CyberSightings

In the Spotlight

The information technology revolution that began in the early 1980s has provided psychologists with several innovative tools, ranging from the Internet to virtual reality and mobile applications. However, the real rise of interest toward Cyberpsychology started in the mid-1990s, when the Web exploded and several researchers began investigating the potential of using emerging technologies in research, practice, and training. The high expectations raised by these studies led several scholars to formulate optimistic predictions about the adoption of computers in psychology. For example, a Delphi study conducted in 2002 to identify the future trends in psychotherapy indicated that computerized therapies and use of virtual reality will substantially increase over the next decade (Norcross JC, et al. 2002. The face of 2010: A Delphi poll on the future of psychotherapy. Professional Psychology: Research and Practice, 33, 316–322). Now that 10 years have passed, it is not easy to establish if that prediction holds true, because there is a lack of studies investigating the adoption of new technologies by psychologists. However, even without empirical evidence, one can intuitively argue that the use of computerized tools in clinical practice has not yet become widespread. In order to understand what are the factors that explain the relatively low adoption of new technologies by psychologists, it is useful to consider separately the two main innovations that characterized cyberpsychology in the last 20 years, namely online therapy and virtual reality therapy. In its simplest form, online therapy (also defined as “e-therapy”) concerns the use of Internet-based technologies (e.g. e-mail, chat, video-conferencing systems) to provide evaluation and treatment services at distance. Over the years, this approach has been tested in several clinical areas and has generated a large number of studies. A query to Medline Trend (http://dan.corlan.net/medline-trend.html/) using the keywords “online therapy” revealed that the number of articles related to this topic increased from N=69 in 1996 to N=1546 in 2011. Although these studies are quite heterogeneous with respect to the tools and protocols tested, the bulk of evidence so far suggests that online (cognitive-behavioral) therapy is at least as effective as face-to-face therapy (e.g., Kessler D, et al. 2009. Therapist-delivered Internet psychotherapy for depression in primary care: a randomised controlled trial. The Lancet, 374, 9690, 628–634). Since the effectiveness and the potential advantages of online therapy are not in question, what are the main barriers to the adoption of this approach? A recent study by Lovejoy et al. (2009. Advancing the practice of online psychotherapy: an application of Rogers' diffusion of innovations theory. Psychotherapy: Theory, Research, Practice, Training, 46, 1, 112–124) has identified several obstacles hindering the diffusion of e-therapy, which include: issues of dehumanizing the therapeutic environment, start-up cost and reimbursement, infrastructure and training, licensure and jurisdiction concerns, ethical guidelines, client and clinician suitability factors, and professional reputation and acceptance within the field. According to the authors, however, these barriers can be overcome through specific strategies, which are discussed in their article. It is interesting to note that the factors specified by Lovejoy et al. do not directly regard the effectiveness of the online therapy approach, but the deontological, ethical, and financial implications that the adoption process involves. The second main trend in cyberpsychology is virtual reality therapy. Early experiments on this approach were carried out in the mid-1990s, with clinical applications ranging from anxiety to specific phobias to eating disorders. A new query run to Medline Trend using the keywords “virtual reality therapy” revealed that studies on this topic have also significantly increased in the last 15 years (from N=26 articles published in 1996 to N=166 publications in 2011), though at a less impressive rate than online therapy studies. The different speed of expansion of these two research areas may be explained by several factors, starting from the mere observation that a virtual reality study is usually more demanding (e.g., in terms of hardware/software costs and technical skills required) than an online therapy study.

As concerns the efficacy of virtual reality therapy, most controlled studies conducted so far indicat that this approach has proven to be at least as effective as conventional cognitive-behavioral therapy. Although these results are encouraging, the adoption of virtual reality therapy is still negligible. A plausible explanation could be that virtual reality technology is still perceived as too expensive and complex to learn. However, findings of a recent study involving a sample of 141 participants do not support this explanation (Bertrand M, Bouchard S. 2008, Applying the Technology Acceptance Model to VR with people who are favorable to its use. Journal of CyberTherapy and Rehabilitation, 1, 200–210). In particular, the study found that the intention to use virtual reality mainly depends on the perceived usefulness of this approach. This, in turn, is influenced by personal factors such as perception of external control, anxiety associated with the use of the computer, and intrinsic motivation. Even if the authors warn that these findings are not generalizable (since the sample included professionals that were already familiar with virtual reality technology), they indicate that in order to promote a wider adoption of virtual reality in therapy, it is not only important to develop technologies that are cheaper and easier-to-use, but also to continue investigating the efficacy, effectiveness, and usefulness of this approach for both the patient and the therapist.

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