Abnormal Psychology

Foundations of Treatment 133

• Computer software can provide virtual reality exposure treatment, which can be

particularly helpful when it would be diffi cult to have a therapist along for an in

vivo exposure (such as on an airplane, for those with a fear of fl ying).

Researchers have found that 4 weeks of computer-assisted CBT treatment for

anxiety plus 8 weeks of self-monitoring with a hand-held device was as effective as

12 weeks of the usual CBT (Newman et al., 1997; Przeworski & Newman, 2004).

Cybertherapy

Therapy most frequently occurs when therapist and patient are together in the

same room, but technology has offered an alternative possibility—therapy at

a distance. One well-established use of technology (at the low-tech end of the

spectrum) is phone calls between therapists and patients for emergencies. For

patients who are not able to get to a therapist’s offi ce, because they live in a rural

area, are housebound with a medical illness, or because their phobias prevent a

face-to-face meeting with a therapist, therapy conducted over the telephone may

be better than no treatment (Ludman et al., 2007; Mohr, Hart, et al., 2005; Tate &

Zabinski, 2004).

Newer technology has made possible another form of treatment that allows

patient and therapist to be in different locations:cybertherapy, or Internet-based

therapy. In such therapy, the patient and the therapist interact online. Clinicians

have developed a number of different cybertherapeutic techniques (Santhiveeran &

Grant, 2005):

• E-therapy,or e-mail exchanges between patient and therapist.

Patient and therapist do not meet face to face. E-mail exchanges

can be valuable to both patient and therapist in providing a real-

time written record of the conversation (Murphy & Mitchell,

1998), and the task of organizing a thoughtful written commu-

nication itself can be therapeutic (Pennebaker, 1999);

• E-mail exchanges between patient and therapist who also meet

face-to-face. Such e-mails may include updates on between-

session homework assignments and questions or comments

raised by a prior session (Barnett & Scheetz, 2003; Ruwaard

et al., 2007).

• Real-time chat room involving a patient and a therapist.


• Real-time face-to face video chats (using webcams) between a

patient and a therapist (Jerome & Zaylor, 2000).

Leon, because of his anxiety about meeting new people, might

fi nd cybertherapy initially more comfortable than face-to-face therapy. However, most

therapists have reservations about using the Internet as a vehicle for therapy. Concerns

about various forms of cybertherapy include (Heinlen et al., 2003):

• Imposters. The individual posing as a therapist may be neither professionally

trained nor licensed.

Privacy•. With Internet or e-mail communications, confi dentiality and privacy can-

not be guaranteed (Young, 2005).

• Incomplete communication. E-mail communications lack important nonverbal

cues (such as body language, facial expressions, and tone of voice); a therapist in

face-to-face therapy sessions uses such information to assess a patient’s problems

and responses to treatment suggestions (Bloom, 1998). However, the use of web-

cams may reduce this concern.

Some studies have shown that treatment via cybertherapy is more effective

than none at all (Lange et al., 2001; Ritterband et al., 2003), but little research

so far has compared cybertherapy to in-person therapy (either in general or for

specifi c disorders). For instance, although e-mail has been used in family therapy

Cybertherapy

Internet-based therapy.

Cybertherapy can be particularly helpful for rural

or housebound patients, enabling them to meet

with a therapist.

AP Photo/Nati Harnik