APRIL 26, 2024
Paul J. Barr, MSc, PhD
Associate Professor, The Dartmouth Institute for Health Policy & Clinical Practice
Lisa A. Mistler, MD, MS, FAPA, FASAM
Associate Professor, Department of Psychiatry
Postdoctoral Research Fellow, CTBH
Geisel School of Medicine at Dartmouth
About the Presentation: Substance use disorder (SUD) is a leading cause of disability in the United States. The chronicity of SUD is compounded by often coexisting affective disorders (co-occurring disorders). Psychotherapies have demonstrated efficacy in trials treating a range of mental illnesses, including SUD, but the real-world effectiveness of therapy is lower. The most effective psychotherapy is achieved through continuing therapeutic support with ‘booster sessions’ of therapy, yet this is difficult to achieve due to the limited supply of therapists and cost to patients. Recently, there has been significant growth in the utilization of technology to augment traditional psychotherapy. The use of audio recording is a strategy to increase the effectiveness of psychotherapy and to maintain the positive changes made by patients for co-occurring substance use and affective disorders. In this CTBH pilot project (PIs Barr, Jacobson), we recruited patients receiving psychotherapy for SUD with a co-occurring affective disorder in an outpatient setting. We recorded two therapy sessions per included patient and reviewed these sessions with patients and therapists. This talk will report on the information patients and therapists identified as meaningful and why. We will also present data on the acceptability and feasibility of using recordings as a tool for therapy. Finally, we will describe our ongoing application of NLP to analyze the impact of paralinguistic therapy features on patient experience and predict meaningful moments from therapy.
About the Presenters: Dr. Paul Barr is an Associate Professor in The Dartmouth Institute for Health Policy & Clinical Practice with advanced training in quantitative and qualitative methods. He received a BSc in Psychology, an MSc in Public Health (Health Services Research stream) at the London School of Hygiene and Tropical Medicine, England, and a PhD in Health Services Research from Queen’s University Belfast, Ireland. Paul’s research involves developing and evaluating measurement tools and interventions, to strengthen shared decision making and improve the communication of medical information with patients and their families. His recent work includes the development of a decision support tool for individuals with depression in collaboration with Mental Health America, with the goal of increasing mental health literacy and improving access to online evidence-based treatments.
Paul is also a Gordon and Betty Moore Foundation Patient and Family Engagement awardee. Through this award, Paul formed the Open Recordings research group, a multidisciplinary group of stakeholders and patients who study the potential clinical utility of recording information about healthcare clinic visits. The group is currently developing Health PAL, a personal health library where audio/video recordings of clinic visits are accessible to patients and caregivers, and key information is automatically indexed and connected to trustworthy online resources, with the goal of improving self-management (funding: National Library of Medicine; Gordon & Betty Moore Foundation). He has studied the use of recordings in different clinical settings and leads a Multi-Site Trial, funded by the National Institute on Aging, of the routine use of recordings in older adults in primary care.
Dr. Lisa Mistler is an Associate Professor in the Department of Psychiatry at Geisel School of Medicine. She has a MS in Brain and Cognitive Sciences from MIT, and subsequently attended medical school at the University of Vermont. For many years she has been an attending psychiatrist at New Hampshire Hospital, with a 5 year stint at Worcester Recovery Center and Hospital in Worcester MA. During this time she also developed a research career, obtaining an MS in Health Services Research at The Dartmouth Institute while serving as a VA Quality Scholar 2006-2008. She was the content expert for development of SAMHSA’s antipsychotic medication decision aid, as well as consultant in developing SAMHSA’s Medication Assisted Treatment decision aid. What has kept her engaged and passionate is the ability to help disempowered patients with severe mental illnesses, such as schizophrenia, bipolar disorder and schizoaffective disorder, rediscover the power they have in order to live the lives they envision for themselves. The common thread tying her career activities together has been working side-by-side with patients to maximize their autonomy in making life decisions. In her clinical work, she helped people gain the knowledge, skill, and capacity to manage their illnesses – to effectively take back power so they can be in the driver’s seat of their lives. By focusing on the clinical interview and the power of engagement and communication, she taught medical students and psychiatry residents to gain the therapeutic deftness to work with patients in a much more patient-centered way that supports autonomy. She is now a Research Postdoctoral Fellow on a T32 working with the Barr lab exploring key aspects of clinician-patient communication that facilitate engagement and behavior change.