Digital Ethics, HIPAA, & TeleMental Health

Resources

Online Courses:
TeleMental Health: Practical Applications ~ TeleMental Health: The New Standard
Psychology of the Web ~ HIPAA Made Friendly
HIPAA and Technology in Mental Health Practices
Electronic Health Records ~ Digital and Social Media Ethics
HIPAA’s Patient Access Rights ~ Online Group Therapy

Table Of Contents

Digital Ethics

HIPAA

TeleMental Health

 
 

Digital Ethics

Digital Ethics-General

Therapists Googling Clients

Clients Googling Therapists

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Yelp: Responding to Negative Postings

Facebook & Psychotherapy and Facebook Privacy Issues

Social Media & Psychotherapy and Counseling

Stalking, Harassment & Violations of Privacy

References: Digital and Social Media Ethics

  • American Association for Marriage and Family Therapy (2015). Code of Ethics. Retrieved from https://www.aamft.org/Legal_Ethics/Code_of_Ethics.aspx
  • American Counseling Association (2014). ACA Code of Ethics. Retrieved from https://www.counseling.org/resources/aca-code-of-ethics.pdf
  • American Psychological Association. (2017). Ethical Principles of Psychologists and Code of Conduct. Retrieved from https://www.apa.org/ethics/code/
  • Balick, A. (2013). The psychodynamics of social networking: Connected-up instantaneous culture and the self. London: Karnac Books.
  • Barnett, J., (2009). Social Networking Sites, Clients, and Ethics: Dilemmas and Recommendations. [Lecture]. From International Conference on Use of the Internet in Mental Health, Montreal 2009. Retrieved from http://bcooltv.mcgill.ca/Viewer2/?RecordingID=27892
  • Barnett, Jeffrey E. & Kolmes, Keely.(2016). The practice of tele-mental health: Ethical, legal, and clinical issues for practitioners. Practice Innovations, Vol 1(1), 53-66.
  • Behnke, Stephen, Ethics in the age of the Internet. APA Monitor on Psychology, July/August 2008, 74-75.
  • Blue, V. (2014). Chapter 7: People search websites. In The smart girl’s guide to privacy. (pp. 84-96). Digita Publications Privacy
  • Collins, L. H. (2007). Practicing safer Listserv use: Ethical use of an invaluable resource. Professional Psychology: Research and Practice, 38, 690-698.
  • DiLillo, D., & Gale, E. B. (2011). To Google or not to Google: Graduate students’ use of the Internet to access personal information about clients. Training and Education in Professional Psychology, Vol 5(3), 160-166.
  • Donner, M., (2007). The Ethical Use of the Listserv: Privacy and Professional Conduct, The California Psychologist, November/December 2007, 22.
  • Duncan-Daston, R., Hunter-Sloan, M., & Fullmer, E. (2013). Considering the ethical implications of social media in social work education. Ethics and Information Technology, 15(1), 35–43.
  • Fange, L., Mishna, F., Zhang, V. F., Van Wert, M., & Bogo, M. (2014). Social media and social work education: Understanding and dealing with the new digital world. Social Work in Health Care, 53, 800–814.
  • Gabbard, G.O. (2012). Clinical challenges in the internet era. American Journal of Psychiatry 169(6): 460–462.
  • Kaslow, Florence W.; Patterson, Terence; Gottlieb, Michael. (2011). Ethical dilemmas in psychologists accessing Internet data: Is it justified? Professional Psychology: Research and Practice, Vol 42(2), 105-112.
  • Kolmes, K. (2009). Managing Twitter As a Mental Health Professional. Retrieved from http://drkkolmes.com/2009/05/04/managing-twitter-as-a-mental-health-professional/#.XTc_ni2ZO8U .
  • Kolmes, K. (2010). Private practice social media policy. Retrieved from http://www.drkkolmes.com/docs/socmed.pdf
  • Kolmes, K. (2012). Social Media in the Future of Professional Psychology. Professional Psychology: Research and Practice, Vol 43(6), 606-612
  • Kolmes, K. (2016). Digital and Social Media Multiple Relationships on the Internet. In Ofer Zur (Ed.) Multiple Relationships in Psychotherapy and Counseling: Unavoidable, Mandatory, and Common Relations Between Therapists and Clients. Taylor & Francis.
  • Kolmes, K. & Taube, D. O., (2014). Seeking and Finding Our Clients on the Internet: Boundary Considerations in Cyberspace. Professional Psychology: Research and Practice, Vol 45(1), Feb 2014, 3-10. doi: 10.1037/a0029958
  • Kolmes, K., & Taube, D. O. (2016). Client discovery of psychotherapist personal information online. Professional Psychology: Research and Practice, Vol 47(2), 147-154
  • Lannin, D. G., & Scott, N. A. (2013). Social Networking Ethics: Developing Best Practices for the New Small World. Professional Psychology: Research and Practice, Vol 44(3), 135-141
  • Lehavot, K., Barnett, J., & Powers, D. (2010). Psychotherapy, professional relationships, and ethical considerations in the MySpace generation. Professional Psychology: Research and Practice. Vol 41(2), 160-166.
  • Mattison, M. (2012). Social work practice in the digital age: Therapeutic e-mail as a direct practice methodology, Social Work, 57, 249-258.
  • National Association of Social Workers (2017). Code o Ethics. Retrieved from https://www.socialworkers.org/About/Ethics/Code-of-Ethics/Code-of-Ethics-English
  • Reamer, F. G. (2015). Clinical social work in a digital environment: Ethical and risk- management challenges. Clinical Social Work Journal 43, 120–32.
  • Reamer, F,G. (2018). Ethical Standards for Social Workers’ Use of Technology: Emerging Consensus. Journal of Social Work Values and Ethics. 15/2.
  • Younggren, J. N. (2010). To Tweet or Not to Tweet, That is the Question. The Clinical Psychologist, 63/2, 18-19.
  • Zur, O. (2012). TelePsychology or TeleMentalHealth in the digital age: The future is here. The California Psychologist 45, 13–15.
  • Zur O. & Donner, M.B. (2009, January/February). The Google Factor: Therapists’ Transparency in the Era of Google and MySpace. The California Psychologist, 23-24.

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HIPAA

HIPAA Rules

HIPAA Forms

E-Mails in Traditional Therapy and in TeleMental Health

Hushmail and other secure email services are a good idea, but many, if not most, clients balk at the extra hassle involved in using them to communicate with their therapists, and may choose to use the familiar and free, but unsecured, emails after being informed of the risk by their therapists (via an Informed Consent and e-mail signature.)

Use of Text in Traditional Therapy and in TeleMental Health

Are Square, Credit Cards, & Banks HIPAA Compliant?

Encryption & Computer Security

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Business Associates

HIPAA & NPI: Registration & Basic Info

HIPAA’s Patient Access Rights: What Patients & Providers Need to Know

De-Identification

EHR Information

Cloud Based Management Systems

HIPAA Audits

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TeleMental Health

Telehealth, e-therapy, online therapy, online counseling, tele-medicine, e-counseling, or TeleMental health: all refer to the use of digital technology to provide clinical services, such as assessment and treatment. Telehealth activities may include providing clinical services by telephone, email, chats, interactive televideo communications technology such as Skype, or via virtual reality (VR) such as Second Life (SL), to individuals in conjunction with face-to-face (f2f) therapy or with no in-person contact. States and organizations vary in their definitions of telehealth.

TeleMental Health Platforms

e-therapyMake sure to verify that the platform you choose to use is HIPAA compliant and complies with your state, federal, and your state and national professional organizations rules, codes of ethics, laws, and/or regulations.

TeleMental Health Technology Comparisons: A useful website that compares different TeleMental Health options by Behavioral Health Innovation

 

TeleMental Health Across State Lines

State Lines

State TeleHealth Laws & Licensing Boards

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Video Conferencing

General Information

Skype, while free, familiar and encrypted, is no longer an acceptable option for videoconferencing as part telemental health as it does not give a BAA and is not considered HIPAA Compliant.

Below is a list of several websites that market videoconferencing services to mental health and other professionals. Some of these sites claim to be HIPAA compliant. You must verify that they are, indeed, HIPAA compliant and request a Business Associate Agreement. Also pay attention to cross state lines laws in regulations.

Eye Contact in Video Conferencing

Is Skype HIPAA Compliant?

Is FaceTime HIPAA Compliant?

Ethics Codes on TeleMental Health

Insurance, Billing, Reimbursement & CPT Codes in E-Therapy & TeleMental Health

Insurance and billing for services

Second Life

Second Life & Virtual Realities

Professional Telehealth Associations

Paperless Office

Federal Resources, Laws, and Regulations

Medicare

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Psychology of the Web & TeleMental Health

Psychology of the Web

Guidelines by Prominent Organizations on TeleMental Health

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Miscellaneous Resources

Distance Counseling Bibliography – Florida State University (2015)

Online Graduate Training in Mental Health

  • Chipchase, L., Hill, A., Dunwoodie, R., Allen, S., Kane, Y., Piper, K., & Russell, T. (2016). Evaluating telesupervision as a support for clinical learning: an action research project. International Journal of Practice-based Learning in Health and Social Care, 2(2), 40-53.
  • Dowling, R. et al. (2017). Digital doctorates? An exploratory study of PhD candidates’ use of online tools. Innovations in Education and Teaching International, 54 (1). 76-86.
  • Kumar, Swapna & Johnson, Melissa (2019) Online mentoring of dissertations: the role of structure and support, Studies in Higher Education, 44:1, 59-71, DOI: 10.1080/03075079.2017.1337736
  • McCord, C.E., et al. (2015) Training the next generation of counseling psychologists in the practice of telepsychology, Counselling Psychology Quarterly, 28:3, 324-344, DOI: 10.1080/09515070.2015.1053433
  • Miles (2018) Harnessing opportunities to enhance the distance learning experience of MSW students: an appreciative inquiry process, Social Work Education, 37 (6)705-717, DOI: 10.1080/02615479.2018.1447557
  • Nasiri, F. (2015). Postgraduate research supervision at a distance: a review of challenges and strategies, Studies in Higher Education40 (10), 1962-1969
  • Roumell, Elizabeth & Bolliger, Doris (2017). Experiences of faculty With doctoral student supervision in programs delivered via distance, The Journal of Continuing Higher Education, 65:2, 82-93, DOI: 10.1080/07377363.2017.1320179
  • Stanley-Clarke, Z.E., English, A & Yeung, P (2018). Cutting the distance in distance education: reflections on the use of e-technologies in a new zealand social work program, Journal of Teaching in Social Work, 38 (2) 137-150, DOI: 10.1080/08841233.2018.1433739
  • Vicary, S. (2018). Social work education through distance learning: the challenges and opportunities, Social Work Education, 37:6, 685-690, DOI: 10.1080/02615479.2018.1495050

E-Supervision, TeleSupervision Resources

Online Group Therapy

  • Andersson, G. (2018). Internet interventions: Past, present and future. Internet interventions, 12: 181-188.
  • Trub, L. & Magaldi, D (2017) Left to Our Own Devices, Psychoanalytic Perspectives, 14:2, 219-236.
  • Simpson, S.G. and Reid, C.L. (2014). Therapeutic alliance in videoconferencing psychotherapy: A review. Australian Journal of Rural Health, 22: 280–299.
  • Weinberg, H. (2020). Online GROUP therapy – in search of a new theory? In H. Weinberg & A. Rolnick (eds.) Theory and Practice of Online Therapy: Internet-delivered Interventions for Individuals, Families, Groups, and Organizations. pp: 172-184. New York: Routledge.

References: TeleMental Health, E-Therapy, Online Therapy, Internet Therapy

  • Aguilera, A., & Berridge, C. (2014). Qualitative feedback from a text messaging intervention for depression: Benefits, drawbacks, and cultural differences. JMIR mHealth and uHealth, 2(4), e46. doi:10.2196/mhealth.3660
  • Aguilera, A., & Muñoz, R. F. (2011). Text messaging as an adjunct to CBT in low-income populations: A usability and feasibility pilot study. Professional Psychology: Research and Practice, 42(6), 472-478. http://dx.doi.org/10.1037/a0025499
  • Agyapong, V. I. O., Mrklas, K., Suen, V. Y. M., Rose, M. S., Jahn, M., Gladue, I., & Greenshaw, A. (2015). Supportive text messages to reduce mood symptoms and problem drinking in patients with primary depression or alcohol use disorder: protocol for an implementation research study. JMIR research protocols, 4(2), e55. doi: 10.2196/resprot.4371
  • Alfonsson, S., Olsson, E., & Hursti, T. (2015). The effects of therapist support and treatment presentation on the clinical outcomes of an Internet based applied relaxation program. Internet Interventions, 2(3), 289-296. http://dx.doi.org/10.1016/j.invent.2015.07.005
  • Anderson, K. M., & Cook, J. R. (2015). Challenges and opportunities of using digital storytelling as a trauma narrative intervention for traumatized children. Advances in Social Work, 16(1), 78-89. Retrieved from https://journals.iupui.edu/index.php/advancesinsocialwork/article/view/18132
  • Anderson, K. M., & Wallace, B. (2015). Digital storytelling as a trauma narrative intervention for children exposed to domestic violence. In J.L. Cohen, J. L. Johnson, & P. Orr (Eds.), Video and filmmaking as psychotherapy: Research and practice (pp. 95-107). New York, NY: Routledge.
  • Andersson, G. (2016). Internet-delivered psychological treatments. Annual Review of Clinical Psychology, 12, 157-179. DOI: 10.1146/annurev-clinpsy-021815-093006
  • Andersson, E., Steneby, S., Karlsson, K., Ljótsson, B., Hedman, E., Enander, J., & Rück, C. (2014). Long-term efficacy of Internet-based cognitive behavior therapy for obsessive–compulsive disorder with or without booster: a randomized controlled trial. Psychological Medicine, 44(13), 2877-2887. https://doi.org/10.1017/S0033291714000543
  • Andersson, G., Topooco, N., Havik, O., & Nordgreen, T. (2016). Internet-supported versus face-to-face cognitive behavior therapy for depression. Expert Review of Neurotherapeutics, 16(1), 55-60. http://dx.doi.org/10.1586/14737175.2015.1125783
  • Backhaus, A., Agha, Z., Maglione, M. L., Repp, A., Ross, B., Zuest, D., & Thorp, S. R. (2012). Videoconferencing psychotherapy: A systematic review. Psychological Services, 9(2), 111-131. http://dx.doi.org/10.1037/a0027924
  • Bashshur, R. L., Shannon, G. W., Bashshur, N., & Yellowlees, P. M. (2016). The empirical evidence for telemedicine interventions in mental disorders. Telemedicine and e-Health, 22(2), 87-113. doi:10.1089/tmj.2015.0206.
  • Ben-Zeev, D., Brenner, C. J., Begale, M., Duffecy, J., Mohr, D. C., & Mueser, K. T. (2014). Feasibility, acceptability, and preliminary efficacy of a smartphone intervention for schizophrenia. Schizophrenia Bulletin,40(6), 1244-1253. https://doi.org/10.1093/schbul/sbu033
  • Berle, D., Starcevic, V., Milicevic, D., Hannan, A., Dale, E., Brakoulias, V., & Viswasam, K. (2015). Do patients prefer face-to-face or internet-based therapy?. Psychotherapy and Psychosomatics, 84(1), 61-62. https://doi.org/10.1159/000367944
  • Campbell, L.F., et al. (Eds.) (2017). A Telepsychology Casebook: Using Technology Ethically and Effectively in Your Professional Practice. Washington, DC APA Books.
  • Chang, Jessica et. al (2016). Videoconference grief group counseling in rural Texas: Outcomes, Challenges, and Lessons Learned, The Journal for Specialists in Group Work 41 (2), 140-160.
  • Chen, M. (2002, April). Leveraging the asymmetric sensitivity of eye contact for videoconference. In Proceedings of the SIGCHI conference on Human factors in computing systems (pp. 49-56).
  • Chiad, M. O. (2008). Structural and linguistic analysis of SMS text messages. Journal of Kerbala University, 6(4), 15-27.
  • Cook, J. E., & Doyle, C. (2002). Working alliance in online therapy as compared to face-to-face therapy: Preliminary results. CyberPsychology & Behavior, 5(2), 95–105.
  • Dowling, Mitchell, et al. (2013). Online counseling and therapy for mental health problems: a systematic review of individual synchronous interventions using chat, Journal of Technology in Human Services, 31 (1) , 1-21
  • Dulin, Patrick et al (2014). Results of a pilot test of a self-administered smartphone-based treatment system for alcohol use disorders: Usability and Early Outcomes, Substance Abuse 35 (2), 165-175
  • Duncan, Angela (2014). Using videoconferencing to provide psychological services to rural children and adolescents: a review and case example, Journal of Clinical Child & Adolescent Psychology 43 (1), 115-127.
  • Glueckauf, R. L.; Maheu, M. M.; Drude, K. P.; Wells, B. A.; Wang, Yuxia; G., David J.; Nelson, E. (2018). ​ Survey of psychologists’ telebehavioral health practices: Technology use, ethical issues, and training needs.​ Professional Psychology: Research and Practice, Vol 49(3), 205-219.
  • Goodyear, Roger et. al (2016) A global portrait of counselling psychologists’ characteristics, perspectives, and professional behaviors, Counselling Psychology Quarterly 29 (2), 115-138.
  • Goss, S., Anthony, K., Stretch, L.S., & Nagel, D.M. (2014). The use of technology in mental health (2nd ed.). Springfield, IL: CC Thomas.
  • Herbst, N., Voderholzer, U., Thiel, N., Schaub, R., Knaevelsrud, C., Stracke, S., & Külz, A. K. (2014). No talking, just writing! Efficacy of an internet-based cognitive behavioral therapy with exposure and response prevention in obsessive compulsive disorder. Psychotherapy and Psychosomatics, 83(3), 165-175. https://doi.org/10.1159/000357570
  • Holländare, F., Gustafsson, S. A., Berglind, M., Grape, F., Carlbring, P., Andersson, G., & Tillfors, M. (2016). Therapist behaviours in internet-based cognitive behaviour therapy (ICBT) for depressive symptoms. Internet Interventions, 3, 1-7. https://doi.org/10.1016/j.invent.2015.11.002
  • Inman, Arpana, Soheilian, S & Luu, L (2018). Building Bridges in a digital era, Journal of Clinical Psychology 75 (2).
  • Johnson, Kaprea & Kalkbrenner, Michael (2017) The utilization of technological innovations to support college student mental health: mobile health communication, Journal of Technology in Human Services, 35:4, 314-339, DOI: 10.1080/15228835.2017.1368428
  • Kelson Joshua, Lam Mary, Keep Melanie & Campbell Andrew (2017) Development and evaluation of an online acceptance and commitment therapy program for anxiety: phase I iterative design, Journal of Technology in Human Services, 35:2, 135-151, DOI: 10.1080/15228835.2017.1309311
  • Klein, J. P., Berger, T., Schröder, J., Späth, C., Meyer, B., Caspar, F., & Hautzinger, M. (2016). Effects of a psychological internet intervention in the treatment of mild to moderate depressive symptoms: results of the EVIDENT study, a randomized controlled trial. Psychotherapy and Psychosomatics, 85(4), 218-228. https://doi.org/10.1159/000445355
  • Karyotaki, E., Kleiboer, A., Smit, F., Turner, D. T., Pastor, A. M., Andersson, G., & Christensen, H. (2015). Predictors of treatment dropout in self-guided web-based interventions for depression: An ‘individual patient data’ meta-analysis. Psychological Medicine, 45(13), 2717-2726. https://doi.org/10.1017/S0033291715000665
  • Luxton, D., N,, E. & Maheu, M. (2016). A Practitioner’s Guide to Telemental Health: How to Conduct Legal, Ethical, and Evidence-Based Telepractice. Washington, DC APA Books.
  • Maheu, M. M., Pulier, M. L., Wilhelm, F. H., McMenamin, J. P., & Brown-Connolly, N. E. (2004). The mental health professional and the new technologies: A handbook for practice today. Mahwah, NJ: Erlbaum.
  • McTavish, FM (2012). How patients recovering from alcoholism use a smartphone intervention, Journal of Dual Diagnosis 8 (4), 294-304.
  • Nicholas, David & Chahauver, Anu (2017). Examining computer use by hospitalized children and youth, Journal of Technology in Human Services 35:4, 277-291, DOI: 10.1080/15228835.2017.1366886
  • Nordgren, L. B., Hedman, E., Etienne, J., Bodin, J., Kadowaki, Å., Eriksson, S., & Carlbring, P. (2014). Effectiveness and cost-effectiveness of individually tailored Internet-delivered cognitive behavior therapy for anxiety disorders in a primary care population: A randomized controlled trial. Behaviour Research and Therapy, 59, 1-11. https://doi.org/10.1016/j.brat.2014.05.007
  • Overholser, James C (2015). Training the scientist–practitioner in the twenty-first century: A risk–benefit analysis, Counselling Psychology Quarterly 28 (3), 220-234
  • Pihlaja, S., Stenberg, J.-H., Joutsenniemi, J. Mehik, H., Ritola, V. Joffe, G. (2018). Therapeutic alliance in guided internet therapy programs for depression and anxiety disorders – A systematic review, Internet Interventions. Volume 11, March 2018, Pages 1-10.
  • Radovic, Ana, DeMand, Alexandra, et al. (2017) SOVA: design of a stakeholder informed social media website for depressed adolescents and their parents, Journal of Technology in Human Services, 35:3, 169-182, DOI: 10.1080/15228835.2017.1347552
  • Reese, R. J., & Chapman, N. (2017). Promoting and evaluating evidence-based telepsychology interventions: Lessons learned from the university of Kentucky telepsychology lab. In M. M. Maheu, K. P. Drude, & S. D. Wright. Career paths in telemental health (pp. 255-261). New York, NY: Springer International Publishing.
  • Rozental, A., Forsell, E., Svensson, A., Andersson, G., & Carlbring, P. (2015). Internet-based cognitive—behavior therapy for procrastination: A randomized controlled trial. Journal of Consulting and Clinical Psychology, 83(4), 808-824. http://dx.doi.org/10.1037/ccp0000023
  • Russo, J. V., Bruce, M. A., & Scull, R. (2017). Click here for mental health support: Extending mental health services to the isolated learner. Recruiting & Retaining Adult Learners, 19(4), 1-7. DOI:10.1002/nsr.30211
  • Soucy, J. N., Owens, V. A., Hadjistavropoulos, H. D., Dirkse, D. A., & Dear, B. F. (2016). Educating patients about Internet-delivered cognitive behaviour therapy: Perceptions among treatment seekers and non-treatment seekers before and after viewing an educational video. Internet Interventions, 6, 57-63. https://doi.org/10.1016/j.invent.2016.09.003
  • Suler, J. R. (2000). Psychotherapy in cyberspace: A 5-dimensional model of online and computer-mediated psychotherapy. CyberPsychology and Behavior, 3(2), 151-159. doi:10.1089/109493100315996
  • Titov, N., Fogliati, V. J., Staples, L. G., Gandy, M., Johnston, L., Wootton, B., & Dear, B. F. (2016). Treating anxiety and depression in older adults: Randomized controlled trial comparing guided v. self-guided internet-delivered cognitive–behavioural therapy. British Journal of Psychiatry Open, 2(1), 50-58. doi:10.1192/bjpo.bp.115.002139
  • Vander Stoep, A., McCarty, C. A., Zhou, C., Rockhill, C. M., Schoenfelder, E. N., & Myers, K. (2017). The children’s attention-deficit hyperactivity disorder telemental health treatment study: Caregiver outcomes. Journal of Abnormal Child Psychology, 45(1), 27-43. doi:10.1007/s10802-016-0155-7
  • Whealin, J. M., King, L., Shore, P., & Spira, J. L. (2017). Diverse veterans’ pre-and post-intervention perceptions of home telemental health for posttraumatic stress disorder delivered via tablet. The International Journal of Psychiatry in Medicine, 52(1), 3-20. https://doi.org/10.1177/0091217417703291
  • Wootton, B. M., Dear, B. F., Johnston, L., Terides, M. D., & Titov, N. (2014). Self-guided internet administered treatment for obsessive-compulsive disorder: Results from two open trials. Journal of Obsessive-Compulsive and Related Disorders, 3(2), 102-108. https://doi.org/10.1016/j.jocrd.2014.03.001
  • Yeung, W. F., Chung, K. F., Ho, F. Y. Y., & Ho, L. M. (2015). Predictors of dropout from internet-based self-help cognitive behavioral therapy for insomnia. Behaviour Research and Therapy, 73, 19-24. https://doi.org/10.1016/j.brat.2015.07.008
  • Zhou, E. S., Partridge, A. H., Blackmon, J. E., Morgan, E., & Recklitis, C. J. (2016). A pilot videoconference group stress management program in cancer survivors: Lessons learned. Rural and Remote Health, 16, 3863. Retrieved from http://www.rrh.org.au/articles/subviewnew.asp?ArticleID=3863

 

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