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.

Interpersonal Relationships: Cyber versus Face-to-Face

With a plethora of communication means--chat rooms, e-mail, instant messaging, social-networking sites--the internet has created an entirely new dynamic between and among individuals and groups. People now have the capability to censor and control their own interactions by managing self-portrayal, contacting multiple others simultaneously, not replying to incoming messages, conversing with complete strangers, and taking time to contemplate responses before sending them. Pairing these options with a web of 1.46 billion users (as of June 2008) creates infinite possibilities for text-based relationships. Because these bonds depart from traditional in-person presence and dialogue, questions arise regarding their legitimacy and potential longevity. For instance, is it possible to feel as emotionally attached to someone met on the web as in real-life? Although internet-based conversation has a fantasy component and lacks the appeal to the five senses of physical reality, it does involve a genuine investment in another person, but it would seem that this closeness cannot be sustained in the long-run.

Before examining the way people relate to one another on the internet, there is an important preexisting factor to investigate--how the individual portrays him or herself. Just as one is cognizant of in-person impressions, he or she can take this idea further by creating a persona of choice. According to Kathryn B. Lord, a self-proclaimed cyber-romance coach, on the web "you are what you write." The possibility of self-misrepresentation may cause some to question the validity of internet relationships that seem based on false pretenses, yet assuming that real-life behavior is the best example of a person is a mistake. People may live day-to-day wearing public "masks" that shroud internal beliefs and urges, for which the American Psychological Association surprisingly lacks a term, yet it may just be a coping method that people employ to conform to their perceptions of societal norms. Consequently, a cyber-identity may reveal what an individual strives to be, an "ideal self," which may appear in a glorified "About Me" fill-in section on Facebook, or an exaggeration of truths while talking in a chat room. A great incongruity between the "real-self" and the "ideal-self" can cause suffering, as stated by Carl Rogers, which might perpetuate the attachment that one feels toward another on the internet because such relations with the "ideal self" are not possible in the face-to-face world.

While the internet affords the opportunity to construct a perfect identity, one can also rely on ambiguity to create mystery. These practices of individuals and those with whom they are in contact produce the foundation for a connection. Ongoing conversation fosters the fledgling relationship, yet a skeptic might question the understanding between the two people because true meaning gets lost in translation. It is difficult, for example, to detect the extent of sarcasm, annoyance, or disapproval due to the lack of facial expression cues, tone of voice, and body language. But, emoticons can help bridge this gap. A recent study by Shao-Kang Lo, Ph.D., proved significant differences in perception of meaning based on presence or lack of emoticons: they "allow receivers to correctly understand the level and direction of emotion, attitude, and attention expression." These cartoon-face symbols (see above) still might not be enough to convince a cynic, however the still remaining anonymity might actually be the greatest factor in attachment. The indeterminate identity and meaning creates a certain excitement and intrigue; it "activates the imagination, stirs up fantasies, enhances the tendency to project your own expectations, wishes, and anxieties unto the somewhat shadowy figure sitting at the other end of the online connection," says John Suler, cyberpsychologist. People feel especially attached to their internet companions when the tendency to project favorable qualities on them unites with the online disinhibition effect--the susceptibility to divulge personal details that may not otherwise be shared, based on anonymity. A feeling of intimacy is inevitable once an individual shares secrets that his or her closest real-life friends might not know.

Devotion is evident based on recent reports about internet relationships. To begin, this past week a Japanese woman was arrested for hacking into her virtual ex-husband's "Maple Story" account and killing his character because she was "divorced unexpectedly." Likewise, in August, Kimberley Jernigan was imprisoned for repeatedly attempting to abduct her "Second Life" ex-boyfriend in real life. It seems that these two individuals would resort to drastic measures only if they felt a sincere connection with the internet ex-boyfriends with whom they solely conversed on the web. The "unusually seductive" interactions based on a "mentally nude commune" sparks tenderness like with the woman to the right, but the human body and hormones also play a role, specifically The Human Oxytocin Mediated Attachment System (THOMAS). Humans innately like to be around unfamiliar people and continually seek targets for attachment, so we therefore want a connection with the unknown; oxytocin accomplishes this by "activating reward regions of the brain when we cooperate with strangers." This hormone is indisputably important because it is also responsible for the feeling of bond between a mother and her children, and between individuals during sexual encounters.

Despite oxytocin's influence on human emotion and attachment, internet relationships do not have long-term potential to fulfill needs because of a lack of touch, smell, and sound that exist with face-to-face interaction. Text-based relationships have a seeing component, yet the absence of the other three is detrimental. Everything done online can be done in person, for example if two people were sitting next to each other on a computer, but the opposite falls short--Suler remarks, "everything you can do with someone in-person can't be duplicated in cyberspace." Besides just touch, smell can ignite passion between people and may be important in mate-selection based on pheromones, or chemical signals about one's DNA makeup that may attract a genetically compatible partner. Ultimately, it is the simultaneous combination of the senses that make in-person contact impossible to recreate. In the beginning of online relationships, the details that the imagination interjects about another create an undeniable thrill, though as time goes on, humans cannot help but yearn for more.