Telehealth for PMDD: Tips from a PMDD Provider

 
 

Liisa Hantsoo, Ph.D. is a Clinical Psychologist and Assistant Professor with the Department of Psychiatry at The University of Pennsylvania Perelman School of Medicine. Hantsoo is also an active member of the IAPMD Clinical Advisory Board.


What is telehealth?

The Mayo Clinic describes telehealth as “the use of digital information and communication technologies, such as computers and mobile devices, to access health care services remotely and manage your health care”. Telehealth comes from the root word “tele,” meaning “distant”. 1 In its simplest form, telehealth refers to the communication of health-related information long-distance, which these days typically involves digital or wireless communication. Telehealth ranges from the text reminders that you receive about an upcoming doctor appointment, to the app you use to track your menstrual cycle, to wearable devices, to having a video session with your therapist.2,3 In this post, we’ll focus on telehealth options for psychotherapy.

Telehealth in Psychotherapy

While traditional psychotherapy involves meeting with your therapist in person, the internet, mobile apps, and wireless technology have ushered in a wide range of new options for mental health care. In some cases, this has moved psychotherapy out of the traditional office setting. Three major forms of telehealth mental healthcare have emerged. First are self-help programs, in which a person works through online or app-based modules of mental health education and exercises without guidance from a therapist, similar to using a self-help book.4 MoodGym and Moodhacker are examples of self-guided programs. A step up from this is computer-assisted or internet-based CBT (iCBT), in which the patient does some self-guided work online, using programs such as Good Days Ahead, with brief check-ins with a therapist.5,6

Finally, the option that includes the most involvement with a therapist is computer-mediated or online psychotherapy, which is similar to a traditional psychotherapy session but done via video conferencing. Instead of meeting face-to-face with your therapist in their office, you are video chatting with them, similar to Skyping or FaceTiming. Some examples of online therapy services are BetterHelp and Talkspace; the American Psychological Association (APA) has a list of popular online therapy services as well.

Advantages and Disadvantages

There are both advantages and drawbacks to using telehealth in mental healthcare settings. On the plus side, telehealth can enable access to psychotherapy to people who otherwise might not be able to access it. For instance, if you live in a remote region where there are few therapists available, online therapy may be more accessible to you. And whether you live in a dense city or a rural area, online therapy lets you bypass a long commute to a therapist’s office. Also, depending on the online therapy provider, it may provide flexibility in scheduling, i.e. connecting with your therapist outside of traditional 9-5 office hours when it may be hard to get away from your desk.

As with any emerging technology, there are areas where improvements are needed. First, not all insurance providers will cover online therapy; you should check with your therapist or insurance provider to find out what is covered. In some cases, certain aspects (such as an hour-long online therapy session) may be covered, while others (e.g. telephone or text-based interaction) may not be. Another potential risk is that commonly-used video conferencing services such as Skype or Facetime may not provide secure, private transmission of data. To comply with health information privacy rules, some online therapy services have implemented secure, encrypted communication channels to ensure your privacy. Finally, video chatting with your therapist from the privacy of your living room is one thing, but chatting from a less private setting, such as a coffee shop or on public transit, is entirely different. Clearly, it’s important to find a private setting where you can be uninterrupted for your online therapy session!

Help for PMDD

If you have PMDD, how might online therapy fit into your mental wellness plan? Psychotherapy can be a great tool in managing symptoms of PMDD. However, there are some unique challenges when seeking psychotherapy treatment for PMDD, whether online or in a traditional setting. First, there is a shortage of qualified providers who are trained in the diagnosis and treatment of PMDD. Second, PMDD is unique in its cyclic nature. It requires daily tracking of symptoms for at least two menstrual cycles to be properly diagnosed.7,8 This calls for care and dedication from both the patient and provider, to ensure accurate diagnosis and ongoing monitoring of symptom worsening or improvement. Third, there have been few clinical studies of psychotherapy specifically for PMDD.9,10 Many therapists who treat PMDD use techniques from cognitive-behavioral therapy (CBT), acceptance and commitment based therapy (ACT) or mindfulness-based techniques. These are all empirically supported techniques that have been studied in clinical trials for anxiety disorders and mood disorders. These techniques can help you identify triggers for mood changes that occur with your PMDD, help you manage strong emotions, notice and modify negative thoughts that you might have premenstrually, address interpersonal interactions that are affected by PMDD or provide physical relaxation tools such as breathing techniques or muscle relaxation.

Advice from a PMDD Provider When Considering Psychotherapy Treatment

As a clinical psychologist who specializes in PMDD treatment, and has done research on telehealth in mental health settings,11,12 here are a few tips for those who are looking into psychotherapy options for PMDD:

  • When looking into a new therapist, whether you prefer online or a traditional setting, it is important to find out whether they are experienced in treating PMDD, and what treatment techniques they use (e.g. CBT, mindfulness, etc). If you are seeking an online therapist, ask how long they have been providing online therapy, and what measures they implement to ensure the privacy of your data and communications.
  • As mentioned above, cost and insurance coverage can be an important consideration. Ask your provider or your healthcare insurer about their policies for online therapy coverage. Find out the cost per session for online therapy, including how long each session is and how many sessions are included, and ask whether additional communication such as texts or emails cost extra.
  • If you go the self-guided route, there are a LOT of mental health apps out there. Choosing an app that was designed based on clinical research by qualified mental health professionals is important. The University of California Irvine maintains a database of mental health apps, called Psyberguide, that provides information on dozens of apps and their reputability.
  • The American Psychological Association (APA), the organization that sets the standard for psychotherapy practice in the U.S., has developed guidelines for therapists and patients surrounding the use of telehealth in mental healthcare, which is worth a look for anyone considering online therapy.
  • The APA also provides a helpful list of questions that you might want to ask a potential online therapist.

References

  1. tele- | Origin and meaning of tele- by Online Etymology Dictionary [Internet]. [cited 2019 Mar 15]. Available from: https://www.etymonline.com/word/tele-
  2. Telehealth [Internet]. Wikipedia. 2019 [cited 2019 Mar 15]. Available from: https://en.wikipedia.org/w/index.php?title=Telehealth&oldid=887650228
  3. What is Telehealth? [Internet]. NEJM Catalyst. 2018 [cited 2019 Mar 15]. Available from: https://catalyst.nejm.org/what-is-telehealth/
  4. Birney AJ, Gunn R, Russell JK, Ary DV. MoodHacker Mobile Web App With Email for Adults to Self-Manage Mild-to-Moderate Depression: Randomized Controlled Trial. JMIR Mhealth Uhealth [Internet]. 2016 [cited 2016 Jul 18];4. Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4748138/
  5. Mohr DC, Duffecy J, Ho J, Kwasny M, Cai X, Burns MN, et al. A randomized controlled trial evaluating a manualized TeleCoaching protocol for improving adherence to a web-based intervention for the treatment of depression. PLoS ONE. 2013;8:e70086.
  6. Stefanopoulou E, Lewis D, Taylor M, Broscombe J, Ahmad J, Larkin J. Are Digitally Delivered Psychological Interventions for Depression the Way Forward? A Review. Psychiatr Q. 2018;89:779–94.
  7. Eisenlohr-Moul TA, Girdler SS, Schmalenberger KM, Dawson DN, Surana P, Johnson JL, et al. Toward the Reliable Diagnosis of DSM-5 Premenstrual Dysphoric Disorder: The Carolina Premenstrual Assessment Scoring System (C-PASS). Am J Psychiatry. 2016;appiajp201615121510.
  8. Epperson CN, Hantsoo LV. Making Strides to Simplify Diagnosis of Premenstrual Dysphoric Disorder. Am J Psychiatry. 2017;174:6–7.
  9. Lustyk MKB, Gerrish WG, Shaver S, Keys SL. Cognitive-behavioral therapy for premenstrual syndrome and premenstrual dysphoric disorder: a systematic review. Arch Womens Ment Health. 2009;12:85–96.
  10. Kleinstäuber M, Witthöft M, Hiller W. Cognitive-behavioral and pharmacological interventions for premenstrual syndrome or premenstrual dysphoric disorder: a meta-analysis. J Clin Psychol Med Settings. 2012;19:308–19.
  11. Kim DR, Hantsoo L, Thase ME, Sammel M, Epperson CN. Computer-assisted cognitive behavioral therapy for pregnant women with major depressive disorder. J Womens Health (Larchmt). 2014;23:842–8.
  12. Hantsoo L, Podcasy J, Sammel M, Epperson CN, Kim DR. Pregnancy and the Acceptability of Computer-Based Versus Traditional Mental Health Treatments. J Womens Health (Larchmt). 2017.