Drexel Battles Anxiety Disorders with Second Life

By Maia Livengood

January 29, 2010 — As the field of psychology struggles to develop a clear, scientific approach for diagnosis and clinical treatment of psychological disorders, Dr. James Herbert, professor of psychology and CoAS associate dean, strives to accelerate this transition through supportive clinical research. His internet-based research does not stem from an interest in technologies per se, but rather, in how modern media can close the gap between state-of-the-art treatments and clinical application.

James HerbertIn our interview, Herbert explained that in most areas of medicine, such as surgery, the translational gap between research and application is small; research is converted relatively quickly into industry-accepted technologies for work in the field. However, in psychology, treatment practices lag behind research, in some cases, by decades.

Factors contributing to this information lag are multifaceted and complex, but Herbert noted a few primary problems within the field. Surprisingly, a lack of malpractice suits in clinical psychology and psychiatry has led to a mismanaged system. Rarely, he said, except in an instance of gross, unethical transgression, do therapists get sued for their treatments. Overall, Herbert reflected, the profession is very reluctant to police itself. And despite the protests of many professionals, who write papers and give lectures in an attempt to dissuade that mentality, there are still an overwhelming number of practitioners who are not educated in a science-based approach to therapy. Most large, urban areas act as psychiatric information spheres due to the abundance of research facilities and researching universities. But in rural areas, one is likely to find that the majority of psychotherapists have not been trained in the newest, research-backed treatments for a variety of disorders. Many, even, continue to revert to Freud’s theories of diagnosis, firmly believing in the existence of the Id, Ego, and Superego, said Herbert. As a result, some therapists practice treatments that aren’t science-based and which could potentially cause harm.>

Ironically, it’s that same interplay (and sometimes conflict) between the humanities and sciences that first attracted Herbert to the field of psychology. In adolescence, he had always enjoyed science. But after graduating high school, he spent a year in Switzerland, where he became intrigued by the humanities. During his undergraduate career, he switched majors several times, from marine biology to international relations to psychology. It was in psychology that he finally discovered a discipline that integrates the humanities and sciences, taking a scientific approach to something inherently humanistic. Ever since, Herbert’s methodology has been to take the basic philosophy of a scientific perspective to enhance his chosen field.

Because systematically changing the professional culture in the field of psychology is a difficult and long-term process, Herbert has instead turned his efforts to helping qualified practitioners find ways to connect with patients in remote areas. Psychology experts tend to live, almost without exception, in large metropolitan areas, thus creating a substantial demand for cost-effective technology that can connect isolated patients with clinical expertise.

Erica YuenConsequently, Herbert has launched a research project with Erica Yuen, a doctoral student, and Dr. Evan Forman, a faculty member, both in the psychology department at Drexel. Their goal was to develop a successful treatment program using internet-based technologies for anxiety disorders. Herbert, Forman, and Yuen began their initial study by constructing a location on “Drexel Island,” a Drexel-operated Second Life application, in which they could interact with participants. The program, using state-of-the-art software, allows users to create a variety of virtual environments, such as business centers, educational centers, community groups and social clubs. Its versatility and unique visual component makes it a great new resource for a variety of communication needs. Users have the ability to choose between chatting (typed interaction) and speaking directly to other avatars (both publically and privately) via headset. Dr. Jean Claude Bradley, associate professor of chemistry and e-Learning coordinator for CoAS, as well as Dr. Ronald Cromer, associate professor and director of behavior and addictions counseling, helped the trio create a virtual therapy room to which participants were granted access at specific times to ensure their privacy. The individuals who took part in the study were located through social networking groups, listserves, social anxiety boards, and online message boards, and were heavily screened to determine eligibility. After a series of interviews, each participant downloaded the Second Life application and was given the opportunity to create an avatar, or a computerized visual representation of themselves.

Inside Second Life
Drexel Island inside the world of Second Life

Currently, the customary treatment for those with social anxiety is exposure therapy, which is used to help patients develop social skills and the necessary confidence to deal with social situations. In this respect, Second Life serves as an effective tool for creating hypothetical/virtual social situations in which therapists’ avatars may interact with patients’ avatars as a model for social interaction. For example, project therapists Yuen, Elizabeth Goetter and Jennie Park, all psychology doctoral students,would bring a participant to a virtual bar where staff members were also logged on as avatars in order to interact with the patient. The very nature of social anxiety disorder makes patients more likely to avoid traditional therapy, so Second Life works twofold by decreasing the geographical barriers as well as the social barriers to treatment. Recalled Yuen, “We had many callers inquire about our in-person treatment program for social anxiety, but they lived too far away to participate, and they also had had trouble finding CBT therapists in their area. We realized that a remote treatment would allow for people without access to a CBT therapist due to their location to receive an effective treatment. [Additionally], James, Evan, and I also wondered if individuals with greater severity of social anxiety symptoms would be more willing to seek therapy if they could receive therapy remotely from the comfort and privacy of their own homes.”

Yuen, Goetter, and Park were also able to adjust the ease or difficulty of conversations and the degree of interaction. For instance, for those with a fear of rejection, a staff member may reject the patient during an interaction, forcing a confrontation of the fear as a form of treatment. This kind of role-playing is highly visual, but still lacks some components of a “real” social encounter. To increase the chances for success in their treatment, the researchers also gave homework assignments to all participants, who practiced their newly acquired skills while interacting with others between Second Life sessions.

Inside Second Life
The Therapy Room located on Drexel Island

The results from the study, conducted February 2009 through December 2009, indicated success: at post-treatment, the majority of participants (64%) no longer met DSM-IV-TR criteria for social anxiety disorders. Fifty-seven percent of clients had a CGI-Improvement score of 1 (very much improved) or 2 (much improved). Additionally, ninety-three percent of clients were “completely” or “mostly” satisfied with their treatment. One hundred percent of clients were “completely” or “mostly” satisfied with their therapist. Seventy-nine percent of clients reported that receiving treatment through Second Life was “very” or “fairly” easy. (Yuen)

With the positive outcome, Yuen will continue to work on a similar study for her doctoral thesis, for which Herbert is her advisor. This study will involve Skype, a software program that allows users to make calls and have webcam chats over the internet. With this program, there is the added benefit of seeing live, real-time facial expressions, said Yuen. The drawback, though, would be losing the variety of teaching environments provided by Second Life. The team is not sure which program will have better results, but Herbert commented that perhaps a hybrid would serve as the best model, allowing for the use of both programs in different conditions.

Herbert and Yuen are currently working on a manuscript based on their initial study. Their next step, if Skype also proves successful, would be to create a head-to-head comparison study between internet-based treatments and in-person treatments. Because the resources needed to demonstrate the effectiveness of these new treatments is expensive, the staff would be looking to NIH grants to help fund the project.

Both Herbert and Yuen reflect that the study is in its very early stages, but as their results indicate a new effective treatment, they are excited to move forward with the Skype trials. And with a potential impact on the professional field of clinical psychology, it’s clear that student and faculty research is the ideal bridge for applying academic principles to real-world problems.

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Maia Livingood '12 is a Business Administration major with concentrations in Finance and Economics, as well as an English minor. Working for the College of Arts and Sciences, she has developed a strong interest in publication management and hopes to build upon the experience throughout her professional career.