Transfer of face-to-face group therapies into online group-chats in a psychiatric outpatient setting during the COVID-19 pandemic.

BACKGROUND: At the height of the COVID-19 pandemic, several mental health care providers were obliged to shut down outpatient services, including group therapies and psychoeducational sessions. The lockdown in many countries is a serious threat for mental well-being, especially for individuals with severe mental illnesses. Discontinued outpatient treatments and a disruption of daily routines are considered to be a risk factor for destabilization of mentally ill patients.
OBJECTIVE: The aim of the present study was to evaluate the acceptability, usability, and feasibility of a group-chat program to replace cancelled face-to-face (f2f) group sessions in an outpatient psychiatric department.
METHODS: Participants (n = 33) were recruited in the outpatient department of a large university medical center in Leipzig, Germany. Former f2f group participants were invited to take part in a therapist-guided group-chat for four weeks (eight sessions) and were asked to evaluate the program via self-administered standardized questionnaires at baseline (T0, pre-intervention), after every chat session (T1), and post-treatment (T2, after 4-6 weeks). The chat groups were specific to the following mental disorder diagnoses and based on the same therapeutic principles and techniques as the former f2f groups: anxiety, depression, obsessive-compulsive disorder (OCD), and adult attention deficit hyperactivity disorder (ADHD). Sociodemographic measures, attitudes towards the COVID-19 pandemic, depressive symptoms (PHQ-9), quality of life (WHOQOL-BREF), treatment credibility/expectancy (CEQ), and participants' satisfaction (ZUF-8) were measured.
RESULTS: Participants joined an average of 5.0 out of eight offered chat sessions. Participation rates in the respective groups were highest in the ADHD group (78.2%) and lowest in the anxiety group (41.1%). The overall pre-intervention level of depressive symptoms was moderate and showed a slight, non-significant improvement at post-treatment (T0: M = 10.7, SD = 5.5; T2: M = 10.2, SD = 5.5). A similar result was observed regarding quality of life (T0: Median = 41.7 - 68.8; T2: Median = 50.0 - 70.3). Treatment credibility and expectancy scores were medium high (T0: Mcredibility = 18.1, SD = 3.8; Mexpectancy = 11.2, SD = 5.1; T2: Mcredibility = 17.1, SD = 4.8; Mexpectancy = 10.3, SD = 5.8). Further, significant correlations were detected between post-treatment expectancy score and post-treatment PHQ-9 score (r = -0.41; p = .024), post-treatment physical quality of life (r = 0.54; p = .001) and post-treatment psychological quality of life (r = 0.53; p = .002). Overall, participants' satisfaction with the program was very high, both after chat sessions and at post-treatment (ZUF-8: M = 20.6, SD = 1.0). Of all participants, a majority (87.1%) rated the program as excellent/good and would recommend the group-chat program to a friend in need of similar help (83.9%).
CONCLUSIONS: A therapist-guided group-chat program to substitute outpatient group-setting treatment during the COVID-19 lockdown was shown to be feasible, usable, and highly acceptable for participants. Online programs, such as this one, provide an easy to implement tool to successfully stabilize participants during a difficult pandemic time. CLINICALTRIAL: The study was approved by the ethics committee of the Medical Faculty of the University of Leipzig (133/20-ek, 03/2020) and is registered in the German Clinical Trials Register: DRKS00021527.