Tag: telehealth

Categories : Mental HealthTags :

Online Anger Management Therapy can be Effective

On By ModernMedia
Photo by Yogendra Singh on Unsplash

Problems with managing anger can have severe consequences for the afflicted individual and their loved ones. A new study from Karolinska Institutet shows a four-week therapy course delivered over the internet can help people to deal with their anger and aggression. The results have been published in the Journal of Consulting and Clinical Psychology.

The study, which the researchers have chosen to call the “anger study”, is the first to compare different internet-mediated emotion regulation strategies against anger. The results are expected to be important for understanding emotion regulation and for the dissemination of evidence-based methods.

Easy to recruit participants

“It is usually very difficult to recruit participants for treatment studies. For the anger study, however, it was very easy, and we had to close the recruitment site after a few weeks due to the high number of applicants. This suggests that there is a pent-up need for the psychological treatment of anger. Many people who have problems with anger feel ashamed, and we think the internet format suits this group particularly well because they don’t have to wait in a reception room or sit face-to-face with a therapist and talk about their anger,” says lead researcher Johan Bjureberg, assistant professor at Karolinska Institutet.

The anger study evaluated the effect of two emotion regulation strategies: mindful emotion awareness; and cognitive reappraisal. Mindful emotion awareness focuses on the ability to notice and accept one’s feelings and thoughts without judging or acting on them. Cognitive reappraisal, on the other hand, focuses on the ability to reinterpret thoughts and situations and identify alternative thoughts that do not trigger difficult feelings.

The 234 participants, all with significant anger problems, were randomly assigned to four weeks of either mindful emotion awareness, cognitive reappraisal, or a combination of these two strategies. All treatments were of approximately the same length and were associated with decreased self-reported anger and aggressiveness at the end of the treatment.

Combination therapy most effective

The combined treatment resulted in significantly lower levels of outward anger expression, aggression, and anger rumination, but not anger suppression, compared to mindful emotion awareness or cognitive reappraisal alone. The combination was particularly effective for participants who were experiencing very high levels of anger at the start of the study. The results strengthen research and theories suggesting that difficulties in regulating emotions and interpreting events and situations can be a major contributing factor to problems in managing anger.

“Our results suggest that a very short treatment of only four weeks administered over the internet with minimal therapist support is effective in reducing anger problems. Our hope is that follow-up studies support this finding and that the treatment can be offered broadly within regular care,” explains Johan Bjureberg.

Source: Karolinska Institutet

Categories : COVIDTags :

Home Pulse Oximeters in COVID no Better Than Just Asking

On By ModernMedia
Photo by Mufid Majnun on Pexels

Self-measurement of oxygen levels with pulse oximeters is no better than just regularly asking patients with COVID if they are short of breath, according to new research published in the New England Journal of Medicine. Pulse oximeters have often been applied because of concerns that patients might not notice their blood oxygen levels sliding dangerously. 

However, people in Penn Medicine’s COVID Watch programme, which monitors patients recovering at home via automated text messaging, had the same outcomes whether they used oxygen-measuring devices or not.

“Compared to remotely monitoring shortness of breath with simple automated check-ins, we showed that the addition of pulse oximetry did not save more lives or keep more people out of the hospital,” said the study’s co-lead author, Anna Morgan, MD, medical director of the COVID Watch program and an assistant professor of General Internal Medicine. “And having a pulse oximeter didn’t even make patients feel less anxious.”

The COVID Watch was launched in March 2020 to remotely monitor COVID patients at home, with 28 500 people enrolled to date. Twice a day for two weeks, text messages were automatically sent to these patients asking how they felt and if they were having difficulty breathing. If patients indicated dyspnoea, the programme would alert a nurse to make contact and arrange care.

“The programme made it easy to identify the sickest patients who needed the hospital, and keep the others at home safely,” said David Asch, MD, executive director of the Center for Health Care Innovation and a professor of Medicine, Medical Ethics and Health Policy. “The programme was associated with a 68 percent reduction in mortality, saving a life approximately every three days during peak enrollment early in the pandemic.”

However it was not known if monitoring blood oxygen would help.

“Early in the pandemic, there was a prevalent theory that oxygen levels in the blood dropped before a COVID patient became symptomatic and short of breath,” said study co-lead author Kathleen Lee, MD. “Detecting this earlier with a home pulse oximeter might provide an opportunity to get patients who are on the cusp of deteriorating to the hospital faster and initiate time-sensitive therapies to improve outcomes.”

The use of pulse oximeters was so intuitively appealing that the process got adopted even before this trial, the first randomised trial to test whether it actually worked.

“Several health systems, and even states like Vermont and countries like the United Kingdom, have integrated pulse oximetry into the routine home management of patients with COVID, but there’s been scant evidence to show this strategy makes a difference,” said the research project’s principal investigator M. Kit Delgado, MD.

In this study, more than 2000 patients enrolled in COVID Watch between Nov. 29, 2020, and Feb. 5, 2021, were randomised to receive standard COVID Watch care or the same program with the addition of a pulse oximeter.

However, no statistical difference was seen in the main study measure, the average number of days enrolled patients spent alive and out of the hospital in the 30 days after they were enrolled. For patients with pulse oximeters, the measure was 29.4 days; for those without, it was 29.5, with no difference across racial liines. This was important as black patients are known to have had worse COVID outcomes and concerns had been raised about the accuracy of pulse oximeters in people with darker skin.
The researchers cautioned that the study focused on pulse oximeters in established programme of remote monitoring, and patients don’t have access to a system like COVID Watch or on-call clinicians, self-monitoring with pulse oximeters may still be a reasonable approach until there is evidence to the contrary.

“Overall, these findings suggest that a low-tech approach for remote monitoring systems based on symptoms is just as good as a more expensive one using additional devices. Automated text messaging is a great way for health systems to enable a small team of on-call nurses to manage large populations of patients with COVID,” said co-principal investigator, Krisda Chaiyachati, MD. “There are a lot of other medical conditions where the same kind of approach might really help.”

Source: University of Pennsylvania School of Medicine