Virtual Reality Supported Therapy Technologies and Ethics

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                      Virtual Reality Supported Therapy:
                           Technologies and Ethics

                           Brian Dixon & Holger Regenbrecht
    PSYCHOLOGY
        and
INFORMATION SCIENCE
                                 (Thanks to Chris Slane)

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                      Outline




                                                                            (c) CyberMind




                         1.           Who we are
                         2.                             pp            py
                                      What is Virtual Supported Therapy?
                         3.           Selected International Projects
                         4.           Example Project: cMRET
                         5
                         5.           Discussion of Pros and Cons
                         6.           The Issues
                         7.           Developing and applying standards
    PSYCHOLOGY
                         8
                         8.           Conclusion and Discussion
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                      Who we are




                        Brian Dixon                                             Holger Regenbrecht
                        Consultant Clinical Psychologist                         Computer Scientist

                        Clinical practitioner:                   Academic and industrial research in:
                          Treatment provision (private practice)      Virtual and Augmented Reality
                          Clinical supervision and teaching                        Teleconferencing
                          Professional ethics consulting           Presence in Virtual Environments
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                      What is Virtual Supported Therapy?


                                            Example - FEAR
                            We all experience fear and avoid certain situations
                            This is usually a normal phenomenon, probably a result of
                            evolutionary survival strategies
                            In some people the extent of the fear negatively affects
                            their social behaviour or daily functioning over an
                            extended period or permanently



                            Treatment may be indicated or even essential
                            Examples: Fear of heights, fear of flying, fear of public
                                 ki lead to i ifi     t disadvantages i private or
                            speaking l d t significant di d       t      in i t
                            business life
                            Clinical psychology has developed methods for the
    PSYCHOLOGY
        and
                            treatment of these phobias
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                      What is Virtual Supported Therapy?


                                                 THERAPY
                            Clients (patients) are confronted with fear-evoking stimuli
                                 with the client imagining the situation (in imagino)
                                                      (e.g.
                                 in reality (in vivo) (e g taking client to bridge)
                            Level of exposure controlled by therapist, various
                            approaches:
                                 di t confrontation of feared object (“flooding”,
                                 direct      f t ti       ff    d bj t (“fl di ”
                                 “implosion”)
                                 careful, graduated exposure (“systematic
                                 desensitisation”, “exposure therapy”)
                            Goal: Client learns to cope with fear-evoking situation by
                            habituating to the anxiety and experiencing p
                                       g                y       p          g personal
                            control of the approach/avoidance behaviour
                            Developments in Virtual Reality technology lead to a third,
                            supplemental method: in virtu therapy
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                      What is Virtual Supported Therapy?


                                            IN VIRTU THERAPY
                            Virtual therapy environment should provoke the same
                            physiological and psychological reactions as in the real-
                                                           al.,
                            world situation (see North et al 1996)
                            Empirical evidence for this - Rothbaum et al. (1995) in
                            treatment of fear of heights.
                                 virtual lifts and bridges
                                 20 students suffering from acrophobia
                                 treatment group and waiting list condition
                                 patients showed effects equivalent to the feared real-
                                 world situations
                                 study laid foundations for the treatment of other
                                 psychological disorders with Virtual Reality


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                                      Virtual Reality Exposure Therapy (VRET)
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                                      Selected International Projects




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                      Selected International Projects::Overview


                            Specific Phobias
                                Fear of Flying
                                F      f Fl i
                                Fear of small animals (spiders, cockroaches …)
                                Fear of Heights
                            Social Phobias
                                Fear of Public Speaking
                                                           (
                            Post Traumatic Stress Disorder (PTSD) )
                                War Veterans
                                Survivors of catastrophes
                            Pain Treatments
                                Burn Pain Distraction




    PSYCHOLOGY
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                                                                               Hodges et. al. (2001)
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                                      Slater et. al. (1999)
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                      Selected International Projects::Example




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                       www.vrphobia.com
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                      Selected International Projects::Fear of Flying




                                                                  • First case study - one
                                                                    subject
                                                                  • Subjective Units of
                                                                    Distress (SUDs) &
                                                                    Questionnaires
                                                                  • self-reported fear
                                                                    decreased from “8” to “4”
    PSYCHOLOGY
        and              Hodges et. al. (1996). A virtual airplane for fear of flying therapy. Proceedings
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INFORMATION SCIENCE      of the 1996 Virtual Reality Annual International Symposium
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                      Selected International Projects::Fear of Spiders




                      • Augmented Reality approach (video-see-through real-
                        world display with overlaid, animated spiders in kitchen
                           i
                        environment)t)
                      • SUDs, interviews and questionnaires

    PSYCHOLOGY
                            et. al. (2005).                               phobias.
                       Juan et al (2005) Using augmented reality to treat phobias IEEE Computer
        and
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                       Graphics and Applications, 25:31–37
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                      Selected International Projects::Fear of Heights 1/2




    PSYCHOLOGY        Hodges et. al., (1995) Virtual environments for treating the fear of heights. IEEE
        and
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                      Selected International Projects::Fear of Heights 2/2

                      Hodges et. al (1995):
                                           screened,
                      • 178 students were screened 17 completed the study (10 % !)
                      • Treatment group and control group
                      • “Feel weak in the knees . . wanting to hold on for dear life.”
                        SUDs,
                      • SUDs Questionnaires and Number and Type of Symptoms
                      • significant decrease of anxiety and avoidance for the
                        treatment group
                      • Sample size too small


                      Regenbrecht et. al (1998):
                      • no actual treatment, measuring presence
                      • real world symptoms obse ed, like s ea g, a o da ce
                         ea o d sy p o s observed, e sweating, avoidance
                        behaviour, even crawling on the floor
                      • high spatial presence (sense of being in the virtual
                                                                environment.
                        environment) measured in fear evoking environment
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                      Selected International Projects::
                                      p
                      Fear of Public Speakingg




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                         Slater et. al. (1999). Public speaking in virtual reality: Facing an audience of
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                         avatars. IEEE Computer Graphics and Applications, 19:6–9
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                      Selected International Projects::PTSD




                      • uncontrolled treatment study
                      • 10 Vietnam Veterans completed the study
                      • clinicians rated that 7 of 8 patients were improved (6 months after
                        treatment)
                      • symptoms decreased from severe to moderate and from moderately
                        to mildly depressed.
    PSYCHOLOGY
        and            Hodges et. al. (2001). Treating Psychological and Physical Disorders with VR.
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INFORMATION SCIENCE    IEEE Computer Graphics and Applications, 21(6):25–33
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                      Selected International Projects::Burn Pain Distraction




                        •     Standard : opiates
                        •     Side effects : tolerance, dependence, nausea, delirium …
                        •     excruciating pain during daily bandage changes
                        •     patients are young : 40% are 22 years old or younger
                        •     Solution : Videogames !

    PSYCHOLOGY         Hodges et. al. (2001). Treating Psychological and Physical Disorders with VR.
        and
INFORMATION SCIENCE    IEEE Computer Graphics and Applications, 21(6):25–33
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                                      Example Project cMRET




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                      Example Project: cMRET


                            Virtual Reality (and with this VRET) depends on sense of
                                      (defining
                            presence (d fi i property)  t )
                            Therapist present in real world
                            Client present in virtual world

                            Whenever the therapist communicates with the client, a
                            break in the sense of presence for the client occurs
                                                  p


                                                                       A Solution:
                                                                      collaborative
                                                                          Virtual
                                                                         Reality
                                                                        Exposure
                                                                         Therapy
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                      Example Project: cMRET




                         Virtual World
                                                                   Client



                                                     Therapist and Client meet
                                                        in one virtual space

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        and              Therapist
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                      Example Project: cMRET




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                                                           CMRET.mp4
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                         Internet-based remote services



                                 Increasing use of computer links for the provision of
                                 services to remote areas where such services are
                                                                           scope.
                                 otherwise inaccessible or only limited in scope

                         Prototype example: ISLANDS project
                         •  collaboration between researchers and practitioners in several
                            EU countries
                         •     p                  y               p
                            implemented mainly in the Czech Republic, Austria and remote
                            island territories of France, Spain and Greece

                         Sulzenbacher et al. (2005)
                         De las Cuevas, (2005)
                         D l C
                         Amditis, Lentziou, Bekiaris, Cabrera and Bullinger (2005).


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                            So, now psychology can do realistic spiders
                            AND put them on the Web!




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                                      (Thanks Chris Slane)
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                          syc o ogy, tec o ogy and e be g
                         Psychology, technology a d wellbeing




                                 Virtual reality technologies are being used to support and
                                 enhance therapies;
                                 Internet communication enables widespread delivery of
                                 services to remote points;

                                 How does this impact on wellbeing?




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                             Pros and Cons of VR supported therapy




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                      Advantages of Virtual Reality Supported
                           py
                      Therapy


                                    t      b tit t f    but i          ti     th d for
                                 not a substitute for – b t is a supportive method f
                                 clinical psychology
                                     increase t t
                                 can i                t ffi i      (    h t d ti )
                                              treatment efficiency (eg shorter duration)
                                 easy distribution and delivery of standardised
                                 programmes
                                 enabling for some clients
                                 permits experiences that may be otherwise
                                 unattainable
                                 increasingly economical (after initial outlay)

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                            Advantages ctd.




                              research is easily and exactly replicable
                              can provide a controlled, safe environment
                              reduces travel demands on clients/therapists
                              can be collaborative between client and therapist
                              ....




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                      Problems with Virtual Reality Supported
                           py
                      Therapy


                       BUT …

                                       p                 g
                                 development costs are high
                                 potential risks in wrong hands (e.g. internet
                                 distribution of standard treatment packages)
                                                                    p      g )
                                 possible entrepreneurial capture and control of
                                 treatment methods
                                 military applications are attracting most funding
                                 professional regulation issues


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                      ctd..


                                      simulator sickness syndromes
                                      unknown long term human side effects of
                                      technology
                                      alienation of some clients
                                      risk of dehumanising psychological therapies
                                      may be inappropriate for some client conditions
                                      cultural issues and implications seldom
                                      considered
                                      …..

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                      VR – supported treatment is a reality

                            Norcross, Hedges, & Prochaska (2002)

                                    h th            t     d   d    ki    f therapeutic
                            62 psychotherapy experts produced rankings of th       ti
                            techniques in terms of impact on psychotherapy, psychologists, and
                            patients

                            1. homework assignments
                            2. relapse prevention
                            3.       f
                            3 use of VR
                            4. problem-solving
                            5. computerised therapies
                            6.…..

                            It is clear that building new virtual environments and
                                                    g
                            developing standardised protocols are crucial if
                            therapists are going to be able to adapt these tools to
                                   day to day          practice
                            their day-to-day clinical practice. Giuseppe Riva (2003)
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                                      ISSUES




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                             ca , ac ce and o ess o a concerns
                         Ethical, Practice a d Professional co ce s


                         Rizzo, Schultheis and Rothbaum (2003)

                                                                          VR,
                         Important review of ethical issues in the use of VR describe:

                                 “looming ethical challenges”
                                   id ff t
                                 side effects,
                                 exclusionary criteria,
                                 professional practice issues
                                 concerns regarding general societal impact

                                 Conclude: those involved in using the technology have a
                                                              to
                                 professional responsibility “to consider and address incumbent
                                 ethical concerns that surround this emerging technology”.


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                         Rizzo, Schultheis and Rothbaum (2003)
                          e ssues
                         Ten issues

                         1.                VE related
                         1 Potential for VE-related side effects
                         2. Use of VR applications with people with altered awareness or
                             reality-testing.
                         3 Using VR out of your area of expertise
                         3.
                         4. Effect of VR on the therapist/client relationship.
                         5. Will Therapists rely on VR as a substitute for good clinical skills
                                to      k h dd
                             or t mask shoddy service?   i ?
                         6. Will advances in VR access lead to cases of faulty self-
                             diagnosis and self-treatment?
                         7. Risks of overstated claims in the application of VR to medical
                             research
                         8. Dependence on virtual vs. "real" world interactions and
                               l ti    hi     ith "real"
                             relationships with " l" people  l
                         9. Potential misuse (eg violent or dehumanizing content)
                         10. “Universal Access” vs. “Digital Divide” in the availability of VR
    PSYCHOLOGY
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                             assessment and treatment
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                         Rizzo et al. 10 issues

                         1. Potential for VE-related side effects


                                  a
                                 “a significant concern as the occurrence of side
                                 effects could limit the applicability of virtual
                                 environments for certain clinical populations.”
                                 identify cybersickness and exposure after-effects
                                 as the two main types of VR side effects,
                                 Those with disabilities may be more vulnerable or
                                 susceptible.


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                         Rizzo et al. 10 issues (ctd)

                                 2. Use of VR applications with people with
                                 altered awareness or reality-testing.


                                 caution required with those with psychiatric
                                 conditions resulting in distorted reality testing or
                                 individuals with cognitive impairments who may
                                 have altered awareness.
                                 Could increase the risk of negative behavioural
                                 responses following exposure or the
                                 development of a propensity for escaping from
                                 reality

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                                                ( )
                         Rizzo et al. 10 issues (ctd)

                           3. Using VR out of area of therapeutic expertise




                                 Clinical training programmes will need to adapt to
                                 the expansion in the use of VR as a therapeutic
                                 tool and incorporate training in the competent
                                 and ethical use of VR into those programmes.




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                                                ( )
                         Rizzo et al. 10 issues (ctd)

                         4. Effect of VR on the therapist/client relationship




                                 “therapists should be cautioned not to hide
                                 behind the technology or let the technology
                                 dominate the session”.




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                         Rizzo et al. 10 issues (ctd)

                                 5. Risk that therapists will rely on VR as a
                                 substitute for good clinical skills or to mask
                                           i
                                 poor services.



                         “therapists should use VR to enhance therapy
                                        s bstit te     it.”
                            rather than substitute for it ”




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                         Rizzo et al. 10 issues (ctd)

                                 6. Possibility that advances in VR access will
                                 lead to cases of faulty self-diagnosis and self-
                                                        y        g
                                 treatment.




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                                  al.
                         Rizzo et al 10 issues (ctd)

                         7. Risks of overstated claims in the
                         application of VR to medical research




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                                  al.
                         Rizzo et al 10 issues (ctd)

                               p
                         8. Dependence on virtual vs. "real" world
                         interactions and relationships with "real"
                         people




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                         Rizzo et al. 10 issues (ctd)

                                 9. Potential misuse (eg violent or
                                 dehumanizing content)
                                 d h       i i     t t)




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                         Rizzo et al. 10 issues (ctd)

                                      10. “Universal Access” vs. “Digital
                                      Divide
                                      Divide” in the availability of VR
                                      assessment and treatment



                                 This refers to the accessibility of technology and
                                     p
                                 computer-assisted treatment.




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                                      Developing and applying standards




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                           e existing Codes/guidelines adequate?
                         Are e st g Codes/gu de es adequate



                         Fisher and Fried (2003).
                            “ongoing technological advances produce new methods
                            of providing services that continually outpace specific
                            guidelines pertaining to these new methods”
                                                       g                 g
                            conclude APA Code recognises the evolving nature of the
                            field and provides standards that are applicable for:
                                      competence
                                      conflicts of interest
                                      informed consent
                                      privacy/confidentiality
                                      public statements/advertising
                                      test selection/scoring.

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                          e   ea a d/ ust a a          guidelines
                         New Zealand/Australian codes, gu de es



                                 Most codes/guidelines provide general guidance that can be
                                 applied to new developments but specific relevance to VR and
                                 internet technologies is missing.
                                 Eg. The NZ Psychologists’ Code of Ethics has relevant
                                 standards (as in Fisher and Fried 2003). The four overarching
                                 p     p                            practitioners to make decisions
                                 principles of that code also allow p
                                 on new technology:
                                      Respect for the dignity of persons and peoples
                                          p
                                      Responsible caring (             promotion of wellbeing)
                                                           g (includes p                    g)
                                      Integrity in relationships
                                      Social justice and responsibility to society

                                 Code of Ethics for Psychologists Working in Aotearoa/New Zealand, 2002



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                         But are they applied?



                         Heinlen et al., 2003
                                              y      g
                                 American Psychological Association (        )
                                                                       (2002) Ethical
                                 Principles and the guidelines of the International Society
                                 for Mental Health Online (2000).
                                  troubling
                                 “troubling levels of noncompliance with APA and ISMHO
                                 principles and an uninformed approach to the ethical and
                                 legal dilemmas unique to Web-based service”.
                                 Areas of concern include: confidentiality, alternative
                                 treatment information, provision of services to minors,
                                 informed consent, promotional statements and claims,
                                 and responses to emergencies.

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                              egu at o a d e o ce e t s difficult
                         AND regulation and enforcement is d cu t



                                 Inadequate traditional state-based professional regulation
                                 of services.
                                 No clear geographical boundaries that limit provision of
                                 services by health practitioners; internet allows
                                 international accessibility.
                                 Trend for treatments to be offered by organisations
                                 without identifiable individual practitioners.
                                 Regulatory bodies need to consider how they can and
                                 should respond to this trend.
                                 Need more international collaboration and development of
                                 international codes - otherwise authorities will be
                                 powerless or irrelevant.

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                      Rizzo et al (2003) propose adoption of guidelines



                         Conduct ethical analysis.
                         Clear description of the protocol under consideration and the list of potential
                             affected parties and stakeholders.
                         Thorough evaluation of each step of the process, identifying both the risks
                             and the benefits for all parties involved
                         Generate a rational foundation for choices at each level of the procedure.

                         Consider the unique risks of VR exposure.

                         Plan for the unexpected.
                         Thoroughly evaluate all possible negative reactions prior to initiation of
                             protocol

                         Integrate safeguards into protocol.
                         The most recent screening procedures (e.g. Simulator Sickness
                             Questionnaire) should be standard in all VR protocols.


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                         Gu de es ctd
                         Guidelines c d


                         Identify more vulnerable groups.
                         Identify those who may be at a higher risk for negative experiences when
                             exposed to VR and when necessary identify the additional steps that
                                  d to b taken to i i i    i k
                             need t be t k t minimize risks among th           individuals.
                                                                         these i di id l

                         Clearly define the need for VR.
                         Consideration and justification for the appropriateness of the addition of VR
                             to protocols should be addressed in all newly proposed applications.

                         Explain the protocol.
                         Description of the VR component of research protocols should be clear and
                            concise with minimal jargon. In many cases, the use of diagrams for
                            explaining hardware is often useful.




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                         Gu de es ctd
                         Guidelines c d



                         Defining data.
                         Because VR affords an environment where all behavioral responses can be
                                                             experience
                            recorded throughout the virtual experience, variables to be measured in
                            the VE should be clearly identified. These variables should be
                            hypothesis driven and based on prior research or knowledge.

                         Identify responsibility, liability and accountability. Given the fact that
                             much remains to be learned regarding medical applications of VR,
                             procedures to address any significant complications should be clearly
                             identified in the early stages of the protocol development.


                         Source: Rizzo, Schultheis and Rothbaum (2003).




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                                      Conclusion and Discussion




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                       Ethical VR – Major challenges

                      • There is a need for a unified code of ethics or
                        g
                        guidelines to ensure VR and internet based services
                        comply with agreed standards.

                      • The development of “cyber-therapy ethics needs to be
                                             cyber therapy ethics”
                        parallel to development of the technology (each
                        informed by the other).

                      • Major awareness gaps (eg cultural factors are largely
                        unaddressed; equity and social justice implications)

                      • It is imperative that professional bodies and regulatory
                        authorities consider what mechanisms and systems
                        might be viable to provide standards and monitoring of
                        those.

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                      • Agreement on (New Zealand or Australasian) practice
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                      Summary

                      •        Advances in VR and internet delivery are promising technologies
                                                                        traditional
                               and are able to augment a wide range of “traditional” treatment
                               services

                      •        More prototypes and laboratory studies are needed but these are
                               often not considered as rapid technological changes lead the
                               development of treatment services (longitudinal field studies
                                               )
                               would be useful).

                      •        A multi-disciplinary approach is essential

                      •        There needs to be parallel, collaborative development of an
                               applicable code of ethics.

                      •        Professional bodies and regulatory authorities must consider their
                               role (if any).

    PSYCHOLOGY        •        Need    ti     id li    (for N Z l d/A t l i )
                               N d practice guidelines (f New Zealand/Australasia)
        and
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        55            february 2008                        bioethics 2008                dixon / regenbrecht
                      To contact us:




                                                          a     o
                                                       Brian Dixon
                                                  brian@psy.otago.ac.nz


                                                  Holger Regenbrecht
                                            holger@infoscience.otago.ac.nz
                                            holger@infoscience otago ac nz


    PSYCHOLOGY
                                                                http://www.hci.otago.ac.nz
                                      Slides download (as pdf): http://www hci otago ac nz
        and
INFORMATION SCIENCE
INFORMATION SCIENCE

        56            february 2008                         bioethics 2008              dixon / regenbrecht
                          e e e ces
                         References


                         Amditis, A., Lentziou, Z., Bekiaris, E., Cabrera, M., and Bullinger, A. (2005).The overall architecture of the ISLANDS system:
                               towards a modular non-conventional telepsychiatry system. Presentation to 10th Annual CyberTherapy Conference,
                               Basel, Switzerland, June 2005.

                                Cuevas,         (2005).                                                                        Results
                         De las Cuevas Carlos (2005) Telepsychiatry: Psychiatric Consultation through Videoconference Clinical Results. Presentation
                                to 10th Annual CyberTherapy Conference, Basel, Switzerland, June 2005.

                          Code of Ethics for Psychologists Working in Aotearoa/New Zealand, 2002. NZ Psychological Society, NZ College of Clinical
                               Psychologists, NZ Psychologists Board

                         Fisher, C B F i d A L (2003). Internet-mediated psychological services and th A
                         Fi h C.B. & Fried, A.L. (2003) I t    t   di t d      h l i l        i      d the American P
                                                                                                               i    Psychological A  i ti    thi
                                                                                                                        h l i l Association ethics
                                code. Psychotherapy: Theory, Research, Practice, Training, 40, 103-111.

                         Heinlen, K., Welfel, E., Richmond, E., et al (2003) The nature, scope, and ethics of psychologists’ e-therapy web sites: what
                               consumers find when surfing the web. Psychotherapy Theory, Research, Practice, Training, 40, 112–124.

                         Hodges et. al., (1995) Virtual environments for treating the fear of heights. IEEE Computer, 28(7):27–34


                         Hodges et. al. (2001). Treating Psychological and Physical Disorders with VR. IEEE Computer Graphics and Applications,
                              21(6):25–33

                         Hodges et. al. (1996). A virtual airplane for fear of flying therapy. Proceedings of the 1996 Virtual Reality Annual International
                              Symposium

                         Juan et. al. (2005). Using augmented reality to treat phobias. IEEE Computer Graphics and Applications, 25:31–37



    PSYCHOLOGY
        and
INFORMATION SCIENCE
INFORMATION SCIENCE

        57            february 2008                                              bioethics 2008                                            dixon / regenbrecht
                          e e e ces
                         References ctd

                         Norcross, J. C., Hedges, M., Prochaska, J. O. (2002).
                         Norcross J C Hedges M & Prochaska J O (2002) The face of 2010: A Delphi poll on the future
                              of psychotherapy. Professional Psychology: Research and Practice, 33, 316-322.
                         North, M.M., North, S.M., & Coble, J.R. (1996). Virtual Reality Therapy: An innovative paradigm.
                              Colorado Springs, CO: IPI Press.

                         Regenbrecht, H.T., Schubert, T.W., & Friedmann, F. (1998). Measuring the Sense of Presence and its
                             relations to Fear of Heights in Virtual Environments. International Journal of Human-Computer
                             Interaction 10(3), 233-249.

                             ,      pp (2003), Virtual Environments. Clinical Psychology IN Psychotherapy: Theory,
                         Riva, Giuseppe (     ),                                  y   gy      y        py       y,
                               Research, Practice, Training, Vol. 40, No. 1/2, 68–76

                         Rizzo, A. A., Schultheis, M. T., & Rothbaum, B. (2002). Ethical issues for the use of virtual reality in the
                              psychological sciences. In S. Bush & M. Drexler (Eds.), Ethical issues in clinical neuropsychology
                              (pp. 243-280). Lisse, NL: Swets & Zeitlinger.
                              (pp           )                          g

                         Rothbaum, B.O.,Hodges, L.F.,Kooper, R.. Effectiveness of Virtual Reality Graded Exposure in the
                              Treatment of Acrophobia. (1995). Behavior Therapy vol. 26, 547-554.

                         Sulzenbacher Hubert & Members of the ISLANDS Consortium Medical University Innsbruck
                              (2005).Telecommunication in Psychiatry: A Needs Assessment of Different Potential User
                              Groups in the ISLANDS Project. Presentation to 10th Annual CyberTherapy Conference, Basel,
                              Switzerland, June 2005.

                         S ate et. al. (1999). ub c speaking     tua ea ty ac g an audience o a ata s            Co pute
                         Slater et a ( 999) Public spea g in virtual reality: Facing a aud e ce of avatars. IEEE Computer
    PSYCHOLOGY                 Graphics and Applications, 19:6–9
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INFORMATION SCIENCE

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                          ostsc pt tec o ogy a d e be g
                         Postscript - technology and wellbeing



                      [Inside a hospital delivery room]
                      First Doctor Bit bare in here today, isn’t it?
                      Second Doctor Yeees.
                      First Doctor More apparatus please, nurse.
                      N      Yes doctor.
                      Nurse Y d t
                      First Doctor Yes, the EEG, the BP monitor and the AVV,
                          please.
                      Second Doctor And get the machine that goes "Ping!"
                      First Doctor And get the most expensive machines in case the
                                        comes.
                          administrator comes
                      - Monty Python's The Meaning of Life

    PSYCHOLOGY
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                           d at o a e
                         And a rationale



                         Hospital Administrator: Ah, I see you have the machine that
                           goes ping. This is my favourite. You see we lease it back
                           from the company we sold it to and that way it comes
                           under the monthly current budget and not the capital
                           account.

                         [Everyone in the room applauds]

                                 Thank you, thank you.

                           Monty P th ' Th M    i    f Lif
                         - M t Python's The Meaning of Life


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    PSYCHOLOGY
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    PSYCHOLOGY
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                          JUST LIE BACK AND I’LL GET A FEW PHOTOS TO LIVEN
    PSYCHOLOGY            UP MY NEXT POWERPOINT PRESENTATION
        and
INFORMATION SCIENCE
INFORMATION SCIENCE
                          (Thanks to Chris Slane)
        64            february 2008                 bioethics 2008   dixon / regenbrecht