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Mental Health

Sleep loss can interrupt the ability of the brain to ‘unlearn’ fear

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A study demonstrates how having less sleep than normal can affect the ability of the brain to suppress fear. The result helps understand why people are more susceptible to anxiety and post-traumatic stress disorder (PTSD) because of regular sleep disturbances.

In sustaining mental health, sleep plays a crucial role. According to a systematic analysis of studies published in 2019, people with insomnia, for example, are nearly three times more likely to develop an anxiety disorder compared to those who sleep normally.

Other studies show that people who experience recurrent sleep problems have a higher risk of PTSD, a common concern for health professionals and military personnel.

The very important factor in this increased risk appears to be not having enough rapid eye movement (REM) sleep, which is the sleep stage where most dreaming occurs.

In general, sleep, and REM sleep in particular, are considered to play a crucial role in the “extinction of fear.” This is the learning process where the stimuli previously associated with negative feelings or interactions are now harmless.

In the journal Biological Psychiatry: Cognitive Neuroscience and Neuroimaging, a recent brain-imaging study reveals how sleep deprivation disrupts the capacity of the brain to forget fear-provoking memories the following day.

Three nights in a sleep lab

At Harvard Medical School and Massachusetts General Hospital in Charlestown, MA, sleep researchers, led by Anne Germain, Ph.D., at the University of Pittsburgh, PA, and Edward Pace-Schott, Ph.D., invited 154 volunteers to spend three nights in a sleep lab.

The researchers allowed them to follow their normal sleep cycles on the first night. The scientists, however, randomly assigned them to one of three groups on the second night: normal sleep, sleep restriction, and sleep deprivation.

The regular sleep group was able to go to bed and wake up at their usual hours, while after sleeping half their usual number, the research team woke the sleep restriction group. The sleep deprivation group were not allowed any sleep at all.

The next morning, the participants underwent a typical experimental protocol for conditioning fear and extinction, while the researchers used functional MRI to scan their brains.

The technique for conditioning fear involved displaying three distinct colors to subjects, one at a time on a screen while they were in the scanner.

The appearance of two of the colors was followed by a mild electric shock. It taught the respondents to equate these colors with being surprised.

In the absence of any shock, one of these colors was then presented to remove this fear of learning, encouraging participants to learn that it was now “safe.”

In the evening, the volunteers were again faced with the colors inside the MRI scanner to find out if the fear conditioning had been effectively removed.

The scans showed that the brains of those who had slept normally engaged a network of regions called the salience network, which is involved in conditioned fear, during the extinction procedure. They also used prefrontal cortex regulatory areas that suppress emotions like fear.

In comparison, the salience network and regions of pain aversion were strongly activated at all stages in the brains of subjects whose sleep was controlled. Their regulatory regions have remained relatively quiet.

“We found that among the three groups, those who had only had half a night’s sleep displayed the most fear-related activity in brain regions and the least activity in emotion control-related areas,” says Dr. Pace-Schott.

All the volunteers were granted permission to sleep as usual on their third night in the lab.

The importance of REM sleep

The researchers speculate that only sleeping the first half of the night deprives a person of most of their REM sleep, which occurs mostly towards the end of a normal period of sleep.

Studies have shown that REM sleep helps people unlearn the previous day’s frightening memories. The new study indicates that it is also necessary on the following day to unlearn fear conditioning.

The researchers were shocked to discover that during the experiment’s fear conditioning and extinction phases, fear-related regions in the brains of participants who were completely deprived of sleep did not work.

In the evening, when the researchers checked the memories of participants of the extinction of fear, the activity pattern in their brains was identical to that in the brains of subjects who usually slept.

The scientists speculate that when people are completely sleep-deprived, a compensatory mechanism will kick in, shielding their brains from conditioning terror.

They write that a similar mechanism can explain why through sleep deprivation therapy, some people with depression experience a temporary easing of their symptoms.

The current research, however, indicates that partial deprivation of sleep does not activate this protective mechanism.

“Medical workers and soldiers often have curtailed or interrupted sleep rather than missing an entire night’s sleep […] Our findings suggest that such partially sleep-deprived individuals might be especially vulnerable to fear-related conditions such as PTSD.”

– Dr. Pace-Schott

The results may also have implications for PTSD and phobia exposure therapy, which includes exposing patients in a controlled therapeutic setting to fear-provoking stimuli. After a bad night’s sleep, they say the treatment could not work well.

One significant limitation of their study the authors note, was that it tested the influence of a single night of reduced sleep. Deprivation of chronic sleep may have numerous effects on the brain and its ability to unlearn fearful memories.

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What is telepsychiatry? Benefits and efficacy

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Telepsychiatry is a technique that employs a telecommunications equipment to deliver psychiatric services to people who live far away from a psychiatrist or who prefer to be at home.

Telepsychiatry may provide a number of advantages, including more ease and accessibility.

The advantages and disadvantages of telepsychiatry are discussed in this article.

Definition

telepsychiatry

Telepsychiatry is a telemedicine subspecialty.

Telemedicine is a type of healthcare delivery that uses video-based technology to provide a variety of services to patients.

Psychiatrists can communicate with patients directly over the phone or via video conferencing using telepsychiatry. Some people choose to have their medical information recorded.

According to the American Psychiatric Association (APA), telepsychiatry can encompass the following services:

  • client education
  • medication management
  • individual therapy
  • psychiatric evaluations and diagnoses
  • group therapy
  • family therapy

Is it effective?

For many people, telepsychiatry can be a viable alternative to traditional in-person psychiatric services.

Telemedicine, according to research, is a cost-effective and effective method of increasing client access to doctors.

According to the American Psychological Association (APA), there is considerable evidence that telepsychiatry can result in improved outcomes and high client satisfaction ratings.

They also claim that telepsychiatry is comparable to in-person care in the following ways:

  • the accuracy of diagnosis
  • the effectiveness of treatment
  • the quality of care
  • client privacy and confidentiality

Telepsychiatry has been shown to be effective in the treatment of post-traumatic stress disorder. It is also effective and tolerable in the treatment of depression, according to studies.

Telepsychiatry is also a successful therapy option for:

According to a review published in 2016, the majority of the research included confirmed that telepsychiatry was a viable and acceptable treatment option for people of all ages.

Benefits

Telepsychiatry has the advantage of being a realistic and cost-effective alternative to in-person psychiatric services.

It’s appropriate for people of all ages, including kids, teenagers, and adults. Telepsychiatry may be preferable to face-to-face treatment for some people, such as autistic people and those with severe anxiety problems.

Other advantages could include:

Accessibility and convenience

Telepsychiatry is a therapeutic option for psychiatrists who need to treat patients in rural or remote locations.

If clients are unable to travel, it can give an easier option for them to get psychiatric services.

It might also mean that you don’t need to take as much time off from job or school.

Care of high quality

Clients and providers alike express high levels of satisfaction with telepsychiatry, according to a 2016 study. Parents and caregivers seeking psychiatric services for their children appear to be particularly satisfied, according to the survey.

According to the same analysis, telepsychiatry appears to be more successful than standard care.

Some people may feel more comfortable opening up in the privacy of their own home.

Cost

Telepsychiatry, according to a 2016 report, can be cost effective.

In comparison to face-to-face treatment, telepsychiatry saves indirect and direct expenditures, according to the paper.

How does it work, and where can a person use it?

Telepsychiatry works in the same way as in-person appointments do.

A person should seek medical help from a nearby clinic or a doctor. They’ll be referred to a psychiatrist after that.

By contacting the psychiatrist who provides the service, the clinic, doctor, or client can schedule the initial telepsychiatry appointment.

The client can log in to the proper video conferencing platform and wait for the psychiatrist to come online once they have an appointment time. Alternatively, they could wait for a call.

Clients should make sure they have all essential records and information on hand, including prescription details. They should also write down any questions or concerns they have.

In-person and telepsychiatry appointments both follow the same criteria and are often formatted in the same way. The psychiatrist and their patient will talk about the issues and goals that are important to them.

The psychiatrist may be able to:

  • create and implement treatment plans
  • prescribe medication
  • schedule follow-up appointments
  • refer the client to other services

Telepsychiatric services are available in a variety of locations, including:

  • mental health centers
  • nursing homes
  • primary care centers
  • prisons
  • residential treatment facilities
  • schools

Is it covered by insurance?

Before booking a telepsychiatry session, people should check with their insurance provider.

The APA provides a map showing the 32 states that have passed legislation allowing for private telemedicine insurance. They also recommend that Medicaid reimbursement plans in 48 states cover some telepsychiatric services.

What to look for in a provider

People should think about the service provider attentively. They should talk to their primary care physician about it.

When looking for a supplier, there are a few things to think about:

  • licensure or credentialing
  • education and training in the field
  • supervision

People should also strive to learn more about the fees and whether telepsychiatry is covered by their insurance.\

Online treatment vs. online telepsychiatry

Telepsychiatry is provided by psychiatrists, whereas internet treatment and counselling is provided by psychologists and psychotherapists.

Both strategies entail direct contact between the client and a therapist or psychiatrist.

Psychiatrists are medical specialists who can diagnose illnesses and, if necessary, provide medication.

Psychologists, therapists, and counsellors aren’t doctors, thus they can’t give you medicine. However, some advanced practise registered nurses are mental health specialists who can write drug prescriptions.

However, a mental health condition can be diagnosed by a psychologist. Psychiatrists can collaborate with them. Therapists can also diagnose mental illnesses, although they are unable to conduct psychological assessments.

Conclusion

Telepsychiatry is a type of telemedicine that provides psychiatric services via phone or video conferencing.

Telepsychiatry practitioners can examine and diagnose, give therapy, and prescribe medication just like in-person psychiatric treatment.

Telepsychiatry appears to be equally as successful as in-person treatment, and for some people, it may even be preferable.

Anyone interested in learning more about telepsychiatry should contact their doctor or psychiatrist.

Sources:

  • https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4744872/
  • https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4582305/
  • https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3709879/
  • https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6661519/
  • https://www.medicalnewstoday.com/articles/telepsychiatry
  • https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4919267/
  • https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3574452/
  • https://www.psychiatry.org/psychiatrists/practice/telepsychiatry
  • https://www.psychiatry.org/patients-families/what-is-telepsychiatry

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Mental Health

Types, uses, and costs of virtual therapy

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Virtual therapy is counselling conducted over the phone, through an app, via video chat, or even through a virtual reality device.

These virtual therapy solutions allow people to receive treatment from the comfort of their own homes, rather than needing to travel to a therapist’s office.

Virtual therapy comes in a variety of forms, each with its own set of benefits and drawbacks. Continue reading to learn more.

Definition

virtual therapy

Telemedicine includes virtual therapy. It encompasses any treatment obtained through the use of an electronic gadget.

The following are some examples of virtual therapy:

  • talking to a practitioner via videoconferencing software
  • using an app to access therapy
  • phone- and email-based therapies, such as when a physical therapist suggests specific exercises via email
  • the use of online devices to assess clients or patients remotely — for instance, when a speech therapist uses online tools to measure progress

Types

Virtual platforms can theoretically be used for any treatment that does not require physical touch or laboratory tests.

The following are the most common types of virtual therapy:

Virtual psychotherapy

Virtual psychotherapy, also known as telemental health or telepsychology, uses video chat, email, phone, text messaging, or email to treat people with mental health concerns, relationship or sexual health problems, or considerable stress.

A licenced therapist conducts traditional treatment through a new platform in most virtual psychotherapy sessions. A client may express their emotions, seek insight into their relationships, and request assistance in making lifestyle adjustments.

Apps or coaching are used in a contemporary form of virtual psychotherapy to improve mental health. Because a person does not receive care from a licenced practitioner, this practise is not considered traditional therapy. They may instead track their own symptoms over time, receive virtual counselling from a bot, or receive daily mental health suggestions.

Virtual physical therapy

Traditional physical therapy is provided in an online or phone-based context using virtual physical therapy. A physical therapist may talk about recent complaints, suggest exercises, or perform testing.

A therapist may ask a client to complete exercises and then analyse their form and progress using a camera.

Some physical therapy applications supplement therapy by providing extra exercises or allowing clients to track their progress in between sessions. These apps can be used in conjunction with virtual or in-person therapy.

Virtual speech therapy

Virtual speech therapy can be used to treat a variety of speech issues, including stuttering, aphasia from a stroke, and difficulty pronouncing words.

A therapist may examine a person’s speech in a virtual session, suggest strategies for resolving speech difficulties, or assist them in practising new speech patterns. To improve speech, a new type of virtual speech therapy uses bots instead of real people.

Virtual speech therapy apps are also available to help people achieve their speech objectives in between sessions or track their progress over time.

Virtual occupational therapy

Occupational therapy is a type of therapy that assists people in learning new skills. It is frequently used in conjunction with other people of treatment. A person who has speech problems as a result of a stroke, for example, can select speech treatment first, then occupational therapy to help them learn the motor skills needed to use a speech assistive device.

A therapist provides coaching, advice, and feedback on techniques via a virtual platform, such as video chat, in virtual occupational therapy. Virtual reality may also be used in some forms of virtual occupational therapy to simulate real-world circumstances that the individual may encounter.

Advantages and disadvantages

When choosing virtual treatment, a client or healthcare provider should weigh the benefits and drawbacks:

Advantages

Virtual therapy is still a very young field, and researchers haven’t thoroughly examined every treatment option. However, preliminary study indicates that it might be useful.

In a 2020 trial of virtual physical therapy after knee surgery, researchers discovered that virtual therapy provided equal benefits to in-person treatment. It also resulted in significant cost savings.

Telemental health services, according to the authors of a 2017 systematic review, provide a similar level of care and outcomes to traditional mental health care.

Virtual therapy also has the following advantages:

  • Increased access to care: Virtual treatment solutions are available to people with physical limitations, who are geographically isolated, or who do not have time to drive to therapy.
  • More privacy: Virtual therapy that is well-managed allows a person to get care in the comfort of their own home, without having to wait in a waiting room or contact with other clients.
  • Cost savings: Virtual therapy may be less expensive. The therapist’s overheads may be reduced, especially if they transition to an all online model of therapy.
  • Client satisfaction: The majority of research on client satisfaction with virtual therapy suggests that it is at least as good as traditional therapy. Virtual care may be less stressful for certain people, resulting in more satisfaction.

Disadvantages

The following are some of the disadvantages of virtual therapy:

  • Data concerns: A third party could infringe on a client’s privacy if a therapist uses the inappropriate platform or fails to encrypt treatment sessions. If a customer seeks help via a public network or leaves their computer unlocked, their coworkers or roommates may be able to see their sessions.
  • Relationship issues: It may be more difficult to build a trusting relationship with the therapist depending on the method chosen by the client. Email-based treatment, for example, eliminates body language and voice tone clues, thereby producing communication problems.
  • Limitations of technology: Therapy can be made more difficult by slow networks, low-quality video, and chat delays.
  • Expertise in technology and philosophy: People who aren’t used to using technology may be less at ease with virtual treatment or feel more nervous about it.

Cost

Virtual therapy has been shown to cut healthcare expenses in several studies. Because therapists have lower overhead costs, they may be able to charge less. Because telehealth can enhance access, it has the potential to save long-term costs by allowing people to receive the preventative care they require and encounter fewer serious health problems.

Virtual therapy is likely to save money on things like automobile maintenance, gas, childcare, and lost work time.

However, not all virtual therapists provide telehealth sessions at a reduced rate. Medicare patients, for example, typically pay the same fee for online care as they would for in-person treatment.

Virtual care is not covered by all insurers, and there is no universal set of rules requiring them to do so. Anyone seeking virtual treatment should speak with their insurance provider about coverage choices or look into alternate payment methods.

Providers

A licenced professional is required to practise telemedicine. Licensing concerns may arise for providers, especially if they practise outside state lines.

Clients should examine licencing regulations and inquire about their therapist’s licence because each state licencing board has its own set of rules.

When a corporation provides support through an app or gives advice from an unlicensed practitioner, they must usually state that they are not providing medical care. A mental health app that provides daily mental health recommendations, for example, cannot claim to provide psychotherapy.

Conclusion

When a person does not want to leave home, or cannot or should not, like in the case of the COVID-19 pandemic, virtual therapy is an excellent choice.

It’s important to check the provider’s qualifications, set specific goals, provide feedback on how well the treatment is going, and transfer providers if the treatment isn’t working.

Sources:

  • https://www.healthit.gov/faq/are-there-state-licensing-issues-related-telehealth
  • https://www.liebertpub.com/doi/abs/10.1089/tmj.2015.0002
  • https://www.sciencedirect.com/science/article/pii/S0885230815000790?via%3Dihub
  • https://www.amjmed.com/article/S0002-9343%2809%2901115-2/fulltext
  • https://www.medicalnewstoday.com/articles/virtual-therapy
  • https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3662387/
  • https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5723163/
  • https://telehealthandmedicinetoday.com/index.php/journal/article/view/4
  • https://www.apa.org/monitor/2017/02/online-therapy
  • https://www.medicare.gov/coverage/telehealth

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Mental Health

What is teletherapy? Benefits and uses

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Teletherapy is a type of mental health counselling that takes place over the phone or via the internet.

More therapists are implementing this type of virtual mental health care into their practice as videoconferencing software improves.

Both the client and the therapist may find teletherapy to be beneficial. The majority of research indicates that it is just as effective as in-person counselling.

Definitions

Teletherapy

Teletherapy is any type of remote therapy that use technology to aid communication between the therapist and the client. Teletherapy can be used in a variety of ways, including:

  • doing therapy sessions over the phone
  • having a group chat for group therapy
  • using videoconferencing for individual, couples, or group therapy
  • receiving therapy via email or instant messenger
  • using apps that connect clients to therapists and offer therapy within the app

Benefits

In comparison to traditional therapy, teletherapy offers a number of advantages.

For therapy clients

Teletherapy appears to be as beneficial as in-person therapy, according to most studies. The following are some of the advantages of pursuing research-backed teletherapy with a qualified therapist:

  • Improved access to care: Traditional treatment is not an option for certain people owing to physical limitations, regional limitations, or scheduling conflicts.
  • Reduced costs: Clients may be able to save money on treatment by using teletherapy. When clients do not have to travel to obtain treatment or pay for child care, they are more likely to incur fewer therapy-related expenses.
  • High levels of satisfaction: Users of high-quality teletherapy report a high level of treatment satisfaction.
  • More personal space: Teletherapy people do not have to wait in crowded waiting rooms and can receive treatment in the comfort of their own homes. For some, this is a welcome relief from privacy concerns.
  • Improved public health: The COVID-19 health crisis highlights how having access to medical treatment at home can help to halt the spread of disease and safeguard vulnerable people. During epidemics and pandemics, teletherapy allows people to receive mental health care at home without risking the spread of infection.

For therapists

Teletherapy may suit some therapists’ personal styles and allow them to achieve their practise goals. Among the advantages are:

  • Reduced overheads: Keeping a workplace in good shape can be costly. Many of the overheads for therapists who transition to a telehealth-only paradigm can be eliminated. Part-time teletherapy providers may be able to hire office space only a few days a week, decreasing costs.
  • The ability to reach more clients: People with impairments, financial concerns, transportation issues, and other impediments to therapy may benefit from telehealth. This increased accessibility allows therapists to assist more people. Therapists might earn more money by expanding their possible client pool.
  • A shorter commute: A therapist who specialises in teletherapy may be able to help clients from the comfort of their own home, minimising or eliminating their travel.

Limitations and disadvantages

While teletherapy offers numerous advantages, it also has significant drawbacks.

For therapy clients

Teletherapy is not a treatment option for everyone. The following are some disadvantages:

  • Compliance: The Health Insurance Portability and Accountability Act (HIPAA) mandates that healthcare providers, including therapists, respect the privacy of their patients or clients. Clients should only work with therapists who encrypt data because unsecure chat and other apps can expose critical information.
  • Therapy environment: Finding the time and space for therapy might be difficult for people with little solitude at home. Treatment in a clinic may be a less stressful option than treatment at home.
  • Technical difficulties: Online counselling might feel uncomfortable and impersonal due to slow internet connections, video programme issues, and communication delays. Telehealth may not be a good option for people who lack technological ability or do not trust digital platforms.
  • Communication: It can be more difficult to discern body language and other subtle clues while communicating over a digital channel. These types of communication are eliminated with email and phone therapy.

For therapists

The following are some of the problems that therapists may face when using digital therapy:

  • Ethical and legal issues: Therapists must follow the regulations of the state licencing board in both the state where they practise and the state where they treat a client. This compliance can necessitate a high level of legal understanding, and breaking the law can jeopardise a therapist’s licence.
  • An increase in client anonymity: It may be more challenging for therapists to support clients who are a danger to themselves or others when they meet with them via a digital platform. Clients may be able to hide their true identity. If a client is in risk of injuring oneself or others, therapists have a responsibility to notify the appropriate authorities, and client anonymity might make this more difficult, thereby jeopardising the therapist’s ethical commitments.
  • Client privacy: HIPAA and other privacy requirements must be followed by therapists. Time and technical expertise are required for selecting the correct platform and taking proactive efforts to secure customer data.
  • Communication barriers: Establishing a good rapport with clients across digital networks can take longer. Body language and other subtle forms of communication may be difficult for certain therapists to read, making it more difficult to provide high-quality treatment.

Uses

Teletherapy is a type of therapy that is similar to traditional therapy. Because in-person treatment does not involve physical contact or laboratory tests, the majority of the therapy experience can be replicated virtually, particularly through video chat. As a result, teletherapy can assist with a variety of diseases and challenges, including depression, anxiety, interpersonal issues, trauma, and chronic stress.

Most disorders for which scientists have attempted teletherapy appear to be treatable, according to new studies. According to a 2010 study, distance-based cognitive behavioural therapy (CBT) for depression may be just as beneficial as in-person counselling.

People who are considering teletherapy should talk to their doctor about it.

How a teletherapy session works

While teletherapy can be done over the phone or via email, most modern telemental health sessions employ video chat.

The therapeutic process is identical to that of face-to-face counselling. It normally starts with a few first sessions in which the therapist and client get to know each other and talk about treatment goals. The therapist may then go more into the client’s concerns, make behavioural modifications recommendations, and urge the client to reflect on their emotions.

The therapist may request that the client take precautions to maintain confidentiality. These could include the following:

  • logging on from a private network
  • keeping their computer locked to prevent others from viewing the session
  • accessing therapy via an encrypted therapy platform

Clients should also inquire about their therapist’s procedures for maintaining client confidentiality and preventing third parties from viewing sessions or notes.

Who is qualified to get teletherapy?

While anyone can offer support to another person via the internet or over the phone, only qualified professionals can call their services therapy. Depending on the state in which they operate, clinicians can call themselves therapists.

Teletherapy may be provided by a variety of providers, including:

  • licensed professional counselors
  • licensed marriage and family therapists
  • licensed clinical social workers
  • licensed psychologists
  • licensed psychiatrists

State licencing requirements vary, but in general, a therapist must be licenced in the state where the client is treated. As a result of this rule, a clinician licenced in Tennessee may not be able to treat a client who lives in California. Providers should verify with the client’s home state’s licencing board to determine their ethical and legal obligations.

Conclusion

People who find it difficult to get to therapy in person may benefit from teletherapy. It’s also a great way to prevent illness from spreading, such as during the COVID-19 pandemic or during flu and cold season.

Quality treatment, like other health services, yields better results. A person should collaborate with their therapist to develop a treatment plan that is both effective and beneficial.

Sources:

  • https://www.apa.org/monitor/2012/03/virtual
  • https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3662387/
  • https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5723163/
  • https://telehealth.org/blog/practicing-over-state-lines/
  • https://journals.sagepub.com/doi/abs/10.1177/1357633X19871746
  • https://www.medicalnewstoday.com/articles/teletherapy
  • https://www.ncsl.org/research/health/mental-health-professionals-duty-to-warn.aspx
  • https://www.apa.org/monitor/2017/02/online-therapy
  • https://www.sciencedirect.com/science/article/abs/pii/S0005789409000781

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