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BMC Psychiatry
Published in: BMC Psychiatry 1/2021

Open Access 01-12-2021 | COVID-19 | Research

Treatment provision for adults with ADHD during the COVID-19 pandemic: an exploratory study on patient and therapist experience with on-site sessions using face masks vs. telepsychiatric sessions

Authors: Helen Wyler, Michael Liebrenz, Vladeta Ajdacic-Gross, Erich Seifritz, Susan Young, Pascal Burger, Anna Buadze

Published in: BMC Psychiatry | Issue 1/2021

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Abstract

Background

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.

Methods

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.

Results

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.

Conclusions

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.
Appendix
Available only for authorised users
Footnotes
1
At the time of data collection, wearing face masks during therapy sessions was not compulsory in Switzerland. However, as of late March 2020, the outpatient clinic made wearing a face mask mandatory for staff with direct patient contact to protect the patients.
 
2
This means that most of the data collection took place during the extraordinary situation in Switzerland, which lasted from the 16th of March until the 19th of June.
 
3
Due to a technical error, item 6 was missing from the questionnaire, which means that the subscale smoothness consisted of 4 instead of 5 items.
 
4
Sensitivity analyses comparing the face-to-face and telephone group were conducted to explore whether the results were affected by collapsing the two telepsychiatric modalities. Results were fairly similar to the main analyses, although two trends (p < .10) emerged, one for WAI-SR-P bond and WAI-SR-T tasks, indicating lower ratings in the telephone condition than in the face-to-face condition for both instances. Telephone sessions were still rated as significantly less deep than face-to-face sessions (B = − 0.60, p = .049). The regression coefficients from the sensitivity analyses can be seen from Table M in the Supplementary File 1.
 
5
Although therapists indicated for the majority of patients that the modality choice was based on or in line with the patients’ request (see Table 1), a patient’s request may not necessarily be identical with their preferred choice out of the five options (e.g. a patient may have experienced light symptoms but still wanted to attend the therapy session and therefore requested changing the format to a telepsychiatric session).
 
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Metadata
Title
Treatment provision for adults with ADHD during the COVID-19 pandemic: an exploratory study on patient and therapist experience with on-site sessions using face masks vs. telepsychiatric sessions
Authors
Helen Wyler
Michael Liebrenz
Vladeta Ajdacic-Gross
Erich Seifritz
Susan Young
Pascal Burger
Anna Buadze
Publication date
01-12-2021
Publisher
BioMed Central
Keyword
COVID-19
Published in
BMC Psychiatry / Issue 1/2021
Electronic ISSN: 1471-244X
DOI
https://doi.org/10.1186/s12888-021-03236-9

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