Improving Patient Mental Health With Psychotherapist Virtual Training
ConditionMental Disorders
Trial statusRecruiting
Trial phaseNot applicable
Trial typeInterventional
Biological sexAll
Age18+
SponsorUniversity of Ottawa
About this trial
Several types of psychotherapy are equally effective to treat mental disorders. However, many patients remain symptomatic after treatment. The investigators demonstrated that a professional development training program to improve psychotherapists' skills at identifying and repairing therapeutic alliance tensions resulted in improved therapeutic alliance (an important therapeutic ingredient) and patient mental health outcomes. However, the investigators delivered this training program by conventional in-person workshops which limited access by psychotherapists living outside large urban centres. Further, post-study interviews with therapists suggested that cultural/diversity factors complicated the therapeutic alliance.
In the current study, the investigators will test the effectiveness and acceptability of a virtually-delivered training program to psychotherapists in North America to improve their capacity to identify and repair problems in the therapeutic alliance, including tensions related to patient diversity. The investigators will also examine how acceptable the virtually-delivered training is to psychotherapists and whether they would use such training in their practice. Participants in the study will be community-based licensed psychotherapists and their patients engaging in therapy in North America. Patient mental health outcomes, therapeutic alliance, and diversity issues will be assessed by comparing outcome measures between three groups: 1) therapists complete a self-paced virtual course + consultation, 2) therapists complete synchronous workshop + consultation, 3) control: therapists do not complete training.
The team of investigators developed Canada's largest psychotherapy practice-research network and has expertise in clinical trials, diversity, and education research of virtual training. State of the art training is often out of the reach of therapists who live outside of urban centres, and the effectiveness and acceptability of providing training virtually is not well-studied in mental health care. This study will improve psychotherapists' effectiveness at managing the therapeutic alliance and issues related to diversity, and will improve patient mental health outcomes thus promising to reduce the burden of mental illness.
Eligibility criteria
This trial accepts healthy volunteersQualifiers
Therapist participants: The investigators will recruit mental health professionals who deliver psychotherapy in North American community settings; inclusion criteria: therapists are in good standing with their provincial or state regulatory college, their scope of practice includes individual psychotherapy for adults in North America; they are able to accept a minimum of 3 new participating patients into their current practice to conduct 6 consecutive therapy sessions via a secure, PHIPA compliant virtual meeting platform.
Patient Participants: Adults (> 18 years) residing in Canada or the United States who want to engage in therapy with a study therapist or who have recently sought services from a study therapist; inclusion criteria: have participated in fewer than 3 sessions with their study therapist and anticipate being able to see their study therapist for 6 sessions over the next 6 months.
Disqualifiers
Therapist participants: The investigators will exclude therapists who are employed by an organization if the investigators cannot obtain organizational approval from their employer or coordinate data collection from an alternate virtual platform in instances where the employing organization does not permit the use of the study platform. Therapists will also be excluded if they have completed professional development workshop after 2017 with PPRNet.
Patient participants: The investigators will exclude patients if they: (a) have a psychotic or neurocognitive disorder that may preclude engagement in psychotherapy, (b) are in concurrent psychological treatment with another practitioner, (c) are at high risk of suicide or suicidal behaviors as assessed by their therapist (e.g., suicide attempt or hospitalization for suicidal behaviors in the past 6 months), or (d) for whom the therapist judge that approaching them with information about the study will be harmful.
Trial design
Design model
Parallel
Treatments tested in this trial
Virtual Training Program
BehavioralTherapists randomized to this condition will receive the professional development via an asynchronous virtual training course. The Virtual Training will include written material, videos, interactive learning activities, and a text-based discussion forum where therapists and faculty will be able to interact in relation to the given activities. Clinical scenario and simulation-based interactive learning will allow therapists to explore clinical situations, make decisions, and evaluate consequences of their actions in a safe environment. Therapists will complete 6 study-related therapy sessions with 3 new patients. After therapists receive the Virtual Training and after they enroll their first patient, therapists will attend bi-weekly 1-hour online consultation meetings that include up to 6 therapists at a time and led by two of the training faculty. Each therapist will attend 10 of these posttraining consultation sessions.
Training as Usual
BehavioralTherapists randomized to this condition will receive the professional development training via a 3-day synchronous workshop delivered via video conference covering the same didactic content as the virtual training course. The workshop will include lectures, written material, videos, and live role play activities. Therapists will complete 6 study-related sessions with 3 new patients. After therapists receive the professional development through Training as Usual and after they enroll their first patient, therapists will attend bi-weekly 1-hour online consultation meetings that include up to 6 therapists at a time and led by two of the training faculty. Each therapist will attend 10 of these posttraining consultation sessions.
No Training
BehavioralTherapists randomized to this control condition will provide psychotherapy via the study video conference platform to 3 new enrolled patients in their typical manner except that they and their patients will also complete the assessments necessary for the study. After study completion, the investigators will provide therapists in the control condition with access to virtual training.
Treatment groups
489 Participants
are divided into 3 treatment groupsGroup A: Virtual Training ProgramExperimental treatment 1 intervention
Group B: Training as UsualActive comparator 1 intervention
Group C: No TrainingActive comparator 1 intervention
Trial outcomes
Primary outcomes
1
Working Alliance Inventory (WAI) therapist or patient short form
12-item self-report measure used to assess the therapeutic alliance by either therapist or client. Yields scores on three subscales: task, bond, and goal. Min subscale score is 12, max score is 84 with higher scores indicate greater alliance.
Time frame
Patients and therapists will complete it after each of 6 consecutive study psychotherapy session (frequency will range from once a week to once a month depending on the client's typical session interval).2
Ruptures Resolution Rating System (3RS)
Observer-based coding system for identifying therapeutic alliance ruptures and resolutions.
Time frame
Sessions will be coded by trained raters after all session recordings have been collected.Secondary outcomes
1
Patient Health Questionnaire (PHQ-9)
Self-report measure used to assess depressive symptoms. Min score is 0; max score is 27 with higher scores indicating greater severity of depressive symptoms.
Time frame
Patients will complete it before starting study psychotherapy sessions, after completing all study sessions (6 weeks to 6 months depending on the client's typical session interval), and at 3-month follow-up.2
Generalized Anxiety Disorder questionnaire (GAD-7)
Self-report measure used to assess anxiety symptoms. Min score is 0; max score is 21 with higher scores indicating higher levels of anxiety symptoms.
Time frame
Patients will complete it before starting study psychotherapy sessions, after completing all study sessions (6 weeks to 6 months depending on the client's typical session interval), and at 3-month follow-up.3
Inventory of Interpersonal Problems (IIP-32)
Self-report measure used to assess interpersonal problems. This 32-item measure yields 8 subscales with a min score of 0 and a max score of 15 per scale with higher scores indicating greater interpersonal problems.
Time frame
Patients will complete it before starting study psychotherapy sessions (6 weeks to 6 months depending on the client's typical session interval), after completing all study sessions, and at 3-month follow-up.4
Defense Mechanism Rating Scales (DMRS-SR-30)
Self-report measure used to assess defense mechanisms. Total score can range from 0 to 120 with low scores indicate low adaptive functioning and higher scores indicate better adaptive functioning.
Time frame
Patients will complete it before starting study psychotherapy sessions, after completing all study sessions (6 weeks to 6 months depending on the client's typical session interval), and at 3-month follow-up.Other outcomes
1
Cultural Humility Scale (CHS)
Patient-rated measure of a therapist's cultural humility. A total score is calculated and ranges from 12 to 60. Higher total scores reflect greater levels of cultural humility.
Time frame
Patients will complete the measure after completing all study therapy sessions.2
Sexist Microaggression Scale (MAWS)
Self-report measure used to assess women's experience of microaggressions during psychotherapy sessions. Total score can range from 7 to 35 with higher scores representing greater experiences of microaggressions from the therapists.
Time frame
Patients who self-identify as women will complete it after each study psychotherapy session (over 6 weeks to 6 months depending on the frequency of sessions).3
Racial Microaggressions in Counseling Scale (RMSC)
Self-report measure used to assess racialized patients' experience of microaggressions during psychotherapy sessions. An average total score is calculated ranging from 1 to 3 with higher scores indicate greater frequency and impact of microaggressions.
Time frame
Patients who self-identify with a marginalized race will complete it after each study psychotherapy session. Sessions will occur over a 6 week to 6 month period depending on the frequency of sessions.4
Sexual Orientation Microaggressions in Psychotherapy Scale (SOMPS)
Self-report measure used to assess lesbian, gay, bisexual, or queer patients' experience of microaggressions during psychotherapy sessions. An average total score is calculated ranging from 1 to 3 with higher scores indicate greater frequency and impact of microaggressions.
Time frame
Patients who self-identify as lesbian, gay, bisexual, or queer will complete it after each study psychotherapy session (sessions will occur over a 6 week to 6 month period depending on the frequency of sessions).Sponsors and contacts
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Source ClinicalTrials.gov