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.

[1]  J. Deutsch,et al.  Virtual Reality for Stroke Rehabilitation , 2011, The Cochrane database of systematic reviews.

[2]  Andrea Weinstein,et al.  Simulated job interview skill training for people with psychiatric disability: feasibility and tolerability of virtual reality training. , 2011, Schizophrenia bulletin.

[3]  Patrick G. Kenny,et al.  Virtual Reality Goes to War: A Brief Review of the Future of Military Behavioral Healthcare , 2011, Journal of Clinical Psychology in Medical Settings.

[4]  M. Levin,et al.  Virtual Reality in Stroke Rehabilitation: A Meta-Analysis and Implications for Clinicians , 2011, Stroke.

[5]  G. Riva.  The Key to Unlocking the Virtual Body: Virtual Reality in the Treatment of Obesity and Eating Disorders , 2011, Journal of diabetes science and technology.

[6]  M. Graber,et al.  Black, white or green: ‘race’, gender and avatars within the therapeutic space , 2011, Medical Humanities.

[7]  Giuseppe Riva,et al.  From virtual reality to interreality in the treatment of anxiety disorders , 2011 .

[8]  Hunter G Hoffman,et al.  A randomized, controlled trial of immersive virtual reality analgesia, during physical therapy for pediatric burns. , 2011, Burns : journal of the International Society for Burn Injuries.

[9]  Kevin M. Holloway,et al.  Effectiveness of virtual reality exposure therapy for active duty soldiers in a military mental health clinic. , 2011, Journal of traumatic stress.

[10]  Eric J. Seibel,et al.  Virtual Reality as an Adjunctive Non-pharmacologic Analgesic for Acute Burn Pain During Medical Procedures , 2011, Annals of behavioral medicine : a publication of the Society of Behavioral Medicine.

[11]  Rachel Kizony,et al.  Using video-capture virtual reality for children with acquired brain injury , 2011, Disability and rehabilitation.

[12]  Paul M. G. Emmelkamp,et al.  Virtual Reality Exposure Therapy for Anxiety Disorders: The State of the Art , 2011 .

[13]  P. Yellowlees,et al.  Practice guidelines for videoconferencing-based telemental health - October 2009. , 2010, Telemedicine journal and e-health : the official journal of the American Telemedicine Association.

[14]  Susan M. Jegley,et al.  Clinician perceptions of virtual reality to assess and treat returning veterans. , 2010, Psychiatric services.

[15]  P. Emmelkamp,et al.  Virtual reality exposure therapy in anxiety disorders: a systematic review of process‐and‐outcome studies , 2010, Depression and anxiety.

[16]  M. Graber,et al.  Get Your Paws off of My Pixels: Personal Identity and Avatars as Self , 2010, Journal of medical Internet research.

[17]  Brent M Barbour,et al.  Driving rehabilitation for military personnel recovering from traumatic brain injury using virtual reality driving simulation: a feasibility study. , 2010, Military medicine.

[18]  Brenda K. Wiederhold,et al.  Lessons Learned from 350 Virtual-Reality Sessions with Warriors Diagnosed with Combat-Related Posttraumatic Stress Disorder , 2010, Cyberpsychology Behav. Soc. Netw..

[19]  José Gutiérrez-Maldonado,et al.  Effect of the mood produced by virtual reality exposure on body image disturbances. , 2010, Studies in health technology and informatics.

[20]  M. Ferrer-García,et al.  The Validity of Virtual Environments for Eliciting Emotional Responses in Patients With Eating Disorders and in Controls , 2009, Behavior modification.

[21]  J. E. Groves,et al.  Computer Simulation and Virtual Reality in the Diagnosis and Treatment of Psychiatric Disorders , 2009, Academic psychiatry : the journal of the American Association of Directors of Psychiatric Residency Training and the Association for Academic Psychiatry.

[22]  Giuseppe Riva,et al.  Virtual reality: an experiential tool for clinical psychology , 2009 .

[23]  A. Rizzo,et al.  Affective outcomes of virtual reality exposure therapy for anxiety and specific phobias: a meta-analysis. , 2008, Journal of behavior therapy and experimental psychiatry.

[24]  G. Riva,et al.  A Second Life for eHealth: Prospects for the Use of 3-D Virtual Worlds in Clinical Psychology , 2008, Journal of medical Internet research.

[25]  Maria T. Schultheis,et al.  Ethical Issues for the Use of Virtual Reality in the Psychological Sciences , 2008 .

[26]  Nicholas Tarrier,et al.  Virtual reality in mental health : a review of the literature. , 2007, Social psychiatry and psychiatric epidemiology.

[27]  Scott C. Simmons,et al.  Telepsychiatry and e-Mental Health Services: Potential for Improving Access to Mental Health Care , 2006, Psychiatric Quarterly.

[28]  Giuseppe Riva,et al.  Virtual Reality in Psychotherapy: Review , 2005, Cyberpsychology Behav. Soc. Netw..

[29]  Stéphane Bouchard,et al.  Virtual Reality Therapy Versus Cognitive Behavior Therapy for Social Phobia: A Preliminary Controlled Study , 2005, Cyberpsychology Behav. Soc. Netw..

[30]  Hunter G Hoffman,et al.  Virtual-reality therapy. , 2004, Scientific American.

[31]  M. Krijn,et al.  Virtual reality exposure therapy of anxiety disorders: a review. , 2004, Clinical psychology review.

[32]  Z. Taintor.  e-Therapy: Case Studies, Guiding Principles, and the Clinical Potential of the Internet , 2003 .

[33]  Kenneth J Ottenbacher,et al.  A virtual reality environment for evaluation of a daily living skill in brain injury rehabilitation: reliability and validity. , 2003, Archives of physical medicine and rehabilitation.

[34]  Larry F. Hodges,et al.  Virtual reality exposure in the treatment of social anxiety , 2003 .

[35]  R. Baños,et al.  Virtual reality in eating disorders , 2003 .

[36]  Kristine H. Luce,et al.  Computer- and Internet-Based Psychotherapy Interventions , 2003 .

[37]  C. Botella,et al.  Virtual reality in the treatment of spider phobia: a controlled study. , 2002, Behaviour research and therapy.

[38]  A. Pfefferbaum,et al.  Preliminary evidence of reduced cognitive inhibition in methamphetamine-dependent individuals , 2002, Psychiatry Research.

[39]  Sarah Nichols,et al.  Health and safety implications of virtual reality: a review of empirical evidence. , 2002, Applied ergonomics.

[40]  D. Fabacher,et al.  The Determinants of Attitudinal Change among Medical Students Participating in Home Care Training: A Multi–center Study , 2002, Academic medicine : journal of the Association of American Medical Colleges.

[41]  Grigore C. Burdea,et al.  Treating Psychological and Physical Disorders with VR , 2022 .

[42]  A. Rizzo,et al.  The application of virtual reality technology in rehabilitation. , 2001 .

[43]  B. Rothbaum,et al.  Virtual reality exposure therapy for Vietnam veterans with posttraumatic stress disorder. , 2001, The Journal of clinical psychiatry.

[44]  R. C. Hsiung,et al.  Suggested principles of professional ethics for the online provision of mental health services. , 2001, Studies in health technology and informatics.

[45]  F. Chisholm,et al.  Teaching in a new key: effects of a co-taught seminar on medical students' attitudes toward schizophrenia. , 2001, Psychiatric rehabilitation journal.

[46]  K. C. Lun,et al.  Virtual reality for relearning daily living skills , 2000, Int. J. Medical Informatics.

[47]  Cristina Botella,et al.  Virtual reality in the treatment of claustrophobic fear: A controlled, multiple-baseline design , 2000 .

[48]  S K Rushton,et al.  Improving cognitive function after brain injury: the use of exercise and virtual reality. , 1999, Archives of physical medicine and rehabilitation.

[49]  John R. Wilson,et al.  Virtual Reality-Induced Symptoms and Effects (VRISE) , 1999, Presence: Teleoperators & Virtual Environments.

[50]  B. Rothbaum,et al.  Virtual Reality Exposure Therapy for PTSD Vietnam Veterans: A Case Study , 1999, Journal of traumatic stress.

[51]  Susan M. Schneider,et al.  Effects of Virtual Reality on Symptom Distress in Children Receiving Chemotherapy , 1999, Cyberpsychology Behav. Soc. Netw..

[52]  K. Ottenbacher,et al.  Task performance in virtual environments used for cognitive rehabilitation after traumatic brain injury. , 1998, Archives of physical medicine and rehabilitation.

[53]  J. Wright,et al.  Computer-assisted psychotherapy. , 2010, The Journal of psychotherapy practice and research.

[54]  B. Rothbaum,et al.  Virtual reality exposure therapy. , 2010, The Journal of psychotherapy practice and research.