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Nursing assessment is the gathering of information about a patient's physiological, psychological, sociological, and spiritual status by a licensed Registered Nurse. Nursing assessment is the first step in the nursing process. ... Nursing assessment is used to identify current and future patient car...

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Technology and Mental Health

Technology and Mental Health provides mental health clinicians with expert, practical, clinical advice on the questions and considerations associated with the adoption of mental health technology tools in the computer age. Increasingly, clinicians want to use technology to provide clients with support through smartphones and mobile applications or to reach clients in remote or rural areas. However, using these tools in practice raises many practical and ethical questions. The book explains current technological developments in therapy, including mobile apps, telemental health, and virtual reality programs. Each chapter gives real-world guidance on adopting and using technology interventions, and the book spans a wide range of client populations. Providers are introduced to the evidence supporting various technology-based interventions and areas for future development. Combining theory, research, and case studies, this practical guide teaches clinicians how to integrate technology into therapeutic interventions with clients. Greg M. Reger, PhD, is a clinical psychologist and associate professor in the Department of Psychiatry and Behavioral Sciences at the University of Washington School of Medicine, Seattle, WA, USA.

Clinical Topics in Psychology and Psychiatry Series Editor: Bret A. Moore, PsyD Boulder Crest Retreat, Virginia, USA

Much of the available information relevant to mental health clinicians is buried in large and disjointed academic textbooks and expensive and obscure scientific journals. Consequently, it can be challenging for the clinician and student to access the most useful information related to practice. Clinical Topics in Psychology and Psychiatryincludes authored and edited books that identify and distill the most relevant information for practitioners and presents the material in an easily accessible format that appeals to the psychology and psychiatry student, intern or resident, early career psychologist or psychiatrist, and the busy clinician. Neurodevelopmental Disorders in Children and Adolescents A Guide to Evaluation and Treatment Christopher J. Nicholls Cognitive Behavioral Therapy for Beginners An Experiential Learning Approach Amy Wenzel Handbook of Psychosocial Interventions for Chronic Pain An Evidence-Based Guide Edited by Andrea Kohn Maikovich-Fong Socratic Questioning for Therapists and Counselors Learn How to Think and Intervene Like a Cognitive Behavior Therapist Scott H. Waltman, R. Trent Codd, III, Lynn M. McFarr, and Bret A. Moore Technology and Mental Health A Clinician’s Guide to Improving Outcomes Edited by Greg M. Reger For more information about this series, please visit: www.routledge.com/ Clinical-Topics-in-Psychology-and-Psychiatry/book-series/TFSE00310

Technology and Mental Health A Clinician’s Guide to Improving Outcomes Edited by Greg M. Reger

First published 2021 by Routledge 52 Vanderbilt Avenue, New York, NY 10017 and by Routledge 2 Park Square, Milton Park, Abingdon, Oxon, OX14 4RN Routledge is an imprint of the Taylor& Francis Group, an informa business © 2021 selection and editorial matter, Greg M. Reger, individual chapters, the contributors The right of Greg M. Reger to be identified as the author of the editorial material, and of the authors for their individual chapters, has been asserted in accordance with sections77 and 78 of the Copyright, Designs and Patents Act 1988. All rights reserved. No part of this book may be reprinted or reproduced or utilised in any form or by any electronic, mechanical, or other means, now known or hereafter invented, including photocopying and recording, or in any information storage or retrieval system, without permission in writing from the publishers. Trademark notice: Product or corporate names may be trademarks or registered trademarks, and are used only for identification and explanation without intent to infringe. Library of Congress Cataloging-in-Publication Data A catalog record for this book has been requested ISBN: 978-1-138-35392-3 (hbk) ISBN: 978-1-138-35394-7 (pbk) ISBN: 978-0-429-02053-7 (ebk) Typeset in Bembo by Apex CoVantage, LLC

This book is dedicated to our many courageous clients and patients who have helped us learn how to best use technology in mental health practice. Personally, Ialso dedicate this work to my lovely wife, Darlene, and my two great kids, Katie and Will, who encourage all my projects and sacrifice family time so that Imight pursue them.

Contents

List of Figures List of Tables List of Contributors Series Editor’s Foreword 1 Enabling Behavioral Health Measurement-Based Care With Technology

x xi xii xvi

1

MILLARD D. BROWN AND JAMIE T. CARRENO-DAVIDSON

2 Practical Guidance on Reaching Remote Patients Through Telemental Health

19

MATT MISHKIND, SARAH SCHWENK, AND BRITTANY SHOEMAKER

3 Internet-Based Mental Health Interventions: Evidence, Practical Considerations, and Future Directions

38

KELLY BLASKO, ROBERT CIULLA, RENÉE CAVANAGH, JULIE KINN, CHRISTINA ARMSTRONG, LOGAN MICHEEL AND TIM HOYT

4 Using Mobile Apps in Mental Health Practice

56

ERIC KUHN AND PEARL MCGEE-VINCENT

5 Use of Virtual Reality Exposure Therapy for Anxiety- and Trauma-Related Disorders ANDREW M. SHERRILL, JESSICA R. GOODNIGHT, MARK S. BURTON, AND BARBARA O. ROTHBAUM

75

viii

Contents

6 Mental Health Practice and Social Media

92

GREG M. REGER AND NOAH HAMMER

7 Innovative and Evolving Mobile Mental Health Technologies for the Treatment of Serious Mental Illness

107

MICHAEL HSU, JESSICA LIPSCHITZ, ROBERT BOLAND, AND JOHN TOROUS

8 Technology-Based Interventions for Substance Use Disorders

127

PATRICK DULIN, ANAYANSI LOMBARDERO, ROBYN MERTZ, AND DIANE K. KING

9 Utilization of Technologies to Support Patients With Eating Disorders

149

C. BARR TAYLOR, SHIRI SADEH-SHARVIT, ELLEN E. FITZSIMMONS-CRAFT, NAIRA TOPOCCO, ELSA ROJAS-ASHE, AND DENISE E. WILFLEY

10 Mobile Technology for Tobacco Cessation

171

ELLEN HERBST, ERIC KUHN, AND JANICE TSOH

11 Older Adults and the Utilization of Mobile and At-Home Health Technologies for Mental Health Care

191

JAMES PHILLIPS, ANDREW SHUTES-DAVID, AND DEBBY W. TSUANG

12 Using Technology to Promote Suicide Prevention

206

SEAN M. BARNES, CHRISTINE L. JACKSON, LAUREL A. GAEDDERT, RYAN HOLLIDAY, LISA A. BRENNER, AND SARRA NAZEM

13 Ethical and Legal Issues in the Clinical Use of Technology JEFFREY E. BARNETT

230

Contents

14 Improving Mental Health Outcomes With Artificial Intelligence

ix

248

DAVID D. LUXTON

15 Shared Immersive Environments and Virtual Worlds and Their Application in Behavioral Health

271

KEVIN M. HOLLOWAY, JENNA ERMOLD, AND KELLY R. CHRESTMAN

Index

294

Figures

6.1 7.1 7.2 7.3 9.1 9.2 9.3 9.4 9.5 11.1

Hypothetical Social Media Post in Veterans Outdoor Group Ecological m-Momentary Assessments Utilize Scheduled Interval Surveys to Assess Patients’ Cognition, Thoughts, Affect, and behavior to Inform Clinical Assessment Digital Phenotyping Utilizes Passive Data From Smartphone Sensors to Characterize Patients’ Behavioral Phenotype to Inform Clinical Sssessments App Evaluation Model Published by the American Psychiatric Association (APA) Mobile App Features Symptom-Wise Tracking Features Reviewing Clients’ Self-Monitoring and Providing Support via Text Texting to Augment the Treatment Effects Haley’s Weekly Self-Monitoring Mean Standardized Gain Scores and Standard Error Bars Demonstrating Significant Processing Speed Improvement Due to Tablet Intervention

95 109 111 113 158 159 161 162 165 195

Tables

2.1 2.2 2.3 5.1 5.2 5.3 6.1 8.1 9.1 9.2 11.1

Best Practices for TMH Training Sessions Establishing Alliance and Setting Expectations Telemental Health Sessions Checklist Exposure Targets in Conventional Exposure and VRE Functions of 360° Video and Two Different VRE Systems Example Clinician Scripts to Help Patient Decide to Use VR Social Media Platforms and Features Intended Use and Components of Available TechnologyBased Interventions Overview of Clinician Involvement for Levels of Digital Interventions Recommended Online Resources for Psychoeducation to Clients Experiencing Shape and Weight Concerns or Eating Disorders Health Technology for Older Adults

26 32 35 76 81 86 94 142 150 153 192

Contributors

Christina Armstrong Connected Health Branch, Defense Health Agency, Tacoma, WA, United States. Sean M. Barnes Rocky Mountain Mental Illness, Research, Education and Clinical Center (MIRECC) for Suicide Prevention, Rocky Mountain Regional VAMC, Aurora, CO, United States; Department of Psychiatry, University of Colorado Anschutz School of Medicine, Aurora, CO, United States. Jeffrey E. Barnett Department of Psychology, Loyola University Maryland, Baltimore, Maryland, United States. Kelly Blasko Connected Health Branch, Defense Health Agency, Tacoma, WA, United States. Robert Boland is Associate Professor of Psychiatry, Department of Psychiatry at Brigham and Women’s Hospital, Boston, Massachusetts, United States. Lisa A. Brenner Departments of Psychiatry, Physical Medicine & Rehabilitation and Neurology, Rocky Mountain Mental Illness, Research, Education and Clinical Center (MIRECC) for Suicide Prevention, Rocky Mountain Regional VAMC, Aurora, CO, United States; Departments of Psychiatry, Physical Medicine & Rehabilitation and Neurology, University of Colorado Anschutz School of Medicine, Aurora, CO, United States. Millard D. Brown Tripler Army Medical Center, Honolulu, Hawaii, United States. Mark S. Burton is Assistant Professor, Emory University School of Medicine, Atlanta, GA, United States. Jamie T. Carreno-Davidson U.S. Army Research Institute of Environmental Medicine, Natick, MA, United States. Renée Cavanagh Connected Health Branch, Defense Health Agency, Tacoma, WA, United States.

Contributors

xiii

Kelly R. Chrestman Center for Deployment Psychology, Uniformed Services University of the Health Sciences, Bethesda, MD, United States. Robert Ciulla Connected Health Branch, Defense Health Agency, Tacoma, WA, United States. Patrick L. Dulin Department of Psychology, University of Alaska Anchorage, Anchorage, AK, United States. Jenna Ermold Center for Deployment Psychology, Uniformed Services University of the Health Sciences, Bethesda, MD, United States. Ellen E. Fitzsimmons-Craft Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, United States. Laurel A. Gaeddert Rocky Mountain Mental Illness, Research, Education and Clinical Center (MIRECC) for Suicide Prevention, Rocky Mountain Regional VAMC, Aurora, CO, United States. Jessica R. Goodnight Postdoctoral Fellow, Anxiety and Trauma Clinic of Atlanta, Atlanta, GA, United States. Noah Hammer Entrepreneur, Founder of Stoak. Ellen Herbst Department of Psychiatry and Behavioral Sciences, University of California, San Francisco (UCSF), San Francisco, CA, United States; Mental Health Service, San Francisco Veterans Affairs (VA) Health Care System (SFVAHCS), San Francisco, CA, United States. Ryan Holliday Rocky Mountain Mental Illness, Research, Education and Clinical Center (MIRECC) for Suicide Prevention, Rocky Mountain Regional VAMC, Aurora, CO, United States; Department of Psychiatry, University of Colorado Anschutz School of Medicine, Aurora, CO, United States. Kevin M. Holloway Center for Deployment Psychology, Uniformed Services University of the Health Sciences, Bethesda, MD, United States. Tim Hoyt Connected Health Branch, Defense Health Agency, Tacoma, WA, United States. Michael Hsu Psychiatry Resident, Department of Psychiatry at Brigham and Women’s Hospital, Boston, Massachusetts, United States. Christine L. Jackson Rocky Mountain Mental Illness, Research, Education and Clinical Center (MIRECC) for Suicide Prevention, Rocky Mountain Regional VAMC, Aurora, CO, United States. Diane K. King Center for Behavioral Health Research and Services, Institute of Social and Economic Research, University of Alaska Anchorage, Anchorage, AK, United States.

xiv Contributors

Julie Kinn Connected Health Branch, Defense Health Agency, Tacoma, WA, United States. Eric Kuhn National Center for PTSD, Dissemination& Training Division, Department of Veterans Affairs Palo Alto Healthcare System, Palo Alto, CA, United States; Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, United States. Jessica Lipschitz Instructor in Psychiatry, Department of Psychiatry at Brigham and Women’s Hospital, Boston, Massachusetts, United States. Anayansi Lombardero Department of Psychology, University of Alaska Anchorage, Anchorage, AK, United States. David D. Luxton Department of Psychiatry and Behavioral Sciences at the University of Washington School of Medicine, Seattle, WA, United States. Pearl McGee-Vincent National Center for PTSD, Dissemination & Training Division, Department of Veterans Affairs Palo Alto Healthcare System, Palo Alto, CA, United States. Robyn Mertz Department of Psychology, University of Alaska Anchorage, Anchorage, AK, United States. Logan Micheel Connected Health Branch, Defense Health Agency, Tacoma, WA, United States. Matt Mishkind Johnson Depression Center, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, CO, United States. Sarra Nazem Rocky Mountain Mental Illness, Research, Education and Clinical Center (MIRECC) for Suicide Prevention, Rocky Mountain Regional VAMC, Aurora, CO, United States; Departments of Psychiatry and Physical Medicine and Rehabilitation, University of Colorado Anschutz School of Medicine, Aurora, CO, United States. James Phillips Geriatric Research, Education, and Clinical Center (GRECC) and Mental Illness Research, Education, and Clinical Center, VA Puget Sound Health Care System, Seattle, WA, United States; Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States. Greg M. Reger Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, United States; VA Puget Sound Healthcare System, Tacoma/Seattle, WA, United States; Washington State Army National Guard, Camp Murray, WA, United States. Elsa Rojas-Ashe Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, United States.

Contributors

xv

Barbara O. Rothbaum Professor, Emory University School of Medicine, Atlanta, GA, United States. Shiri Sadeh-Sharvit Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, United States, Center for m2Health, Palo Alto University, Palo Alto, CA, United States, Baruch Ivcher School of Psychology, Interdisciplinary Center, Herzliya, Israel. Sarah Schwenk Johnson Depression Center, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, CO, United States. Andrew M. Sherrill Assistant Professor, Emory University School of Medicine, Atlanta, GA, United States. Brittany Shoemaker In private practice with Realize Wellness, LLC. She was employed by the Steven A. Cohen Military Family Clinic at the University of Colorado Anschutz Medical Campus when the chapter was written. Andrew Shutes-David Geriatric Research, Education, and Clinical Center (GRECC) and Mental Illness Research, Education, and Clinical Center, VA Puget Sound Health Care System, Seattle, WA, United States; Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States. C. Barr Taylor Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, United States, Center for m2Health, Palo Alto University, Palo Alto, CA, United States. Naira Topocco Internet, Health and Clinical Psychology Research Group, Department of Behavioral Sciences and Learning, Linkoping University, Sweden. John Torous Director of Digital Psychiatry Division, Department of Psychiatry at Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States. Janice Tsoh Department of Psychiatry and Behavioral Sciences, University of California, San Francisco (UCSF), San Francisco, CA, United States. Debby W. Tsuang Geriatric Research, Education, and Clinical Center (GRECC) and Mental Illness Research, Education, and Clinical Center, VA Puget Sound Health Care System, Seattle, WA, United States; Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States. Denise E. Wilfley Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, United States.

Series Editor’s Foreword

Technology and Mental Health: A Clinician’s Guide to Improving Outcomes is the latest volume in one of Routledge’s most popular series, Clinical Topics in Psychology and Psychiatry (CTPP). The overarching goal of CTPP is to provide mental health practitioners with practical information on psychological and psychopharmacological topics. Each volume is comprehensive but easy to digest and integrate into day-to-day clinical practice. It is multidisciplinary, covering topics relevant to the fields of psychology and psychiatry, and it appeals to the student, novice, and senior clinician. Books chosen for the series are authored or edited by national and international experts in their respective areas, and contributors are also highly respected clinicians. The current volume exemplifies the intent, scope, and aims of the CTPP series. Technological advances in the delivery of mental health services have grown considerably over the past decade. This should not be surprising, considering the relatively recent proliferation of smartphones, innovations in computer hardware and software, and technological advancements in the broader health care system. In fact, even before clinicians and behavioral health organizations began to intentionally incorporate technology into their practice, consumers were connecting through a variety of mobile applications and computer learning platforms for the purpose of reducing distress and increasing overall psychological well-being. In this instance, the field decided to “catch-up” with the consumer. In concert with advances in technological applications within the areas of mental health and wellness, the ever-growing focus on patient-centered care has resulted in more informed, engaged, and directive consumers of mental health services. Indeed, the days of the passive patient taking directives from the health care provider are gone. Many consumers of health care services in general, and mental health services specifically, play an integral part in the selection of interventions and clinical outcomes. As a means to support this engagement, mental health providers should develop an awareness of the myriad technological tools—self-directed or collaboratively used in session—that can enhance their practice. The current volume provides the mental health provider practical and clinically driven knowledge on the

Series Editor’s Foreword

xvii

adoption and implementation of cutting-edge applications, techniques, systems, and programs focused on integrating technology into a comprehensive plan of care. In Technology and Mental Health: AClinician’s Guide to Improving Outcomes, Dr. Greg M. Reger provides a superb review of the most important aspects of technology and mental health care. He brings together some of the country’s top experts in psychology and psychiatry, technology, and translational science. The volume includes a discussion of the potential advantages of each tec...