Department of Forensic Psychiatry, Institute of Forensic Medicine, University of Bern, Bern, Switzerland.
Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland.
BMC Psychiatry. 2021 May 5;21(1):237. doi: 10.1186/s12888-021-03236-9.
Maintaining the therapeutic care of psychiatric patients during the first wave of the COVID-19 pandemic in Switzerland required changes to the way in which sessions were conducted, such as telepsychiatric interventions or using face masks during on-site sessions. While little is known about how face masks affect the therapeutic experience of patients and therapists, the effectiveness of telepsychiatry is well documented for several psychiatric disorders. However, research on the benefits of telepsychiatry in adult patients with attention-deficit/hyperactivity disorder (ADHD) remains scarce. This seems problematic since the symptoms typically associated with ADHD, such as attention problems and distractibility, may lessen the utility of telepsychiatry for this particular group. The present study's aim was to explore how adult patients with ADHD and their therapists experienced therapy sessions during the COVID-19 pandemic in three different settings: face-to-face with the therapist wearing a face mask, via telephone, or via videoconferencing.
In this exploratory, quantitatively driven mixed-method study (quantitative questionnaire data and qualitative data from open-ended responses), we assessed patients' evaluation of the session, their treatment satisfaction, and patients' and therapists' ratings of therapeutic alliance. We also collected qualitative comments on both sides' experience of the session. Overall, 97 therapist and 66 patient questionnaires were completed. Results are reported for the N = 60 cases for which data from both parties were available. Sequential multiple regressions adjusted for therapist and number of sessions were used for the main quantitative analyses.
No statistically significant differences regarding session flow, post-session positivity, satisfaction and therapeutic alliance were observed. The only exception was that telepsychiatric sessions were rated as significantly less deep than face-to-face sessions, an effect that may decline over time, especially in the videoconferencing group. Patients and therapists identified similar facilitating and complicating aspects, but differed in their emphasis of specific elements.
Both settings, on-site with the therapist wearing a face mask and telepsychiatric, seem to be valid options to continue treatment of adults with ADHD during a situation such as the COVID-19 pandemic. Aspects such as patient preference, session content, and therapeutic methods may be useful to identify the most suitable modality.
在瑞士 COVID-19 大流行的第一波期间，维持精神病患者的治疗护理需要改变治疗方式，例如远程精神病干预或在现场治疗期间使用口罩。虽然人们对口罩如何影响患者和治疗师的治疗体验知之甚少，但远程精神病学对几种精神障碍的有效性已得到充分证明。然而，关于远程精神病学在成年注意力缺陷/多动障碍（ADHD）患者中的益处的研究仍然很少。这似乎存在问题，因为与 ADHD 相关的典型症状，如注意力问题和注意力分散，可能会降低远程精神病学对该特定群体的实用性。本研究的目的是探讨在 COVID-19 大流行期间，在面对面治疗师戴口罩、通过电话或视频会议三种不同设置下，成年 ADHD 患者及其治疗师如何体验治疗。
在这项探索性的、以定量驱动的混合方法研究（定量问卷数据和开放式回答的定性数据）中，我们评估了患者对治疗的评估、治疗满意度以及患者和治疗师对治疗联盟的评分。我们还收集了双方对治疗体验的定性意见。共有 97 名治疗师和 66 名患者完成了问卷。报告了对双方数据均可用的 60 例患者的数据结果。使用调整治疗师和治疗次数的顺序多重回归进行了主要的定量分析。
在治疗流程、治疗后积极性、满意度和治疗联盟方面，没有观察到统计学上的显著差异。唯一的例外是，与面对面治疗相比，远程精神病治疗被评为深度显著降低，这种影响可能会随着时间的推移而下降，尤其是在视频会议组中。患者和治疗师识别出相似的促进和复杂因素，但强调的具体因素不同。
在 COVID-19 大流行等情况下，现场治疗师戴口罩和远程精神病治疗似乎都是继续治疗成年 ADHD 患者的有效选择。患者偏好、治疗内容和治疗方法等方面可能有助于确定最合适的治疗方式。
