Co-written with David B. Feldman, Ph.D.
The new iOS upgrade made headlines in September, with some singing its praises and others counting its flaws. It's almost impossible not to compare this new edition of the iPhone and iPad operating system to its predecessor. It's worth noting, however, that the picture's bigger than smartphones and tablets. Every technology update replaces something else. We've seen technology replace human beings on assembly lines. We've also seen it displace in-person book sales. And now, it looms larger by the day in the psychological treatment of trauma survivors. Should we be worried or thrilled?
In 2011, Ravi Chandra, writing for Psychology Today, highlighted a number of concerns, suggesting that while there "has been some evidence for enhanced CBT [Cognitive-Behavioral Therapy] efficacy using text messaging to deliver messages to those with Major Depression, and also for smoking cessation... there seem to be particular features and benefits of so called FTF (face to face) therapy that may not be present in video-therapy via Skype and similar mechanisms."
These issues really haven't changed much since then, but that hasn't stopped engineers and practitioners from developing and disseminating new technological tools and interventions. The research is beginning to show that, while technology may not replace in-person therapy, advances are making life better for survivors.
Videoconferencing software like Skype and Google+ Hangouts, for instance, is allowing therapists and clients to connect across vast geographical distances. Known as teletherapy or tele-mental-health, a variety of therapeutic interventions with diverse populations have now been delivered with the aid of this technology. The potential is great, particularly for bringing services to distant rural areas and other parts of the world with few local therapists.
As Kathleen Griffins and Helen Christensen write in their 2007 article in the Australian Journal of Rural Health, "There is evidence that the prevalence of mental health problems in rural areas is at least as high as among metropolitan residents and that rates of suicide are higher than in city or urban areas. However, fewer people in rural areas seek help for mental disorders."
There are concerns, however.
First and foremost is the issue of privacy. Given the stigma still attached to mental health difficulties, many people don't want their family, friends, or neighbors knowing they're in counseling. If email messages are exchanged, who else can access those messages? Are traces somehow left as information makes its way across computer networks? What happens if the laptop of a client or therapist is stolen? These issues aren't that much different than classical confidentiality concerns in in-person therapy, though that doesn't make them any less crucial.
But is therapy transmitted through pixels as effective as in-person therapy? Debate within the mental health field rages on, with opinion very much divided. Given that video conferencing technology is so commonplace, with webcams present in almost all of our laptops, tablets, and cell phones, it's hard to remember that its widespread accessibility is extremely new. As such, research on the topic is still in its infancy. Concerns include whether the trust and interpersonal bonds experienced between clients and therapists will diminish through the use of technology, and how this could affect the outcome of counseling, as well as whether a lack of technology literacy may put some groups of people at a disadvantage.
But still, the research shows promise. In their 2008 article in the Journal of Technology and Human Services, Azy Barak, Liat Hen, Meyran Boniel-Nissim, and Na'ama Shapira statistically examined the results of 92 studies (containing almost 12,000 patients total) testing various online psychotherapeutic interventions for a range of conditions.
The results of each study varied widely, with most showing some success and a handful showing little or none. Overall, however, the authors reported that the effectiveness of the online interventions seemed to be in the same range as in-person interventions. But the details mattered. Online interventions weren't equally successful for all conditions, showing larger effects for treating post-traumatic stress disorder and anxiety disorders than other conditions. In addition, the age of clients seemed to matter, with relatively little treatment success reported for older adults compared with the 25 to 39 age group. So, though the results are generally encouraging, it's a mistake to paint with too broad a brush.
Besides simple video sessions, organizations such as the U.S. Department of Veterans Affairs National Center for Post-Traumatic Stress Disorder and the U.S. Department of Defense's National Center for Telehealth and Technology are rolling out smartphone apps like PTSD Coach and Breathe2Relax, designed to help sufferers of combat trauma treat their symptoms and learn important coping skills. These apps are intended to be used in tandem with traditional psychotherapy, but when geography, physical ability or stigma prevent in-person treatment, these apps could make the difference.
Social support from family and friends, which, according to research is one of the major predictors of resilience after trauma, also may receive a boost from Internet technologies. While locally available social support may vary dramatically from community to community, virtual support is available practically 24/7. Common sense tells us that online support may not be as effective as real in-the-flesh human contact. Yet, it's worth considering whether virtual communities, linking people who might never actually meet, may genuinely help some to cope with adversity.
Take for instance the 2012 case in which C. Corey Fisk, a homebound woman with multiple sclerosis went on something called a photo walk with photographer John Butterill. The two met online through a social network. Using his smartphone, Butterill streamed a live walk to Fisk's computer, offering virtual interaction and helping her to do something she might not otherwise be able to do. Or the case of Stutter Social, an organization that connects people who stutter through video conferencing. Here, a 71-year old man from Split, Croatia, meets with other stutters online from across the globe, transforming the way he interacts and offering him opportunities to improve his speech.
It's far from clear whether online therapy is as good as traditional therapy. As the U.S. Department of Veterans Affairs states on the web page introducing its PTSD Coach app, "PTSD is a serious mental health condition that often requires professional evaluation and treatment. PTSD Coach is not intended to replace needed professional care."
Nonetheless, technology is offering increasing hope and alternatives for survivors. The amazing plasticity of technology mirrors our own potential as human beings to be resilient in the face or trauma and adversity.
Lee Daniel Kravetz and David B Feldman are the authors of the upcoming book by HarperCollins/HarperWave, Supersurvivors: The Surprising Link Between Suffering & Success, out Summer of 2014. Read more at www.facebook.com/SupersurvivorsTheBook and LIKE us on Facebook.
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