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This review covers the therapeutic use of such technologies, whether they are delivered via telephones or computers, as well as their use in supervising and training program staff members. It is not concerned with most other uses cree new technologies e. Although technology-assisted care TAC provides a of opportunities to enhance behavioral health services Eonta et al. As with onlline rest of this Treatment Improvement Protocol TIPthe literature review focuses on research involving adults.

Because a good deal of the research in this area has been conducted outside the United States, studies involving foreign populations are identified as such; those that are not so identified should be assumed to have taken place in the United States. This review focuses on the past 10 years of research, with occasional references to older, seminal literature. When possible, it uses other reviews to summarize earlier studies. The review generally does not draw conclusions, but instead tries to present several points of view so that readers who are interested in the issue may seek out the appropriate literature and draw their own conclusions.

Thus, readers should not accept the presentation of one article's findings as an endorsement of one position over another. The larger Beautiful housewives ready friendship Flint Michigan that follow discuss the use of such technologies to address prevention and treatment specifically of mental and substance use disorders and are organized by the disorder addressed. Those sections may include research on one or multiple types of technology, depending on what recent literature is available.

One intervention may involve components that use any Ladies for sex Saint-Omer these technologies, and there Crete IL wife swapping almost always some overlap with other e. Although the system of categorizing interventions by the technology used is common in the literature, it is not the only way to categorize them, and there are other features of these interventions that can be used to distinguish one from another.

For example, interventions can be categorized as either synchronous involving communications occurring in real time or asynchronous occurring outside real time, with some delay between the sending and receiving of the communication; Suler, ; Yellowlees et al. The larger portion of this review discusses interventions according to the disorder or problem targeted by the intervention. This section introduces cjatting technologies, presents basic findings about their use and effectiveness drawing on other reviews when availableand also highlights interventions that can be used to address multiple substance use and mental disorders as opposed to interventions directed at a single disorder or group of on,ine, such as anxiety disorders.


However, some disorders e. Adding phone calls to a Web-based intervention may also improve treatment compliance and outcomes Graham et al.

Leach and Christensenin a literature review on telephone-based teeh for mental and substance use disorders, located 14 studies involving interventions for abe 6 studiesanxiety 3eating disorders 3substance use disorders 1and schizophrenia 1. They concluded that such interventions could reduce symptoms of anxiety and depression as well as disordered eating behaviors.

They also found limited and somewhat flawed evidence that such interventions could reduce alcohol use for individuals with alcohol use disorders and hospitalization rates for people with schizophrenia. However, most of the chafting they reviewed had methodological problems, such as small sample sizes, high dropout rates, and a lack of randomization, which limited their ability to draw firm conclusions about effectiveness.

They also noted that effective telephone-based interventions were highly structured and made use of homework asments for clients.

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Another review crlom Mohr, Vella, Hart, Heckman, and Simonwhich included 12 trials of phone-based interventions for depression, also found that such interventions were associated with ificantly greater reductions in depressive symptoms than were control conditions; these interventions were also associated with reductions in symptoms from baseline to posttreatment follow-up that were comparable with those observed in many in-person interventions.

Dorstyn, Mathias, and Denson conducted a meta-analytic review of telephone-based counseling interventions for people with acquired physical disabilities e.

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In their interviews with therapists, Day and Schneider found that some counselors felt that treatment using audio only caused them to miss important information e. Clients who had tried telephone-based services generally expressed satisfaction with them and found those services helpful for a variety of behavioral health problems Reese et crlom.

Many clients also rcoom a preference for telephone counseling. In one survey of clients who had received both telephone-based and in-person counseling, 96 percent stated they would be willing to seek telephone-based services again; by comparison, only 63 percent said they would be willing to use in-person services again Reese et al. Video conferencing, which provides both audio and video, has been used in a variety of behavioral health settings, usually to provide what would otherwise be an in-person service to clients who are not able to reach the provider's location.

The review is focused on interactive video conferencing because reviewers found that this chattimg had the largest research base in support of its use of any of the technologies they considered. Backhaus et cgatting.

wge They concluded that: This was a feasible approach to providing therapy. Therapists were able to develop a therapeutic alliance using this technology although that might Lonely women Denver tx limited to one-on-one therapy, as studies involving group and family therapy found some problems in this area.

Most users were satisfied with this method of delivery and reported a level of satisfaction comparable with that reported by clients receiving in-person therapy, and the major sources of dissatisfaction were technical difficulties. Clients using video conferencing had similar levels of retention and showed similar levels of clinical improvement to those receiving in-person treatments, with some differences depending droom the specific disorder being treated e.

Although they found the research insufficient to draw a strong conclusion, the tern that were available indicated that this approach was about as effective as in-person services and was an appropriate option, especially with clients who had difficulties accessing in-person services. Richardson, Frueh, Grubaugh, Egede, and Elhai also reviewed literature on the use of video conferencing for behavioral health. They summarized earlier literature, as presented in older literature reviews, which consisted mainly of case studies, program descriptions, and anecdotal support fere the use of video conferencing technology.

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Taken together, the literature does provide strong support for the acceptability to clients of such services and the reliability of assessments conducted using such technology. In the literature published sincethey found Glenbrook NV adult personals support for those claims, and some studies that indicated that video conferencing interventions were superior to no treatment or a reduced level of in-person services.

They also reviewed three studies that compared video conferencing interventions with in-person treatment and did not find any ificant differences in outcomes for participants in the two groups, with both groups experiencing improvements. These three studies involved relatively brief interventions, and the authors of the largest of them O'Reilly et al.

The authors also observed a of methodological problems with many of the studies of video conferencing interventions and noted that many counselors remain wary of trying such interventions in spite of research suggesting their effectiveness. These reviewers also found that research generally indicated that video conferencing was cost-effective relative to in-person treatment, especially when costs related to travel and expenses for counselors were taken into.

Norman reviewed 72 articles concerning video conferencing, with a focus on how well this technology might be adapted in the United Kingdom, and concluded that it appeared to be an effective way to deliver counseling services and was promising for clients living in free areas. The author also concluded that although some early research did not find video conferencing to be cost-effective, most studies did find it to tteen so, and current developments in technology were likely to increase its cost-effectiveness.

More recent data from the U. Department of Veterans Affairs VA confirmed that video afe interventions can aid healthcare systems in cutting overall costs. An evaluation of telemental health services i.

For example, Hailey et al. They also observed methodological problems with much of the research involving video conferencing.

A review by Simpson focused on the use of video conferencing to conduct psychotherapy and also observed a lack of rigor in most of the research. More recently, Kramer et al. Factors such Looking for a computer sex Midway West Virginia friend bandwidth, image resolution, and display size may affect clients' and counselors' experiences with video conferencing ATA, There is some research indicating that at least one of these factors i.

Other research indicates that certain aspects of assessment e. Maheu et al. Some counselors are using publicly available video conferencing software froom as Skype, rather than professional video conferencing software, to communicate with clients. Morgan and Polowy concluded that it can be difficult to protect and ensure the confidentiality of clients' communications over Skype. A variety of professional cuatting are available for counselors to conduct this type of therapy, and such programs may be more appropriate.

As noted, video conferencing has been shown in a of studies to be an effective technology for conducting clinical interviews and other assessments ATA, ; Richardson et al. Specific populations that have had success using this type of technology include rural residents of nursing homes Rabinowitz et al. For example, in a Canadian study, Germain, Marchand, Bouchard, Guay, and Drouin found that ratings of the strength of therapeutic alliances for clients with PTSD did not differ ificantly between clients treated via video conferencing and those treated in person.

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Most therapists did believe that a strong therapeutic relationship could be developed in this medium, and some observed that the alliances they developed were even stronger than they might have been if the therapy had been conducted in person. Another potential concern with video conferencing is whether or not interventions developed for delivery in person can be adapted to mu medium.

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Although research is limited, Morland et al. Patient-rated alliance is also a ificant factor to consider, and although some studies have found patient-rated alliance to be a positive predictor of favorable outcomes, the complex combinations of patient Honolulu dating sex, therapist ratings, and particular conditions can yield that are challenging to interpret Huppert et al. However, text-based interventions are discussed in a separate section of this literature review.

Online interventions can also be used to improve specific areas of functioning for people with mental illness. For example, van der Zanden, Speetjens, Arntz, and Onrust reported on an online course in the Netherlands to teach parenting skills to parents with mental illness. Although the dropout rate in the pilot study was high only 58 percent completed the posttreatment assessmentthose who did complete the intervention had ificant improvements in parenting skills and parental competence.

Barak et al.

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Of Women who want sex in Newmarket ga interventions included in that meta-analysis, those using CBT appeared to be the most effective compared with those using psychoeducational or chattng behavioral approaches. The authors also found that there was a ificantly greater effect size for interventions that were delivered individually compared with a group therapy format and that interventions appeared to be more effective for clients ages 19 to 39 compared with those who rree 40 or older.

However, olnine later review by Hanley and Reynoldswhich focused on text-based online therapy only see discussion later in this sectioncautioned that Barak and colleagues' conclusions on the greater effectiveness of CBT interventions delivered online reflected a more general bias in research toward more technical and less relational interventions as the former are easier to research.

Similarly, chtating review of computerized CBT interventions by Green and Iverson found good evidence to support the use of such interventions for anxiety disorders, depressive disorders, eating disorders, smoking cessation, and ctoom drinking. The authors also noted that although data are limited, the available research indicates that these interventions will perform as well in community settings Frakes KY sexy women they do in research trials.

Another review by Kiluk et al. The authors found that computer-assisted interventions were more effective than waitlist controls in 88 percent of the studies, more effective than placebo conditions in 65 percent of the studies, and more effective than active control conditions in 48 percent of the studies.

The authors did not find any ificant differences in effectiveness across four different of target problems depression, anxiety, nicotine dependence, and substance use disorders. Studies that used worse methodologies were ificantly more likely to find computerized interventions more effective than control conditions than studies that used better methodologies.

In Kiluk and colleagues' review, each of the 75 studies was rated according to how well it met 14 different criteria of methodological soundness. None of the studies met the minimum standard for all of the criteria, only three met 13 of the criteria, and the mean quality score was Most recent research does indicate that Web-based interventions have chagting lower costs than do traditional treatments, thus making them more likely to be cost-effective Hedman et al.

Tate, Finkelstein, Khavjou, and Gustafson chattnig eight studies of Web-based interventions that provided data on cost savings and concluded that such interventions are more cost-effective than traditional services. These authors also discussed some of the specific cost considerations involved in the development and use of Web-based Looking for a female Gold coast-tweed 24 health services.

An earlier review by Palmqvist, Carlbring, and Anderssonbased on fewer studies, also found that such interventions promised to be more cost-effective. Both reviews, however, included a of studies from outside the United States, where different approaches to healthcare might affect costs, as well as studies that did not include all startup costs.

Research has consistently found that Web-based treatment is less labor intensive for staff members, and many studies have found relatively low time requirements for the staff members involved in service delivery Andrews et al. Web-based interventions can be either guided or unguided. In guided interventions, a therapist or other staff member communicates with the client to assist him or her in using the online intervention e.

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Some interventions have found better when even a minimal amount of contact in the form of simple reminders was added to an online treatment e. Interventions vary shemales new moore to the type and amount of guidance provided by staff members as well as the type of staff member providing that guidanceand those factors are likely to be important in determining whether a guided intervention will be more effective than an unguided one.

In their review of Web-based therapeutic interventions, Palmqvist and colleagues concluded that greater therapist involvement is associated with larger effect sizes. However, other studies involving treatments for social anxiety disorder SAD; Furmark et al.

The effect of therapist contact may also vary according to the type and frequency of contact. Klein and colleagues did not find any ificant differences in outcomes for people receiving a Web-based treatment for panic disorder when they received three s a week from their therapist instead of one. However, chattihg evaluation of an online program to facilitate recovery from bipolar disorder found that adding communications from a peer coach did ificantly improve initial and long-term use of the program Simon, Ludman, et al.