Bits and Bytes of Psychology: Cyberpsychology (Part 1 of 2)

Heartache, back pain, anxiety, a daughter’s scanty eating habits: a quick tour of cyberspace and one stumbles upon doctors, virtual support groups, pharmaceutical deliveries, various therapists and coaches. An email is written, a virtual community is notified, and a blog or chat opened to look for answers.

Technology has radically changed the world, and with it, the world of emotional suffering and asking for help.

Rather than avoiding the cyber-movement and technological advancement, psychologists instead have used it to their advantage. The three domains of cyberpsychology include evaluations of internet use, psychological treatment, and psychological research. The most up-to-date usages are the subject of "Gesundheit und Neue Medien" (SpringerWienNewYork) by psychologists Birgit U. Stetina  and Ilse Kryspin-Exner.

Dr. Stetina is a friendly woman, and has an open and laid back style, and at first you would take her for an American. But though she has traveled, presented and published internationally, she is utterly Viennese… so Viennese that she has never lived outside of the Gürtel. And it was an interest in Sigmund Freud and psychoanalysis that lead her to psychology. Now she is analysing its use on the internet.

"There is mass of health-related information online. [But] there is no information regarding how accurate the material is. This is very dangerous, in fact extremely dangerous," asserted Stetina.

For online medical information, there is HON – Health on the Net Foundation – and its honor code. Online psychological interventions now have seals for quality control, issued by either the American or German Psychological Associations. "But there is nothing really known by the users," she said.

There are positive sides to our endless cyber-searches for answers to health questions: The isolated patient can be reached and the masses empowered. Patients suffering from rare diseases or disorders (physically or mentally) limiting their ability to connect with others are now able to find help or connect with others patients.

The general public also has the benefit of more information, which increases their involvement and personal responsibility for their own health, as required in our society and medical system. Over the course of the 20th century, as the main cause of death has changed from infectious diseases to non-communicable conditions – some 63.5% in 2008, according to the WHO – and life expectancy has commensurately increased. These conditions (cardiovascular diseases, 30.5%, and cancer, 13.3%) are typical "lifestyle diseases." They can be prevented.

The first step to prevention is information. Still, doctors have yet to be convinced. "Only a quarter of general practitioners are willing to speak to their patients about the surfed information," asserted Stetina.

Online self-help groups are another venue for those looking for answers and support. Unfortunately, most self-help groups are not provided, or even monitored, by professionals.

"This has had fatal results," Stetina related, "incidents occurring after people connect on suicide forums. These forums are on one hand very helpful for the people to express their thoughts; it takes a lot of pressure from them. On the other hand, when these pages are not monitored by a professional, something can happen, as it did five years ago when an Austrian teenage girl made a contract with a Norwegian guy to commit suicide together."

Further complicating the situation in virtual reality are the legal aspects of the treatment. "These do not matter online," Stetina asserted. "So while email assisted online therapy is not allowed in Austria, people interested in talking to a psychologist or therapist via email may still contact someone in Switzerland or Germany."

Even more recent is the access to consumer review sites, with reviews of psychological services, as reported by Keely Kolmes in the Mar. 18 edition of The New York Times. However, the value is questionable: A person writing a poor review may include inappropriate details or may have misunderstood some aspect of the treatment. There is also no way to know what disorder the reviewers suffer from, and if their disorder will distort the review provided.

"Psychological interventions should be like a five-star hotel: the clients deserve the best possible care," Stetina said, citing Dr. Kryspin-Exner, Head of the Division of Clinical and Health Psychology at the University of Vienna, with whom she trained years ago. In this sense, Stetina sees the reviews as helpful for the patients to gain insight into treatment styles.

Cyberpsychology goes beyond online interventions: Stetina and her team at the University of Vienna have further developed virtual reality therapy for people suffering from various phobias. Using video-game technology, detailed immersion situations, like NOFEAR, have been developed, in which the therapy sittings can be guided by physiological information – blood pressure, skin conductance, pulse and breathing rates – provided by sensors on the patient. Thus, the pace of the therapy can be slowed or increased based on the physiological signs of anxiety during the sessions.

"The most important factor of virtual reality therapy is immersion – sinking in – having it feel like the real world. Therapeutic programs were not very good, but the gaming industry has a larger budget for graphics than psychological institutes."

The future has as many possibilities, probably as many as roles one can play online: tall, dark and handsome for a dating service, a cyberstalker or hacker, a political activist for Anonymous, an expert for Wikipedia, and one can nearly see the next notice: "Skype a Psych."  This remarkable tool has had an impact on all areas of psychology.

But despite the benefits, we still need to be cautious about the use of the internet in physical and mental health, psychologists warn: The same caution should be used when opening one’s mind as when opening one’s front door.