Therapy in virtual environments--clinical and ethical issues.

BACKGROUND: As virtual reality and computer-assisted therapy strategies are increasingly implemented for the treatment of psychological disorders, ethical standards and guidelines must be considered. This study determined a set of ethical and legal guidelines for treatment of post-traumatic stress disorder (PTSD)/traumatic brain injury (TBI) in a virtual environment incorporating the rights of an individual who is represented by an avatar. MATERIALS AND METHODS: A comprehensive literature review was undertaken. An example of a case study of therapy in Second Life (a popular online virtual world developed by Linden Labs) was described. RESULTS: Ethical and legal considerations regarding psychiatric treatment of PTSD/TBI in a virtual environment were examined. The following issues were described and discussed: authentication of providers and patients, informed consent, patient confidentiality, patient well-being, clinician competence (licensing and credentialing), training of providers, insurance for providers, the therapeutic environment, and emergencies. Ethical and legal guidelines relevant to these issues in a virtual environment were proposed. CONCLUSIONS: Ethical and legal issues in virtual environments are similar to those that occur in the in-person world. Individuals represented by an avatar have the rights equivalent to the individual and should be treated as such.

Ethical dilemmas in online research and treatment of sexually abused adolescents.

BACKGROUND: In a recent uncontrolled trial of a new therapist-assisted Web-based treatment of adolescent victims of sexual abuse, the treatment effects were found to be promising. However, the study suffered a large pretreatment withdrawal rate that appeared to emanate from reluctance among the participants to disclose their identity and obtain their parents' consent. OBJECTIVE: Our objectives were to confirm the effects of the online treatment in a controlled trial and to evaluate measures to reduce pretreatment withdrawal in vulnerable populations including young victims of sexual abuse. METHODS: The study was designed as a within-subject baseline-controlled trial. Effects of an 8-week attention-placebo intervention were contrasted with the effects of an 8-week treatment episode. Several measures were taken to reduce pretreatment dropout. RESULTS: Pretreatment withdrawal was reduced but remained high (82/106, 77%). On the other hand, treatment dropout was low (4 out of 24 participants), and improvement during treatment showed significantly higher effects than during the attention placebo control period (net effect sizes between 0.5 and 1.6). CONCLUSIONS: In treatment of vulnerable young populations, caregivers and researchers will have to come to terms with high pretreatment withdrawal rates. Possible measures may reduce pretreatment withdrawal to some degree. Providing full anonymity is not a viable option since it is incompatible with the professional responsibility of the caregiver and restricts research possibilities.

Compliance of social work e-therapy websites to the NASW Code of Ethics.

The purpose of this research is to evaluate the compliance of e-therapy websites to the NASW Code of Ethics. The E-therapy Site Compliance Evaluation Form (ESCEF) was used to retrieve data from 66 e-therapy websites with social workers. This study utilized a mixed method using both qualitative and quantitative approaches. A high level of compliance was found with the duty to inform and a low level of compliance was found with the duty to maintain professional boundaries. The duty to maintain confidentiality and procedures to be used in an emergency yielded mixed results, raising some concerns. Although a large percentage (59%) presented the procedures to be used in an emergency, only a third (32%) required giving information on local backups. Implications are discussed for social work practice, policy guidelines, research, and education.

Computer-based treatment for anxiety and depression: is it feasible? Is it effective?

The rise of consumerism, escalating levels of technological change and increasing demand for better dissemination of psychological treatments signal a transformation in the treatment of mental health problems. Soon health care consumers will have a choice as to whether they wish to consult a clinician in his/her rooms in order to receive a diagnosis, treatment and support, or instead to receive these services electronically, or a combination of both. Some of the online services currently available include structured therapy programs, psychological treatment by email, real-time online counselling, professionally assisted chat rooms, self-help groups, health information and educational modules. This paper reviews the use of computer programs in mental health care and, in particular, for the treatment of anxiety and depression. Issues of feasibility, ethics, and effectiveness are discussed and the future of computer-based treatment programs in mental health is considered.

Computer-supported cognitive behavioral treatment of anxiety disorders.

This article reviews the empirical literature pertaining to the use of computer-supported cognitive-behavioral treatment of anxiety disorders, including palmtop computers, virtual reality exposure therapy, and personal computer software programs. The advantages and disadvantages unique to each type of technology are described. The review concludes with a discussion of ethical issues, barriers to the use of technology by clinicians, and suggestions for a process by which scientists and practitioners can conceptualize how technology can advance our understanding of anxiety and our dissemination of effective treatments.

Online therapy: review of relevant definitions, debates, and current empirical support.

The current article reviews the most recent literature addressing the definitions, ethical considerations, and potential strengths and limitations of online therapy. In addition, a framework is provided for how to conceptualize and categorize different aspects of online therapy for research purposes. Relevant studies of both online and face-to-face therapy as well as suggestions for future research are outlined.

Ethical codes and values in a virtual world.

Some members of the so-called virtual world deny that technology such as the virtual environment (VE) is value-laden. But there are a variety of complex issues which arise in VE that make it necessary to think about ethics and values in VE applications. Using VE in therapy and psychotherapy research or diagnostics leads to several ethical concerns. VE can impoverish those aspects of life that are essential to social development, interpersonal relations, and emotional growth. This paper will focus on the concept called "virtual world," a question of metaphysics. After reviewing general ethical principles, ethics in applied sciences will be described. Ethical decision-making, code of conduct, and specific issues in VE will be discussed. The VE community is challenged to set guidelines around VE, and its ethics and values. A set of measurement tools around ethical codes and values in a virtual world ought to be discursively gained in this virtual world and in real society as a whole.