be reduced in care settings. Specific focus on secure mental health services is warranted because restrictive practices are often seen as an integral part of forensic psychiatry but have received limited research attention relative to other areas of psychiatric practice. The aim of this scoping review was to map and evaluate recent empirical research that examines the use of restrictive practices, the consequences of using them and efforts to reduce restrictive practices, in secure mental health settings published since June 2015. The purpose of this review was to identify limitations and gaps in the literature in order to inform further research. PsycINFO, Medline, Embase, CINAHL, Scopus and ASSIA databases were searched for studies published between 2015 and 2020. Following electronic and manual searches, 36 studies were included. The studies were grouped into four main areas: 1) Nature of the problem describing the type, incidence, prevalence and scope of restrictive practices in secure mental health services; 2) Service user perceptions and experiences of restrictive practices; 3) Staff experiences, views and decision making; and 4) Interventions designed to reduce the use of restrictive practices. Findings support the notion that restrictive practices have a detrimental impact on the wellbeing of most service users in adult secure services as well as the staff who use them. Continued efforts to reduce restrictive practices are needed and the importance of collaborative working cannot be understated. Implications for future research, clinical practice, policy and best practice guidelines are all discussed.

The aim of the present study was to investigate what factors are predictive of behavioural and emotional dysfunction in adolescence. A sample of 60 young people accommodated under a welfare or youth custody service order in a UK secure children’s home between 2016 and 2018 was used. Data regarding young people’s Adverse Childhood Experiences (ACE’s) history, scores on standard assessments and factors thought to indicate behavioural and emotional dysfunction were collected from file information. Correlations and regression models were used to analyse the data. Analyses found that young people in this setting had been exposed to more ACEs than the general population. Furthermore, signs of behavioural and emotional dysfunction as a result of exposure to ACE’s appeared to be present from early adolescence. It was found that exposure to verbal and sexual abuse were the greatest predictors of involvement in risk incidents. The young person’s substance misuse habits were the best predictor of the length of stay in the secure children’s home. These findings may have policy implications and highlight the need for early interventions with young people exposed to ACE’s.