Title: A Second Life for E-Health: Prospects for the Use of Virtual On-Line Worlds in Clinical Psychology
1A Second Life for E-Health Prospects for the Use
of Virtual On-Line Worlds in Clinical Psychology
- Alessandra Gorini
- Andrea Gaggioli, Giuseppe Riva
- Applied Technology for Neuro-Psychology Lab
- Istituto Auxologico Italiano, Milan, Italy
2OUTLINE
- Origins, definition and limitations of e-health
- Introduction to the WEB 2.0 and the on line
virtual worlds - Is it possible to use the on line virtual worlds
for therapeutical purposes? - Presentation of a case study
- Conclusions
3At the beginning was e-health
4WHAT IS E-HEALTH?
- the use of technology (mobile phone, email,
chat) to provide access to medical assessment,
diagnosis, intervention, and information across
distance - key advantages (Glueckauf et al. 2003)
- deliver health information and services across
geographical distance for underserved population - enhance the quality of health information and
services in particular areas or for specific
populations - ensure continuous medical and psychological
service
5MAIN LIMITATIONS
- It does not take advantages of all the
possibility offered by Internet being limited to
e-mail, chat, and videoconferences - The sense of presence is limited
- Conventional e-therapy tools (i.e. email)
typically do not support multiple users
6WEB 2.0 AND 3-D VIRTUAL WORLDS A NEW FRONTIERS
FOR E-HEALTH?
7WEB 2.0
- Web 2.0 is a read-write web
- It allows users to rate, comment, annotate, edit,
create, mix and share content from different
locations - It is a people-centric social Web, that
facilitates social networking and active
collaboration between users
8WEB 2.0, VR AND E-HEALTH
- The combination of WEB 2.0 and Virtual Reality
(VR) allows the creation of distributed on line
VEs that enhance the communication between
therapists and patients, increasing the sense of
PRESENCE during the virtual interaction
93-D VIRTUAL WORLDS FOR E-HEALTH
- Hp Virtual worlds may convey higher feelings of
presence and social presence than conventional
e-therapy tools do - facilitating the clinical communication process
- creating higher levels of interpersonal trust
between therapist and patient
10ON LINE VIRTUAL WORLDS OFFER THEIR USERS THE
POSSIBILITY TO
- Share common VE being in different physical
places - Have digital characters representing themselves
- Communicate in real-time using chat or voice in
public or private way - Experience a great sense of presence
11ON LINE VIRTUAL WORLDS FOR PSYCHOLOGICAL
INTERVENTIONS AN EXPLORATIVE PROTOCOL
- Single case study
- AIM evaluate the potential of the virtual
support sessions when, for contingent causes,
patient and therapist can have only one
face-to-face encounter per month.
12WHATS NEW?
- The use of on line virtual worlds (SECOND LIFE)
for psychological support/therapy - The use of VR environments for a
psychoanalitic-oriented approach
13THE PATIENT C.B.
- Sex female
- Age 47
- Education academic degree in engineering
- Status married (since 1995)
- Son 1 (8 year old)
- Diagnosis (2002) dependent personality disorder
(DSM-IV) also characterized by obsessive-compulsiv
e traits and severe physical somatizations that
needed a pharmacological treatment. - Treatment from 2002 to 2006 psychoanalytic
treatment based on two sessions per week that
produced a significant symptomatic remission and
an increasing in self and work efficiency. - From 2006 to now sporadic consultation sessions,
with a recent request to start a second phase of
analytic-oriented treatment, apparently
uncompatible with her work engagement which often
demanded her to travel in italy and abroad. -
- Technological abilities basic knowledge of the
main Windows applications no familiarity with
videogames and VR systems.
14THE THERAPIST
- Sex male
- Age 51
- Education MD, both psychiatrist and
psychoanalist, with a personal interest in
studying the relationship between human mind-body
and technological devices of prosthesis. - He has recently changed his homeplace and
life-style, living for half a week in Milan, and
the rest of the time in another Italian city,
located about 300 Km far from Milan. - Technological abilities basic knowledge of the
main Windows applications no familiarity with
videogames and VR systems.
15- The difficulty in combining their working
commitments and the physical distance have been
some of the reasons pushing C.B. and her
therapist to try this innovative approach. - Privacy issues all the chat transcriptions were
countersigned by both the therapist and the
patient.
16ASSESSMENT
Betts questionnaire Imaginative abilities Before the beginning of the treatment
Computer knowledge and experience questionnaire Computer abilities Before the beginning of the treatment
Barfield Presence questionnaire Level of Presence Every 2 weeks from the beginning of the treatment
17THE SL VIRTUAL OFFICE
18TREATMENT SCHEDULES
- 2 virtual sessions per week (45 min each)
- 1 face to face session per month
- The patient and the therapist agree on date and
time of the virtual appointments with the same
modalities they use for real ones.
19TECHNICAL REQUIREMENTS
- 2 laptops and an ADSL internet connection.
- Way of interaction text-based chat
20PRELIMINARY DATA FROM 8 VIRTUAL SESSIONS 2 FACE
TO FACE ENCOUNTERS
21QUANTITATIVE DATA (1)
CB The therapist
Betts questionnaire 39/70 43/70
Computer knowledge and experience questionnaire 2/5 3/5
Barfield Presence questionnaire
1) If your level in the real world is 100, and your level of presence is 1 if you have no presence, rate your level of presence in this virtual world 50 60
2) How strong was you sense of presence, being there, in the virtual environment (1-5 scale) 3 3
22QUANTITATIVE DATA (2)
- CB interrupted the spasmolytic therapy and
restarted her regular job activity AS EXPECTED
FROM A TRADITIONAL THERAPY
23QUALITATIVE OBSERVATIONS
- First virtual appointment slowness
- Analysis of text chats formal aspects and
relation style were comparable to those observed
during the face-to-face sessions (CB refers her
emotional contents and reactions, makes free
associations, reports dreams waiting for
therapists interpretation. - No sign of inhibition
24THE 3 FOUNDAMENTAL RULES OF PSYCHOANALYSIS
- The fundamental rule it urges that patients say
whatever comes into their heads, even if they
think it unimportant or irrelevant or
nonsensensicalor embarrassing or distressing - The rule of abstinence it designates a number of
technical recommendations that Freud stated
regarding the general framework of the
psychoanalytic treatment, including, for example,
the prescription to have no physical or gaze
contacts with the patient -
- The constancy of setting virtual reality offers
the therapist the possibility to create a
therapeutic environment more stable than any
other real physical setting, other than to
maintain the avatars aspect unchanged over time
25THE PRIVACY PROBLEM
- The only critical point emerged regards the
privacy of the virtual setting. - The virtual office is complitely safe and only
invited and authorizad people can have access.
26CONCLUSION
- The presence of a medium between the patient and
the therapist does not interfere with the
therapeutical relationship - SL is intuitive the scarce ability in the use of
computer and technological devices does not
significantly limit the virtual interaction
between the patient and the therapist
27BUT MOST IMPORTANT
- The possibility to share a common on-line virtual
space, gives the patient and the therapist the
opportunity to meet each others twice a week
even if they are physically distant.
28NEXT STEPS
- Collect more data
- Make a controlled study (virtual world vs simple
chat) - Test the virtual setting in different situations
(patients with severe physical disabilities,
underserved population, prisoners, etc)
29CRITICAL REMARKS
- The proposal sounds very innovative, but we would
like to underline that in our view virtual
therapy can be effective only if used as an
adjunct to traditional therapy, or as part of an
aftercare plan. - We advise against any kind of therapy being
practiced exclusively on the web because of its
supportive rather than exhaustive nature. This
point must be made clear to online therapy
providers and the general public.
30- THANK YOU FOR YOUR ATTENTION!
- a.gorini_at_auxologico.it