Articles de revues sur le sujet « Psychother »

Korrigierte Zusammenfassung Ziel: Darstellung der Häufigkeit von selbstberichtetem diagnostiziertem Burnout-Syndrom und psychiatrische Komorbiditäten. Methode: Bundesweite Studie, n = 7987. Burnout-Syndrom: selbstberichtete ärztl./psychother. Diagnose. Psychische Störungen: diagnostisches Interview, n = 4483. Ergebnisse: Prävalenz: Lebenszeit 4,2 %, 12 Monate 1,5 %. Irgendeine psychische Störung: 70,9 % derer mit Burnout-Diagnose. Assoziierte Störungen: somatoforme, affektive, Angststörungen. Schlussfolgerung: Burnout-Diagnosen werden seltener berichtet als erwartet. Betroffene haben häufig eine manifeste psychische Störung.

AbstractA plethora of empirical data support a positive (or “brighter”) pathway to optimal human functioning as specified within Basic Psychological Needs Theory (Ryan and Deci in Psychol Inq 11(4):319–33, 2000). Yet, far less is known about the negative (or “darker”) pathway, a process evoking of human dysfunction and ill-being (cf. Vansteenkiste and Ryan in J Psychother Integr 23(3):263, 2013). Further, debate surrounds the independence and interplay between psychological need satisfaction and psychological need frustration and how these dynamic constructs are experienced within individuals. In this work, variable and person-oriented analyses were employed to: (i) investigate the relationships between the basic psychological needs and symptoms of stress, depression and anxiety as well as with life satisfaction; and (ii) identify different psychological need profiles and their relationship with psychological function. Participants (N = 2236; M Age = 42.16 years; SD = 7.8) were UK-based operational firefighters who completed an online survey. Results of regression analyses showed a moderating effect of psychological need satisfaction on the relationship between need frustration and negative psychological symptoms. Latent profile analyses revealed five distinct basic psychological need profiles that carry implications for human psychological functioning. Some support for an asymmetrical relationship between need satisfaction and need frustration emerged (Vansteenkiste and Ryan in J Psychother Integr 23(3):263, 2013), yet, examples of above average need satisfaction and frustration scores were also observed. Worker profiles where psychological need frustration prevailed over need satisfaction had the poorest psychological health.

Transference has been described as unconscious feelings that are transposed onto another significant individual ( Bloom. J Am Psychoanal Assoc. 1973 ;21:61-76). In the strictest sense, this occurs only in therapy settings, but in a more general sense, it occurs throughout life. Transference can be negative, positive, or sexualized. If unresolved it can create a sticky transference neurosis and impediments to progress (Koo. J Psychother Pract Res. 2001;10(1):28-36). Short-term dynamic therapy, as propounded by Dr Habib Davanloo, is structured to prevent the development of a transference neurosis and addresses the transference from the very beginning, including the first session itself. Following is a case of sexual transference which was addressed in the mid-phase of short-term psychodynamic psychotherapy.

There are three ethical reactions on the misfortune of other person: compassion, advice, practical help (M.M. Bakhtin). The foundation of all these forms of common- sense psychological support is in humane co-experiencing. Professional psychother- apy should take into account its cultural-historical soil that makes the category of co-experiencing significant for all therapeutic schools. In this article the place and the meaning of the category of co-experiencing in co-experiencing psychotherapy is considered. Co-experiencing is a constitutive category for the approach and is regarded as an internal creative work of the therapist, which is aimed at facilitat- ing the productive way of patient’s development of experiencing. Goals, subject and method of co-experiencing are being characterized. An analysis of links between categories of “co-experiencing” and “understanding” are given. A phenomena of “co-experiencing understanding” is being described.

Imposter phenomenon is defined as a self-perception of intellectual fraudulence despite achieving objective success and accomplishments. Imposter phenomenon has been rigorously explored among high-achieving career professionals. The present qualitative study is an attempt to explore imposter phenomenon experiences among female software engineers in the Indian Information and Technology sector. The data, derived through in-depth and semi-structured interviews, has been analysed through a hybrid of an inductive and a theoretical thematic analysis method. Clance and Imes’ (1978, Psychother: Theory Res Pract, 15(3):241) article, “The Imposter Phenomenon in High Achieving Women: Dynamics and Therapeutic Intervention,” has been used for screening the sample and also, as a theoretical lens. The study reveals that external attribution of success, fear of failure, anxiety, and devaluing accomplishments are core psychological processes associated with the imposter phenomenon experience. The current work further found that parenting patterns characterized by lack of praises, comparison among siblings, lack of trust in children’s potential, and strict gender values are significant antecedents of Imposter Phenomenon.

Background Awareness of synchronicity may be an opening to more general spiritual awareness. Empirical research analyzing the process of increased synchronicity awareness and investigating shifts in personal spirituality and mental health is limited. Might synchronicity awareness be a porthole for a more general sense of personal spiritual awareness, namely the experience of directly lived daily events as spiritually meaningful? Purpose This study evaluated a six-week synchronicity discussion group, Synchronicity Awareness Intervention (SAI), delivered to emerging educators and human service professionals. Its aim was to increase awareness of synchronistic events and to support spiritual awareness. Participants Final enrollment consisted of 12 females and 1 male, with a mean age of 26.8 years (SD=5.29). Religious denominations were 38.5% Catholic, 30.8% Protestant, 15.4% Hindu, 7.7% Buddhist, and 7.7% Atheist. Research Design The study used a pretest-posttest within subject design. This report focuses on the postintervention qualitative data collected through semi-structured interviews. Findings Data suggested that SAI was associated with increased awareness of synchronicity and suggested beneficial effects of synchronicity awareness on personal spirituality and mental health. Results showed that the program was well received and highly rated by the participants, indicating that it was an acceptable form of a spiritually informed psychother-apeutic discussion group. Conclusions This preliminary study showed promising support for the feasibility, acceptability, level of engagement, and potential helpfulness of an SAI in a group setting. Synchronicity awareness may support spiritual awareness and improve mental health.

BSD City is an area that is planned to be a pioneer of the Integrated Smart Digital City, triggered by the population of BSD which is dominated by millennials and alpha generations who grow up following technological developments. Millennials have a high level of anxiety, stress and depression. To reduce high levels of stress art has an important role where art can change one's emotions and behavior, have a positive impact on stress management, reduce anxiety levels and improve mood. Digital technology has allowed art to go beyond existing boundaries, so that art in the present and in the future will be more dynamic, flexible in accordance with the character of the millennials generation. Therefore, this design aims to provide a forum for interaction between art and humans and among fellow human beings from various groups by utilizing technological advances to maximize the interactions that occur and foster creative thinking and self-expression through digital art. The design is done by survey method and shape grammar. A museum where visitors can explore digital art and interact directly with the artwork and express their emotions freely into a museum, is needed by the Millennials at this time. AbstrakKota BSD merupakan suatu kawasan yang direncanakan akan menjadi pionir Integrated Smart Digital City, dipicu oleh penduduk BSD yang didominasi oleh generasi milenial dan generasi alfa yang tumbuh dengan mengikuti perkembangan teknologi. Generasi milenial memiliki tingkat kecemasan, stress, dan depresi yang tinggi. Untuk mengurangi tingkat stress yang tinggi itu seni memiliki peran yang penting dimana seni dapat mengubah emosi dan perilaku seseorang, memberi dampak positif pada manajemen stress, mengurangi tingkat kecemasan dan meningkatkan mood.[1] Teknologi digital telah memungkinkan seni untuk melampaui batasan-batasan yang ada, sehingga seni di masa sekarang dan di masa yang akan datang menjadi lebih dinamis, fleksibel sesuai dengan karakter generasi millennials. Oleh karena itu, perancangan ini bertujuan untuk menyediakan wadah interaksi antara seni dengan manusia dan antara sesama manusia dari berbagai golongan dengan memanfaatkan kemajuan teknologi untuk memaksimalkan interaksi yang terjadi serta menumbuhkan pemikiran kreatif dan ekspresi diri melalu seni digital. Perancangan dilakukan dengan metode survei dan shape grammar. Museum dimana pengunjung dapat mengeksplorasi seni digital dan berinteraksi langsung dengan karya seni tersebut serta mengekspresikan emosinya secara bebas menjadi museum yang dibutuhkan generasi milenial di masa ini.[1] Sabine C. Koch & Fuchs T, Embodied Arts Therapies, (Arts Psychother, 2011)

Technological progress has experienced very rapid development. Technology that has developed began to slowly replace the conventional way of becoming more modern, especially in terms of psychological tests. The psychological test known as a psychological test is a test that is carried out to measure aspects of the individual psychologically. One of these psychological tests is the PAPI Kostick Test which is an inventory report of a person's personality in a work environment. The online PAPI Kostick test was developed using HTML, CSS, JavaScript, and PHP. Application testing was conducted to obtain correlation in terms of appearance, comfort, convenience, satisfaction, and long-term use.

Background:The Ankylosing Spondylitis Association of Switzerland (SVMB) offers weekly group exercise therapy for people with axial Spondyloarthritis (axSpA) supervised by physiotherapists (PTs). Given the EULAR physical activity (PA) recommendations [1] and recent research [2, 3], the SVMB has implemented a new concept including assessments evaluating all fitness dimensions, daily PA and disease activity. Based on its results, individual exercise-coaching by the group PT is provided to support the adherence to exercising in correct mode and dose. PTs use the visual-tactile instrument PRISM (Pictorial Representation of Illness and Self Measure) [5] to explore patients’ perceived burden of disease (BD) and importance of PA as starting-point for the exercise-coaching.Objectives:To measure to what extent the perceived BD and importance of PA, measured with PRISM, change over time and to evaluate if the PRISM results are associated with established measures of disease activity and daily PA across four pilot groups including four PTs and 30 people with axSpA.Methods:Each participant had three exercise-coaching sessions within six months. Each session was started by applying the PRISM, which is a white A4 board with a yellow disk at the bottom right hand corner. The participant was asked to imagine that the board represented his/her life and the yellow disk represented his/her “Self”. Then, a red disk, representing axSpA, and later a blue disk, representing PA, were handed and the participant was asked to place the disks where they represented best their importance in the participant’s life. The distances between Self and the red and blue disk respectively were measured in centimeters to quantify BD/importance of PA, and correlated with the Bath Ankylosing Spondylitis Disease Activity Inventory, BASDAI (measuring disease activity) and weekly METs (measured with the International PA Questionnaire, IPAQ) by means of spearman rank correlation. The analysis was based on the first session at baseline (T0) and the third session after six months (T1) and paired t-test was applied, to identify changes between sessions.Results:Complete data were available for 23 participants. Neither BD (distance to Self at T0: 13.7±7.2cm; T1: 12.1±6.2cm; t=0.386, p=0.703) nor importance of PA (distance to Self at, T0: 7.3±5.3cm; T1: 7.0±4.5cm); t=0.246, p=0.808) changed within six months. The perceived importance of PA correlated with IPAQ measured METs at T1 (r=0.572, p=0.00), no correlation between BD and METs was found.Conclusion:The stable perceived BD could be explained by long disease duration of participants and established disease management. The stable importance of PA could be due to the sample, as for group exercise participants PA may already be important. The correlation between importance of PA and MET at T1 could indicate that people learned more about the meaning of PA leading to a better understanding of the importance of PA. Future research should evaluate factors influencing the perceived importance of PA as well as further explore the use of PRISM in the context of exercise-coaching.References:[1]Rausch AK, et al. Ann Rheum Dis 2018; 9(77):1251-1260. 45[2]Sveaas SH, et al. Br J Sports Med 2019;0:1-7.[3]Rausch AK, et al. RMD open, 2018; 4:e000713.[4]Garber CE, et al. Med Sci Sports Exerc 2011;43:1334–59.[5]Buchi S, et al. Psychother Psychosom 2002;71(6):333-341.Acknowledgments:We thank Beatrice Walker and René Braem from Swiss Ankylosing Spondylitis Association.Disclosure of Interests:None declared

A content analysis of the representative Journals in the field of psychothera-py research has been performed. The analysis focused on the articles’ keywords. We ana-lyzed 7,086 works published in 17 Journals, in the period 2005-2011, using a two-step multidimensional procedure. Firstly, a cluster analysis led to the extrapolation of 4 groups of keywords, each of them interpreted as the marker of a topic active within the literature. Secondly, a factorial analysis was carried out in order to picture the thematic orientation of the most representative Journals, namely the main topics they focus on and how they differ from each other in this respect.

Objetiva-se elucidar o conceito de perversão no cerne da scientia sexualis do século XIX e na psychothia sexualis de Krafft-Ebing. Para tanto, parte-se de breve contextualização acerca da configuração político-econômica europeia nos séculos XVIII e XIX. Posteriormente, são apresentadas análises sobre a configuração epistemológica do discurso médico no século XIX. No cerne dessa configuração epistemológica, interessam os fundamentados que embasam os postulados de base orgânico-positivista, a scientia sexualis, acerca do conceito de perversão no século XIX. Por fim, são analisados os postulados de Krafft-Ebing acerca da perversão.

COVID-19 Pandemic resulted in social mobility and travel restrictions to contain the infection. It has been reported that there happened post-pandemic surge in the use of the internet and social media as people rely on it more often for entertainment, work, and learning purposes. It is also been used as an unhealthy coping strategy for pandemic related stress. The smartphone was found to be the most common gadget used for accessing internet-based services. Owing to the postural alterations related to the small screen size of smartphones, neck pain was reported very commonly among smartphone users. Neck pain among smartphone users is a public health concern needing immediate attention in the pandemic time. Many of the risk factors leading to neck pain among smartphone users are modifiable. The authors outline preventive strategies that are mostly self- regulated. The strategies recommended include reducing Smartphone usage time (Smartphone-Free Time, Smartphone-Free Zone), maintaining ideal posture (Focus Breaks, Mobility Breaks, How am I keeping my posture?, Hands-free alternatives), doing regular exercises, preparing and following an activity schedule, and inculcating healthy habits. References Sohrabi C, Alsafi Z, O’Neill N, Khan M, Kerwan A, Al-Jabir A, et al. World Health Organization declares global emergency: A review of the 2019 novel coronavirus (COVID-19). Int J Surg 2020; 76: 71–6. https://doi.org/10.1016/j.ijsu.2020.02.034 Király O, Potenza MN, Stein DJ, King DL, Hodgins DC, Saunders JB, et al. Preventing problematic internet use during the COVID-19 pandemic: Consensus guidance. Compr Psychiatry 2020; 100:152180. https://doi.org/10.1016/j.comppsych.2020.152180 Sun Y, Li Y, Bao Y, Meng S, Sun Y, Schumann G, et al. Brief Report: Increased Addictive Internet and Substance Use Behavior During the COVID‐19 Pandemic in China. Am J Addict 2020 ;29(4):268–70. https://doi.org/10.1111/ajad.13066 Varga E. How does the Internet Influences the Readers’ Behavior. Procedia Manuf. 2020; 46:949–56. https://doi.org/10.1016/j.promfg.2020.05.013 Zhuang L, Wang L, Xu D, Wang Z, Liang R. Association between excessive smartphone use and cervical disc degeneration in young patients suffering from chronic neck pain. J Orthop Sci. 2020; https://doi.org/1016/j.jos.2020.02.009 Davey S, Davey A. Assessment of smartphone addiction in indian adolescents: a mixed method study by systematic-review and meta-analysis approach. Int J Prev Med.2014;5(12):1500–11. Available from: http://www.ncbi.nlm.nih.gov/pubmed/25709785 Smetaniuk P. A preliminary investigation into the prevalence and prediction of problematic cell phone use. J Behav Addict 2014 Mar;3(1):41–53. https://doi.org/1556/JBA.3.2014.004 Lee H, Seo MJ, Choi TY. The Effect of Home-based Daily Journal Writing in Korean Adolescents with Smartphone Addiction. J Korean Med Sci. 2016;31(5):764. https://doi.org/3346/jkms.2016.31.5.764 Yu S, Sussman S. Does Smartphone Addiction Fall on a Continuum of Addictive Behaviors? Int J Environ Res Public Health.2020;17(2):422. https://doi.org/10.3390/ijerph17020422.10. Kwon M, Kim D-J, Cho H, Yang S. The smartphone addiction scale: development and validation of a short version for adolescents. PLoS One2013;8(12): e83558. https://doi.org/1371/journal.pone.0083558 Ding D, Li J. Smartphone Overuse – A Growing Public Health Issue. J Psychol Psychother.2017;07(289):1-3. https://doi.org/0.4172/2161-0487.1000289 Boumosleh JM, Jaalouk D. Depression, anxiety, and smartphone addiction in university students- A cross sectional study. PLoS One 2017;12(8): e0182239. https://doi.org/1371/journal.pone.0182239 Xie Y, Szeto G, Dai J. Prevalence and risk factors associated with musculoskeletal complaints among users of mobile handheld devices: A systematic review. Appl Ergon.2017 Mar;59:132–42. https://doi.org/1016/j.apergo.2016.08.020 Alsalameh AM, Harisi MJ, Alduayji MA, Almutham AA, Mahmood FM. Evaluating the relationship between smartphone addiction/overuse and musculoskeletal pain among medical students at Qassim University. J Fam Med Prim care. 2019;8(9):2953–9. https://doi.org/4103/jfmpc.jfmpc_665_19 Toh SH, Coenen P, Howie EK, Smith AJ, Mukherjee S, Mackey DA, et al. A prospective longitudinal study of mobile touch screen device use and musculoskeletal symptoms and visual health in adolescents. Appl Ergon. 2020; 85:103028. https://doi.org/1016/j.apergo.2019.103028 Lee S, Kang H, Shin G. Head flexion angle while using a smartphone. Ergonomics. 2015 Feb 17;58(2):220–6. https://doi.org/1080/00140139.2014.967311 Guan X, Fan G, Chen Z, Zeng Y, Zhang H, Hu A, et al. Gender difference in mobile phone use and the impact of digital device exposure on neck posture. Ergonomics. 2016;59(11):1453–61. https://doi.org/10.1080/00140139.2016.1147614 Han H, Shin G. Head flexion angle when web-browsing and texting using a smartphone while walking. Appl Ergon. 2019; 81:102884. https://doi.org/1016/j.apergo.2019.102884 Singla D, Veqar Z. Association between forward head, rounded shoulders, and increased thoracic kyphosis: a review of the literature. J Chiropr Med. 2017;16(3):220–9. https://doi.org/1016/j.jcm.2017.03.004 Park J-H, Kang S-Y, Lee S-G, Jeon H-S. The effects of smart phone gaming duration on muscle activation and spinal posture: Pilot study. Physiother Theory Pract. 2017;33(8):661–9. https://doi.org/10.1080/09593985.2017.1328716 Xie Y, Szeto GPY, Dai J, Madeleine P. A comparison of muscle activity in using touchscreen smartphone among young people with and without chronic neck–shoulder pain. Ergonomics. 2016;59(1):61–72. https://doi.org/10.1080/00140139.2015.1056237 Hansraj KK. 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The paper presents data from the examination of 54 patients with combined mental pa-thology. The main group (MG) included 27 patients with comorbid recurrent affective and panic disorders. Patients (27 people) in the control group (CG) were diagnosed with inde-pendent affective disorder. The clinical and psychological parameters of the patients’ personal sphere in the main and control groups were studied and analyzed. The trait profile of patients with MG is represented by disharmonious manifestations and significant peak rise in the scales: “hypochondria”, “depression” and “psychasthenia”. According to the analysis conducted, the following personality characteristics were marked in patients with a combined variant of recurrent affective and panic disorders: inert thinking style, insecurity, high sensitivity, impressionability, dependence on the surroundig people’s opinion, suspiciousness, caution, discretion, high moral exactingness towards oneself and others, conscientiousness, comfort and diligence, unsociability, secrecy and isolation. Besides, the relationship between personal characteristics and choice of protective and coping behavior in patients MG and CG was determined as part of the study. To reduce the discomfort caused by a stressful situation, the patients with MG used the following coping mechanisms: “escape-avoidance” and “acceptance of commitment”. In order to resolve inner experiences patients with a combined variant of recurrent affective and panic disorders use destructive mechanisms of personality psychological defense by the type “denial”, “suppression”, “regression” and “compensation”. As part of the study conducted, the main psychocorrective targets were identified, includ-ing the components of defensive-coping patients’ behavior that showed manifestations of recurrent affective and panic disorders. The results obtained can be taken into account when developing a psychotherapeutic program aimed at harmonizing the personal profile of pa-tients. In the course of psychotherapeutic correction, it is advisable to use methods of the cognitive-behavioral direction, relaxation techniques and breathing exercises. The obtained results can be taken into account when developing a psychotherapeutic pro-gram aimed at harmonization of the patients’ personal profile. In the course of psychothera-peutic correction, the use of cognitive-behavioral methods, relaxation techniques and breathing exercises is advisable.

IntroductionTrauma-focused cognitive behavioural therapies are the first-line treatment for posttraumatic stress disorder (PTSD) in children and adolescents. Nevertheless, open questions remain with respect to efficacy: why does this first-line treatment not work for everyone? For whom does it work best? Individual clinical trials often do not provide sufficient statistical power to examine and substantiate moderating factors. To overcome the issue of limited power, an individual participant data meta-analysis of randomised trials evaluating forms of trauma-focused cognitive behavioural therapy in children and adolescents aged 6–18 years will be conducted.Methods and analysisWe will update the National Institute for Health and Care Excellence guideline literature search from 2018 with an electronic search in the databases PsycINFO, MEDLINE, Embase, Cochrane Central Register of Controlled Trials and CINAHL with the terms (trauma* OR stress*) AND (cognitive therap* OR psychotherap*) AND (trial* OR review*). Electronic searches will be supplemented by a comprehensive grey literature search in archives and trial registries. Only randomised trials that used any manualised psychological treatment—that is a trauma-focused cognitive behavioural therapy for children and adolescents—will be included. The primary outcome variable will be child-reported posttraumatic stress symptoms (PTSS) post-treatment. Proxy-reports (teacher, parent and caregiver) will be analysed separately. Secondary outcomes will include follow-up assessments of PTSS, PTSD diagnosis and symptoms of comorbid disorders such as depression, anxiety-related and externalising problems. Random-effects models applying restricted maximum likelihood estimation will be used for all analyses. We will use the Revised Cochrane Risk of Bias tool to measure risk of bias.Ethics and disseminationContributing study authors need to have permission to share anonymised data. Contributing studies will be required to remove patient identifiers before providing their data. Results will be published in a peer-reviewed journal and presented at international conferences.PROSPERO registration numberCRD42019151954.

Abbass A et al. Short-Term Psychodynamik Psychotherapy for Functional Somatic Disorders: A Meta-Analysis of Randomized Controlled Trials. Psychother Psychosom 2020; 89: 363–370 Kann man funktionelle somatische Störungen mit einer psychodynamischen Kurzzeit-Therapie behandeln? Ein internationales Team hat dazu eine Meta-Analyse durchgeführt – schon zum zweiten Mal.

Schäfer SK et al. Impact of COVID-19 on Public Mental Health and the Buffering Effect of a Sense of Coherence. Psychother Psychosom 2020 Aug 18: 1–7. doi: 10.1159/000510752. Online ahead of print Im März 2020 erreichte die COVID-19-Pandemie die westliche Welt. Wie hat sich das auf die psychische Gesundheit der Menschen ausgewirkt – und welche Rolle spielt dabei das Kohärenzgefühl?

Hilbert A et al. Psychopathological Networks in Cognitive-Behavioral Treatments for Binge-Eating Disorder. Psychother Psychosom 2020. doi: 10.1159/000509458 Die Netzwerkanalyse ist ein methodischer Ansatz zur Beschreibung von Interaktionsmustern und kommt immer häufiger im Bereich der Psychotherapie zum Einsatz. A. Hilbert und ihr Team haben jetzt die Symptomstruktur bei Binge-Eating-Störungen mit dieser Methode sichtbar gemacht und untersuchen ferner mögliche Veränderungen des Netzwerkes durch kognitive Verhaltenstherapie.

Blunschi CC, Watzke B. Patientenratgeber bei Depressionen: Wie evidenzbasiert sind sie? Psychother Psych Med 2020; 70: 57–64 Schriftliche Ratgeber für Menschen mit Depressionen tragen als niedrigschwellige Informationsquelle dazu bei, dass Depressionen früher erkannt und behandelt werden. Aufgrund der unüberschaubaren Angebote im Buchhandel stellt sich jedoch die Frage nach ihrer Qualität. Blunschi und Watzke haben in ihrer Studie die Ausführlichkeit und Leitlinienkonformität verschiedener Depressionsratgeber im deutschsprachigen Raum überprüft.

Kleinstäuber M et al. Cognitive Behaviour Therapy Complemented with Emotion Regulation Training for Patients with Persistent Physical Symptoms: A Randomised Clinical Trial. Psychother Psychosom 2019; 88: 287–299 Anhaltende körperliche Symptome ohne medizinische Erklärung sind mit hohen Kosten für das Gesundheitssystem verbunden. Bisherigen Studienergebnissen zufolge erreicht die kognitive Verhaltenstherapie bei diesen Patienten kleine bis mittlere Effekte. Kleinstäuber und Kollegen überprüften mit einer randomisiert kontrollierten Studie, ob sich diese Ergebnisse verbessern, wenn man die bisherige Therapie mit einem Training zur Emotionsregulation kombiniert.

Rafanelli C. et al. Sequential Combination of Cognitive Behavioral Treatment and Well-Beeing Therapy in Depressed Patients with Acute Coronary Syndromes: A Randomized Controlled Trial (TREATED-ACS Study). Psychother Psychosom 2020; 89: 345–356. Doi: 10.1159/000510006 Viele Menschen mit einem akuten Koronarsyndrom (AKS) leiden komorbid an einer depressiven Symptomatik und Demoralisierung. Dies geht mit einem niedrigen therapeutischen Commitment, häufigeren Rückfallquoten und erhöhter Mortalität einher. Wissenschaftler aus Italien überprüften nun, ob eine Kombinationsbehandlung aus kognitiver Verhaltenstherapie (KVT) und Well-Being Therapie (WBT) sowohl depressive als auch kardiovaskuläre Symptome nachhaltig reduzieren kann.

ObjectivesThe purpose is to analyze existing studies related to the field of demoralization through bibliometrics.MethodologyRelevant literature on demoralization was searched from PubMed, Web of Science, the Cochrane Library, and CINAHL Complete. Bibliometric analysis was performed using GraphPad Prisma 8.2.1, VOSviewer 1.6.18 and R software. Research publication trends, author-country collaboration, research hotspots and future trends were explored by generating network relationship maps.ResultsA total of 1,035 publications related to the field of demoralization were identified. The earliest relevant studies have been published since 1974, and the studies have grown faster since 2000. Psyche-oncology and Psychother Psychosom had the highest number of publications (n = 25). The United States, Italy and Australia have made outstanding contributions to the field and there was an active collaboration among leading scholars. Major research hotspots include the multiple ways of assessing demoralization, the specificity of various demographics and psychological disorders in different disease contexts, and the association and distinction of diverse clinical psychological abnormalities. The impact of COVID-19 on demoralization and subsequent interventions and psychological care may become a future research direction.ConclusionThere has been a significant increase in research in the field of demoralization after 2000. The United States provided the most publications. There is overall active collaboration between authors, countries, and institutions. In future research, more attention will be paid to the effects of COVID-19 on demoralization and intervention care for this psychology.

AbstractMoments of meeting (MoM) are characterized by instances of special intersubjective connection between the therapist and patient which causes a change in the implicit relational knowing (IRK) of both individuals. MoM have been widely described for non-creative arts therapies, but there is little information about their characteristics in dance/movement therapy (DMT). This study seeks to explore and characterize the MoM in DMT from the perception of professional therapists. Nine dance/movement therapists (dmts) were consulted using a multimodal approach that travels between writing and movement (Panhofer, 2011) and data were examined using qualitative content analysis. The results show that the characteristics of MoM can be grouped into three categories: (1) relationship (shared experience, experience of fusion, security and kinesthetic empathy) (2) emotion (emotional intensity and genuine affection) and (3) movement (physical closeness, eye contact, emergency, irruption of the present and release of the flow). These results are contrasted with what was originally proposed by the Boston Group (Lyons-Ruth et al in Infant Ment Health J 19(3):282–289, https://doi.org/10.1002/(sici)1097-0355(199823)19:3<282::aid-imhj3>3.0.co;2-o, 1998) and recently by Duarte et al. (Psychother Res 31:1–14, https://doi.org/10.1080/10503307.2021.1948138, 2021) and Lauffenburger (Am J Dance Ther 42(1):16–32, https://doi.org/10.1007/s10465-020-09321-y, 2020), finding similarities and new elements exclusive to DMT. This work contributes to a deeper understanding and conceptualization of MoM in the specific field of DMT and its clinical practice.

Introdução: Os psicoestimulantes são drogas que aumentam o estado de alerta e concentração dos seus usuários e são usados principalmente no tratamento de TDAH e narcolepsia. Entretanto, o uso dessas substâncias como potenciadores cognitivos tem crescido exponencialmente na busca por um rendimento melhor nos estudos ou no trabalho. Nesse cenário, algumas questões são levantadas a respeito dos efeitos nocivos para os usuários de psicoestimulantes. Objetivo: avaliar a prevalência do uso de psicoestimulantes e correlacionar com a utilização de outras substâncias, de modo a entender as causas e as consequências do uso indiscriminado do metilfenidato. Material e método: Revisão bibliográfica de livros, artigos e publicações sobre o tema e análise de pesquisas realizadas sobre o uso do metilfenidato para melhor compreensão do assunto. Resultados: Estudos mostraram que os principais motivos da utilização do metilfenidato são melhorar a atenção e aumentar o estado de vigília durante o consumo de álcool e de outras drogas. Conclusão: O uso indiscriminado de potenciadores cognitivos em longo prazo pode alterar vias noradrenérgicas e dopaminérgicas, predispondo transtornos obsessivos compulsivos e aditivos.Descritores: Estimulantes do Sistema Nervoso Central; Metilfenidato; Transtorno da Personalidade Compulsiva.ReferênciasOutram SM. The use of methylphenidate among students: the future of enhancement? J Med Ethics. 2010;36(4):198-202.Freese L, Signor L, Machado C, Ferigolo M, Barros HMT. Non-medical use of methylphenidate: a review. Trends Psychiatry Psychother. 2012;34(2):110-15.Ortega F, Barros D, Caliman L, Itaborahy C, Junqueira L, Ferreira CP. A Ritalina no Brasil: produções, discursos e práticas. Interface Comum Educ Saúde. 2010;14(34):499-510.Itaborahy C. A Ritalina no Brasil: uma década de produção, divulgação e consumo [dissertação]. Rio de Janeiro: Instituto de Medicina Social, Universidade Estadual do Rio de Janeiro; 2009.Urban KR, Gao WJ. Performance enhancement at the cost of potential brain plasticity: neural ramifications of nootropic drugs in the healthy developing brain. Front Syst Neurosci. 2014;8:38.Bassols AM, Sordi AO, Eizirik CL, Seeger GM, Rodrigues GS, Reche M. Prevalência de estresse em uma amostra de estudantes do curso de medicina da Universidade Federal do Rio Grande do Sul. Rev HCPA. 2008; 28(3):153-57.Pereira DS, Souza RS, Buaiz V, Siqueira MM. Uso de substâncias psicoativas entre universitários de medicina da Universidade Federal do Espírito Santo. J bras psiquiatr. 2008;57(3):188-95.Barros D, Ortega F. Metilfenidato e aprimoramento cognitivo farmacológico: representações sociais de universitários. Saúde Soc. 2011;20(2):350-62.Cruz TC, Barreto Junior EPDS, Gama MLM, Maia LCDM, Melo Filho MJXD, Manganotti Neto O et al. Uso não prescrito de metilfenidato entre estudantes de medicina da Universidade Federal da Bahia. Gazeta Méd Bahia. 2011;81(1):3-6.Cesar ELR, Wagner GA, Castaldelli-Maia JM, Silveira CM, Andrade AG, Oliveira LG. Uso prescrito de cloridrato de metilfenidato e correlatos entre estudantes universitários brasileiros. Rev Psiq Clín. 2012;39(6):183-88.Carneiro SG, Prado AST, Araújo ECJ, Moura HC, Strapasson JF, Rabelo NF et al. O uso não prescrito de metilfenidato entre acadêmicos de Medicina. Cadernos UniFOA: Edição Especial Ciênc da Saúde e Biol. 2013:53-9.Pasquini NC. Uso de metilfenido (mfd) por estudantes universitários com intuitode “turbinar” o cérebro. Rev Biol Farm. 2013;9(2):107-13.Mota JS, Pessanha FF, Prevalência do uso de metilfenidato por universitários de Campos dos Goytacazes, RJ. Vértices. 2014;16(1):77-86.Silveira RR, Lejderman B, Ferreira PEMS, Rocha GMP. Patterns of non-medical use of methylphenidate among 5th and 6th year students in a medical school in southern Brazil. Trends Psych Psychother. 2014; 36(2):101-06.Affonso RS, Lima KS, Oyama YM, Deuner MC, Garcia DR, Barboza LL et al. O uso indiscriminado do cloridrato de metilfenidato como estimulante por estudantes da área da saúde da Faculdade Anhanguera de Brasília (FAB). Infarma. 2016;28(3):166-72.Wille ARF, Salvi JO. Prevalência do uso de metilfenidato em acadêmicos de um centro universitário em Ji-Paraná, Rondônia. BJSCR. 2018;24(3):13-9.Tolentino JEF, Silva Neto JP. O uso off label de metilfenidato entre estudantes de medicina para aprimoramento do desempenho acadêmico. CCS 2019;30(1): Ahead of Print - AOF)Lima RF. Compreendendo os mecanismos atencionais. Ciência e Cognição. 2005;6:113-22.Rotta NT, Ohlweiler L, Riesgo RS. Transtorno da aprendizagem: abordagem neurobiológica e multidisciplinar. São Paulo: Artmed; 2016.Stahl SM. Psicofarmacologia – bases neurocientíficas e aplicações práticas. Guanabara Koogan; 2014.Brunton LL, Chabner BA, Knollmann BC. As bases farmacológicas da terapêutica de Goodman & Gilman. 12. ed. Porto Alegre: AMGH Editora; 2002.Gillick BT, Zirpel L. Neuroplasticity: an appreciation from synapse to system. Arch phys med rehabil. 2012;93(10):1846-55.Gomes KM, Souza RP, Inácio CG, Valvassori SS, Réus GZ, Martins MR et al. Avaliação do ciclo claro e escuro no comportamento relacionado à ansiedade e à depressão em ratos de diferentes cidades após tratamento crônico com hidrocloridrato de metilfenidato. Rev bras psiquiatr. 2011;33(1):55-8.

Introduction: despite large and widely accepted research on effectiveness, most of psychotherapy research has been done with adults; few studies have been published on the process of adolescent psychotherapy, due to the complexity of the subject and the absence of instruments sensitive enough to empirically capture its nuances. Within psychoanalytic framework, a developmental approach is particu-larly helpful in the psychotherapy of adolescents. Objective: the purpose of this study was to investigate the typical features of Italian Adolescence Psychodynamic Psychotherapy and its similarities and differences with other adolescence psycho-therapeutic approaches; We also aimed at analyzing typical therapists’ responses to adolescent patients. Method: 50 italian adolescence psychotherapists filled a brief questionnaire about their clinical expertise, completed the Adolescent Psychothe-rapy Q – Set (APQ) and the Therapist Response Questionnaire (TRQ) in order to describe their “actual” practice with adolescents. Results: therapeutic process is characterized by a priority to helping adolescent make sense of his own experience, it focuses on present relationships and emotions rather than on past. Strong similar-ities with Mentalization Based Therapy, mild and no correlations with Cognitive-Behavioral Therapy and Classical Psychoanalysis respectively were found; towards adolescents therapists generaly display positive and protective countertransference responses. They less frequenlty show negative responses as overprotection, hostility or feeling of overwhelming. Conclusions: APQ and TRQ can provide meaningfull information about adolescent psychotherapy process. Instruments’ improvement (i.e. reviewd items for APQ) and future perspectives are also discussed.

Zusammenfassung Hintergrund Patienten mit einer narzisstischen Persönlichkeitsstörung (NPS) gelten im Rahmen der therapeutischen Arbeit als besonders herausfordernd. Allerdings liegen gut kontrollierte Studien zur Effektivität von Psychotherapie bei NPS-Patienten bislang nicht vor, sodass viele Interventionsprozesse auf theoretischen Konstrukten basieren. Die Klärungsorientierte Psychotherapie (KOP) ist ein psychothera-peutisches Verfahren, welches sich aus Konzepten der Kognitiven Verhaltenstherapie, der Klientenzentrierten Psychotherapie und verschiedenen prozessorien-tierten Verfahren entwickelt hat. Die vorliegende Untersuchung versucht eine Quantifizierung der Effektivität einer psychotherapeutischen Behandlung der NPS per KOP. Methode und Ergebnisse Retrospektive Kohorten-Studie. Die prä-post per-Protokoll-Analyse von 173 behandlungssuchenden NPS-Patienten1 zeigte nach Abschluss der Behandlung (58,6±10,5 Sitzungen) signifikante Verbesserungen von zentralen störungsrelevanten Parametern (mit größtenteils mittleren Effektstärken). Insbesondere das primäre Zielkriterium (d.h. der ehrgeizige/narzisstische Persönlichkeitsziel im „Persönlichkeits-Stil- und Störungs-Inventar“ (PSSI) zeigte eine positive Veränderung (mittlere Effektstärke: d=−0,49 [−0,67; −0,31], p<0,001). In Bezug auf die Verbesserung depressiver „states“ und „traits“, Neurotizismus sowie der Selbstakzeptanz konnte sogar ein großer Effekt gefunden werden. Die niedrigsten Effektstärken fanden sich bei der Stärkung der Selbstregulation (d=0,2 [0,03; 0,36], p=0,02). Diskussion Da keine intention-to-treat-Analyse durchgeführt wurde, kann eine Überschätzung der Effektstärken der Behandlung nicht ausgeschlossen werden. Die Ergebnisse deuten an, dass der KOP eine bevorzugte Position bei der Behandlung der narzisstischen Persönlichkeitsstörung eingeräumt werden kann. Aus Sicht der evidenzbasierten Medizin unterstützen die Ergebnisse dieser bisher umfangreichsten Studie zur Psychotherapie der NPS eine Anhebung des Evidenzlevels der Wirksamkeit der KOP bei der Behandlung dieser Störung von Stufe IV auf Stufe III.

Objective: Methods: To investigate the therapeutic benets of EMDR psychotherapy in treating MDD associated with PTSD. A pilot study was performed by using standardized EMDR psychotherapy in subjects with MDD associated with PTSD. The inclusion criteria were the followings; (1) Adults aged 18 years old or older, (2) Subjects being treated with antidepressants for at least two months assumably stable blood levels, (3) Subjects with depressive symptoms based upon the Patient Health Questionnaire (PHQ-9) depressive scale, (4) Subjects with positive score for traumatic events based upon the Children's Revised Impact of Events Scale-13 (CERIES-13, Thai version). The subjects were eligible if they fullled all four criterias. The subjects were treated with 60-90 minutes of EMDR psychotherapy twice a week for three weeks. The changes in PHQ-9 depressive scale, CERIES-13 scale, and Rosenberg self-esteem scale were obtained before the treatment, at the end of the treatment, and 3 months after treatment. The collective data was analyzed with a Paired t-test. Eighteen subjects with a mean age of 28 years were enrolled Results: in the study. The subjects had signicantly decreased PHQ-9 scale and CERIES-13 scale (mean difference [MD] = -11.47, p<0.001; MD = - 36.47, p<0.001, respectively), and had signicantly increased self-esteem scale (MD = 9.13, p<0.001) at 3 months after treatment when compared to prior results. The study demonstrated the therapeutic benets of adding EMDR psychothera Conclusion: py in MDD associated with PTSD patients who were currently treated with antidepressants. The benets of adding EMDR psychotherapy may possibly reduce depressive symptoms, PTSD symptoms and improve self-esteem in subjects. Further evaluation of the effectiveness of EMDR psychotherapy is in a guaranteed randomized controlled trial method

Brasil. Convenção Interamericana para Prevenir, Punir e Erradicar a Violência Contra a Mulher “Convenção de Belém do Pará”. Adotada em Belém do Pará, Brasil, em 9 de junho de 1994, no Vigésimo Quarto Período Ordinário de Sessões da Assembléia Geral. Comissão Interamericana de Direitos Humanos. Belém (PA); 1994 [citado 2016 Dez 15]. Disponível em: http://bvsms.saude.gov.br/bvs/publicacoes/convencaobelem1994.pdf Cortes LF, Padoin SMM. Intencionalidade da ação de Cuidar mulheres em situação de violência: contribuições para a Enfermagem e Saúde. Esc Anna Nery Rev Enferm [Internet]. 2016 [citado 2016 Out 13]; 20(4). Disponível em: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1414-81452016000400202&lng=pt&nrm=iso Rocha SV, Almeida MMG, Araújo TM. Violência contra a mulher entre residentes de áreas urbanas de Feira de Santana, Bahia. Trends Psychiatry Psychother. [Internet]. 2011 [citado 2016 Out 13]; 33(3): 164-8. 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Violência interpessoal: estudo descritivo dos casos não fatais atendidos em uma unidade de urgência e emergência referência de sete municípios do estado de São Paulo, Brasil, 2008 a 2010. Epidemiol Serv Saúde [internet]. 2012 [citado 2016 Out 21]; 21(2):293-304.Disponível em http://scielo.iec.pa.gov.br/scielo.php?script=sci_arttext&pid=S167949742012000200012&lng=pt&nrm=iso Leite FM, Bravim LR, Lima EF, Primo CC. Violência contra a mulher: caracterizando a vítima, a agressão e o autor. Rev pesqui cui fundam [internet]. 2015 [citado 2016 Out 25]; 7(1):2181-219. Disponível em: http://bases.bireme.br/cgibin/wxislind.exe/iah/online/?IsisScript=iah/iah.xis&src=google&base=BDENF〈=p&nextAction=lnk&exprSearch=26717&indexSearch=ID Veloso MMX, Magalhães CMC, Dell'Aglio DD, Cabral IR, Gomes MM. Notificação da violência como estratégia de vigilância em saúde: perfil de uma metrópole do Brasil. Ciênc saúde coletiva [Internet]. 2013 [citado 2016 Out 23]; 18( 5):1263-72. 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Photo by National Cancer Institute on Unsplash ABSTRACT The COVID-19 pandemic has brought about the advent of many new telehealth technologies as providers have been forced to shift their practice from the clinic to the cloud. Perhaps, none of these fields has been as widely advertised and expanded as telemental health. While many have lauded this change, it is important to question whether this method of practice is truly beneficial for patients, and further whether it benefits all patients. This paper critically examines the current structure of telemental health interventions and compares them to more traditional in-person interactions, reflecting on the unique benefits and challenges of each method, and ultimately concluding that telemental health is the wrong modality for certain patients and modalities. INTRODUCTION As the e-health revolution rapidly progresses, scientists, healthcare professionals, and technology experts are attempting to determine which areas of medical practice will best adapt to changing dynamics. Two key professions that are ripe for this kind of disruption are psychiatry and psychology. The American Psychiatric Association, along with its partners in the American Telemedicine Association, states that “telemental health in the form of interactive videoconferencing has become a critical tool in the delivery of mental health care. It has demonstrated its ability to increase access and quality of care, and, in some settings, to do so more effectively than treatment delivered in-person.”[1] This claim, though appearing bombastic, is also reflected, though with more nuance, by the American Psychological Association. For its part, the American Psychological Association states that “the expanding role of technology and the continuous development of new technologies that may be useful in the practice of psychology present unique opportunities, considerations, and challenges to practice.”[2] Thus, the point of this paper will be to examine whether the rapidly expanding system of telemental health is ethical based on its adherence to accepted standards of care, privacy concerns, and concerns about the boundaries of the patient-provider relationship. l. Standard of Care Concerns One of the most considerable objections to the broader implementation of telemental health services is the speculation that it is less effective than in-person treatment. It would follow that a system that is broadly implemented would not only fail to be beneficent, but it would also fail to be non-maleficent. Providers would be knowingly providing an ineffective treatment. Some may argue that such a system would also violate the principle of justice. It would create an unequal system of care in which those patients who could afford to see their therapist in person would benefit more than those who could not. However, data from a wide variety of sources at first glance, would seem to contradict these fears.[3] A review of the literature regarding the implementation of telemental health in geriatric patients, for example, showed that telemental health was as good as in-patient psychiatric care in several areas, including the diagnosis of dementia, nursing home consultations, and in conducting psychotherapy for geriatric patients and their caregivers.[4] On the other end of the age spectrum, a review of nineteen randomized controlled trials and one clinical trial demonstrated high comparative effectiveness between telemental health interventions in children and adolescents.[5] Hailey et al. found that telemental health interventions were effective in over half of the 65 studies reviewed. These studies encompassed a diverse and wide-ranging number of psychiatric disciplines, including child psychiatry, post-traumatic stress disorder, dementia, cognitive decline, smoking cessation, and eating disorders. Methods included phone- and web-based interventions.[6] Indeed, the data is not just limited to outpatient settings. For example, Reinhardt et al. conducted a literature review of studies about telemental health visits for psychiatric emergencies and crises. They found that no studies reported a significant statistical difference in diagnosis or disposition among psychiatric patients who presented to the Emergency Department. In addition, their review demonstrated a reduction in length of stay, reduction in time to care, and decreased costs among these patients. The authors also reviewed literature pertaining to crisis response teams and patients with severe mental illness. Both studies demonstrated that telemental health visits for these patients were similar, if not better, than face-to-face visits. In addition, both patients and practitioners showed high satisfaction with these services.[7] Thus, the implementation of telemental health is limited to out-patient settings and could feasibly be implemented in the in-patient and emergency settings. There is, however, one particularly glaring gap in telemental health services: group therapy. Perhaps the most famous example of group therapy is Alcoholics Anonymous, but group therapy has expanded to include many different modalities. Group therapy is a common intervention for many mental illnesses and can be incredibly effective in treating diseases ranging from PTSD to borderline personality disorder.[8] In a pilot study comparing a video teleconference based Dialectical Behavioral Therapy (DBT) group to an in-person DBT group, Lopez et al. found that while patients had similar levels of cohesion with the facilitator, participants in the video teleconference group saw less group cohesion than their peers in the in-person group. Further, while many patients in the video teleconference group believed that the convenience offset the adverse effects, many also wished for an in-person group. Attendance was also significantly higher in the video teleconference group.[9] Thus, while the video teleconference group did report some positives, some significant differences raise ethical questions. How well does a group do without cohesion? For example, if a person needing to be consoled breaks down and cries in front of the group, the in-person response may be different from the video conference. In the in-person group, other group members may place a gentle hand on the shoulder of the grieving person or maybe even hug them. The group facilitator or group members in the video conference group could say the same words of consolation as those in the in-person group. However, there still seems to be some missing action. The idea of physical touch, in this way, can mean a lot more than just a small action. Van Wynsberghe and Gastmans argue that this kind of deprivation may lead to feelings of depersonalization.[10] And, to an extent, their supposition is supported by the data presented by Lopez et.al. The low level of group cohesion in the video conference group could suggest that other group members seem unimportant to the participants. They are simply things on a screen, not real people. Dr. Thomas Insel, former National Institute of Mental Health Director writes that while technology may hold the key to improving mental health on the population level, there is a human-sized piece of the puzzle missing from these interventions. The solution, he asserts, lies somewhere in the integration of these two types of experiences, one that he terms “high-tech and high-touch.”[11] The lack of touch and physical presence is an obstacle for both patients and providers. At best this may lead to a slightly poorer provider-patient relationship and at worst may result in poorer quality care. ll. Privacy & Confidentiality Concerns Privacy and confidentiality are among the most serious concerns for practitioners and patients, made more complex by the advent of e-health. Major news outlets provide plenty of examples of breaches of confidentiality of people’s electronic records. Even significant systems, often thought to be secure, used to facilitate direct contact between people in the wake of COVID-19, like Zoom, have been breached. Not too long ago, "Zoom Bombing” was a national phenomenon, appearing in online classrooms, often sharing explicit or politically motivated content. Psychiatric patients are susceptible to issues surrounding privacy and confidentiality, and they may even come from communities that ostracize and stigmatize mental illness. These concerns must be taken seriously. Of course, both the American Psychiatric Association and the American Psychological Association address privacy concerns. Both organizations note in their guidelines that relevant HIPAA regulations apply to telehealth and doctors must use apps and videoconferencing tools with the highest levels of security.[12] Interestingly, the American Psychiatric Association takes these instructions one step further. It requires providers to be in a private room during telehealth videoconferences or calls and that people seeking care also have a private space so that any conversations are not overheard. This not only prevents violations of privacy but reassures the therapeutic relationship between provider and patient.[13] While providers can take these steps to ensure their patients’ privacy, an internet connection may not guarantee privacy. Many privacy issues are more easily mitigated in a clinical space. For example, walls and doors can be soundproofed, or white noise can be played in the waiting room to ensure that therapeutic conversations are not overheard. And while the American Psychiatric Association asks providers to mitigate these risks as they would in their respective clinics, there is another layer to online privacy. Providers should be concerned about telecommunications providers, how they collect information, and what types of information they collect.[14] If, for example, the patient must navigate to the practitioner’s webpage to enter into the therapy portal, that information might be tracked and used to generate personalized ads for the patient. If a person suffering from severe paranoia started receiving ads for psychiatric medication, they may react negatively to the invasion of privacy. That type of targeted advertising could even exacerbate a mental health condition. The scandals surrounding the National Security Administration (NSA) in recent years have added another layer of complexity to the issue of privacy. Whistleblowers like Edward Snowden, revealed that the government was collecting metadata from text messages, videos, and social media. Government surveillance is an added risk of mental health videoconferencing.[15] The government would not be bound by the rules that require privacy with few exceptions like the Tarasoff law, which could require disclosure to stop a violent act as a clinical care provider. The government might judge someone a risk-based on ill-gotten surveillance data, wrongly add a person to a watch list, or engage in further surveillance of a patient whom non-clinicians working in government assess to be a potential danger. Protection from government surveillance is a fundamental ethical endeavor. Yet government as a collector of data without a warrant or with easily attained FISA and other warrants is problematic. Scenarios may seem far-fetched but are within the realm of possibility. Secondly, the provider must envision how this might hinder care. For example, patients aware of the possibility of government surveillance may be reluctant to show up to online meetings if they show up at all. Perhaps they are so sensitive to these issues that they stop checking with their therapist altogether. It is easy to see how a person who has schizophrenia and shows signs of paranoia may avoid telehealth for fear of being tracked. Of course, one could also have privacy concerns about a therapist’s office. Perhaps patients are nervous about being seen in the office or parking lot. They might worry about being overheard. These concerns, however, can be mitigated fairly simply, for example, patients could find anonymous means of transportation and practitioners can soundproof their offices. Thus, in both the office and the videoconference, concerns can be mitigated easily and tangibly, but not eliminated entirely. Mental health providers should use the highest quality communication services with end-to-end encryption to bolster online privacy. lll. Boundary Issues and Professionalism The boundaries here are philosophical, not physical. Both the American Psychiatric Association and the American Psychological Association work to ensure that the patient-professional boundaries are kept as close to normal as possible. Both organizations expect practitioners to maintain the highest levels of professionalism when dealing with patients using telemental health services.[16] Practitioners are responsible for enforcing boundaries through informing their patients about appropriate behavior so that patients are discouraged from calling at inappropriate times absent an emergency. Videoconferencing systems and multi-layered protections like passwords and gatekeeping would prevent patients from logging into another patient’s appointment. These boundaries exist for a good reason. A 2017 report demonstrated that there is an escalating shortage of psychiatrists.[17] Nearly 1 in 5 people in the US has a mental health condition.[18] Mental health providers are nearly overwhelmed, therefore inappropriate, frequent, and unnecessary contact adds another level of complexity to treating patients. Mental health providers need to be stewards of the resource they provide. They must concentrate on the patient they are with. They also must guard themselves against burnout, because dealing with patients too often, even though technology allows for it, will lead to them being less effective for the rest of their patients. While these professional boundaries must be policed carefully, practitioners should also be careful of having boundaries that are too high. Thus, providers must balance between too much intimacy and too little.[19] Presence and physical touch have symbolic meaning. Being with a person reaffirms their personhood, and both provider and patient can feel that. Humans are relational beings, and a physical relationship often comforts people. It may also legitimize and reinforce the patient through sensation and perception. There may be something inherently missing from the practice of telemental health, as exemplified by the group members’ inability to console others in group therapy sessions over teleconference.[20] The screen may also be an agent of depersonalization. It may make the patient’s complaints seem less real. Or perhaps the patient may feel as though they are not being heard. Although the evidence of telemedicine’s successes above may seem to contradict this, none of the studies that extoll the benefits of telemental health have follow-up periods greater than one year. And while many studies show that patients are highly satisfied with telemental health, measurements of satisfaction are not standardized. It remains unclear whether patients benefit enough from their telemental sessions or whether they require more regular sessions to stay as satisfied as they were with in-person mental health care. Perhaps as time goes on, patients become more frustrated with telemental health. The research must answer these questions, but currently, it does not sufficiently address metaphysical arguments against telemental health. CONCLUSION Privacy is a key practical issue that remains. Although providers try to combat issues of privacy by using high-level conferencing software, which has end-to-end encryption,[21] surveillance and breaches may occur. While not suitable for all kinds of patients, telemental health services prove to be effective for groups of people that otherwise may not have been able to receive care over the past two years. There are some settings, such as group therapies, that are best suited for in-person meetings. Although online sessions encourage individuals to show up regularly, their downsides are not yet known. There is incredible power in the idea of presence, and humans are inherently relational beings. For some, a lack of contact is unwelcomed and makes therapy less satisfying. Opportunities to use in-person clinical care remain a priority for some patients, and healthcare providers should further investigate prioritizing in-person care for those who want it. Telemental health could be beneficial for emergencies, natural disasters, vulnerable groups, or when patients cannot get to their provider's office. However, for now, telemental health should not take a leading role in providing mental health treatment. - [1] Chiauzzi E, Clayton A, Huh-Yoo J. Videoconferencing-Based Telemental Health: Important Questions for the COVID-19 Era from Clinical and Patient-Centered Perspectives. JMIR Ment Health, 2020. doi:10.2196/24021 [2] Joint Task Force for the Development of Telepsychology Guidelines for Psychologists. Guidelines for the practice of telepsychology. American Psychologist, 2020. 791–800. doi.org/10.1037/a0035001 [3] Gentry MT, Lapid MI, Rummans TA. Geriatric Telepsychiatry: Systematic Review and Policy Considerations. Am J Geriatr Psychiatry. 2019 doi: 10.1016/j.jagp.2018.10.009; Campbell R, O'Gorman J, Cernovsky ZZ. Reactions of Psychiatric Patients to Telepsychiatry. Ment Illn. 2015;7(2):6101, 2015. doi:10.4081/mi.2015.6101; Malhotra S, Chakrabarti S, Shah R. Telepsychiatry: Promise, potential, and challenges. Indian J Psychiatry, 2013. doi: 10.4103/0019-5545.105499; Reinhardt I, Gouzoulis-Mayfrank E, Zielasek J. Use of Telepsychiatry in Emergency and Crisis Intervention: Current Evidence. Curr Psychiatry Rep, 2019. doi: 10.1007/s11920-019-1054-8 [4] Gentry, Lapid, and Rummans, Geriatric Telepsychiatry [5] Abuwalla, Zach & Clark, Maureen & Burke, Brendan & Tannenbaum, Viktorya & Patel, Sarvanand & Mitacek, Ryan & Gladstone, Tracy & Voorhees, Benjamin. Long-term Telemental health prevention interventions for youth: A rapid review, 2017. Internet Interventions. Doi.11. 10.1016/j.invent.2017.11.006. [6]Hailey D, Roine R, Ohinmaa A. The effectiveness of telemental health applications: a review, 2008. Can J Psychiatry. doi:10.1177/070674370805301109. [7] Reinhardt, Gouzoulis-Mayfrank, and Zielasek, Use of Telepsychiatry in Emergency and Crisis Intervention [8] Kealy, David & Piper, William & Ogrodniczuk, John & Joyce, Anthony & Weideman, Rene. Individual goal achievement in group psychotherapy: The roles of psychological mindedness and group process in interpretive and supportive therapy for complicated grief, 2018. Clinical Psychology & Psychotherapy. doi:10.1002/cpp.2346. Schwartze D, Barkowski S, Strauss B, Knaevelsrud C, Rosendahl J. Efficacy of group psychotherapy for posttraumatic stress disorder: Systematic review and meta-analysis of randomized controlled trials. Psychother Res, 2019. doi: 10.1080/10503307.2017.1405168; Wetzelaer P, Farrell J, Evers SM, Jacob GA, Lee CW, Brand O, van Breukelen G, Fassbinder E, Fretwell H, Harper RP, Lavender A, Lockwood G, Malogiannis IA, Schweiger U, Startup H, Stevenson T, Zarbock G, Arntz A. Design of an international multicentre RCT on group schema therapy for borderline personality disorder. BMC Psychiatry, 2014. doi: 10.1186/s12888-014-0319-3 [9] Lopez, Amy et al. “Therapeutic groups via video teleconferencing and the impact on group cohesion.” mHealth, 2020. doi:10.21037/mhealth.2019.11.04 [10] Van Wynsberghe A, Gastmans C. Telepsychiatry and the meaning of in-person contact: a preliminary ethical appraisal. Med Health Care Philos, 2009. doi: 10.1007/s11019-009-9214-y. [11]Thomas Insel, “Tech Can Help Solve Our Mental Health Crisis. But We Can’t Forget The Human Element.,” Substack newsletter, Big Technology (blog), January 27, 2022, https://bigtechnology.substack.com/p/tech-can-help-solve-our-mental-health. [12] Armstrong, C. M., Ciulla, R. P., Edwards-Stewart, A., Hoyt, T., & Bush, N. Best practices of mobile health in clinical care: The development and evaluation of a competency-based provider training program, 2018. Professional Psychology: Research and Practice. doi.org/10.1037/pro0000194 [13] Armstrong, C. M., Ciulla, R. P., Edwards-Stewart, A., Hoyt, T., & Bush, N. Best practices of mobile health in clinical care: The development and evaluation of a competency-based provider training program [14] Sabin JE, Skimming K. A framework of ethics for telepsychiatry practice. Int Rev Psychiatry, 2015. doi:10.3109/09540261.2015.1094034 [15] Lustgarten, S. D., & Colbow, A. J. Ethical concerns for telemental health therapy amidst governmental surveillance, 2017. American Psychologist. doi.org/10.1037/a0040321 [16] Armstrong, C. M., Ciulla, R. P., Edwards-Stewart, A., Hoyt, T., & Bush, N. Best practices of mobile health in clinical care: The development and evaluation of a competency-based provider training program [17] Merritt Hawkins. An Overview of the Salaries, Bonuses, and Other Incentives Customarily Used to Recruit Physicians, Physician Assistants and Nurse Practitioners, 2018. http://physicianresourcecenter.com/wp-content/uploads/2018/09/Merritt-Hawkins-2018-Review-of-Physician-and-Advanced-Practitioner-Incentives.pdf [18] Bose, J., Hedden, S., Lipari, R., Park-Lee, E. Key Substance Use and Mental Health Indicators in the United States: Results from the 2015 National Survey on Drug Use and Health, 2015. https://www.samhsa.gov/data/sites/default/files/NSDUH-FFR1-2015/NSDUH-FFR1-2015/NSDUH-FFR1-2015.pdf [19] Sabin and Skimming. A Framework of Ethics for Telepsychiatry Practice [20] Van Wynsberghe and Gastmans, Telepsychiatry and the Meaning of In-Person Contact [21] Lustgarten and Colbow, Ethical Concerns for Telemental Health Therapy amidst Governmental Surveillance