The delivery of biological, psychosocial and psychotherapeutic interventions remains central to t... more The delivery of biological, psychosocial and psychotherapeutic interventions remains central to the treatment of patients with psychiatric disorders.1–3 It is therefore essential to manage the provision of these treatment modalities. Psychotherapy is therefore considered a core skill set for psychiatrists, and the Canadian Psychiatric Association (CPA) affirms the position of psychotherapy in psychiatry. Canadian psychiatry has emphasized an integrated biopsychosocial approach to the assessment and management of mental health problems.1–7 Psychiatrists must possess competence in evidence-supported treatments including psychotherapies.7–9 Treatment strategies should consider the place of pharmacology, psychotherapy, and systemic interventions. The inherent private nature of the practice of psychotherapy, and the often-competing theoretical schools contribute to ambiguity and differing definitions or descriptions of different therapies. Today, most psychotherapies and common factors have been operationally defined with greater clarity (e.g.10–13), although some constructs remain more abstract. Treatments should demonstrate both their efficacy and clinicaland cost-effectiveness, or benefit in real-world settings irrespective of their orientation.15–18 The last few decades have witnessed a significant growth of research in psychotherapy. Randomized controlled trials and meta-analyses demonstrate that numerous psychotherapies can be effective for mood, anxiety, psychotic, substance misuse, eating, and personality disorders (e.g.19–25). Research has contributed to treatment guidelines that recommend specific psychotherapies across the life span.26–28 Research also demonstrates that common factors across therapies, including therapist interpersonal effectiveness, predict psychotherapy outcomes.
Acquiring expertise in psychotherapy is central to the professional development of psychiatrists ... more Acquiring expertise in psychotherapy is central to the professional development of psychiatrists able to employ a broad therapeutic repertoire in their clinical practice. This article reviews how postgraduate psychiatry programs address this important aspect of training. We present the results of a national survey of psychotherapy education in Canadian psychiatry residency programs. The results highlight significant advances over the past decade in curriculum, in teaching methods, and in evaluation. These include training in evidence-based, manualized, time-limited therapies such as cognitive-behavioural and interpersonal therapy, greater attention to evaluating competence, and integrating electronic technology. Trends and advances in postgraduate and continuing medical psychotherapy education programs are considered in association with principles of adult learning. Health education research endorses the provision of longitudinal training programs that integrate learning and practic...
Background We examined the implementation of a behavioural activation (BA) model, via telemedicin... more Background We examined the implementation of a behavioural activation (BA) model, via telemedicine, for perinatal populations during a confluence of significant global events in 2020. We conducted a rigorous qualitative study to identify relevant barriers and facilitators from the perspectives of both perinatal participants and treatment providers, We also present two case studies where BA was used and adapted to provide patient-centered care. Methods Within the ongoing SUMMIT non-inferiority randomized controlled trial in Canada and US, we interviewed a random selection of perinatal participants (n=23) and all treatment providers (n=28). A content analysis framework was developed to identify relevant barriers and facilitators and frequencies were calculated for each emergent theme within and across respondent groups. Results Key facilitators reported by participants receiving BA were that BA helped with support and social connection (73.9%), creative problem solving (26.1%) and attending to pandemic-related symptoms (21.7%). Key facilitators endorsed by providers to deliver BA were the use of telemedicine (35.7%) and loosening of government restrictions (21.4%). Both participant groups reported similar barriers to BA during the pandemic such as a lack of privacy and limited activities due to pandemic restrictions. However, providers were more likely to endorse pandemic-related life stressors as a barrier to treatment delivery compared to participants (64.3% vs. 34.8%). Both participant groups experienced explicit discussion of race and the racial justice movements during sessions as beneficial and reported harms of not doing so to the therapeutic alliance. Conclusions BA offers a person-centered model to facilitate social connection through creative problem-solving for women with perinatal depressive and anxiety symptoms within the context of the COVID-19 pandemic. Explicit discussion of race and racial injustice during sessions is an important and helpful aspect in psychological treatments.
Background Interpersonal Psychotherapy (IPT) is an affect- and relationally focused, time-limited... more Background Interpersonal Psychotherapy (IPT) is an affect- and relationally focused, time-limited treatment supported by research spanning >4 decades. IPT focuses on stressful interpersonal experiences of loss, life changes, disputes, and social isolation. It emphasizes the role of relationships in recovery. This scoping review describes, within a historical perspective, IPT’s evolution as an evidence-supported treatment of psychiatric disorders. Methods English-language publications (n = 1119) identified via EMBASE, MEDLINE, PsycINFO, and Web of Science databases (1974–2017), augmented with manual reference searches, were coded for clinical focus, population demographics, format, setting, publication type, and research type. Quantitative and qualitative analyses identified IPT publications’ characteristics and trends over four epochs of psychotherapy research. Results IPT literature primarily focused on depression (n = 772 articles; 69%), eating disorders (n = 135; 12%), anxiety disorders (n = 68; 6%), and bipolar disorder (n = 44; 4%), with rising publication rates and numbers of well-conducted randomized, controlled trials over time, justifying inclusion in consensus treatment guidelines. Research trends shifted from efficacy trials to effectiveness studies and population-based dissemination initiatives. Process research examined correlates of improvement and efficacy moderators. Innovations included global initiatives, prevention trials, and digital, web-based training and treatment. Conclusion Sparked by clinical innovations and scientific advances, IPT has evolved as an effective treatment of psychiatric disorders across the lifespan for diverse patients, including underserved clinical populations. Future research to elucidate mechanisms of change, improve access, and adapt to changing frameworks of psychopathology and treatment planning is needed. IPT addresses the universal centrality of relationships to mental health, which is as relevant today as it was over 40 years ago.
Chapter 4 describes a case of IPT treatment of major depressive disorder with a focus on role tra... more Chapter 4 describes a case of IPT treatment of major depressive disorder with a focus on role transitions, and how social roles are central to our sense of identity, how all individuals may hold numerous roles (partner, child, parent, sibling, neighbor, community member, etc.), besides having vocational roles (colleague, employee, employer, or professional). It looks at how social roles determine the ‘rules of engagement’ (around communication, sharing of responsibilities) and expectations we have of one another, and how a change in one’s social role (losing a job, moving to another city, becoming partnered, ending a spousal or long-term romantic relationship, adjusting to a disabling or disfiguring medical condition, becoming a new parent) can generate a shift in or loss of one’s sense of self. It examines how these role transitions also evoke changes in one’s needs for or access to social supports and how a role change can be stressful enough to provoke an episode of major depress...
Psychotherapies, such as Interpersonal Psychotherapy (IPT), that have proven effective for treati... more Psychotherapies, such as Interpersonal Psychotherapy (IPT), that have proven effective for treating mental disorders mostly lie dormant in consensus-treatment guidelines. Broadly disseminating these psychotherapies by training trainers and front-line health workers could close the gap between mental health needs and access to care. Research in continuing medical education and knowledge translation can inform the design of educational interventions to build capacity for providing psychotherapy to those who need it. This paper summarizes psychotherapy training recommendations that: adapt treatments to cultural and health organizational contexts; consider implementation barriers, including opportunity costs and mental health stigma; and engage local opinion leaders to use longitudinal, interactive, case-based teaching with reflection, skills-coaching, simulations, auditing and feedback. Community-based training projects in Northern Ontario, Canada and Ethiopia illustrate how best-educa...
Canadian journal of psychiatry. Revue canadienne de psychiatrie, 2013
To address the gaps between need and access, and between treatment guidelines and their implement... more To address the gaps between need and access, and between treatment guidelines and their implementation for mental illness, through capacity building of front-line health workers. Following a learning needs assessment, work-based continuing education courses in evidence-supported psychotherapies were developed for front-line workers in underserviced community settings. The 5-hour courses on the fundamentals of cognitive-behavioural therapy, interpersonal psychotherapy, motivational interviewing, and dialectical behaviour therapy each included videotaped captioned simulations, interactive lesson plans, and clinical practice behaviour reminders. Two courses, sequentially offered in 7 underserviced settings, were subjected to a mixed methods evaluation. Ninety-three nonmedical front-line workers enrolled in the program. Repeated measures analysis of variance was used to assess pre- and postintervention changes in knowledge and self-efficacy. Qualitative data from 5 semistructured focus ...
The delivery of biological, psychosocial and psychotherapeutic interventions remains central to t... more The delivery of biological, psychosocial and psychotherapeutic interventions remains central to the treatment of patients with psychiatric disorders.1–3 It is therefore essential to manage the provision of these treatment modalities. Psychotherapy is therefore considered a core skill set for psychiatrists, and the Canadian Psychiatric Association (CPA) affirms the position of psychotherapy in psychiatry. Canadian psychiatry has emphasized an integrated biopsychosocial approach to the assessment and management of mental health problems.1–7 Psychiatrists must possess competence in evidence-supported treatments including psychotherapies.7–9 Treatment strategies should consider the place of pharmacology, psychotherapy, and systemic interventions. The inherent private nature of the practice of psychotherapy, and the often-competing theoretical schools contribute to ambiguity and differing definitions or descriptions of different therapies. Today, most psychotherapies and common factors have been operationally defined with greater clarity (e.g.10–13), although some constructs remain more abstract. Treatments should demonstrate both their efficacy and clinicaland cost-effectiveness, or benefit in real-world settings irrespective of their orientation.15–18 The last few decades have witnessed a significant growth of research in psychotherapy. Randomized controlled trials and meta-analyses demonstrate that numerous psychotherapies can be effective for mood, anxiety, psychotic, substance misuse, eating, and personality disorders (e.g.19–25). Research has contributed to treatment guidelines that recommend specific psychotherapies across the life span.26–28 Research also demonstrates that common factors across therapies, including therapist interpersonal effectiveness, predict psychotherapy outcomes.
Acquiring expertise in psychotherapy is central to the professional development of psychiatrists ... more Acquiring expertise in psychotherapy is central to the professional development of psychiatrists able to employ a broad therapeutic repertoire in their clinical practice. This article reviews how postgraduate psychiatry programs address this important aspect of training. We present the results of a national survey of psychotherapy education in Canadian psychiatry residency programs. The results highlight significant advances over the past decade in curriculum, in teaching methods, and in evaluation. These include training in evidence-based, manualized, time-limited therapies such as cognitive-behavioural and interpersonal therapy, greater attention to evaluating competence, and integrating electronic technology. Trends and advances in postgraduate and continuing medical psychotherapy education programs are considered in association with principles of adult learning. Health education research endorses the provision of longitudinal training programs that integrate learning and practic...
Background We examined the implementation of a behavioural activation (BA) model, via telemedicin... more Background We examined the implementation of a behavioural activation (BA) model, via telemedicine, for perinatal populations during a confluence of significant global events in 2020. We conducted a rigorous qualitative study to identify relevant barriers and facilitators from the perspectives of both perinatal participants and treatment providers, We also present two case studies where BA was used and adapted to provide patient-centered care. Methods Within the ongoing SUMMIT non-inferiority randomized controlled trial in Canada and US, we interviewed a random selection of perinatal participants (n=23) and all treatment providers (n=28). A content analysis framework was developed to identify relevant barriers and facilitators and frequencies were calculated for each emergent theme within and across respondent groups. Results Key facilitators reported by participants receiving BA were that BA helped with support and social connection (73.9%), creative problem solving (26.1%) and attending to pandemic-related symptoms (21.7%). Key facilitators endorsed by providers to deliver BA were the use of telemedicine (35.7%) and loosening of government restrictions (21.4%). Both participant groups reported similar barriers to BA during the pandemic such as a lack of privacy and limited activities due to pandemic restrictions. However, providers were more likely to endorse pandemic-related life stressors as a barrier to treatment delivery compared to participants (64.3% vs. 34.8%). Both participant groups experienced explicit discussion of race and the racial justice movements during sessions as beneficial and reported harms of not doing so to the therapeutic alliance. Conclusions BA offers a person-centered model to facilitate social connection through creative problem-solving for women with perinatal depressive and anxiety symptoms within the context of the COVID-19 pandemic. Explicit discussion of race and racial injustice during sessions is an important and helpful aspect in psychological treatments.
Background Interpersonal Psychotherapy (IPT) is an affect- and relationally focused, time-limited... more Background Interpersonal Psychotherapy (IPT) is an affect- and relationally focused, time-limited treatment supported by research spanning >4 decades. IPT focuses on stressful interpersonal experiences of loss, life changes, disputes, and social isolation. It emphasizes the role of relationships in recovery. This scoping review describes, within a historical perspective, IPT’s evolution as an evidence-supported treatment of psychiatric disorders. Methods English-language publications (n = 1119) identified via EMBASE, MEDLINE, PsycINFO, and Web of Science databases (1974–2017), augmented with manual reference searches, were coded for clinical focus, population demographics, format, setting, publication type, and research type. Quantitative and qualitative analyses identified IPT publications’ characteristics and trends over four epochs of psychotherapy research. Results IPT literature primarily focused on depression (n = 772 articles; 69%), eating disorders (n = 135; 12%), anxiety disorders (n = 68; 6%), and bipolar disorder (n = 44; 4%), with rising publication rates and numbers of well-conducted randomized, controlled trials over time, justifying inclusion in consensus treatment guidelines. Research trends shifted from efficacy trials to effectiveness studies and population-based dissemination initiatives. Process research examined correlates of improvement and efficacy moderators. Innovations included global initiatives, prevention trials, and digital, web-based training and treatment. Conclusion Sparked by clinical innovations and scientific advances, IPT has evolved as an effective treatment of psychiatric disorders across the lifespan for diverse patients, including underserved clinical populations. Future research to elucidate mechanisms of change, improve access, and adapt to changing frameworks of psychopathology and treatment planning is needed. IPT addresses the universal centrality of relationships to mental health, which is as relevant today as it was over 40 years ago.
Chapter 4 describes a case of IPT treatment of major depressive disorder with a focus on role tra... more Chapter 4 describes a case of IPT treatment of major depressive disorder with a focus on role transitions, and how social roles are central to our sense of identity, how all individuals may hold numerous roles (partner, child, parent, sibling, neighbor, community member, etc.), besides having vocational roles (colleague, employee, employer, or professional). It looks at how social roles determine the ‘rules of engagement’ (around communication, sharing of responsibilities) and expectations we have of one another, and how a change in one’s social role (losing a job, moving to another city, becoming partnered, ending a spousal or long-term romantic relationship, adjusting to a disabling or disfiguring medical condition, becoming a new parent) can generate a shift in or loss of one’s sense of self. It examines how these role transitions also evoke changes in one’s needs for or access to social supports and how a role change can be stressful enough to provoke an episode of major depress...
Psychotherapies, such as Interpersonal Psychotherapy (IPT), that have proven effective for treati... more Psychotherapies, such as Interpersonal Psychotherapy (IPT), that have proven effective for treating mental disorders mostly lie dormant in consensus-treatment guidelines. Broadly disseminating these psychotherapies by training trainers and front-line health workers could close the gap between mental health needs and access to care. Research in continuing medical education and knowledge translation can inform the design of educational interventions to build capacity for providing psychotherapy to those who need it. This paper summarizes psychotherapy training recommendations that: adapt treatments to cultural and health organizational contexts; consider implementation barriers, including opportunity costs and mental health stigma; and engage local opinion leaders to use longitudinal, interactive, case-based teaching with reflection, skills-coaching, simulations, auditing and feedback. Community-based training projects in Northern Ontario, Canada and Ethiopia illustrate how best-educa...
Canadian journal of psychiatry. Revue canadienne de psychiatrie, 2013
To address the gaps between need and access, and between treatment guidelines and their implement... more To address the gaps between need and access, and between treatment guidelines and their implementation for mental illness, through capacity building of front-line health workers. Following a learning needs assessment, work-based continuing education courses in evidence-supported psychotherapies were developed for front-line workers in underserviced community settings. The 5-hour courses on the fundamentals of cognitive-behavioural therapy, interpersonal psychotherapy, motivational interviewing, and dialectical behaviour therapy each included videotaped captioned simulations, interactive lesson plans, and clinical practice behaviour reminders. Two courses, sequentially offered in 7 underserviced settings, were subjected to a mixed methods evaluation. Ninety-three nonmedical front-line workers enrolled in the program. Repeated measures analysis of variance was used to assess pre- and postintervention changes in knowledge and self-efficacy. Qualitative data from 5 semistructured focus ...
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