Behavioural Telehealth: Research and Development at the University of British Columbia


Kate Collie

	Contact info: KateCollie@KateCollie.com http://www.katecollie.com	Kate Collie, PhD, MFA, ATR, is an artist, art therapist, researcher, and professional workshop facilitator. Her research interests include the use of the arts in healthcare, innovative approaches to expanding access to behavioural healthcare (including internet art therapy), and psychosocial dimensions of medical illness, especially breast cancer. After completing an interdisciplinary PhD at the Institute of Health Promotion Research at the University of British Columbia, Dr. Collie was a postdoctoral research fellow and then a research associate at the Center for Stress and Health in the Department of Psychiatry and Behavioral Sciences at Stanford University. As a visual artist, Dr. Collie has taught at schools and universities in the US and Canada, and has exhibited her paintings and sculptures internationally. As a workshop facilitator, her specialties are therapeutic art groups for people with major illnesses and creativity workshops for artists and non-artists. Dr. Collie is an Adjunct Full Professor at the California Institute of Integral Studies http://www.ciis.edu and an Online Instructor for the Cybercounselling training program jointly offered by the University of Toronto Department of Social Work and Worldwide Therapy Online http://therapyonline.ca. Internet Art Therapy Collaborative research by Kate Collie and Davor Cubranic

		[ Selected Publications \| Selected Conference Presentations ]

	Selected Publications
		Collie, K. (under review). Art groups as a support group alternative for underserved women with breast cancer.
		Abstract: Support groups that promote emotional expression and social support have been shown to significantly improve coping and reduce distress for women with breast cancer. However, many women with breast cancer from medically underserved groups do not participate in support groups. It is important to address barriers that prevent participation and to consider alternatives, such as art groups, that may be more appealing to non-mainstream women. Fifteen women with breast cancer from underserved groups living in the San Francisco Bay Area were interviewed for the study. A narrative analysis of the interview data yielded eight storylines that convey the women’s perceptions of social, cultural, and psychological barriers to support group participation and their enthusiasm for art groups as a way to overcome these barriers.
		Collie, K., Kreshka, M. A., Ferrier, S., Parsons, R., Graddy, K., Avram, S., Mannell, P., Chen, X-H., Perkins, J., & Koopman, C. (in press). Videoconferencing for delivery of breast cancer support groups to women living in rural communities: A pilot study. *Psycho-Oncology.*
		Abstract: Women with breast cancer in rural areas are likely exhaust their usual sources of psychosocial support while still facing challenges posed by breast cancer, but are unlikely to have access to professionally-led support groups. In this community-based project, we assessed the feasibility and acceptability of providing support groups to women with breast cancer in a large rural area using videoconferencing and a workbook journal, and we assessed the intervention’s potential to reduce distress and increase emotional expression and self-efficacy for coping with cancer. Twenty-seven women in the Intermountain Region of northeastern California participated in 8-session support groups led by an oncology social worker by going to nearby videoconferencing sites. Feasibility and acceptability were demonstrated. Older as well as younger women were comfortable using videoconferencing and said the groups were valuable because they promoted information sharing and emotional bonds with other women with breast cancer. They emphasized the importance of a professional facilitator and identified advantages of using videoconferencing for support groups. Pretest and posttest comparisons showed significant decreases in depression and posttraumatic stress disorder symptoms. The results suggest that the intervention has the potential to provide a valuable service that is not readily available in rural communities.
		Collie, K., Kreshka, M. A., Avram, S., Parsons, P., Ferrier, S., Graddy, K., & Koopman, C. (2006). Support groups by video-conferencing for women with breast cancer. Telemedicine and E-Health, 12(2),232. Collie, K., Backos, A., Malchiodi, C., & Spiegel, D. (2006). Art therapy for combat-related PTSD: Recommendations for research and practice. *Art Therapy: Journal of the American Art Therapy Association, 23(4)*.
		Abstract: With a new generation of American combat veterans returning from Iraq, the nation has an obligation to do everything possible to improve care for PTSD. Although art therapy has been understudied in this context, it shows promise as a means of treating hard to treat symptoms of combat-related PTSD such as avoidance and emotional numbing while also addressing the underlying psychological situation that gives rise to these symptoms. In this paper, we establish a conceptual foundation for research about art therapy as a treatment for combat-related PTSD by situating art therapy within the context of other PTSD treatments, outlining a theoretical rationale for using art therapy as a treatment for PTSD, and clarifying 'best practices' for using art therapy as a treatment for combat-related PTSD. We recommend group treatment in three stages and suggest that art therapists who treat combat-related PTSD receive specialized training in trauma intervention and PTSD theory.
		Collie, K., Bottorff, J. L., & Long, B. C. (2006). A narrative view of art making and art therapy by women with breast cancer. *Journal of Health Psychology, 11(5)*, 761-775.
		Abstract: Art therapy (with an art therapist) and art making (without an art therapist) show promise as avenues for psychosocial support for women with breast cancer. The purpose of this study was to gain an in-depth understanding of how 17 women with breast cancer in Canada and the US used art therapy and their own art making to address their psychosocial needs, focusing particularly on meaning making. Narrative analysis of interviews yielded four storylines: Art and Art Therapy as a Haven, Getting a Clearer View, Clearing the Way Emotionally, and Enhancing and Enlivening the Self. The storylines show existence being affirmed, confirmed, and proclaimed through visual artistic expression and meaning making being achieved through physical acts of making.
		Collie, K., Bottorff, J. L., Long, B. C., & Conati, C. (2006). Distance art groups for women with breast cancer: Guidelines and recommendations. Journal of Supportive Care in Cancer, 14(8), 849-858.
		Abstract:To overcome barriers that prevent women with breast cancer from attending support groups, innovative formats and innovative modes of delivery both need to be considered. The present study was part of an interdisciplinary program of research in which researchers from counseling psychology, psycho-oncology, nursing, computer science, and fine art have explored art making as an innovative format and telehealth as a mode of delivery. For this study, we conducted focus groups and interviews with 25 people with expertise about breast cancer, art, art therapy, and distance delivery of mental health services to generate guidelines for distance art-based psychosocial support services to women with breast cancer. A qualitative analysis of the focus group and interview data yielded guidelines for developers and facilitators of distance art groups for women with breast cancer pertaining to (a) emotional expression, (b) emotional support, (c) emotional safety, and (d) accommodating individual differences, plus special considerations for art therapy groups. Further research is needed pertaining to the use of computers, involvement of art therapists, and screening out vulnerable clients.
		Koopman, C., Kreshka, M.A., Bodai, B.I., Nakata, T., Wolf, H., Chen, X.H., Angell, K., Graddy, K., McCoy, R., & Collie, K. (2006). A randomized study of alternative support for rural and isolated women in an HMO: Effects on depression, PTSD and emotional coping. Annals of Behavioral Medicine, 31, Suppl. S134. Collie, K. & Long, B. C. (2005). Considering ‘meaning’ in the context of breast cancer. Journal of Health Psychology, 10(6), 843-853.
		Abstract: In this paper, we show that a psychological view of global and situational meanings is inadequate for understanding meaning making in the context of breast cancer. We outline research that has illuminated breast cancer meanings that differ from standard illness meanings and we highlight impediments to meaning making for women with breast cancer. We conclude that it is less helpful to promote a particular kind of illness meaning for women with breast cancer than to (a) create conditions that women with breast cancer have said are conducive to meaning making, (b) accept and acknowledge meanings that women with breast cancer themselves find valuable, and (c) actively work to change dominant discourses that constrain meaning making for women with breast cancer.
		Collie, K., Wong, P., Tilston, J., Butler, L. D., Turner-Cobb, J., Kreshka, M. A., Parsons, R., Graddy, K., Cheasty, J. D. & Koopman, C. (2005). Self-efficacy, coping, and difficulties interacting with health care professionals among women living with breast cancer in rural communities. *Psycho-Oncology, 14,* 901-912.
		Abstract:This study examined self-efficacy, coping, and social support in relation to difficulties interacting with physicians and nurses among women living with breast cancer. One hundred women living in rural, mountainous communities of northeastern California were recruited, with 89 providing complete data for this study. All women completed a battery of questionnaires that included the CARES - Medical Interaction Subscale and measures of self-efficacy, coping, satisfaction with social support, and demographic and medical characteristics. In a multiple regression analysis, difficulties interacting with medical professionals were found to be greater among women who were not married, who used more behavioral disengagement or less self-distraction to cope with breast cancer, and who reported less self-efficacy for affect regulation and for seeking and understanding medical information. Emotional venting and satisfaction with social support for dealing with cancer-related stress were not, however, significantly related to difficulties in interacting with the medical team. This model accounted for an adjusted value of 42% of the variance. Further research is needed to identify possible causal relationships related to these findings and to determine what interventions might be warranted to improve medical interactions for women with breast cancer living in rural areas.
		Collie, K., Čubranić, D., & Long, B. (2002). Audiographic Communication for Distance Counselling: A Feasibility Study. *British Journal of Guidance and Counselling, 30(3),* 269-284.
		Abstract: To explore the feasibility of conducting counselling or therapy that involves image making via the Internet, and simultaneously to identify new issues to consider when implementing online counselling services, 10 people selected for their relevant expertise were invited to use an audiographic telecommunication system and to comment on it. Content analysis of focus group discussions and interviews yielded the following significant issues: (a) concerns about technical failure, (b) relevance for people with disabilities, (c) the need for clinical procedures and communication guidelines, and (d) lack of shared physical presence. The co-researchers considered this form of distance delivery to be viable, and identified parameters that would ensure safe and ethical delivery. Implications for practice and future development are discussed.
		Collie, K., Čubranić, D., & Long, B. (2004). Interpersonal communication in behavioural Telehealth: What can we learn from other fields? In J. Bloom & G. Walz (Eds.) Encore edition of Cybercounseling and Cyberlearning: Strategies and Resources for the Millennium, published jointly by the American Counseling Association and the *ERIC Counseling and Student Services Clearinghouse*.
		Abstract: This paper contains a description of the preliminary stages of the development by the two authors of a computer system and basic procedures for computer-supported distance art therapy. We discuss this innovative form of telehealth within the context of psychosocial care for people with traumatic illnesses, particularly cancer. The paper includes a rationale for developing distance art therapy services for people who have traumatic illnesses, a general description of computer-supported distance art therapy, and a technical description of the computer system we have created.
		Collie, K., & Čubranić, D. (2002) Computer-supported distance art therapy: A focus on traumatic illness. In H. Resnick (Ed.) *Innovations in Social Work and Technology: Practice and Education*. Binghamton, NY: Haworth Press.
		Abstract: This paper contains a description of the preliminary stages of the development by the two authors of a computer system and basic procedures for computer-supported distance art therapy. We discuss this innovative form of telehealth within the context of psychosocial care for people with traumatic illnesses, particularly cancer. The paper includes a rationale for developing distance art therapy services for people who have traumatic illnesses, a general description of computer-supported distance art therapy, and a technical description of the computer system we have created.
		Collie, K., Mitchell, D., & Murphy, L. (2000). Skills for cybercounseling: Maximum impact at minimum bandwidth. In J. Bloom & G. Walz (Eds.) Cybercounseling and Cyberlearning: Strategies and Resources for the Millennium. American Counseling Association. (See ERIC digest below.)
		Abstract: In July and August of 1999, Kate Collie conducted an interview with Dan Mitchell (DM) and Lawrence Murphy (LM) on the topic of online counseling skills. The interview was done by e-mail so DM and LM could simultaneously describe and demonstrate skills they use in their e-mail counseling practice. The interview is reproduced here, along with a brief introduction in which the context for the interview is outlined, the people involved are introduced, and the key concepts that underlie the discussion are highlighted.
		Collie, K., Mitchell, D., & Murphy, L. (2000). E-mail Counseling: Skills for Maximum Impact. *ERIC Digest.* Collie, K., & Čubranić, D. (1999). An art therapy solution to a telehealth problem. *Art Therapy: The Journal of the American Art Therapy Association, 16(4),* 186-193.
		Abstract: Telehealth refers to the use of telecommunications technologies to increase equality of access to health care. In this paper, we describe a gap that exists in the area of telehealth, and propose that computer-supported distance art therapy can fill the need for telehealth delivery methods that, like text-only Internet services, can reach people in their own homes, and, like videoconferencing, can include both audio and visual communication. We refer to an action research study we conducted in which we worked collaboratively to design and evaluate a computer system that supports distance group art therapy, and argue that art therapy is uniquely suited to telehealth, for reasons related to the history of art therapy, the nature of the art therapy process, characteristics of visual art as a medium of expression, particular qualities of computer images, and psychological effects of using a computer.
		Collie, K., Čubranić, D., & Booth, K. (1999). Computer-supported distance art therapy: Beyond computerization. In Proceedings of WebNet 1999, AACE: Association for the Advancement of Computers in Education. Collie, K., Cubranic, D., & Booth, K. (1998). Participatory design of a system for computer-supported distance art therapy. In *Proceedings of the Participatory Design Conference 1998*, (pp. 29-36). Seattle, WA: Computer Professionals for Social Responsibility.
		Abstract: Rapid expansion of the Internet has resulted in the emergence of electronic counselling and psychotherapy services. These services show great potential to make therapy accessible to a wider range of people, especially those with disabilities or long-term illnesses. Research is needed to assess the possibilities and pitfalls of this new form of mental health care. In this paper we describe the participatory design process during which we developed a system to support distance art therapy and simultaneously identified key issues to consider for research and practice in this incipient field. We present the design rationale, the context, and a detailed description of our interaction with the participatory design team. The process significantly changed perceptions of the usefulness of distance art therapy on the part of the research team and yielded a computer system and a list of advantages and potential problems of distance therapy. Additionally, the participatory design process opened up a wide range of new ideas about telepresence, accessibility, and psychotherapy.
		Čubranić, D., Collie, K., & Booth, K. (1998). Computer support for distance art therapy. In *Summary of CHI’98: Human Factors in Computing Systems* (pp. 277-278). Los Angeles, CA: ACM Press.
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	Selected Conference Presentations
		Collie, K., Ferrier, S., Kreshka, M. A., & Koopman, C. (2006, May). Support groups by video-conferencing for women with breast cancer. *Annual Meeting of the American Telemedicine Association, San Diego, CA. Collie, K., & Koopman, C. (2006, March). Poster: Art groups for underserved women with breast cancer. Annual Meeting of the Society of Behavioral Medicine,San Francisco, CA. Koopman, C., Kreshka, M.A., Bodai, B.I., Nakata, T., Wolf, H., Chen, X.H., Angell, K., Graddy, K., McCoy, R., & Collie, K. (2006, March). Poster: A randomized study of alternative support for rural and isolated women in an HMO: Effects on depression, PTSD and emotional coping. Annual Meeting of the Society of Behavioral Medicine,San Francisco, CA. Koopman, C., Kreshka, M.A., Ferrier, S., Collie, K., Parsons, R., Graddy, K., Chen, X.H., & Avram, S. (2006, March). Poster: Expanding rural access: Distance delivery of support groups. Annual Meeting of the American Psychosomatic Society. Denver, CO. Collie, K. (2005, Sept). Poster: Psychosocial support for underserved women with breast cancer: A role for art. California Breast Cancer Research Program Symposium, Sacramento, CA Collie, K. (2005, June). Workshop: Emotional expression and health. Annual Conference of the Society for the Arts in Healthcare,Edmonton, AB.* Collie, K. (2003, April). Art therapy for women with breast cancer: A ‘Royal Road’ to self care? Canadian Association of Psychological Oncology – 6th World Congress, Banff, AB. Collie, K. (2003, April). Art therapy and breast cancer. Annual Conference of the Society for the Arts in Healthcare, San Diego, CA. Buchanan, T., Collie, K., Horovitz, E., Malchiodi, C., Miller, G., & Parker-Bell, B. (2001, November). Computers in Art Therapy: A Palette of Possibilities. Annual Conference of the American Art Therapy Association, Albuquerque, NM. Collie, K. (2001, September) Internet Art Therapy. *Smart, Sexy, Healthy: A Summit on Art, Disability, and Computer Technology* at the *Banff Centre New Media Institute, Banff, AB. Collie, K. (2001, April). Arts-Medicine and Telehealth: A Participatory Workshop. Annual Conference of the Society for the Arts in Healthcare. Collie, K. (2000, November). Computer-Supported Distance Art Therapy: New Possibilities for Medical Art Therapy. Annual Conference of the American Art Therapy Association, St. Louis, MO. Collie, K., Čubranić, D., & Wick, C. (2000, June). Women-Centred Design in Telehealth: A Participatory Workshop. IFIP Seventh International Conference on Women, Work, and Computerization, Vancouver, BC. Collie, K. (2000, June). Art Therapy & Physical Illness: A Role for the Internet? Annual Conference of the British Columbia Art Therapy Association, Vancouver, BC. Collie, K., Čubranić, D., & Booth, K. (1999, October). Computer-Supported Distance Art Therapy: Beyond Computerization. WebNet 99: Association for the Advancement of Computers in Education, Honolulu, HI. Collie, K. & Čubranić, D. (1999, August). The Development and Evaluation of a Computer System for Distance Art Therapy. American Psychological Association Annual Convention, Boston, MA, August 20-24, 1999 Collie, K. & Čubranić, D. (1999, March). A creative solution to a telehealth problem: Computer-supported distance art therapy. Advanced Systems Institute Exchange, Vancouver, BC. Collie, K. & Čubranić, D. (1999, February). Computer-Supported Distance Art Therapy: A Cross-Disciplinary Collaboration. IISGP Annual Symposium, University of British Columbia, Vancouver, BC. Collie, K., Čubranić, D., & Booth, K. (1998, November). Participatory Design of a System for Computer-Supported Distance Art Therapy. Participatory Design Conference 1998, Seattle, WA. Collie, K. & Čubranić, D. (1998, October). Internet Art Therapy. Discipline and Deviance: Genders,Technologies, Machines, Duke University, Durham, NC. Čubranić, D., Collie, K., & Booth, K. (1998, April). Computer Support for Distance Art Therapy. CHI’98: Human Factors in Computing Systems*, Los Angeles, CA.
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