Paula Ravitz | University of Toronto (original) (raw)

Papers by Paula Ravitz

Research paper thumbnail of Psychotherapies at a Glance: Consensus Guideline–Recommended Psychotherapies for Adults With Psychiatric Disorders

American journal of psychotherapy, Mar 15, 2024

Research paper thumbnail of Psychotherapy in Psychiatry

The Canadian Journal of Psychiatry

The delivery of biological, psychosocial and psychotherapeutic interventions remains central to t... more The delivery of biological, psychosocial and psychotherapeutic interventions remains central to the treatment of patients with psychiatric disorders.1–3 It is therefore essential to manage the provision of these treatment modalities. Psychotherapy is therefore considered a core skill set for psychiatrists, and the Canadian Psychiatric Association (CPA) affirms the position of psychotherapy in psychiatry. Canadian psychiatry has emphasized an integrated biopsychosocial approach to the assessment and management of mental health problems.1–7 Psychiatrists must possess competence in evidence-supported treatments including psychotherapies.7–9 Treatment strategies should consider the place of pharmacology, psychotherapy, and systemic interventions. The inherent private nature of the practice of psychotherapy, and the often-competing theoretical schools contribute to ambiguity and differing definitions or descriptions of different therapies. Today, most psychotherapies and common factors have been operationally defined with greater clarity (e.g.10–13), although some constructs remain more abstract. Treatments should demonstrate both their efficacy and clinicaland cost-effectiveness, or benefit in real-world settings irrespective of their orientation.15–18 The last few decades have witnessed a significant growth of research in psychotherapy. Randomized controlled trials and meta-analyses demonstrate that numerous psychotherapies can be effective for mood, anxiety, psychotic, substance misuse, eating, and personality disorders (e.g.19–25). Research has contributed to treatment guidelines that recommend specific psychotherapies across the life span.26–28 Research also demonstrates that common factors across therapies, including therapist interpersonal effectiveness, predict psychotherapy outcomes.

Research paper thumbnail of Integrating Evidence-Supported Psychotherapy Principles in Mental Health Case Management: A Capacity-Building Pilot

The Canadian Journal of Psychiatry, Oct 3, 2019

Objectives: Mental health case managers comprise a large workforce who help patients who struggle... more Objectives: Mental health case managers comprise a large workforce who help patients who struggle with complex mental illnesses and unmet needs with respect to the social determinants of health. This mixed-methods capacity-building pilot examined the feasibility, experiences, and outcomes of training community-based mental health case managers to integrate evidence-based psychotherapy principles into their case conceptualization and management practices. Methods: Case-based, once-weekly, group consultations and training in applied therapeutic principles from mentalizing, interpersonal psychotherapy, motivational interviewing, and other evidence-based psychotherapies were provided to case managers over 8 months. A trauma-informed and culturally sensitive approach was emphasized to improve therapeutic alliances and to foster adaptive expertise and an appreciation of individual patient differences. Results: Qualitative analyses of focus groups and individualized interviews identified a shift toward being more reflective rather than reactive, with improved empathy, patient engagement, morale, and confidence resulting from the training (N ¼ 16). Self-reported pre-post counseling self-efficacy changes revealed significant improvements overall, driven by improved microskills and an ability to deal with challenging client behaviors (N ¼ 10; P < 0.05). Conclusions: This pilot demonstrated that case-based consultations and training of mental health case managers within a community-of-practice in trauma-informed, culturally sensitive application of evidence-supported psychotherapy principles were feasible and acceptable with scalable potential to improve case managers' counseling self-efficacy, reflective capacity, empathy, and morale. Further research in this area is needed with a larger sample, and patient and health systems outcomes. Abré gé Objectifs : Les chargés de cas de santé mentale constituent une forte main-d'oeuvre qui aide les patients aux prises avec des maladies mentales complexes et des besoins non comblés à l'égard des déterminants sociaux de la santé. Ce pilote de renforcement des capacités aux méthodes mixtes a examiné la faisabilité, les expériences et les résultats de la formation des chargés de cas de santé mentale communautaire afin d'intégrer les principes de la psychothérapie fondée sur des données probantes dans la conceptualisation de leurs cas et les pratiques de prise en charge.

Research paper thumbnail of Interpersonal psychotherapy for depression

Research paper thumbnail of Training community-based psychotherapists to maintain a therapeutic alliance: A psychotherapy practice research network study

Psychotherapy, Mar 1, 2023

Research paper thumbnail of Psychotherapy in Psychiatry

The Canadian Journal of Psychiatry, Nov 1, 2021

2004-22s-R1]. Note: It is the policy of the Canadian Psychiatric Association to review each posit... more 2004-22s-R1]. Note: It is the policy of the Canadian Psychiatric Association to review each position paper, policy statement and clinical practice guideline every five years after publication or last review. Any such document that has been published more than five years ago and does not explicitly state it has been reviewed and retained as an official document of the CPA, either with revisions or as originally published, should be considered as a historical reference document only.

Research paper thumbnail of Pause-4-Providers: A descriptive and qualitative study of drop-in web-based mindfulness sessions to enhance well-being amongst healthcare workers during the COVID-19 Pandemic (Preprint)

Research paper thumbnail of Change in satisfaction with social support as a common outcome in interpersonal psychotherapy and cognitive behavioral therapy for depression

Journal of Psychotherapy Integration, May 11, 2023

Research paper thumbnail of Interpersonal Psychotherapy and Mentalizing—Synergies in Clinical Practice

American Journal of Psychotherapy, 2022

Interpersonal psychotherapy (IPT) is an evidence-supported relationally-focused treatment for peo... more Interpersonal psychotherapy (IPT) is an evidence-supported relationally-focused treatment for people living with depression and other psychiatric disorders in the context of stressful life events. Mentalizing, also relationally focused, promotes the ability to perceive, understand and interpret human behaviour in terms of intentional mental states of others or oneself in order to support social learning. IPT and mentalizing-based treatments (MBT) both seek to improve interpersonal effectiveness, albeit it with different emphasis in the therapeutic process: IPT promoting interpersonal problem solving and MBT promoting understanding of the obstacles to this outcome. Our proposition is that the central intentions of IPT and mentalizing are essentially linked and complimentary-understanding others and oneself in relationship facilitates interpersonal problem resolution and symptomatic recovery, and enhances resilience. The clinical synergies of IPT and mentalizing are elaborated and illustrated through a case example of a socially isolated individual with depression and interpersonal sensitivities.

Research paper thumbnail of Scaling up quality-assured psychotherapy: The role of therapist competence on perinatal depression and anxiety outcomes

General Hospital Psychiatry, Jul 1, 2023

Research paper thumbnail of Scaling Up Maternal Mental healthcare by Increasing access to Treatment (SUMMIT) through non-specialist providers and telemedicine: a study protocol for a non-inferiority randomized controlled trial

Trials, Mar 5, 2021

Background: Depression and anxiety impact up to 1 in 5 pregnant and postpartum women worldwide. Y... more Background: Depression and anxiety impact up to 1 in 5 pregnant and postpartum women worldwide. Yet, as few as 20% of these women are treated with frontline interventions such as evidence-based psychological treatments. Major barriers to uptake are the limited number of specialized mental health treatment providers in most settings, and problems with accessing in-person care, such as childcare or transportation. Task sharing of treatment to nonspecialist providers with delivery on telemedicine platforms could address such barriers. However, the equivalence of these strategies to specialist and in-person models remains unproven. Methods: This study protocol outlines the Scaling Up Maternal Mental healthcare by Increasing access to Treatment (SUMMIT) randomized trial. SUMMIT is a pragmatic, non-inferiority test of the comparable effectiveness of two types of providers (specialist vs. non-specialist) and delivery modes (telemedicine vs. in-person) of a brief, behavioral activation (BA) treatment for perinatal depressive and anxiety symptoms. Specialists (psychologists, psychiatrists, and social workers with ≥ 5 years of therapy experience) and non-specialists (nurses and midwives with no formal training in mental health care) were trained in the BA protocol, with the latter supervised by a BA expert during treatment delivery. Consenting pregnant and postpartum women with Edinburgh Postnatal Depression Scale (EPDS) score of ≥ 10 (N = 1368) will be randomized to one of four arms (telemedicine specialist,

Research paper thumbnail of Treatment-resistant major depressive disorder: current definitions, epidemiology, and assessment

Treatment-Resistant Mood Disorders, 2015

Research paper thumbnail of Culturally sensitive psychotherapy for perinatal women: A mixed methods study

Journal of Consulting and Clinical Psychology

Research paper thumbnail of Replicating patient-level moderators of CBT and IPT’s comparative efficacy for depression

Research paper thumbnail of In Review Advances in Psychotherapy Education

Acquiring expertise in psychotherapy is central to the professional development of psychiatrists ... more Acquiring expertise in psychotherapy is central to the professional development of psychiatrists able to employ a broad therapeutic repertoire in their clinical practice. This article reviews how postgraduate psychiatry programs address this important aspect of training. We present the results of a national survey of psychotherapy education in Canadian psychiatry residency programs. The results highlight significant advances over the past decade in curriculum, in teaching methods, and in evaluation. These include training in evidence-based, manualized, time-limited therapies such as cognitive-behavioural and interpersonal therapy, greater attention to evaluating competence, and integrating electronic technology. Trends and advances in postgraduate and continuing medical psychotherapy education programs are considered in association with principles of adult learning. Health education research endorses the provision of longitudinal training programs that integrate learning and practic...

Research paper thumbnail of Adapting behavioral activation for perinatal depression and anxiety in response to the COVID-19 pandemic and racial injustice

Journal of Affective Disorders, 2021

Background We examined the implementation of a behavioural activation (BA) model, via telemedicin... more Background We examined the implementation of a behavioural activation (BA) model, via telemedicine, for perinatal populations during a confluence of significant global events in 2020. We conducted a rigorous qualitative study to identify relevant barriers and facilitators from the perspectives of both perinatal participants and treatment providers, We also present two case studies where BA was used and adapted to provide patient-centered care. Methods Within the ongoing SUMMIT non-inferiority randomized controlled trial in Canada and US, we interviewed a random selection of perinatal participants (n=23) and all treatment providers (n=28). A content analysis framework was developed to identify relevant barriers and facilitators and frequencies were calculated for each emergent theme within and across respondent groups. Results Key facilitators reported by participants receiving BA were that BA helped with support and social connection (73.9%), creative problem solving (26.1%) and attending to pandemic-related symptoms (21.7%). Key facilitators endorsed by providers to deliver BA were the use of telemedicine (35.7%) and loosening of government restrictions (21.4%). Both participant groups reported similar barriers to BA during the pandemic such as a lack of privacy and limited activities due to pandemic restrictions. However, providers were more likely to endorse pandemic-related life stressors as a barrier to treatment delivery compared to participants (64.3% vs. 34.8%). Both participant groups experienced explicit discussion of race and the racial justice movements during sessions as beneficial and reported harms of not doing so to the therapeutic alliance. Conclusions BA offers a person-centered model to facilitate social connection through creative problem-solving for women with perinatal depressive and anxiety symptoms within the context of the COVID-19 pandemic. Explicit discussion of race and racial injustice during sessions is an important and helpful aspect in psychological treatments.

Research paper thumbnail of Interpersonal Psychotherapy: A Scoping Review and Historical Perspective (1974–2017)

Harvard Review of Psychiatry, 2019

Background Interpersonal Psychotherapy (IPT) is an affect- and relationally focused, time-limited... more Background Interpersonal Psychotherapy (IPT) is an affect- and relationally focused, time-limited treatment supported by research spanning >4 decades. IPT focuses on stressful interpersonal experiences of loss, life changes, disputes, and social isolation. It emphasizes the role of relationships in recovery. This scoping review describes, within a historical perspective, IPT’s evolution as an evidence-supported treatment of psychiatric disorders. Methods English-language publications (n = 1119) identified via EMBASE, MEDLINE, PsycINFO, and Web of Science databases (1974–2017), augmented with manual reference searches, were coded for clinical focus, population demographics, format, setting, publication type, and research type. Quantitative and qualitative analyses identified IPT publications’ characteristics and trends over four epochs of psychotherapy research. Results IPT literature primarily focused on depression (n = 772 articles; 69%), eating disorders (n = 135; 12%), anxiety disorders (n = 68; 6%), and bipolar disorder (n = 44; 4%), with rising publication rates and numbers of well-conducted randomized, controlled trials over time, justifying inclusion in consensus treatment guidelines. Research trends shifted from efficacy trials to effectiveness studies and population-based dissemination initiatives. Process research examined correlates of improvement and efficacy moderators. Innovations included global initiatives, prevention trials, and digital, web-based training and treatment. Conclusion Sparked by clinical innovations and scientific advances, IPT has evolved as an effective treatment of psychiatric disorders across the lifespan for diverse patients, including underserved clinical populations. Future research to elucidate mechanisms of change, improve access, and adapt to changing frameworks of psychopathology and treatment planning is needed. IPT addresses the universal centrality of relationships to mental health, which is as relevant today as it was over 40 years ago.

Research paper thumbnail of Major Depressive Disorder

Casebook of Interpersonal Psychotherapy, 2012

Chapter 4 describes a case of IPT treatment of major depressive disorder with a focus on role tra... more Chapter 4 describes a case of IPT treatment of major depressive disorder with a focus on role transitions, and how social roles are central to our sense of identity, how all individuals may hold numerous roles (partner, child, parent, sibling, neighbor, community member, etc.), besides having vocational roles (colleague, employee, employer, or professional). It looks at how social roles determine the ‘rules of engagement’ (around communication, sharing of responsibilities) and expectations we have of one another, and how a change in one’s social role (losing a job, moving to another city, becoming partnered, ending a spousal or long-term romantic relationship, adjusting to a disabling or disfiguring medical condition, becoming a new parent) can generate a shift in or loss of one’s sense of self. It examines how these role transitions also evoke changes in one’s needs for or access to social supports and how a role change can be stressful enough to provoke an episode of major depress...

Research paper thumbnail of Psychotherapy Knowledge Translation and Interpersonal Psychotherapy: Using Best-Education Practices to Transform Mental Health Care in Canada and Ethiopia

American journal of psychotherapy, 2014

Psychotherapies, such as Interpersonal Psychotherapy (IPT), that have proven effective for treati... more Psychotherapies, such as Interpersonal Psychotherapy (IPT), that have proven effective for treating mental disorders mostly lie dormant in consensus-treatment guidelines. Broadly disseminating these psychotherapies by training trainers and front-line health workers could close the gap between mental health needs and access to care. Research in continuing medical education and knowledge translation can inform the design of educational interventions to build capacity for providing psychotherapy to those who need it. This paper summarizes psychotherapy training recommendations that: adapt treatments to cultural and health organizational contexts; consider implementation barriers, including opportunity costs and mental health stigma; and engage local opinion leaders to use longitudinal, interactive, case-based teaching with reflection, skills-coaching, simulations, auditing and feedback. Community-based training projects in Northern Ontario, Canada and Ethiopia illustrate how best-educa...

Research paper thumbnail of Continuing education to go: capacity building in psychotherapies for front-line mental health workers in underserviced communities

Canadian journal of psychiatry. Revue canadienne de psychiatrie, 2013

To address the gaps between need and access, and between treatment guidelines and their implement... more To address the gaps between need and access, and between treatment guidelines and their implementation for mental illness, through capacity building of front-line health workers. Following a learning needs assessment, work-based continuing education courses in evidence-supported psychotherapies were developed for front-line workers in underserviced community settings. The 5-hour courses on the fundamentals of cognitive-behavioural therapy, interpersonal psychotherapy, motivational interviewing, and dialectical behaviour therapy each included videotaped captioned simulations, interactive lesson plans, and clinical practice behaviour reminders. Two courses, sequentially offered in 7 underserviced settings, were subjected to a mixed methods evaluation. Ninety-three nonmedical front-line workers enrolled in the program. Repeated measures analysis of variance was used to assess pre- and postintervention changes in knowledge and self-efficacy. Qualitative data from 5 semistructured focus ...

Research paper thumbnail of Psychotherapies at a Glance: Consensus Guideline–Recommended Psychotherapies for Adults With Psychiatric Disorders

American journal of psychotherapy, Mar 15, 2024

Research paper thumbnail of Psychotherapy in Psychiatry

The Canadian Journal of Psychiatry

The delivery of biological, psychosocial and psychotherapeutic interventions remains central to t... more The delivery of biological, psychosocial and psychotherapeutic interventions remains central to the treatment of patients with psychiatric disorders.1–3 It is therefore essential to manage the provision of these treatment modalities. Psychotherapy is therefore considered a core skill set for psychiatrists, and the Canadian Psychiatric Association (CPA) affirms the position of psychotherapy in psychiatry. Canadian psychiatry has emphasized an integrated biopsychosocial approach to the assessment and management of mental health problems.1–7 Psychiatrists must possess competence in evidence-supported treatments including psychotherapies.7–9 Treatment strategies should consider the place of pharmacology, psychotherapy, and systemic interventions. The inherent private nature of the practice of psychotherapy, and the often-competing theoretical schools contribute to ambiguity and differing definitions or descriptions of different therapies. Today, most psychotherapies and common factors have been operationally defined with greater clarity (e.g.10–13), although some constructs remain more abstract. Treatments should demonstrate both their efficacy and clinicaland cost-effectiveness, or benefit in real-world settings irrespective of their orientation.15–18 The last few decades have witnessed a significant growth of research in psychotherapy. Randomized controlled trials and meta-analyses demonstrate that numerous psychotherapies can be effective for mood, anxiety, psychotic, substance misuse, eating, and personality disorders (e.g.19–25). Research has contributed to treatment guidelines that recommend specific psychotherapies across the life span.26–28 Research also demonstrates that common factors across therapies, including therapist interpersonal effectiveness, predict psychotherapy outcomes.

Research paper thumbnail of Integrating Evidence-Supported Psychotherapy Principles in Mental Health Case Management: A Capacity-Building Pilot

The Canadian Journal of Psychiatry, Oct 3, 2019

Objectives: Mental health case managers comprise a large workforce who help patients who struggle... more Objectives: Mental health case managers comprise a large workforce who help patients who struggle with complex mental illnesses and unmet needs with respect to the social determinants of health. This mixed-methods capacity-building pilot examined the feasibility, experiences, and outcomes of training community-based mental health case managers to integrate evidence-based psychotherapy principles into their case conceptualization and management practices. Methods: Case-based, once-weekly, group consultations and training in applied therapeutic principles from mentalizing, interpersonal psychotherapy, motivational interviewing, and other evidence-based psychotherapies were provided to case managers over 8 months. A trauma-informed and culturally sensitive approach was emphasized to improve therapeutic alliances and to foster adaptive expertise and an appreciation of individual patient differences. Results: Qualitative analyses of focus groups and individualized interviews identified a shift toward being more reflective rather than reactive, with improved empathy, patient engagement, morale, and confidence resulting from the training (N ¼ 16). Self-reported pre-post counseling self-efficacy changes revealed significant improvements overall, driven by improved microskills and an ability to deal with challenging client behaviors (N ¼ 10; P < 0.05). Conclusions: This pilot demonstrated that case-based consultations and training of mental health case managers within a community-of-practice in trauma-informed, culturally sensitive application of evidence-supported psychotherapy principles were feasible and acceptable with scalable potential to improve case managers' counseling self-efficacy, reflective capacity, empathy, and morale. Further research in this area is needed with a larger sample, and patient and health systems outcomes. Abré gé Objectifs : Les chargés de cas de santé mentale constituent une forte main-d'oeuvre qui aide les patients aux prises avec des maladies mentales complexes et des besoins non comblés à l'égard des déterminants sociaux de la santé. Ce pilote de renforcement des capacités aux méthodes mixtes a examiné la faisabilité, les expériences et les résultats de la formation des chargés de cas de santé mentale communautaire afin d'intégrer les principes de la psychothérapie fondée sur des données probantes dans la conceptualisation de leurs cas et les pratiques de prise en charge.

Research paper thumbnail of Interpersonal psychotherapy for depression

Research paper thumbnail of Training community-based psychotherapists to maintain a therapeutic alliance: A psychotherapy practice research network study

Psychotherapy, Mar 1, 2023

Research paper thumbnail of Psychotherapy in Psychiatry

The Canadian Journal of Psychiatry, Nov 1, 2021

2004-22s-R1]. Note: It is the policy of the Canadian Psychiatric Association to review each posit... more 2004-22s-R1]. Note: It is the policy of the Canadian Psychiatric Association to review each position paper, policy statement and clinical practice guideline every five years after publication or last review. Any such document that has been published more than five years ago and does not explicitly state it has been reviewed and retained as an official document of the CPA, either with revisions or as originally published, should be considered as a historical reference document only.

Research paper thumbnail of Pause-4-Providers: A descriptive and qualitative study of drop-in web-based mindfulness sessions to enhance well-being amongst healthcare workers during the COVID-19 Pandemic (Preprint)

Research paper thumbnail of Change in satisfaction with social support as a common outcome in interpersonal psychotherapy and cognitive behavioral therapy for depression

Journal of Psychotherapy Integration, May 11, 2023

Research paper thumbnail of Interpersonal Psychotherapy and Mentalizing—Synergies in Clinical Practice

American Journal of Psychotherapy, 2022

Interpersonal psychotherapy (IPT) is an evidence-supported relationally-focused treatment for peo... more Interpersonal psychotherapy (IPT) is an evidence-supported relationally-focused treatment for people living with depression and other psychiatric disorders in the context of stressful life events. Mentalizing, also relationally focused, promotes the ability to perceive, understand and interpret human behaviour in terms of intentional mental states of others or oneself in order to support social learning. IPT and mentalizing-based treatments (MBT) both seek to improve interpersonal effectiveness, albeit it with different emphasis in the therapeutic process: IPT promoting interpersonal problem solving and MBT promoting understanding of the obstacles to this outcome. Our proposition is that the central intentions of IPT and mentalizing are essentially linked and complimentary-understanding others and oneself in relationship facilitates interpersonal problem resolution and symptomatic recovery, and enhances resilience. The clinical synergies of IPT and mentalizing are elaborated and illustrated through a case example of a socially isolated individual with depression and interpersonal sensitivities.

Research paper thumbnail of Scaling up quality-assured psychotherapy: The role of therapist competence on perinatal depression and anxiety outcomes

General Hospital Psychiatry, Jul 1, 2023

Research paper thumbnail of Scaling Up Maternal Mental healthcare by Increasing access to Treatment (SUMMIT) through non-specialist providers and telemedicine: a study protocol for a non-inferiority randomized controlled trial

Trials, Mar 5, 2021

Background: Depression and anxiety impact up to 1 in 5 pregnant and postpartum women worldwide. Y... more Background: Depression and anxiety impact up to 1 in 5 pregnant and postpartum women worldwide. Yet, as few as 20% of these women are treated with frontline interventions such as evidence-based psychological treatments. Major barriers to uptake are the limited number of specialized mental health treatment providers in most settings, and problems with accessing in-person care, such as childcare or transportation. Task sharing of treatment to nonspecialist providers with delivery on telemedicine platforms could address such barriers. However, the equivalence of these strategies to specialist and in-person models remains unproven. Methods: This study protocol outlines the Scaling Up Maternal Mental healthcare by Increasing access to Treatment (SUMMIT) randomized trial. SUMMIT is a pragmatic, non-inferiority test of the comparable effectiveness of two types of providers (specialist vs. non-specialist) and delivery modes (telemedicine vs. in-person) of a brief, behavioral activation (BA) treatment for perinatal depressive and anxiety symptoms. Specialists (psychologists, psychiatrists, and social workers with ≥ 5 years of therapy experience) and non-specialists (nurses and midwives with no formal training in mental health care) were trained in the BA protocol, with the latter supervised by a BA expert during treatment delivery. Consenting pregnant and postpartum women with Edinburgh Postnatal Depression Scale (EPDS) score of ≥ 10 (N = 1368) will be randomized to one of four arms (telemedicine specialist,

Research paper thumbnail of Treatment-resistant major depressive disorder: current definitions, epidemiology, and assessment

Treatment-Resistant Mood Disorders, 2015

Research paper thumbnail of Culturally sensitive psychotherapy for perinatal women: A mixed methods study

Journal of Consulting and Clinical Psychology

Research paper thumbnail of Replicating patient-level moderators of CBT and IPT’s comparative efficacy for depression

Research paper thumbnail of In Review Advances in Psychotherapy Education

Acquiring expertise in psychotherapy is central to the professional development of psychiatrists ... more Acquiring expertise in psychotherapy is central to the professional development of psychiatrists able to employ a broad therapeutic repertoire in their clinical practice. This article reviews how postgraduate psychiatry programs address this important aspect of training. We present the results of a national survey of psychotherapy education in Canadian psychiatry residency programs. The results highlight significant advances over the past decade in curriculum, in teaching methods, and in evaluation. These include training in evidence-based, manualized, time-limited therapies such as cognitive-behavioural and interpersonal therapy, greater attention to evaluating competence, and integrating electronic technology. Trends and advances in postgraduate and continuing medical psychotherapy education programs are considered in association with principles of adult learning. Health education research endorses the provision of longitudinal training programs that integrate learning and practic...

Research paper thumbnail of Adapting behavioral activation for perinatal depression and anxiety in response to the COVID-19 pandemic and racial injustice

Journal of Affective Disorders, 2021

Background We examined the implementation of a behavioural activation (BA) model, via telemedicin... more Background We examined the implementation of a behavioural activation (BA) model, via telemedicine, for perinatal populations during a confluence of significant global events in 2020. We conducted a rigorous qualitative study to identify relevant barriers and facilitators from the perspectives of both perinatal participants and treatment providers, We also present two case studies where BA was used and adapted to provide patient-centered care. Methods Within the ongoing SUMMIT non-inferiority randomized controlled trial in Canada and US, we interviewed a random selection of perinatal participants (n=23) and all treatment providers (n=28). A content analysis framework was developed to identify relevant barriers and facilitators and frequencies were calculated for each emergent theme within and across respondent groups. Results Key facilitators reported by participants receiving BA were that BA helped with support and social connection (73.9%), creative problem solving (26.1%) and attending to pandemic-related symptoms (21.7%). Key facilitators endorsed by providers to deliver BA were the use of telemedicine (35.7%) and loosening of government restrictions (21.4%). Both participant groups reported similar barriers to BA during the pandemic such as a lack of privacy and limited activities due to pandemic restrictions. However, providers were more likely to endorse pandemic-related life stressors as a barrier to treatment delivery compared to participants (64.3% vs. 34.8%). Both participant groups experienced explicit discussion of race and the racial justice movements during sessions as beneficial and reported harms of not doing so to the therapeutic alliance. Conclusions BA offers a person-centered model to facilitate social connection through creative problem-solving for women with perinatal depressive and anxiety symptoms within the context of the COVID-19 pandemic. Explicit discussion of race and racial injustice during sessions is an important and helpful aspect in psychological treatments.

Research paper thumbnail of Interpersonal Psychotherapy: A Scoping Review and Historical Perspective (1974–2017)

Harvard Review of Psychiatry, 2019

Background Interpersonal Psychotherapy (IPT) is an affect- and relationally focused, time-limited... more Background Interpersonal Psychotherapy (IPT) is an affect- and relationally focused, time-limited treatment supported by research spanning >4 decades. IPT focuses on stressful interpersonal experiences of loss, life changes, disputes, and social isolation. It emphasizes the role of relationships in recovery. This scoping review describes, within a historical perspective, IPT’s evolution as an evidence-supported treatment of psychiatric disorders. Methods English-language publications (n = 1119) identified via EMBASE, MEDLINE, PsycINFO, and Web of Science databases (1974–2017), augmented with manual reference searches, were coded for clinical focus, population demographics, format, setting, publication type, and research type. Quantitative and qualitative analyses identified IPT publications’ characteristics and trends over four epochs of psychotherapy research. Results IPT literature primarily focused on depression (n = 772 articles; 69%), eating disorders (n = 135; 12%), anxiety disorders (n = 68; 6%), and bipolar disorder (n = 44; 4%), with rising publication rates and numbers of well-conducted randomized, controlled trials over time, justifying inclusion in consensus treatment guidelines. Research trends shifted from efficacy trials to effectiveness studies and population-based dissemination initiatives. Process research examined correlates of improvement and efficacy moderators. Innovations included global initiatives, prevention trials, and digital, web-based training and treatment. Conclusion Sparked by clinical innovations and scientific advances, IPT has evolved as an effective treatment of psychiatric disorders across the lifespan for diverse patients, including underserved clinical populations. Future research to elucidate mechanisms of change, improve access, and adapt to changing frameworks of psychopathology and treatment planning is needed. IPT addresses the universal centrality of relationships to mental health, which is as relevant today as it was over 40 years ago.

Research paper thumbnail of Major Depressive Disorder

Casebook of Interpersonal Psychotherapy, 2012

Chapter 4 describes a case of IPT treatment of major depressive disorder with a focus on role tra... more Chapter 4 describes a case of IPT treatment of major depressive disorder with a focus on role transitions, and how social roles are central to our sense of identity, how all individuals may hold numerous roles (partner, child, parent, sibling, neighbor, community member, etc.), besides having vocational roles (colleague, employee, employer, or professional). It looks at how social roles determine the ‘rules of engagement’ (around communication, sharing of responsibilities) and expectations we have of one another, and how a change in one’s social role (losing a job, moving to another city, becoming partnered, ending a spousal or long-term romantic relationship, adjusting to a disabling or disfiguring medical condition, becoming a new parent) can generate a shift in or loss of one’s sense of self. It examines how these role transitions also evoke changes in one’s needs for or access to social supports and how a role change can be stressful enough to provoke an episode of major depress...

Research paper thumbnail of Psychotherapy Knowledge Translation and Interpersonal Psychotherapy: Using Best-Education Practices to Transform Mental Health Care in Canada and Ethiopia

American journal of psychotherapy, 2014

Psychotherapies, such as Interpersonal Psychotherapy (IPT), that have proven effective for treati... more Psychotherapies, such as Interpersonal Psychotherapy (IPT), that have proven effective for treating mental disorders mostly lie dormant in consensus-treatment guidelines. Broadly disseminating these psychotherapies by training trainers and front-line health workers could close the gap between mental health needs and access to care. Research in continuing medical education and knowledge translation can inform the design of educational interventions to build capacity for providing psychotherapy to those who need it. This paper summarizes psychotherapy training recommendations that: adapt treatments to cultural and health organizational contexts; consider implementation barriers, including opportunity costs and mental health stigma; and engage local opinion leaders to use longitudinal, interactive, case-based teaching with reflection, skills-coaching, simulations, auditing and feedback. Community-based training projects in Northern Ontario, Canada and Ethiopia illustrate how best-educa...

Research paper thumbnail of Continuing education to go: capacity building in psychotherapies for front-line mental health workers in underserviced communities

Canadian journal of psychiatry. Revue canadienne de psychiatrie, 2013

To address the gaps between need and access, and between treatment guidelines and their implement... more To address the gaps between need and access, and between treatment guidelines and their implementation for mental illness, through capacity building of front-line health workers. Following a learning needs assessment, work-based continuing education courses in evidence-supported psychotherapies were developed for front-line workers in underserviced community settings. The 5-hour courses on the fundamentals of cognitive-behavioural therapy, interpersonal psychotherapy, motivational interviewing, and dialectical behaviour therapy each included videotaped captioned simulations, interactive lesson plans, and clinical practice behaviour reminders. Two courses, sequentially offered in 7 underserviced settings, were subjected to a mixed methods evaluation. Ninety-three nonmedical front-line workers enrolled in the program. Repeated measures analysis of variance was used to assess pre- and postintervention changes in knowledge and self-efficacy. Qualitative data from 5 semistructured focus ...