In this paper the application of computer technology and the use of the Internet in mental health care are critically reviewed. A number of on-line screening devices have been developed for anxiety disorders, mood disorders, and substance abuse disorders, with great potential for clinical practice. On line assessment is generally equivalent to clinical assessment. A number of studies have shown that self-help treatment programmes on stand-alone computers are as effective as routine clinical care. The Internet enhances the therapeutic possibilities of computers by offering feedback of therapists and more tailor-made treatment. A number of randomized clinical trials (RCTs) have shown that Internet-based treatment is more effective than no-treatment and as effective as face-to-face treatment. Research so far has been limited to anxiety disorders, burn-out, depression, headache, insomnia, tinnitus and obesity. Further, exposure through virtual reality has been found effective in a number of RCTs in specific phobias, but results with respect to the effects of the use of virtual reality techniques to other disorders are inconclusive. It is concluded that computer-driven assessment and treatment has many advantages and few disadvantages. A number of reasons are discussed which will preclude large-scale implementation of computer-driven assessment and therapy in the near future.

Keywords:
Virtual reality treatment, Internet-based treatment, On-line assessment, Information technology, Computer-guided therapy
1.
Baker L, Wagner TH, Singer S, Bundorf MK: Use of the Internet and e-mail for health care information: Results from a national survey. JAMA 2003;289:2400–2406.
2.
Ernst E, Schmidt K: ‘Alternative’ cures for depression – How safe are web sites? Psychiatry Res 2004;129:297–301.
3.
Buchanan T: Online assessment: Desirable or dangerous? Prof Psychol Res Pr 2002;33:148–154.
4.
Richman WL, Kiesler S, Weisband S, Drasgow F: A meta-analytic study of social desirability distortion in computer administered questionnaires, traditional questionnaires, and interviews. J Appl Psychol 1999;84:754–775.
5.
Newman MG: Technology in psychotherapy: An introduction. J Clin Psychol 2004;60:141–145.
6.
Wallace P: The Psychology of the Internet. Cambridge, Cambridge University Press, 1999.
7.
Levine S, Ancill RJ, Roberts AP: Assessment of suicide risk by computer-delivered self-rating questionnaire. Acta Psychiatr Scand 1988;80:216–220.
8.
Stones A, Perry D: Survey questionnaire data on panic attacks gathered using the World Wide Web. Depress Anxiety 1997;6:86–87.
9.
Herrero J, Meneses J: Short Web-based versions of the Perceived Stress (PSS) and Cen ter for Epidemiological Studies-Depression (CESD) scales: A comparison to pencil and paper responses among Internet users. Comput Human Behav, in press.
10.
Favolden P, McBride C, Bagby RM, Ravitz P: A web-based screening instrument for depression and anxiety disorders in primary care. J Med Internet Res 2003;5:23.
11.
Brodey BB, Rosen CS, Brodey IS, Sheetz BM, Steinfeld RR, Gastfriend DR: Validation of the Addiction Severity Index (ASI) for internet and telephone self-report administration. J Subst Abuse Treat 2004;26:253–259.
12.
Lenert LA, Looman T, Agoncillo T, Nguyen M, Sturley A, Jackson CM: Potential validity of conducting research on headache in Internet populations. Headache 2002;42:200–203.
13.
Marks IM, Kenwright M, McDonough M, Whittaker M, O’Brien T, Mataix-Cols D: Saving clinicians’ time by delegating routine aspects of therapy to a computer: A randomized controlled trial in panic/phobia disorder. Psychol Med 2004;34:9–17.
14.
Greist JH, Marks IM, Baer L, Kobak KA, Wenzel KW, Hirsch MJ, Mantle JM, Clary CM: Behavior therapy for obsessive-compulsive disorder guided by a computer or by a clinician compared with relaxation as a control. J Clin Psychiatry 63:138–145.
15.
Osgood-Hynes DJ, Greist JH, Marks IM: Self-administered psychotherapy for depression using a telephone-accessed computer system plus booklets: An open US-UK study. J Clin Psychiatry 1998;59:358–365.
16.
Williams CJ: Overcoming Depression: A Five Areas Approach. London, Arnold, 2001.
17.
Yates F: Evaluation of the Balance Computer Intervention. London, Report Mental Health Foundation, 1996.
18.
Hester RK, Delaney HD: Behavioral Self-Control Program for Windows: Results of a controlled trial. J Consult Clin Psychol 1997;65:685–693.
19.
Squires DD, Hester RK: Using technological innovations in clinical practice: The drinker’s check-up software program. J Clin Psychol 2004;60:159–169.
20.
Proudfoot J, Goldberg D, Everit MB, Marks I, Gray JA: Computerized, interactive, multimedia cognitive-behavioural program for anxiety and depression in general practice. Psychol Med 2003;33:217–227.
21.
Gega L, Marks I, Mataix-Cols D: Computer-aided CBT self-help for anxiety and depressive disorders: Experience of a London clinic and future directions. J Clin Psychol 2004;60:147–157.
22.
King SA, Engi S, Poulos ST: Using the internet to assist family therapy. Br J Guid Couns 1998;26:43–52.
23.
Murphy LJ, Mitchell DL: When writing helps to heal: E-mail as therapy. Br J Guid Couns 1998;26:21–32.
24.
Sampson JP, Kolodinsky RW, Greeno BP: Counseling on the information highway: Future possibilities and potential problems. J Couns Dev 1997;75:203–212.
25.
Lange A, van de Ven JP, Schrieken B, Bredeweg B, Emmelkamp PMG: Internet-mediated, protocol driven treatment of psychological dysfunction. J Telemed Telecare 1999;6:15–21.
26.
Lange A, Schrieken B, van de Ven JP, Bredeweg B, Emmelkamp PMG, van der Kolk J, Lydsdottir L, Massaro M, Reuvers A: ‘Interapy’: The effects of a short protocolled treatment of post-traumatic stress and pathological grief through the Internet. Behav Cogn Psychother 2000;28:175–192.
27.
Lange A, van de Ven JP, Schrieken B, Emmelkamp PMG: Interapy. Treatment of posttraumatic stress through the Internet: A controlled trial. J Behav Ther Exp Psychiatry 2001;32:73–90.
28.
Lange A., Rietdijk D, Hudcovicova M, van de Ven JP, Schrieken S, Emmelkamp PMG: Interapy. A controlled randomized trial of the standardized treatment of posttraumatic stress through the Internet. J Consult Clin Psychol 2003;71:901–909.
29.
Timmerman IGH, Emmelkamp PMG, Sanderman R: The effects of a stress-management training program in individuals at risk in the community at large. Behav Res Ther 1998;36:863–875.
30.
De Jong GM, Emmelkamp PMG: Implementing a stress-management training: Comparative trainer effectiveness. J Occup Health Psychol 2000;5:309–320.
31.
Lange A, van de Ven JP, Schrieken B, Smit M: Interapy Burn-out: Prävention und Behandlung von Burn-out über das Internet. Verhaltenstherapie 2004;14:190–199.
32.
Carlbring P, Westling BE, Ljungstrand P, Ekselius L, Anderson G: Treatment of panic disorder via the Internet: A randomized trial of a self-help program. Behav Ther 2001;32:751–764.
33.
Carlbring P, Ekselius L, Andersson G: Treatment of panic disorder via the Internet: A randomized trial of CBT vs applied relaxation. J Behav Ther Exp Psychiatry 2003;34:129–140.
34.
Carlbring P, Nilsson-Ihrfet E, Waara J, Kollenstam C, Buhrman M, Kaldo V, Söderberg M, Ekselius L, Andersson G: Treatment of panic disorder: Live therapy vs self-help via the Internet. Behav Res Ther, in press.
35.
Alcaniz M, Botella C, Banos R, Perpina C, Rey B, Lozano JA, Guillen V, Barrera F, Gil JA: Internet-based telehealth system for the treatment of agoraphobia. Cyberpsychol Behav 2003;6:355–358.
36.
Christensen H, Griffiths KM, Jorm AF: Delivering interventions for depression by using the internet: Randomized controlled trial. BMJ 2004;328:265–286.
37.
Devineni T, Blanchard EB: A randomized controlled trial of an internet-based treatment for chronic headache. Behav Res Ther 2005;43:277–292.
38.
Anderson G, Lundström P, Ström L: Internet-based treatment of headache: Does telephone contact add anything? Headache 2003;43:353–361.
39.
Ström L, Petterson R, Anderson G: A controlled trial of self-help treatment for recurrent headache conducted via the Internet. J Consult Clin Psychol 2000;68:722–727.
40.
Ström L, Petterson R, Anderson G: Internet-based treatment for insomnia: A controlled evaluation. J Consult Clin Psychol 2004;72:113–120.
41.
Andersson G, Strömgren T, Ström L, Lytkens L: Randomized controlled trial of Internet-based cognitive behavior therapy for distress associated with tinnitus. Psychosom Med 2002;64:810–816.
42.
Tate DF, Jackvony EH, Wing RR: Effects of Internet behavioural counseling on weight loss in adults at risk for type 2 diabetes-a randomized trial. JAMA 2003;289:1833–1836.
43.
Tate DF, Zabinski MF: Computer and Internet applications for psychological treatment: Update for clinicians. J Clin Psychol 2004;60:209–220.
44.
Emmelkamp PMG: Behavior therapy with adults; in Lambert M (ed): Bergin and Garfield’s Handbook of Psychotherapy and Behavior Change, ed 5. New York, Wiley, 2004, pp 393–446.
45.
Krijn M, Emmelkamp PMG, Olafsson R: Virtual reality exposure therapy in anxiety disorders. Clin Psychol Rev 2004;24:259–281.
46.
Emmelkamp PMG, Krijn M, Hulsbosch L, de Vries S, Schluemie M, van der Mast CPAG: Virtual reality treatment versus exposure in vivo: A comparative evaluation in acrophobia. Behav Res Ther 2002;40:509–516.
47.
Krijn M, Emmelkamp PMG, Biemond R, De Wilde De Ligny C, Schuemie MJ, van der Mast CA: Treatment of acrophobia in virtual reality: The role of immersion and presence. Behav Res Ther 2004;42:229–239.
48.
Rothbaum BO, Hodges L, Smith S, Lee JH, Price L: A controlled study of virtual reality exposure therapy for fear of flying. J Consult Clin Psychol 2000;70:428–432.
49.
Maltby N, Kirsch I, Mayers M, Allen GJ: Virtual reality exposure therapy for the treatment of fear of flying: A controlled investigation. J Consult Clin Psychol 2002;70:1112–1118.
50.
Krijn M, Emmelkamp PMG, Olafsson RP, Bouwman M, van Gerwen LJ, Spinhoven Ph, Schuemie MJ, van der Mast CAPG: Fear of Flying: A Comparative Evaluation of Virtual Reality Exposure Therapy, Cognitive Behavioural Methods and Bibliotherapy. Submitted.
51.
Riva G: Virtual reality in psychotherapy. Cyberpsychol Behav, in press.
52.
Optale G, Marin S, Pastore M, Nasta A, Pianon C: Male sexual dysfunctions and multimedia immersion therapy (follow-up). Cyberpsychol Behav 2003;6:289–294.
53.
Bordnick PS, Graap KM, Copp H, Brooks J, Ferrer M, Logue B: Utilizing virtual reality to standardize nicotine craving research. Addict Behav 2004;29:1889–1894.
54.
Lee JH, Ku J, Kim K, Kim B, Kim IY, Yang BH, Kim SH, Wiederhold BK, Wiederhold MD, Park DW, Lim Y, Kim SI: Experimental application of virtual reality for nicotine craving through cue exposure. Cyberpsychol Behav 2003;6:275–280.
55.
Kuntze FM, Stoermer R, Mager R, Roessler A, Mueller-Spahn F, Bullinger A: Immersive virtual environments in cue exposure. Cyberpsychol Behav 2001;4:497–501.
56.
Tse MMY, Ng JKF, Chung JWY: Visual stimulation as pain relief for Hong Kong Chinese patients with leg ulcers. Cyberpsychol Behav 2003;6:315–320.
57.
Schneider SM, Ellis M, Coombs WT, Shonkwiler EL, Folsom LC: Virtual reality intervention for older women with breast cancer. Cyberpsychol Behav 2003;6:301–307.
58.
Gershon J, Zimand E, Pickering M, Tothbaum BO, Hodges L: A pilot and feasibility study of virtual reality as a distraction for children with cancer. J Am Acad Child Adolesc Psychiatry 2004;43:1243–1249.
59.
Lee JH, Ku JH, Cho W, Hahn WY, Kim IY, Lee S, Kang Y, Deog YK, Yu T, Wiederhold BK, Wiederhold MD, Kim, SI: A virtual reality system for the assessment and rehabilitation of the activities of daily living. Cyberpsychol Behav 2003;6:383–388.
60.
Sveistrup H, McComas JTM, Marshall S, Finestone H, McCormick A, Babulic K, Mayhew A: Experimental studies of virtual reality-delivered compared to conventional exercise programs for rehabilitation. Cyberpsychol Behav 2003;6:245–249.
61.
Gaggioli A, Morganti F, Walker R, Meneghini A, Alcaniz M, Lozano JA, Montesa J, Gil JA, Riva G: Training with computer-supported motor imagery in post-stroke rehabilitation. Cyberpsychol Behav 2004;7:327–332.
62.
Flynn D, van Schaik P, Blackman T, Femcott C, Hobbs B, Calderon C: Developing a virtual reality-based methodology for people with dementia: A feasibility study. Cyberpsychol Behav 2003;6:591–611.
63.
Cho BH, Kim S, Shin DI; Lee JH, Lee SM, Kim IY, Kim SI: Neurofeedback training with virtual reality for inattention and impulsiveness. Cyberpsychol Behav 2004;7:519–526.
64.
Morie JF, Iyer K, Valanejad K, Sadek R, Miraglia D, Milam D: Emotionally evocative environments for training. Army Sci Conf, Orlando, 2002.
65.
Fava GA: Conflict of interest in psychopharmacology: Can Dr Jekyll still control Mr Hyde? Psychother Psychosom 2004;73:1–4.
66.
Suler J: Assessing a person’s suitability for online therapy: The ISMHO clinical case study group. International Society for Mental Health Online. Cyberpsychol Behav 2001;4:675–679.
67.
Cook JE, Doyle C: Working alliance in online therapy as compared to face-to-face therapy: Preliminary results. Cyberpsychol Behav 2002;5:95–105.
68.
Hsiung RC: Suggested principles of professional ethics for the online provision of mental health services. Medinfo 2001:10:1296–1300.
© 2005 S. Karger AG, Basel
2005
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.