Archive for the ‘Clinical Psychology’ Category
Internet-based psychotherapy is a hot topic since a few years. The main advantage is money: Computers are much cheaper to run than licensed psychotherapist. So if a computer could achieve the same or nearly the same treatment outcome as a human expert this would be a huge advantage, as computer systems can be replicated almost infinitely (and once the program is written at almost no costs). We have to keep in mind that for political and economical decision making the effect size is not the only important factor. When considering which project to found something like “effect size“ / costs is more appropriate. In times of long waiting lists and many people without health insurance, cheap treatment means reaching more people. Another advantage is that physical boundaries are not important anymore. If a specialist for a specific therapy is 1000km away it just does not matter anymore. Furthermore the possibilities for comprehensive care, by involving personal with different expertise (social workers, psychologists, physicians) can be achieved by using the internet as a medium.
On the other hand there are some drawbacks. Privacy is a difficult factor as digital information is much more vulnerable than a handwritten dossier. Traffic which uses the internet (and not some special intranet) is always at risk, not to mention the risks on the computer of the client and therapist itself (viruses, Trojan horses, etc…). Face to face contact also offers additional information about the client (non-verbal communication, punctuality, interaction with other patients/staff members) that are lost in a digital environment. Therapeutic alliance is also more difficult to achieve in purely internet-based psychotherapies. I believe that ultimately internet-based therapy will play huge role in mental health care, especially in the concept of stepped-care. There are many ways to use computers and the internet to improve on the (very expensive) system we have today, but face to face therapy will always be an important part of every sever disorder, as (disturbed) human interaction often lays at the core of the problems. That said, we should try to develop digital forms of psychotherapy because not only will that give access to important help to much more people, but we will also be able to learn about the therapeutic process from that experience. In turn that will also increase efficiency of traditional psychotherapy and supply us with new hypothesis and theories.
http://www.vrphobia.com (which turned up as #1 in Google) is an organization that is called Virtual Reality Medical Center. They treat all kinds of anxiety related disorders, but seem to focus mainly on specific phobias. After the intake session the client is taught skills to suppress automatic fear reactions. In the following sessions the client is gradually exposed to the feared stimulus. In other words: VR desensitisation.
Obesity and addiction have some common properties. This research seeks to integrate some findings of addiction research into eating disorder therapy. In that light they make use of VR for distinct goals: Help the client to experience the own body in situations that are normally avoided. This experience is supposed to have influence on body perception and also empower the client. In the VR patients came “face to screen” with their personal risk situations (supermarket, gym, etc…) and could train emotion regulation and problem-solving skills in a save environment. The randomized clinical trial seems to indicate that the ECT group did indeed better than standard CBT.
As http://www.cybertherapy.info/cybertherapy/8_Optale.pdf shows also psycho-dynamic therapists start to see the merits in using new technology. Erection dysfunction and premature ejaculation are treated in a virtual environment (the porn industry will love that application) together with standard psychotherapy. The possibility to enact the new strategies in a save and private environment is supposed to speed up the therapeutic process. First clinical trials seem to indicate that this might indeed work for some clients, also it is not clear for whom exactly. Sample size is not adequate in study 1, power is much stronger in study 2. Results are not telling a clear story (yet?).
By the way:
http://www.cybertherapy.info/ is the most comprehensive and excellent source for material about VR in psychotherapy that I could find on the net. Especially have a look at the free books, like http://www.cybertherapy.info/pages/book2.htm or http://www.cybertherapy.info/pages/book3.htm. The articles are downloadable as PDF (just scroll down). Especially look at book 3 session 2 that comprises some clinical controlled trials with cybertherapy (which seems to be the keyword I was desperately looking for).