Women’s Behavioral Medicine continues to support patients during COVID-19 pandemic using virtual cognitive behavioral therapy

OBGYN Clinical Update | April 2021

By Sheryl A. Kingsberg, PhD and Erika L. Kelley, PhD

The current COVID-19 pandemic is exacerbating disparities experienced by marginalized groups, including among women and gender-diverse individuals. These disparities due to pandemic conditions are made worse for women in many domains, including in the caregiver workforce, reproductive health care, and mental health and psychological distress. Rates of intimate partner violence, which is already disproportionately experienced by women even in non-pandemic conditions, have escalated during the pandemic, which confers greater risk for a variety of mental and physical health conditions. As an example, rates of depression and anxiety appear to be higher among pregnant and postpartum women during the pandemic, compared with pre-pandemic conditions, with rates shown as high as 40% for depression and 72% for anxiety1,2. Psychotherapy and/or psychotropic medication, available at University Hospitals, are evidence-based treatments for a multitude of mental health conditions affecting women.

Given these challenges, the UH OBGYN Division of Behavioral Medicine hit the ground running and immediately shifted to virtual behavioral health visits on day 1 of the shut down in March 2020. COVID-19 pushed the division to be innovative in providing mental healthcare virtually and patients have embraced it.  Initial concern that a 2-dimensional screen interaction would diminish the necessary personal connection between patient and provider was unfounded. In fact, we find that in many cases, the connection is enhanced and there are clear reasons for this.  First, sitting close up to a computer or phone screen has patient and provider in a much closer face to face gaze than if several feet from each other in an office setting and rarely do people look away from the screen. Second, the provider has a snapshot into a person’s home in the background. Third, it is much easier for patients to get to their appointments - our No-show rates have gone down considerably. There is no driving and parking time required and if a patient forgets about their appointment, we can call to assist and they can immediately log in to their visit. Fourth, often patients are more disclosing on screen when in their own homes than they would be in our hospital offices. 

Fortunately, commercial and government insurance has supported telehealth and it looks like that will continue. Data supports the effectiveness of virtual cognitive behavioral therapy (CBT) in treating mental health conditions as comparable in person CBT3,4,5,6. In addition, our patient referral base has now expanded across the entire state and soon may expand to other states.  We can reach people who otherwise would have no access to mental health care. This is particularly helpful for new mothers with postpartum depression—they no longer have to bundle the baby and try to manage the logistics of getting herself and her baby to our office for a session. Instead, she can see us comfortably from her home.

The Division of Behavioral Medicine is a particularly special addition to the Department of Obstetrics and Gynecology. Very few hospitals worldwide include such a division within a medical department. The Behavioral Medicine faculty provides both outpatient in-person and virtual appointments and are active in teaching and research on patient behavior, interviewing skills, health promotion and counseling, management of chronic illness, and women’s health.

This division specializes in women's reproductive health issues including:

• Infertility
• Pregnancy loss
• Pregnancy and postpartum-related mood disorders
• Sexual disorders
• Menopause
• Gynecologic oncology
• Gynecologic pain disorders
• Gender and transgender health

To schedule an appointment phone 216-844-5086.

References

1. Davenport MH, Meyer S, Meah VL, Strynadka MC and Khurana R (2020) Moms Are Not OK: COVID-19 and Maternal Mental Health. Front Glob Womens Health 1: doi: 10.3389/fgwh.2020.00001.
2. Lebel C, MacKinnon A, Bagshawe M, Tomfohr-Madsen L, Giesbrecht G. Elevated depression and anxiety symptoms among pregnant individuals during the COVID-19 pandemic. J Affect Disord. 2020;277:5-13. doi:10.1016/j.jad.2020.07.126.
3. Thomas N, McDonald C, de Boer K, Brand RM, Nedeljkovic M, Seabrook L. Review of the current empirical literature on using videoconferencing to deliver individual psychotherapies to adults with mental health problems. Psychol Psychother. 2021 Feb 23. doi: 10.1111/papt.12332. Epub ahead of print. PMID: 33620133.
4. Stubbings DR, Rees CS, Roberts LD, Kane RT. Comparing in-person to videoconference-based cognitive behavioral therapy for mood and anxiety disorders: randomized controlled trial. J Med Internet Res. 2013;15(11):e258. Published 2013 Nov 19. doi:10.2196/jmir.2564.
5. Berryhill MB, Culmer N, Williams N, Halli-Tierney A, Betancourt A, Roberts H, King M. Videoconferencing Psychotherapy and Depression: A Systematic Review. Telemed J E Health. 2019 Jun;25(6):435-446. doi: 10.1089/tmj.2018.0058. Epub 2018 Jul 26. PMID: 30048211.
6. Sztein DM, Koransky CE, Fegan L, Himelhoch S. Efficacy of cognitive behavioral therapy delivered over the Internet for depressive symptoms: A systematic review and meta-analysis. J Telemed Telecare. 2018 Sep;24(8):527-539. doi: 10.1177/1357633X17717402. Epub 2017 Jul 11. PMID: 28696153.