Online Therapy: Cyberspace Meets Outer Space

In my first post, I concluded that internet addiction is likely to be a manifestation of disorders, like depression or anxiety, and should not be added to the Diagnostic and Statistical Manual of Mental Disorders. While many individuals do believe it is worthy of its own diagnosis, perhaps they would be convinced otherwise if the internet could actually help correct the behavior that they believe is solely attributable to its use. Could online therapy be sufficient to diminish the symptoms of a mental affliction? The prospect seems promising but is not yet prominent regarding online counseling for the average citizen. Instead, current attention falls on a population in a high-risk situation, without the ability to see a live therapist--astronauts. An Associated Press news article published this past week, "Depressed Astronauts Might Get Computerized Solace," reveals NASA's intent to launch a $1.74 million project called the Virtual Space Station designed by Dartmouth psychologist Dr. Mark Hegel, seen to the right. This undertaking, sponsored by the National Space Biomedical Research Institute, will help astronauts identify the reasons for their depression and combat the symptoms using a method called the "problem-solving treatment."

This week I probed the blogosphere for reactions to NASA's plan. First, I commented on "Therapy in Space" by Dr. Greg Mulhauser because of his credibility with a Ph.D. and establishment with his own consulting firm. Mulhauser thinks the Virtual Space Station will be important in the advancement of internet therapy as a whole because of NASA's name and the supplied funding. I also commented on "The Madness of Offering Depressed Astronauts a Computerized Shrink," by a skeptical creative media director, Chris Matyszczyk. I have posted my input on the two respective blogs, but have also included it below for convenience.

"Therapy in Space"
Comment:
I appreciate your information and insight regarding internet therapy, especially since I see its potential to become more wide-spread with this funding and added attention. Even though you say it has been in existence for a while, it is not yet in the foreground; I believe it would be beneficial particularly for individuals who do not have the means to afford such mental help. Also, because there is a societal stigma attached to participating in therapy sessions, individuals could opt to handle these personal matters in a more inconspicuous fashion.

You quote Dr. Jay Buckley saying, "The Virtual Space Station is based on proven treatment programs and is a very helpful way to work on problems in general," but how do you think internet-based therapy compares with face-to-face therapy? I understand that for astronauts this is the only option, but projecting into the future for the general public, do you think internet therapy would be a sufficient alternative? I believe it would depend on the nature of the disorder, but it seems that milder diagnoses could highly benefit from something like this that would promote reflection and self-evaluation.

I think you offer a valid point regarding asynchronous therapy via email. While it does have the time-delay, it seems like a healthy outlet for astronauts to discuss their mental concerns to an unbiased party. The emails could act as a diary for these space-explorers to anonymously record thoughts and feelings, which alone seems therapeutic. In their situation, it may be difficult to share issues with other crew members based on a fear of judgment or a perception of weakness, but in an email they would feel empowered to know that a psychologist is listening and will provide feedback. A problem might arise if an astronaut becomes frustrated and expects a quick-fix. The mental unrest that lies within an individual must also be coped with by that person alone; a psychologist just acts as a catalyst in this process.

"The Madness of Offering Depressed Astronauts a Computerized Shrink"
Comment:
I read the recent article about the Virtual Space Station that NASA is creating to help depressed astronauts, and would like to thank you for your opinion on the matter. To begin, you say that "many of these astronauts were already a bit weird before they floated off into space," which might be true, but I believe astronauts go through extremely strict physical and mental tests to assess their potential ability to remain sane while in an enclosed environment. Even if you think astronauts were previously "crazy" before launching into space, its still seems important for them to have access to a program that will foster introspection and mental self-evaluation. I understand the process of therapy differently than you do; I do not think that astronauts input questions or feelings and have an automated-type response, but instead, the pre-recorded psychologist offers different mind exercises that the individual can perform, like a meditation. It seems useless for the astronaut to type a message because therapists do not give answers, however they do help one come to terms with stresses using various methods of self-reflection.

You express doubt in the non-human qualities of the computer, and suggest that a better alternative would be to have a psychologist there in person, despite the potential problems with regard to number of people on the mission. First of all, therapists are not superhuman and are subject to depression and other mental disorders just like everyone else. Secondly, if there were a psychologist on the spacecraft, they would become part of the crew; part of the reason for depression is that the astronaut is surrounded by the same people and are disconnected from the outside world. A therapist online would help someone feel a connection to home. Also, you ask how anyone could feel comfortable revealing a strange dream of theirs to a "mere computer," but according to the online disinhibition effect, people are much more likely to divulge personal information on a computer as opposed to in real life because of anonymity. With all of that said, I believe that online therapy is far from perfect, but it seems like the best alternative for these individuals, given their location.

Probing Cyberspace: Resources in Social Psychology

While exploring the internet for cyberpsychology sites, I found some beneficial sources examining recent advances, but also helping to explain social psychology as a whole. To evaluate the various online books, informational sites, and organizations, I will use the Webby Awards Criteria, while blogs will be analyzed according to the IMSA Criteria. Links to these sites appear to right under linkroll. First is an online book called Cyberpsychology: Principles of Creating Virtual Presence by Dr. Leon James which contains excellent insight into the relationship between virtual reality and actuality, but the page has text spanning from side to side, top to bottom. It would benefit by breaking the block of daunting content with relevant pictures to create a more dynamic environment. Similarly, John Suler's The Psychology of Cyberspace has a bland main page that needs updating, but has applicable images infused in each chapter (like that to the left) and links to recent articles about cyberpsychology to supplement the older text.

Another great resource by Suler is his blog of the same title--The Psychology of Cyberspace. The greatest strength is the credibility of the blogger; Suler is a professor and leader in the emerging field. While many of the provided links prove very helpful, such as the archived posts, those connecting to his bio page and online book lead to nonexistent ends. Additionally, Suler along with Azy Barak has created a book in the form of a blog, Psychological Aspects of Cyberspace: Theory, Research, Applications. It is one of my personal favorites because of its innovation in making an online book interactive; each chapter has a separate link leading to the full PDF version, yet also allows for comments from outsiders. Although it presents each chapter in the same colors, this site would appear more professional if the homepage followed suit to create a streamlined look. Similarly dynamic, Pamela Rutledge's Media Psych Cafe is stimulating because of the opportunity to participate in the blogger's survey study and the information regarding upcoming external events in the field. Despite it seeming well-established, I wish there were more comments and dialogue surrounding each post. By contrast, Graham Jones Internet Psychologist has an abundance of conversation between the blogger and guests, but a bio directly on his page would enhance credibility. Like Jones' blog, The Media Zone creates discourse but in a different way: real-life anecdotes engage the reader and allow for a deeper understanding of the material because of relatable evidence. Like its greater site--Psychology Today Blogs--The Media Zone has too many distracting advertisements that detract from a sense of scholarship. Psychology Today Blogs is a great repository, though, and offers blogs written by reliable individuals.

Moving onto resource sites led me to Cyberpsychology, a web page with links to articles of relevant content, but a detrimentally homemade and unprofessional appearance. Conversely, the Internet Psychology Research Institution's main strength is its authoritative look with uniform colors on the homepage and every subsequent link. Although easily navigable and a seemingly promising resource, this site currently has many links leading to empty pages or "coming soon" signs. Social Psychology Network is like the previous in that its goal is to create accessible articles on recent studies, but it is much more established. The overall experience of a reader is positive because it is maneuverable, has links to partner sites for even more information, has an interactive forum, and is aesthetically pleasing. It is very difficult to critique, but the functionality could improve if search results appeared more quickly. Another website with a wide variety of resources--most notably blogs, news, and research--is called PsychCentral. It is legitimate because of its sixteen-year life, but is gimmicky due to some of the self-quizzes, especially those about relationships which seem suited to a girls' gossip magazine. By contrast, the Journal of Computer-Mediated Communication appears very scholarly and has archives dating back to 1995; unfortunately, the site began posting new articles onto a different "synergy site" linked from the homepage, but the old ones are of the highest quality and worth visiting.

As a supplement to many of these subject-specific resources, readers can explore social psychology basics with the Alphabetical Glossary of terms. Prentice Hall created this list but there is no link back to the publisher's homepage--it seems an academic publisher would want to take credit for the glossary. Although the site is very bare, just black and white, it serves its purpose as a reference; almost as bare is Social Psychology, a great resource for the basics of topics ranging from theories and methods to gender and sex. Unlike the aforementioned glossary, this site would benefit from some attention to color and organization. It has a place to submit input which affords readers a sense of influence. Another important resource is the DSM-IV-TR, which answers questions that a layperson and psychologist alike might have about the Diagnostic and Statistical Manual. While it has a frequently asked questions portion, and discusses coding issues, it would benefit from greater detail like having an online version of the book for access in any location. Just as the DSM is a staple, staying informed about recent advances is equally essential; Psychology in the News has a collection of current articles sorted by publication date, with the newest at the top. Even though it is conveniently organized, the site could be improved with a search function that would sort through archived articles from the past. Psychology in the News is a faction of the American Psychological Association (see logo on right), a very prominent organization. APA's sleek site avoids clutter by having drop-down menus under each main heading, such as careers and publications. It caters to individuals with tabs on the side especially for advertisers, authors, and students, among others. To improve, each portion of the site should have the same colors so that the reader is not confused as to where he or she has been led--within the same site or to an outside source. A parallel organization, Association for Psychological Science, is more difficult to navigate because it does not have a site map and quick links like APA. While APS links to valuable resources like journal articles, the site would benefit by offering greater access to non-members. Lastly, the National Institute of Mental Health is a government site that offers access to publications in both English and Spanish, which appeals to a greater audience, but the entire site should be bilingual. These resources have given me a better understanding of social psychology as a field and made me realize the abundance of valuable resources available on the web.

Internet Addiction: A Valid Affliction?

Psychologists continue to debate the legitimacy of internet addiction and its worthiness of a place in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, due out in May 2012. Currently, the DSM-IV-TR does not include a section for addictions; substance abuse, its closest relative, exists on the first axis. Axis I disorders constitute mental illness, but the inclusion of internet addiction among them is a mistake because the internet itself is not an addiction, but a disguise for an existing disorder or an escape from boredom. In a hasty effort to pathologize human behavior, individuals attempt to shirk responsibility for their actions--diagnosing internet addiction would further enable this behavior. Although other countries recognize and treat internet addiction, this fascination should not be included in the DSM-V as an Axis I disorder, but instead, noted on the fourth axis as an environmental factor, only if a true Axis I disorder exists.

Superficially, surfing the internet for the majority of a day seems unhealthy and like an addiction, but other factors exist; excessive use may mask mental illness. Before reaching a conclusion, it is important to establish true addiction criteria: obsession with using the internet, tolerance and withdrawal symptoms, inability to limit use, and reliance on the internet to alter mood. But, the internet is not the abuser. The individual is not the victim (see left picture). According to media psychologist, Pamela Rutledge, "Like most addictions, Internet addiction is not about the Internet," but rather, it concerns the individual using the internet to the point of destruction within his or her own life. Those who use such internet activities to alter moods are exceptional candidates for an existing mental disorder, such as anxiety or depression. Regarding internet addiction as proven methodologically, Louise Nadeau, of Universite de Montreal's Department of Psychology, admits that "there is no reliable study or clinical data on the issue." To include internet addiction in the DSM-V on such a whim undermines the value of psychology as an empirical science.

By contrast, this lack of evidence may be irrelevant because the internet might simply be a functional way to complete work and a stimulating way to pass time. Because humans have an innate desire to avoid boredom, they enjoy using the internet because it offers endless possibilities for communication and information-gathering. With the internet's multi-functionality, one can complete a work e-mail, instant message a friend, and listen to an mp3 all simultaneously. If the internet were not used to complete these activities, the time spent doing each individually might actually exceed that in front of the computer. Additionally, if people could not use the internet, they would find other means of gaining access to what they want, for example excessive text messaging or video-game playing.

By rejecting these alternatives, a cycle governed by laws of behavioral psychology begins. One initially logs onto the internet to avoid boredom, and in turn, that avoidant behavior becomes positively reinforced by communication and entertainment, among others. Human behaviors work on this principle, though, so to call this an addiction is pathologizing regular human conduct. Normal behavior should not include withdrawal symptoms, yet a British online newspaper, MailOnline claims that an increase in blood pressure and brain activity do occur: "The stress of being disconnected [is] equivalent to that of running half an hour late for a key meeting, being about to sit an important exam or, in the worst cases, being sacked." This still seems normal. For example, if an individual is barred from the internet and experiences stress while expecting a work email, the stress really stems from the workplace and its expectations. The internet is simply an efficient means to finish overwhelming projects, like in the picture to the right. These studies on internet addiction must be examined skeptically; many studies are conducted to prove its harmful effects based on the agendas of psychologists who want to diagnose it as a disorder.

Instead of diagnosing internet addiction on the first axis, psychologists must make "internet abuse" more secondary. Because addictions do not currently exist as a category, psychologists would have to create one; this would further encourage future additions to an "addictions" category. Instead, to help preserve the integrity of the current DSM-IV-TR, psychologists could adopt a method of diagnosis whereby they would add "internet abuse" to the psychosocial and environmental axis IV. With this, they could still treat a patient for spending an unhealthy amount of time doing one thing, but it would put "the internet" in the background. This should only be used if there is in fact a true clinical diagnosis. For example, a psychologist diagnoses a patient with depression, spending an unhealthy amount of time watching tragic movies. Watching tragedies is arbitrary. The diagnosis is still depression whether the patient unhealthily manifests energy in watching tragedies, using the internet, or a plethora of other activities. No matter the activity, a psychologist would still try to train the patient in time management, coping skills, and productive ways to spend time.

Making "internet abuse" secondary would avoid a patient feeling the powerlessness that exists with axis I diagnoses. Upon receiving a diagnosis, one may feel less responsible for his or her actions; the likelihood of blaming behaviors or emotions on a psychosis heightens. Also, a self-fulfilling prophecy may emerge--a patient begins to act a certain way based on expectations of someone with that disorder. Dr. Jerald J. Block believes in diagnosing internet addiction and cites South Korea for considering it among its most problematic public health issues; 210,000 children ages 6-19 require treatment, and of those, 20% to 24% require hospitalization. By exaggerating this problem, children in South Korea will grow up to believe that they have a disease, so anything they become attached to in the future, the internet or otherwise, they can blame on "the disease." The older generation may not understand that the world is rapidly changing and that technology is a main component--"This is a media culture and to succeed in it, we have to know how to harness media technologies for our positive use and make peace with them," said Rutledge. Living in a "media culture", we must realize the importance of the internet, while still monitoring our activities and time spent doing them. Most importantly, if we take responsibility for our actions and use the internet as a helpful tool, we will seldom confuse it for a life-consuming monster.