Plenary Talk California Psychological Association

April 28, 2018 – La Jolla, CA 8:30 – 10:30 a.m.

Ricardo F. Muñoz, Ph.D. Palo Alto University Using Digital Tools to Expand Psychological Practice:

Helping as Many People as Possible

Adrian Aguilera, Ph.D. Panel Discussant University of California, Berkeley

Nancy Haug, Ph.D. Panel Discussant Palo Alto University

Paul Marcille, Ph.D. Panel Discussant President, California Psychological Association Palo Alto University

Handouts for CPA Plenary Talk – April 28, 2018, 8:30 – 10:30 a.m.: Using Digital Tools to Expand Psychological Practice: Helping as Many People as Possible

Ricardo F. Muñoz – Palo Alto University - Page 1 of 5

Resources

Textbooks:

Cucciare, M. A, & Weingardt, K. R. (2010). Using technology to support evidence-based behavioral health practices: A clinician’s guide. New York, NY: Routledge/Taylor & Francis.

Marks, I. M., Cavanagh, K., & Gega, L. (2007). Hands-on help: Computer-aided psychotherapy.

New York, NY: Taylor & Francis.

Articles:

Afshin, A., Babalola, D., Mclean, M., Yu, Z., Ma, W., Chen, C., … Mozaffarian, D. (2016). Information technology and lifestyle: A systematic evaluation of Internet and mobile interventions for improving diet, physical activity, obesity, tobacco, and alcohol use. Journal of the American Heart Association, 5(9), e003058. doi: 10.1161/JAHA.115.003058

Barrera, A. Z., Wickham, R. E., & Muñoz, R. F. (2015). Online prevention of postpartum depression for Spanish- and English-speaking pregnant women: A pilot randomized controlled trial. Internet Interventions, 2(3), 257–265. doi: 10.1016/j.invent.2015.06.002

Bennett, G. G., & Glasgow, R. E. (2009). The delivery of public health interventions via the Internet: Actualizing their potential. Annual Review of Public Health, 30(1), 273–292. doi: 10.1146/annurev.publhealth.031308.100235

Bennett, K., Bennett, A. J., & Griffiths, K. M. (2010). Security considerations for e-mental health interventions. Journal of Medical Internet Research, 12(5), e61. doi: 10.2196/jmir.1468

Bravin, J. I., Bunge, E. L., Evare, B., Wickham, R. E., Pérez-Stable, E. J., & Muñoz, R. F. (2015). Socioeconomic predictors of smoking cessation in a worldwide online smoking cessation trial. Internet Interventions, 2(4), 410–418.http://doi.org/10.1016/j.invent.2015.10.001

Bunge, E. L., Beard, C. L., Stephens, T. N., Leykin, Y., & Muñoz, R. F. (2017). Mood management

effects of a brief behavioral activation Internet intervention. Journal of Technology and Behavioral Science, published online 28 November, 2017, https://doi.org/10.1007/s41347-017-0026-2.

Bunge, E., Williamson, R. E., Cano, M., Leykin, Y., Muñoz, R. F. (2016). Mood management effects of

brief unsupported Internet interventions. Internet Interventions. 5, 36-43. Buntrock, C., Ebert, D. D., Lehr, D., Smit, F., Riper, H., Berking, M., & Cuijpers, P. (2016). Effect

of a web-based guided self-help intervention for prevention of major depression in adults with subthreshold depression: A randomized clinical trial. JAMA, 315(17), 1854–1863. doi: 10.1001/jama.2016.4326

Handouts for CPA Plenary Talk – April 28, 2018, 8:30 – 10:30 a.m.: Using Digital Tools to Expand Psychological Practice: Helping as Many People as Possible

Ricardo F. Muñoz – Palo Alto University - Page 2 of 5 Calear, A. L., & Christensen, H. (2010). Review of internet-based prevention and treatment programs for

anxiety and depression in children and adolescents. Medical Journal of Australia, 192(11), S12–S14.

Christensen, A., Miller, W. R., & Muñoz, R. F. (1978). Paraprofessionals, partners, peers, paraphernalia, and print: Expanding mental health service delivery. Professional Psychology, 9, 249-270.

Craske, M. G., Rose, R. D., Lang, A., Welch, S. S., Campbell-Sills, L., Sullivan, G., … Roy-Byrne, P. P.

(2009). Computer-assisted delivery of cognitive behavioral therapy for anxiety disorders in primary-care settings. Depression and Anxiety, 26(3), 235–242. doi: 10.1002/da.20542

Drozd, F., Vaskinn, L., Bergsund, H. B., Haga, S. M., Slinning, K., & Bjørkli, C. A. (2016). The implementation of Internet interventions for depression: A scoping review. Journal of Medical Internet Research, 18(9), e236. doi: 10.2196/jmir.5670

Drum, K. B. & Littleton, H. L. (2014). Therapeutic boundaries in telepsychology: Unique issues and best practice recommendations. Professional Psychology: Research and Practice, 45, 309-315. doi: 10.1037/a0036127.

Ebert, D. D., Cuijpers, P., Muñoz, R. F., & Baumeister, H. (2017) Prevention of mental health disorders using Internet- and mobile-based interventions: A narrative review and recommendations for future research. Frontiers of Psychiatry, 8, 1-16. doi: 10.3389/fpsyt.2017.00116

Ebert, D. D., Donkin, L., Andersson, G., Andrews, G., Berger, T., Carlbring, P., … Cuijpers, P. (2016).

Does Internet-based guided-self-help for depression cause harm? An individual participant data meta-analysis on deterioration rates and its moderators in randomized controlled trials. Psychological Medicine, 46(13), 2679–2693. doi: 10.1017/S0033291716001562

Ebert, D. D., Zarski, A.-C., Christensen, H., Stikkelbroek, Y., Cuijpers, P., Berking, M., & Riper, H. (2015). Internet and computer-based Cognitive Behavioral Therapy for anxiety and depression in youth: A meta-analysis of randomized controlled outcome trials. PLOS ONE, 10(3), e0119895. doi: 10.1371/journal.pone.0119895

Fisher, M., Loewy, R., Hardy, K., Schlosser, D., & Vinogradov, S. (2013). Cognitive interventions targeting brain plasticity in the prodromal and early phases of schizophrenia. Annual Review of Clinical Psychology, 9(1), 435–463. doi: 10.1146/annurev-clinpsy-032511-143134

Fitzgerald, T. D., Hunter, P. V., Hadjistavropoulos, T., & Koocher, G. P. (2010). Ethical and legal considerations for Internet-based psychotherapy. Cognitive Behaviour Therapy, 39(3), 173–187. doi: 10.1080/16506071003636046

Geraghty, A. W., Muñoz, R. F., Yardley, L., Mc Sharry, J., Little, P., Moore, M. (2016). Developing an Unguided Internet-Delivered Intervention for Emotional Distress in Primary Care Patients: Applying Common Factor and Person-Based Approaches. Journal of Medical Internet Research: Mental Health, 3(4): e53. DOI: 10.2196/mental.5845; PMID: 27998878

Handouts for CPA Plenary Talk – April 28, 2018, 8:30 – 10:30 a.m.: Using Digital Tools to Expand Psychological Practice: Helping as Many People as Possible

Ricardo F. Muñoz – Palo Alto University - Page 3 of 5 Gill, S. K., Muñoz, R. F., & Leykin, Y. (2017). The influence of perceived stress and depression on

suicide-related beliefs in Caucasian and Indian adults. Crisis, https://doi.org/10.1027/0227-5910/a000492

Grohol, J. (2009). Research-backed online mental health interventions. Psych Central. Retrieved from:

http://psychcentral.com/blog/archives/2009/11/02/research-backed-online-mental-health-interventions/

Horvath, K. J., Ecklund, A. M., Hunt, S. L., Nelson, T. F., & Toomey, T. L. (2015). Developing

Internet-based health interventions: A guide for public health researchers and practitioners. Journal of Medical Internet Research, 17(1), e28. doi: 10.2196/jmir.3770

Iloabachie, C., Wells, C., Goodwin, B., Baldwin, M., Vanderplough-Booth, K., Gladstone, T., … Van Voorhees, B. W. (2011). Adolescent and parent experiences with a primary care/Internet-based depression prevention intervention (CATCH-IT). General Hospital Psychiatry, 33(6), 543–555. doi: 10.1016/j.genhosppsych.2011.08.004

Joint Task Force for the Development of Telepsychology Guidelines for Psychologists. (2013). Guidelines for the practice of telepsychology. American Psychologist, 68, 791-800. doi: 10.1037/a0035001

Karyotaki, E., et al. (2017). Efficacy of self-guided internet-based cognitive behavioral therapy in the treatment of depressive symptoms: A meta-analysis of individual participant data. JAMA Psychiatry, 74(4), 351-359. doi:10.1001/jamapsychiatry.2017.0044

Karyotaki, E., Kleiboer, A., Smit, F., Turner, D. T., Pastor, A. M., Andersson, G., … uijpers, P. (2015). Predictors of treatment dropout in self-guided web-based interventions for depression: An ‘individual patient data’ meta-analysis. Psychological Medicine, 45, 2717-2726. doi: 10.1017/S0033291715000665

Kobak, K. A., Craske, M. G., Rose, R. D., & Wolitsky-Taylor, K. (2013). Web-based therapist training on cognitive behavior therapy for anxiety disorders: A pilot study. Psychotherapy, 50(2), 235–247. doi: 10.1037/a0030568

Leykin, Y., Aguilera, A., Pérez-Stable, E. J., & Muñoz, R. F. (2013). Prompting depression treatment seeking among smokers: A comparison of participants from six countries in an internet stop smoking RCT. Journal of Technology in Human Services, 31, 238-247.

Leykin, Y., Muñoz, R. F. & Contreras, O. (2012). Are consumers of Internet health information

“cyberchondriacs”? Characteristics of 24,965 users of a depression screening site. Depression and Anxiety. 29, 71-77. PMID: 21681872

Leykin, Y., Muñoz, R. F., Contreras, O., Latham, M. D. (2014). Results from a trial of an unsupported

internet intervention for depressive symptoms. Internet Interventions, 1(7), 175-181. doi:10.1016/j.invent.2014.09.002

Leykin, Y., Thekdi, S. M., Shumay, D. M., Muñoz, R. F., Riba, M., & Dunn, L. B. (2012). Internet

interventions for improving psychological well-being in psycho-oncology: Review and recommendations. Psycho-Oncology. 21, 1016-25. PMID: 21608075

Handouts for CPA Plenary Talk – April 28, 2018, 8:30 – 10:30 a.m.: Using Digital Tools to Expand Psychological Practice: Helping as Many People as Possible

Ricardo F. Muñoz – Palo Alto University - Page 4 of 5 Liu, N. H., Contreras, O., Muñoz, R. F., & Leykin, Y. (2014). Assessing suicide attempts and depression

among Chinese speakers over the internet. Crisis. 35, 322-329. PMID: 25115490

Muñoz, R. F. (2010). Using evidence-based Internet interventions to reduce health disparities worldwide. Journal of Medical Internet Research, 12(5):e60. PMID: 21169162

Muñoz, R. F. (2017). The efficiency model of support and the creation of digital apothecaries. Clinical Psychology: Science and Practice, 24, 46-49. doi:10.1111/cpsp.12174

Muñoz, R.F., Aguilera, A., Schueller, S.M., Leykin, Y., Pérez-Stable, E.J. (2012). From online randomized controlled trials to participant preference studies: Morphing the San Francisco Stop Smoking Site into a worldwide smoking cessation resource. Journal of Medical Internet Research, 14(3), e64. doi:10.2196/jmir.1852

Muñoz, R. F., Barrera, A.Z., Delucchi, K., Penilla, C., Torres, L.D., Pérez-Stable, E.J. (2009). International Spanish/English Internet smoking cessation trial yields 20% abstinence rates at one year. Nicotine and Tobacco Research, 11, 1025-1034.

Muñoz, R. F., Bunge, E. L., Chen, K., Schueller, S. M., Bravin, J. I., Shaughnessy, E. A., & Pérez-

Stable, E. J. (2016). Massive Open Online Interventions: A novel model for delivering behavioral-health services worldwide. Clinical Psychological Science, 4, 194–205.

Muñoz, R. F., Chen, K., Bunge, E. L., Bravin, J. I., Shaughnessy, E. A., & Pérez-Stable, E. J. (2014).

Reaching Spanish-speaking smokers online: a 10-year worldwide research program. Revista Panamericana de Salud Pública, 35(5-6), 407-414.

National Institute for Health and Clinical Excellence (Great Britain). (2006). Computerised cognitive

behaviour therapy for depression and anxiety. Technology Appraisal 97 (review of Technology Appraisal 51). London: National Institute for Health and Clinical Excellence.

National Institute for Health and Clinical Excellence (Great Britain). (2006). Computerised cognitive behaviour therapy for depression and anxiety (review). London: National Institute for Health and Clinical Excellence.

Oldenburg, B., Taylor, C. B., O’Neil, A., Cocker, F., & Cameron, L. D. (2015). Using new technologies to improve the prevention and management of chronic conditions in populations. Annual Review of Public Health, 36(1), 483–505. doi: 10.1146/annurev-publhealth-031914-122848

Proudfoot, J., Klein, B., Barak, A., Carlbring, P., Cuijpers, P., Lange, A., … Andersson, G. (2011). Establishing guidelines for executing and reporting Internet intervention research. Cognitive Behaviour Therapy, 40(2), 82–97. doi: 10.1080/16506073.2011.573807

Ritterband, L. M., Ardalan, K., Thorndike, F. P., Magee, J. C., Saylor, D. K., Cox, D. J., … Borowitz, S. M. (2008). Real world use of an Internet intervention for pediatric encopresis. Journal of Medical Internet Research, 10(2), e16. doi: 10.2196/jmir.1081

Handouts for CPA Plenary Talk – April 28, 2018, 8:30 – 10:30 a.m.: Using Digital Tools to Expand Psychological Practice: Helping as Many People as Possible

Ricardo F. Muñoz – Palo Alto University - Page 5 of 5 Ritterband, L. M., Thorndike, F. P., Cox, D. J., Kovatchev, B. P., & Gonder-Frederick, L. A. (2009). A

behavior change model for Internet interventions. Annals of Behavioral Medicine, 38(1), 18–27. doi: 10.1007/s12160-009-9133-4

Ritterband, L. M., Thorndike, F. P., Gonder-Frederick, L. A., Magee, J. C., Bailey, E. T., Saylor, D. K., & Morin, C. M. (2009). Efficacy of an Internet-based behavioral intervention for adults with insomnia. Archives of General Psychiatry, 66(7), 692–698.

Rotondi, A. J., Anderson, C. M., Haas, G. L., Eack, S. M., Spring, M. B., Ganguli, R., … Rosenstock, J. (2010). Web-based psychoeducational intervention for persons with schizophrenia and their supporters: One-year outcomes. Psychiatric Services, 61(11), 1099–1105. doi: 10.1176/ps.2010.61.11.1099

Rozental, A., Andersson, G., Boettcher, J., Ebert, D. D., Cuijpers, P., Knaevelsrud, C., … Carlbring, P. (2014). Consensus statement on defining and measuring negative effects of Internet interventions. Internet Interventions, 1(1), 12–19. doi: 10.1016/j.invent.2014.02.001

Schueller, S. M., Leykin, Y., Pérez-Stable, E. J., & Muñoz, R. F. (2013). Selection of intervention components in an Internet Stop Smoking participant preference trial: Beyond randomized controlled trials. Psychiatry Research, 205, 159-64. PMID: 22985547

Shen, N., Levitan, M.-J., Johnson, A., Bender, J. L., Hamilton-Page, M., Jadad, A. (Alex) R., & Wiljer,

D. (2015). Finding a depression app: A review and content analysis of the depression app marketplace. JMIR mHealth and uHealth, 3(1). doi: 10.2196/mhealth.3713

Stasiak, K., Fleming, T., Lucassen, M. F. G., Shepherd, M. J., Whittaker, R., & Merry, S. N. (2015). Computer-based and online therapy for depression and anxiety in children and adolescents. Journal of Child and Adolescent Psychopharmacology, 26(3), 235–245. doi: 10.1089/cap.2015.0029

Steinwachs, D. M., Roter, D. L., Skinner, E. A., Lehman, A. F., Fahey, M., Cullen, B., … Gallucci, G. (2015). A web-based program to empower patients who have schizophrenia to discuss quality of care with mental health providers.

Subramaniam, K., & Vinogradov, S. (2013). Cognitive training for psychiatric disorders. Neuropsychopharmacology Reviews, 38(1), 242–243. doi: 10.1038/npp.2012.177

Taylor, C. B., Kass, A. E., Trockel, M., Cunning, D., Weisman, H., Bailey, J., … Wilfley, D. E. (2016). Reducing eating disorder onset in a very high risk sample with significant comorbid depression: A randomized controlled trial. Journal of Consulting and Clinical Psychology, 84(5), 402–414. doi: 10.1037/ccp0000077

Haug Handouts for CPA Plenary Talk Panel – April 28, 2018, 8:30 – 10:30 a.m. Page 1 of 3

Plenary Talk

Using Digital Tools to Expand Psychological Practice: Helping as Many People as Possible

California Psychological Association 2018 Convention

La Jolla, California – April 28, 2018 8:30 – 10:30 a.m.

Panel discussant: Nancy Haug, Ph.D. Professor Palo Alto University

nhaug@paloaltou.edu

DELIVERING VIDEO PSYCHOTHERAPY

Doxy.me is a free, HIPAA-compliant video conferencing platform designed for healthcare. Client view in the “waiting room”:

Doxy.me allows a custom design for the waiting room and check-in, simulating an actual therapy environment.

Haug Handouts for CPA Plenary Talk Panel – April 28, 2018, 8:30 – 10:30 a.m. Page 2 of 3

Clinician view with live chat option for typing messages:

Video Best Practices (adapted from: doxyme.freshdesk.com) Audio/Video Quality

1. The video quality adjusts based on available bandwidth. The faster and more stable your broadband connection, the better the video quality you will receive.

2. Poor Wi-Fi connections impact call quality so use an ethernet cable if possible. 3. Limit internet usage during a call. For example, do not stream movies or download music at the

same time, even on a different computer on the same network. 4. Newer computers with plenty of available processing power tend to have better performance.

Close unused programs on your computer. 5. Use an HD webcam to have an HD video feed.

Call Aesthetics 1. Face a light source (not behind you). 2. Limit background noise. 3. Have a clean and professional background. 4. If you or your participant experiences audio feedback, sit between 2-4 feet from the webcam.

Tips for Being Prepared:

• Reduce risk of technical difficulties (see above). • Establish a process for transmitting documents -- many platforms have screen sharing. • Allow time before a video session to log in to your system. • Expect technical difficulties; Respond calmly and explicitly. • Set ground rules for the client so that they are in a quiet, private location without distractions. • Create a safety plan to manage emergencies.

Haug Handouts for CPA Plenary Talk Panel – April 28, 2018, 8:30 – 10:30 a.m. Page 3 of 3

Zoom.us for Telehealth is another HIPAA-compliant option for clinicians that allows screen sharing of documents. Zoom has both basic (free) and pro/business options with additional features. Clinician screen sharing a DBT worksheet:

Other recommendations for video therapy:

• Try to be in the same physical location and position for each session. • Avoid wearing prints, stripes, and busy or stark attire to improve your image clarity. • Spend time “connecting” before the session, especially with clients in distant locations. • Socialize new clients to the video therapy process. • Exaggerate non-verbal communication and talk slowly due to potential audio delay. • Minimize hand movements and distractions. • Attend to the non-verbal communication of your client. • Consider differences in digital culture and how this may be impacting your client (e.g.,

information processing, social cues, language, etc.)

(Tips adapted from Dr. Carolyn Green, Ph.D., Video Therapy training) *NOTE: The “clients” in these screen shots are not real clients.

Breathe2RelaxNational Center for Telehealth & Technology

April 28, 2018 -- 8:30 - 10:30 a.m. Marcille Handouts for CPA Plenary Talk Panel 1

Simple Habit Meditation App

April 28, 2018 -- 8:30 - 10:30 a.m. Marcille Handouts for CPA Plenary Talk Panel 2

Pacifica for Stress & Anxiety App

April 28, 2018 -- 8:30 - 10:30 a.m. Marcille Handouts for CPA Plenary Talk Panel 3

Thera Chat to help with homework and engagement between therapy session.

April 28, 2018 -- 8:30 - 10:30 a.m. Marcille Handouts for CPA Plenary Talk Panel 4