This course offers the mental health professional a variety of skills necessary for using the Internet as a powerful communication and information technology tool. From the pages of this course, participants link directly, via the internet, to a world of resources tailored to the needs of psychologists, social workers, counselors, MFTs and addictions professionals.
The Internet contains billions of Web pages, including vast archives of mental health resources. But, with few control standards, such as those guiding the print world, the Mental Health Internet is both difficult to navigate and difficult to fully trust.
This course provides hands-on training for Internet exploration, search strategies and training about the tools necessary to accomplish objectives. The course begins with basic navigation training, followed by an Internet guided tour of clinical resources available for professionals working with clients. Participants gain access to dozens of useful websites, in addition to web forums, mailing lists, newsgroups, and chat forums for mental health professionals.
Finally, the professional topics of online therapy, telehealth, technostress, and Internet addiction are covered in some detail. The author of this online course is David Lukoff, Ph.D.
Learning Objectives
Upon completion of this course participants will be able to:
- Discuss specific benefits and advantages to mental health professionals through navigating the internet.
- Discuss how to avoid potential shortcomings, risks and problems found on the internet.
- List ways to find a wealth of online information and resources designed for psychologists, social workers, counselors, MFTs and addictions professionals.
- Apply internet mental health search skills.
- Access internet web forums, mailing lists, newsgroups, and chat forums for mental health professionals.
- Explain principles of online therapy and counseling, as well as, general health care via the internet.
- Recognize the symptoms of internet addiction and its treatment.
Internet Structure and History
What is the Internet?
Physically the Internet is composed of a global network of computers that are linked to one another. Some of these computers, designated as servers, store vast amounts of data including text, graphics, audio, and video files that are accessible to anyone hooked to the Internet usually without cost. The networking of computers is creating a Global Digital Library. Since the 17th century, it has been the dream of Encyclopediasts to compile all knowledge in an easily accessible form. But human knowledge quickly outstripped the capacity of one set of books to contain everything. However, such compilation, organization, and dissemination of all knowledge is now being achieved 200 years later by means of computer networks instead of books. And information is not limited to text documents. Graphic, audio, and video resources are increasingly available on the Internet.
The Internet is also a powerful communication tool. E-mail is still the most popular use of the Internet. The Internet's potential as a tool for communicating has been limited by bandwidth considerations, but many expect that within a few years, videoconferencing will be routine. Audio conferencing is quite feasible with today's modems. Ours may turn out to be the "communication age" rather than the "information age."
History of the Internet
The Internet was initially conceived and developed in the 1960's by the U.S. Department of Defense to create a command-and-control network that would function following a nuclear war. They realized that no network's switches and wiring could be entirely protected from the impact of atomic bombs. The solution was to create a totally decentralized communication network with no central authority or network which could be knocked out. Messages would be sent via any of a number of alternative routes over whatever lines were available at the moment.
In his Short History of the Internet, Bruce Sterling describes this conception in his science fiction style: The particular route that the packet took would be unimportant. Only final results would count. Basically, the packet would be tossed like a hot potato from node to node to node, more or less in the direction of its destination, until it ended up in the proper place. If big pieces of the network had been blown away, that simply wouldn't matter; the packets would still stay airborne, lateralled wildly across the field by whatever nodes happened to survive. This rather haphazard delivery system might be "inefficient" in the usual sense (especially compared to, say, the telephone system)-but it would be extremely rugged. In 1969, the Pentagon's Advanced Research Projects Agency linked the first computers in a network termed ARPANET, which was the forerunner of today's Internet.
Scientists were also interested in expanding their capacity to exchange data and findings that were being generated at an accelerating rate after World War II. In 1984, the National Science Foundation created NSFNET, which made many technical advancements, linking more and more powerful super computers. Corporations like Sprint and MCI began to build their own faster networks. NSF withdrew from the "backbone" business as commercial firms have taken over the operation of the major Internet arteries. Commercial uses of the Internet are expanding exponentially. Meanwhile, there are plans to build another network for use by universities. The exact shape that all these networks will assume is unclear, but their growth seems inevitable.
Growth of the Internet
The growth of the Internet has outpaced all other forms of mass communication, exceeding that of radio, television, and even the personal computer itself. As of August 2001, an estimated 500 million people are connected to the Internet, with the majority in North America and Western Europe, but there are users in every country on the globe (see Internet World Stats). The web has greatly simplified access to information compared with gopher, ftp, and telnet, the earlier information retrieval systems that require knowledge of many arcane commands. The web has an entirely graphical interface, meaning all you need to do to locate, save, and print resources is point and click with a mouse.
Originally proposed in 1989, the web did not gain any widespread popular use until Mosaic, the first browser, became available in early 1993. Usage of the web then doubled every 4 months for several years, and is only now slowing because the statistical base has gotten larger. The web is currently driving the development of the Internet. In 1993, there were a mere 130 servers storing web pages. As of August 2001, there are an estimated 150 million web sites with over 2 billion pages indexed by the Google search engine.
Why Learn to Navigate the Mental Health Internet?
The Internet is a revolutionary information technology which rivals speech, writing, and books in its potential to transform the exchange of human knowledge. It is having a major impact on training and practice in all of the mental health professions. The portion of the Internet known as the World Wide Web, only in existence since 1993, already contains vast archives of scientific and clinical literature. The entire body of published healthcare and scientific literature is available online in abstract form via PsycINFO, MEDLINE and other important searchable bibliographic databases. In some scientific areas, the Internet has already become the major publication vehicle, entirely supplanting printed journals (e.g., a physics web site called e-Print).
For mental health professionals, the Internet provides access to research on clinical interventions and online seminars for exchanging professional knowledge, news, and meeting announcements. In addition, the Internet contains numerous pamphlets, brochures, and other self-help resources which can be given to clients. Mental health professionals use e-mail to conduct research, write articles, and disseminate professional news and events.
The Internet also allows mental health professionals to participate in online case seminars that expand their personal knowledge base and refine their professional skills. Since Hippocrates, health professionals have held interdisciplinary case seminars to disseminate the latest understandings in their fields. Like a case seminar, the Internet is inherently cross-disciplinary. Resources on mental health are found from the perspectives of all health care disciplines (e.g., psychology, medicine, nursing, social work, etc.). The information exchange and communication capacities of the Internet create a global Virtual Case Seminar which provides access to cross-disciplinary resources and colleagues.
Searches on the Internet also cross scientific disciplinary boundaries. An online search on the web for a mental health topic (e.g., anxiety) will return sources from anthropology, religion, the humanities, and biology, which offer valuable perspectives on clinical issues.
Caveats and Concerns
While this course is primarily concerned with the Internet's potential to be a resource for mental health professionals, one should not overlook its downsides as well. Anyone can put up a web site about anything. While this can be seen as furthering the decentralization and democratization of access to information, the lack of any quality control also permits the creation of worthless and even misleading web sites. However, there are some counterbalancing trends. Some organizations provide ratings of web sites, for example, the Mental Health Net site, which you will visit several times in the course, performs this service for mental health professionals by rating sites both for content and ease of use.
There are also serious issues to consider about the long-term impact of the Internet. As people communicate more and more in cyberspace, do they lose touch with their communities and bioregions? Does spending more and more time in front of a monitor have a deleterious effect on family life (as has been demonstrated with television watching)? This issue is considered further in the course section on Internet Addiction. Will the Internet promote further disconnection between mind and body as communication is stripped of its visual, kinesthetic, olfactory and other sense components, and people spend more time in physically unchallenging activities? While these issues should be carefully considered and investigated, the Internet is here to stay, is expanding exponentially, and is an important resource for mental health professionals.
Online Learning
Online learning will evolve rapidly over the next 10 years (practically a millennium in Internet time!) to become an indispensable tool in clinical practice. In 1997, the American Psychological Association issued a report on the Education, Training and Continuing Professional Education of Psychologists that highlighted the increasing role that the new computer-based technologies will play in our profession: In order to participate in organized healthcare operations at the level of policy maker, researcher, manager, program evaluator, MIS designer, cost/outcome specialist, or even as a provider of care, psychologists must develop skills in using these [computer-based] technologies that will increasingly be included in the repertoire of psychologists if they are to successfully compete with other providers. (p. 72) The advanced degrees we have earned are not certification of perpetual competence. Mental health professionals need to be constantly engaged in learning activities. The Internet is fast becoming the prevailing infotechnology for learning, especially activities involving information retrieval, processing, creation, and communication. Its usefulness in training psychotherapy skills is still quite limited, but the Internet is a powerful infotechnology tool for staying current with research findings, learning about the development of new clinical approaches, tracking trends in the marketplace that affect the mental health field, and engaging in peer collaboration and supervision.
This shift in educational principles and practices related to networked digital technologies will affect the whole clinical educational enterprise. Venerable clinical training institutions such as ground rounds are now being put online--at UCLA, Stanford, and University of Chicago for example (You will visit these in this course).Thus mental health professionals regardless of location have access to the best universities and most recent developments in their field.
Online Clinical Resources
Fisherman in Alaska with a Dual Diagnosis
The three cases in this lesson cover a wide range of conditions, including depression, ptsd, substance abuse, medical illnesses, and sleep disorders. They are presented with links to illustrate the range of Internet resources available on clinical topics. This first case concerns rural mental health delivery. It is based on my experience teaching a workshop on the Internet to mental health workers on the Aleutian Islands of Alaska. Many were village-based counselors who had only 36 hours of training and no college education, and yet they provide multiple mental health services ranging from hospice care to detox. Many are now embracing the Internet to fill in their gaps in training and information on assessment and therapy.
John is a 29 year old man living in the rural Alaskan town of King Cove. He works seasonally on the fishing boats, but when not fishing, he abuses alcohol. Recently he has begun using amphetamine as well. He is a dually diagnosed patient. For the past 2 years, he has been taking Zoloft for treatment of Major Depression. He has been referred to the mental health clinic because he has an enlarged liver presumed to be related to his abuse of alcohol. He states that he doesn't see the connection between his liver problem and drinking, and doubts that he's an alcoholic since he doesn't drink when he's working on the fishing boat. He is part Aleutian Indian and has expressed interest in learning more about his Native American background. Denial
The first therapeutic objective is to convince John that he does have a serious problem related to alcohol and that his health is being affected by it. An online interactive test would demonstrate to John that he does meet criteria for alcohol dependence.
EXERCISE: Take the Alcohol Screening Test as John, making up responses to fit someone who has an alcohol problem.
These are links to pictures from the University of Utah Medical School pathology mini-tutorial on the effects of alcohol on the liver that can be shown to John. The following is a brochure on substance abuse from the National Clearinghouse for Alcohol and Drug Information that can be printed out and given to John.
Alcoholics Anonymous
John agrees to get involved with a 12-step program. However, there is no AA meeting currently being held in the small Alaskan village he lives in. However John lives one block from the clinic and is quite willing to come in to use the computer to read the Big Book of Alcoholics Anonymous and to join an online AA group when he is on shore.
Below are links to online AA groups
Aleutian Roots
John's recovery could be aided by expanding his social support network for sobriety, including re-connecting with his indigenous roots. In addition to finding local resources, an Internet search on the Aleutian Indian Tribe turned up these sites.
Clinical Education
Information on Zoloft is available on several sites, as you'll learn in lesson 4. Here is the information from the Internet Mental Health Site:
Dual Diagnosis Website: Mental Illness, Drug Addiction and Alcoholism.
Dual Diagnosis patients present unique treatment challenges. Visit Kathleen Sciacca's Dual Diagnosis Website.
Housebound Woman with Multiple Sclerosis
This case demonstrates the range of self-help services available on the Internet. In some surveys, over half of all Internet users reported using the Internet to seek information about a health issue within the past month. Tom Ferguson, M.D., who is head of the Consumer Healthcare Informatics area at Harvard Medical School and hosts one of the largest self-help sites, argues that Consumer Health Informatics will usher in a transition from Industrial Age to Information Age Health:
Health care is being reinvented, turning patients into providers and providing customized health information at the touch of a button. The self-care movement goes back at least to the early 1970s. What is different today is that we are seeing the emergence of a whole new generation of electronic tools that will make it considerably easier to do what only the most dedicated and diligent could do before. Consumer Health Informatics (CHI) is the study and development of a new breed of computer and telecommunication systems designed to be used use by layfolk. It now seems clear that later generations of CHI systems will allow us to build a new Information Age health care system around the health-savvy, health-responsible layperson. Ferguson Report While his examples are all from medicine, his points apply to healthcare delivered by mental health professionals as well. Online support and self-care are currently among the most popular uses of the Internet. Tom Ferguson, MD reports that online groups concerning- physical health
- mental health
- recovery and general problems of living
each make up about one third of the traffic. His article gives an overview of the field. A Guided Tour of Self-Help Cyberspace by Tom Ferguson, MDThe client is a 72 year old woman with advanced multiple sclerosis. After her recent exacerbation, she finds it very difficult to attend her support group. She has a voice activated computer which she uses for e-mail with her family, and she wants to participate in an online support group. She also wants to know how to obtain medical information on the Internet. She has asked you to help her find reputable sites.
Online support groups
Research demonstrates the value of support groups for persons coping with physical illness. You want to provide the client with some online support resources since she only has a few sessions allotted to work with you and is physically unable to attend a local support group.
Both newsgroups and mailing list online support groups are available for persons coping with MS. The difference between these two types of online communication is covered in Lesson 5.
Psychcentral is a web site maintained by John Grohol, Psy.D., which has a list of online medical support group including alt.support.ms-recovery , alt.support.mult-sclerosis, alt.support.mult-sclerosis.alternatives and a Multiple Sclerosis mailing list. (Try searching for multiple sclerosis to find these.)
Medical information on the Internet
The Internet is a vast archive of medical information, but not all is from credible sources. In addition, it is easy for consumers to get overwhelmed by the magnitude of resources available. You believe the client would benefit from a referral to a couple of reputable web sites.
World of Multiple Sclerosis
This site is an international cooperative effort utilizing experts in all areas of MS to offer current and useful information to all members of the MS community (health professionals, researchers, persons with MS, families and carers) as well as the general public.
Sexually Abused Man with PTSD and Sleep Problems
This case illustrates the range of professional and self-help resources available online on abuse and sleep problems.
CaseMr. G is a 42 year old health administrator who is experiencing post traumatic stress symptoms due to childhood sexual abuse. His presenting concern is frequent and intense nightmares. He is also having insomnia related to his fear of the nightmares, and has been drinking to fall asleep. He brings you the URLs of web sites he has been visiting and interacting on, including a dream interpretation site and a site on trauma. He wants you to check to make sure these sites are maintained by credible sources. He has requested EMDR therapy, which he read about in a newspaper article.
Treatment Issues
Sleep Hygiene and Nightmares
Some educational materials on sleep hygiene and nightmares would be useful for Mr. G.
Below are some online informational brochures that Mr. G could be given.
Dream Interpretation and Trauma Sites
You also agree to check on the dream interpretation and trauma sites that Mr. G is visiting to make sure they are maintained by credible sources such as university-affiliated and professional organizations.
Mr. G has been reading online materials by John Suler, Ph.D., a Professor of Psychology at Rider University, describing techniques for working with dreams. This is a non-commercial informational site which addresses dreamwork in a clinically researched informed manner.
Mr. G has been exchanging email on DreamMoods.com which has materials to help people understand their dreams. RAINN.org Rape, Abuse & Incest National Network (RAINN) is a leading anti-sexual assault organization which has information on what to do if sexually ssaulted.
PTSD and EMDR
You want to find out more about the clinical use of EMDR for PTSD.
This article by Shawn P. Cahill, Ph.D. was published in the Psychiatric Times July 2000 Vol. XVII Issue 7.
Clinical Education
Medicine.net This is a site with clinical information on PTSD.
There are many online papers for therapists that are contained on this site.
While these resources are oriented toward helping health professionals working in the VA to understand, diagnose, and treat combat-related PTSD, many of their resources are applicable to non-combat related PTSD.
PTSD and Problems with Alcohol Use
For example, this article addresses the common co-occurrence of PTSD and alcohol abuse which applies to Mr. G:
MEDLINE Search
A MEDLINE search reveals the latest research on the use of EMDR for the treatment of PTSD. Click on the link below and enter the terms emdr ptsd (do not use and or quotes) MEDLINE Search for EMDR and PTSD
Mental Health Internet Search Skills
Search Engines
The Google search engine indexes over 1.5 billion pages on the World Wide Web (WWW) or web as it is usually called. And thousands of sites are being added daily. While the Internet is an extraordinarily powerful information technology, it is difficult to master. There are no bibliographic standards such as those which guide the print world. There is no equivalent to the ISBN to uniquely identify a document; no standard indexing structures such as the Library of Congress catalog classification system; no central holding catalog with the Internet's entire contents. Many Internet documents lack even the name of the author and the date of publication. Thus, despite being the world's largest library, the Internet's contents are shelved in no particular order, and there is no central catalog.
Instead of a central catalog, the Internet offers hundreds of different search tools, each with their own database, command language, search capabilities, and method of displaying results. The two most important tools are search engines and directories.
Search engines are tools for locating resources on the Internet based on keywords. When you enter a keyword into a search engine, it compares your term with its database of keywords from Internet sites. It then generates a list of sites with that keyword. Sites are linked so you can click on them to visit. Search engines rely on "robots" or "spiders" that comb the Internet and index sites based on the presence of keywords and also by submissions from webmasters.
Web searching is a nonlinear interactive process. Whereas a search on MEDLINE locates just journal articles, a search engine finds resources of many different types. My search on Metacrawler for PTSD and EMDR returned sites for:
- therapists in private practice
- guides to other sites on trauma
- a consumer-run PTSD information site
- the VA PTSD site an abstract to a journal article
- announcement of a conference on PTSD
- a professional membership organization for emdr practitioners
- a Department of Psychiatry Traumatic Stress Information Page
You learn about your topic as you search, and can then refine your search. Once you find some sites that are germane to your topic, they will probably provide you with the links to other sites you will want to visit. This interconnectedness is why it's called a World Wide Web. Some search engines, such as Infoseek, have a "Find similar pages" feature, which allows you to narrow your search to sites similar to the one selected.
Search Engines
These are examples of the over 300 search engines now available. Google uses some additional algorthymns that rank sites based on which are the most linked to and visited, which often identifies better quality sites.REQUIRED QUEST EXERCISE 1:
Search Engine
Conduct a search on Google for depression. Record the number of hits (called Results) you obtain. The number of hits (called results) is: A. more than 50,000 , B. More than 1,000,000 , C. More than 2,000,000 , D. More than one billion .
Record your answer for later insertion into the Quiz.
Metasearch Engines
Metasearch engines, such as Metacrawler and Inference, send your keyword query out to many search engines, collate the results, and eliminate duplicates. Since all search engines index only a portion of the Internet, metasearch engines may provide the broadest coverage. . Notice that Metacrawler has a "more like this" link next to each site which allows you to refine your search.REQUIRED QUEST EXERCISE 2:
Search Engines
Conduct a search on Metacrawler
for anxiety. At the top of the page it lists which of the following categories for additional searches: A. Anxiety Disorders , B. Anxiety Attacks , C. Text Anxiety , D. All of the above
Record your answer for later insertion into the Quiz.
Natural Language Search Engines
Natural Language Search Engines allow searches using full sentences. This is a relatively new but promising approach. Ask.Com permits this and is also a Metasearch engine.
Conducting Advanced Searches
With keyword searching, it helps to specify more than one term to narrow your search. Search engine's "advanced search" features offer a powerful way to search with greater flexibility. Single word searches on most topics will yield thousands or often hundreds of thousands of hits. Advanced searches allow for more precise searches.
REQUIRED QUEST EXERCISE 3:
Advanced Searches
Go to Google Advanced Search. Conduct two advanced searches, one using "exact wording or phrase" and one using "one or more of these words". True or false: These are the only two options offered on Google advanced search.
Record your answer for later insertion into the Quiz.
Site Search Engines
Some large mental health web sites have their own search engines which function just like the Internet search engines, but they search for documents and files only on their own site.
About.com Guide to Mental Health Search Engines
has an extensive list of links to search engines from mental health sites collected by Leonard Homes, Ph.D.
Tutorials
UC Berkeley Library Tutorial Finding Information on the Internet
UC Berkeley Library Tutorial on How to Choose the Search Tools
Tutorial:A comprehensive tutorial on web searching is available from the Teaching Library at the University of California at Berkeley. Their extensive directory of Internet search tools is constantly updated and well worth bookmarking. Spend 15-20 minutes reading the UC Berkeley Library Tutorial:
Directories
Directories organize web sites into categories. Directories are searched by drilling down through menus and submenus until the specific topic is found. Yahoo! is the granddaddy of Internet directories, which are also called webliographies when they contain hot links to the sites listed. Yahoo! has over 1,000,000 sites in its directory with areas for Mental Health, Nursing, and other clinical topics (e.g., Sexuality, Geriatric and Aging).
In addition to General Web Directories such as Yahoo! and Excite, there are also specialized Mental Health Internet Directories. Mental Help Net is the most comprehensive directory for mental health information and a good place to begin any search. There are also dozens of Medical Directories which have areas on psychiatry and mental health.
Many directories, because they are so large, also provide a site search engine that uses keywords to locate sites listed in the directory. Thus you can use a search engine to find listings on Yahoo! or Mental Help Net, even though they are directories.
The specialized Mental Health Internet Directories are often more efficient for locating mainstream resources such as research publications and government reports. But search engines find sites not included in the directories, such as local chapters of mental health organizations, self-help groups, foundations, and personal home pages, which can also contain useful mental health information. A complete search, especially for client resources, requires use of both a search engine and a directory.
Below are some of the most useful directories for mental health resources.
General Web Directories
REQUIRED QUEST EXERCISE 4:
General Web Directories
Conduct a search on Yahoo! Mental Health:Diseases and Conditions for mood disorder. Which of these is not included in the list of Mood Disorders: A. Bipolar Disorders , B. Depressive Disorders , C. Seasonal Affective Disorders , D. Dysthymia
Record your answer for later insertion into the Quiz.
Mental Health Directory
REQUIRED QUEST EXERCISE 5:
Mental Help Net Internet Directories
Go To Mental Help Net topic: Eating Disorders. Links to Associations feature which of the following: A. National Eating Disorders Association. , B. Self-Help for Eating Disorders Inc. , C. The Anorexia/Bulimia Parents Association , D. Eating Disorders Awareness & Prevention
Record your answer for later insertion into the Quiz.
Medical Directories
REQUIRED QUEST EXERCISE 6:
Medical Directories
Conduct a search on MedWeb for Irritable Bowel Syndrome . The site with Patient Information: Irritable Bowel Syndrome is maintained by: A. Digestioninfo.com , B. Temple University School of Medicine Gastroenterology Section , C. Yahoo , D. Unknown
Record your answer for later insertion into the Quiz.
Medline
Medline is a very powerful tool for obtaining the latest diagnostic and treatment findings, and it is free and easy to use. Medline (MEDlars onLINE) is a computerized bibliographic database of citations to published healthcare journal articles maintained by the National Library of Medicine (NLM). The bibliographic database covers the fields of medicine, nursing, dentistry, veterinary medicine, the health care system, and the preclinical sciences. It contains bibliographic citations (e.g., authors, title, and journal reference) and author abstracts from over 3900 biomedical journals published in the United States and 70 foreign countries. Medline currently contains over 10 million records dating back to 1966. While medical information is available from many sources, such as magazine articles, books, and web sites, Medline is considered a very authoritative resource because most of the Medline journals use peer review to determine articles scientific validity.
PubMed
While Medline is available for free on at least 20 web sites, PubMed is the web interface designed by the National Library of Medicine (NLM) which maintains Medline. NLM designed PubMed for searching over the Internet. PubMed provides a variety of search modes. You can run a simple search by entering one search term in the query box, or construct complex search strategies using Boolean commands and a search menu interface.
Despite the enormity of the Medline database, it is easy to search. You will almost always be able to find what you want using simple search terms. In a couple of hours of practice and reading of the online PubMed Manuals, you can become a power user, taking advantage of MeSH index terms, field searches, and Boolean connectors. However, even as a search novice, you will be able to conduct effective searches.
Basic Search Mode
In the Basic Search mode, you enter search terms (either free-text words or Medical Subject Headings (MeSH)) terms, author names, or a journal name. You can enter multiple search terms, such as emdr ptsd. PubMed automatically puts an "AND" Boolean connector between words, so inserting emdr and ptsd is the same as emdr ptsd.
Authors' names should be inserted in the form
Jones AL (no commas, initials are optional)
REQUIRED SEARCH EXERCISE 7:
Medline Author
Conduct a search on PubMed for Martin Seligman, Ph.D. (use Seligman M). The article Positive psychology, An Introduction by Seligman ME and Csikszentmihalyi M. appeared in: A. American Journal of Psychology , B. American Psychologist , C. Mayo Clinic Proceedings , D. Behavioral Research and Therapy
Record your answer for later insertion into the online quiz form.
Related Articles
Citations in PubMed will have a [See Related Articles] link to the right of the author. Clicking on this link results in the conduct of another search in Medline for articles which are most closely related to the original article. PubMed compares words from the Title and Abstract of each citation, as well as the MeSH headings assigned, using a powerful word-weighted algorithm. The Related Articles citation display is in rank order from most to least relevant. The citation you linked from is displayed first. This is a very powerful yet simple way to refine your search.
For example, if you were conducting the search for the case described in Lesson Two for the Sexually Abused Man with PTSD and Sleep Problems, and you entered EMDR and PSTD, you would find a number of articles on combat-related PTSD, morbid jealousy, and survivors of a natural disaster. But there is one record for the article,
A controlled study of eye movement desensitization and reprocessing in the treatment of posttraumatic-stress disordered sexual assault victims, by Rothbaum BO.
By clicking on the [See Related Articles] link to the right of the author, you will conduct another search for articles closer to the topic of emdr and sexual abuse.
Medline Exercise
Conduct a search on PubMed for emdr ptsd by entering these terms into the search box.
Find the article by Lazrove S
Click on the author name. The Abstract Report looks like this:
An open trial of EMDR as treatment for chronic PTSD.
Lazrove S, Triffleman E, Kite L, McGlashan T, Rounsaville B
Click on [See Related Articles] to see how this refines the search
Displaying Results
Multiple Pages
Your search may find more records than can be displayed on a single screen. If the total number of citations retrieved exceeds the selected "Docs Per Page" value, the bottom of the Document Summary page will have a link to the other pages containing the rest of the search results. To move to the next page, click on the Go to button.
Number of citations on each page
By default, PubMed will retrieve your search results and display the citations in batches of 20 per page, but you can change the number by clicking on the pull-down menu. The option to change this default may also be selected on the Document Summary page (initial display of citations).
Entrez Date
Entrez Date is the date that a record was initially added to PubMed. Use the pull-down menu to limit to a pre-selected range of days or years. If you do not specify a date range, PubMed searches for citations entered into the database from 1966 to the present.
Printing PubMed Records
To print, use the Print function of your web browser as you would to print any web page.
Consider changing the Documents Per Page option to display all of your citations on one web page and then print them all at once.
Ordering Documents
Medline only contains abstracts of articles. The Order Documents feature allows you to use an automated document ordering program called Loansome Doc to electronically order the full text of a citation from a Loansome Doc participating library in your area. There are other online document delivery services available for Medline as well.
REQUIRED SEARCH EXERCISE 8:
Boolean search on PubMeD
Conduct a Boolean search on PubMed Medline using the two keywords depression imipramine. The number of citations returned is: A. under 100 , B. Between 100-1000 , C. 1000- 10,000 D. over 10,000
Record your answer for later insertion into the quiz form.
Audio and Video Resources
The availability of audio and video resources on the Internet is likely to increase dramatically, especially as more people get access to higher bandwidth which makes audio and video and "stream" better. With increased download speeds, audio and video files can be viewed with fewer interruptions. But if you are using a dial-up modem, expect to encounter some sudden buffering delays as the Internet gets congested.
Media Players
RealPlayer and MediaPlayer are free browser plug-ins that allow audio and video files to be read. You probably have a copy of at least one already installed on your browser. Unfortunately RealPlayer files can't be read by MediaPlayer and vice versa. You can download them at:Lectures
Stanford Health Library
Many universities are putting lectures online. The Stanford Health Library is one example. It offers a range of RealVideo lectures of 30 to 60 minutes that address many mental health topics. They are offered in 4 different bandwidths, 300K, 112K, 56K and 28K. You must have the RealPlayer software on your computer to view these movies, and your computer must also have or be hooked up to speakers. Below are some Stanford Health Library RealVideo lectures which are pertinent to mental health:
- Hypertension: The Silent Killer
- Childhood Asthma: Fighting For Breath
- Death and the Doctor: The Final Step in the Art of Healing
- Say My Name: Black Women and Health
- Integrating Alternative and Conventional Medicine
- Culture, End of Life and Bioethics: What Differences Make a Difference?
- Mood and Menopause
Working Together: Interdisciplinary Care of the Sexual Trauma Survivor
- Sleep Disorders
- Trauma and Memory
- With a Little Help From My Friends: Support Groups for Cancer Patients
Grand Rounds
A number of schools now put their Grand Rounds presentations online. Below are some examples of recent titles from
UCLA NPI Grand Rounds
Late Life Depression: Neuroanatomical and Physiological Insights
Beyond the Symptoms of Schizophrenia: A Neurocognitive Perspective
Recent Advances in the Understanding and Treatment of Childhood OCD
New Strategies for Treating Depression
The Unconscious Mind and Psychopathology: The Role of Sibling Experiences
Just When You Thought it Was Safe to Turn 40: Late Onset Schizophrenia
Psychopharmacology of Herbal Medications
Grand Rounds Presentations Exercise
Choose one of the UCLA Grand Rounds presentations and view it.
Audio & Video Search EnginesREQUIRED QUEST EXERCISE 9:
Audiovisual resources
Conduct a search for depression using AltaVista Video Finder. Find the title of a presentation that would be appropriate for patient educational use. True or false: your search results include a still photo from the video presentation.
Record your answer for later insertion into the Quiz.
Medical Information
Introduction
Mental health professionals often work with clients who present with medical conditions as as issue in their treatment, such as coping with new physical symptoms, lifestyle changes demanded by their illness, or life threatening diseases. Surveys show that 60% of Internet users have sought health information online. Consumer access to medical information is changing the practice of health care. As patients become more knowledgeable, treatment decisions are being negotiated or even initiated by patients.
This is true of mental health treatment as well. While working as a psychologist at the San Francisco VA, a patient brought in a print out of sites on PTSD, and another asked about herbs for depression she learned about from a web site. This phenomenon has become known as the Consumer Health Informatics movement. Tom Ferguson, M.D., who heads the Consumer Healthcare Informatics area at Harvard Medical School, is one of its main proponents. He describes the movement:
As health information flow becomes widely available to all, we are beginning to see the medical equivalent of the toppling of the "Berlin Wall" that once separated lay healthcare from professional medicine. Some of our widely held assumptions are now questionable. We have assumed, for instance, that ...medicine is something only doctors can know about.
Ferguson Report Consumer health informatics provides citizens with the tools, skills, information, and support they need in the emerging new healthcare system. These changes will also require a change in thinking for health professionals in that consumers will now increasingly be seen not only bring in their problems but also as resources. Healthcare providers have habitually overlooked (and often actively discouraged the use of) the biggest health resource of all: people's ability as informed layfolk and experienced self-helpers to prevent and manage their own health problems. He sees this and other shifts as we move from Industrial Age Medicine to Information Age Healthcare.
Self-Care in the Information Age by Tom Ferguson, M.D.
Evaluating Online Information
Evaluating Health Information on the Internet
Since anyone can publish on the web, it is important to develop skills in evaluating online information. A number of training modules and guidelines are available through the Michigan Electronic Library:
Typical suggested critieria include:
- Credibility
- Bias
- Accuracy
- Currency
- Relevance
- Significance
- Intended Audience
- Usability
It is usually reasonable to assume that a site maintained by a unversity or a professional organization is providing credible information, but a virtue of the Internet is ready access to other sites and databases such as Medline which can be used to cross-validate claims.
Disease Sites
There are over 30,000 medical sites available on the Internet. Most are specialized for a certain condition or problem. Some are maintained by medical schools and professional organizations. The United States government also sponsors many health-related sites. Others are personal home pages. Yet others are commercial sites which make unsubstantiated claims for their products or therapies. Thus the quality of medical information varies widely.A model medical site which has won many awards is
This comprehensive site from the University of Pennsylvania is designed for both consumers and health professionals. It contains information on specific types of cancer (e.g., breast cancer, lymphoma), medical specialties that deal with cancer (e.g., radiation oncology, gynecologic oncology, chemotherapy, bone marrow transplant), psychosocial support and personal experiences, cancer causes, screening and prevention, clinical trials, financial issues for patients, and exhibitions of art by people whose lives have been touched by cancer.
Yahoo: Diseases and ConditionsThousands of disease-focused sites can be found here
Medical Directories
The sites listed below are 3 reputable, comprehensive, and easy to use sites containing medical information
Medscape
Contains over 7000 full-text, peer-reviewed clinical medicine articles. Articles are linked to Medscape's Clinical Discussions, other Internet resources, and related specialty areas on Medscape. A search engine is available.You will have to register first, but use of the site is free. REQUIRED QUEST EXERCISE 10:
Medical information
The Medscape site contains listings for all of the following medical specialty areas except: A. Infectious Diseases, B. Oncology , C. Parasitic , D. Cardiology
Record your answer for later insertion into the Quiz.
Health Finder
Consumer health and human services information web site developed by the U.S. Department of Health and Human Services. Includes online publications, clearinghouses, databases, web sites, and support and self-help groups, as well as government agencies and not-for-profit resources.
Medications
Vitually the entire PDR (Physician's Desk reference) is available online. In addition, one can access the latest research via Medline.
Mental Health Net: Psychopharmacology and Drug References
Includes some of its own information, but also provides links to information on psychiatric medications located on other sites, including Internet Mental Health, PharmInfoNet, and RxList.
Internet Mental Health: Medications
Site designed by Canadian psychiatrist Dr. Philip Long with information about the pharmacology, indications, contraindications, warnings, adverse effects, overdose, dosage, supplied forms, and research of the most common psychiatric medications.
RxList
The material is derived from Mosby, Inc., a publisher focused on the health sciences. The database is not limited to psychiatric medications, but includes informaion on over 4000 medications including Description, Clinical Pharmacology, Clinical Studies, Indications and Usage, Contraindications, Warnings, Precautions, Drug Interactions, Adverse Reactions, Drug Abuse and Dependence, Overdosage, Dosage and Administration, Animal Pharmacology, Patient Information, and How Supplied. Note tha navigation aids at the top of the pages for additional information on the various drugs. The search engine on the home page locates information by drug name. It uses "fuzzy searching" to allow for spelling errors by finding close matches.
Yahoo! Health: Drugs and Medications
REQUIRED QUEST EXERCISE:
Medications11
Go to RxList and do a search for prednisone. Click on the first "prednisone" that is displayed. Then click on Warnings/Precautions near the top of the page. Under Precautions General, it states that:
Psychic derangements may appear when corticosteroids are used including: a) euphoria b) personality changes c) psychotic manifestations d) all of the above
Record your answer for later insertion into the Quiz.
Clinical Practice Guidelines
Clinical practice guidelines are systematically developed consensus statements to assist health professionals in their decision-making about appropriate treatments for specific problems. Sometimes surveys are used with as many as 65-100 of the leading experts in each field polled, as in the Expert Consensus Guideline Series. Conferences, a web page, continuing education as well as working with policy makers in the public sector and in managed care are often part of the process of constructing "best practice" guidelines.
In medicine, compliance with published clinical valid and scientifically based guidelines seems to improve patient outcomes. Their efficacy in mental health has not been established, but they are useful guides to interventions that have demonstrated some success. As the authors of the Expert Consensus Guideline Series noted:
The honest answer for many of the questions is that we simply don't know. Throughout history, conventional wisdom has often been wrong. Expert opinion must always be subject to the corrections provided by the advance of science. Moreover, precisely because we asked the experts about the most difficult questions facing you in clinical practice, many of their recommendations must inevitably be based on incomplete research information and may have to be revised as we learn more. Despite this, the aggregation of the universe of expert opinion is often the best tool we have to develop guideline recommendations. Certainly the quantification of the opinions of a large number of experts is likely to be much more trustworthy than the opinions of a small group of experts or of any single person. The dissemination of practice guidelines is part of the push throughout the health field to standardize treatment. One rationale that professionals have for engaging in the creation of practice guidelines is to forestall the imposition of guidelines by constituencies that have less clinical scientific goals (cost containment, bureaucratic simplicity, spreading potentially idiosyncratic personal opinion). However, it needs to be highlighted that guidelines are never a substitute for good clinical judgment and common sense. In addition, there is a clear emphasis on cognitive-behavioral approaches in most of the guidelines.
Sites With Online Practice Guidelines
National Institute of Health (NIH)
NIH has convened working groups of clinical researchers and experts to develop practice guidelines about:
- Diagnosis and Treatment of Attention Deficit Hyperactivity
- Disorder
- Effective Medical Treatment of Opiate Addiction
- Interventions to Prevent HIV Risk Behaviors
- Diagnosis and Treatment of Depression in Late Life
- Treatment of Panic Disorder
- Differential Diagnosis of Dementing Diseases
- Electroconvulsive Therapy
- Mood Disorders: Pharmacologic Prevention of Recurrences
The Expert Consensus Guideline Series
Expert Knowledge Systems, the publisher of these guidelines, describes itself as a knowledge-transfer company dedicated to bringing expert intelligence to bear on critical decision making for government, industry, and the individual. It has a steering committee of three psychiatrists. They have published guidelines for:
- Treatment of Behavioral Emergencies
- Treatment of Depression in Women Bipolar Disorder
- Schizophrenia
- Obsessive-Compulsive Disorder
- Agitation in Older Persons with Dementia
National Guideline Clearinghouse (NGC)
NGC is a public resource for evidence-based clinical practice guidelines sponsored by the Agency for Health Care Policy and Research in partnership with the American Medical Association and the American Association of Health Plans. In the mental health area, it has guidelines for 98 mental disorders including::
- Anxiety Disorders
- Delirium, Dementia, Amnestic, Cognitive Disorders
- Eating Disorders
- Mental Disorders Diagnosed in Childhood
- Mood Disorders
- Schizophrenia and Disorders with Psychotic Feature
- Sexual and Gender Disorders
- Substance-Related Disorders
American Psychiatric Association (APA)
The APA has developed guidelines for:
- Panic Disorder
- Psychiatric Evaluation of Adults
- Bipolar Disorder
- Major Depressive Disorde in Adults
- Eating Disorders
- Substance Use Disorders: Alcohol, Cocaine, Opioids
- Alzheimer's Disease and Other
- Dementias of Late Life
- Schizophrenia
- Nicotine Dependence
AusEinet Good Practice Guidelines
The Australian Early Intervention Network for Mental Health in Young People has developed good practice guidelines for a number of conditions impacting on the mental health of young people including:
REQUIRED QUEST EXERCISE: 12
Practice Guidelines
Go to The ExpertConsensus Guideline Series. The guide for attention deficit disorder also covers what other problem?
a) autism b) learning disabilities c) hyperactivity d) none of the above
Record your answer for later insertion into the Quiz.
Diagnostic Information
The Mental Health Net site has information on
DSM-IV Codes
The author of the book DSM-IV Made Easy also maintains a web site with DSM-IV criteria listed
ICD-9-CM Mental Disorder Codes
A company called eICD.com provides information about and sells resources on the ICD Codes
REQUIRED QUEST EXERCISE: 13
Diagnostic Information
Go to DSM-IV Codes and find the five digit code for Vascular Dementia With Delirium (listed in Cognitive Disorders; Mental Disorders Due to a General Medical Condition)
a) 290.40 b) 290.41 c) 290.42 d) none of the above
Record your answer for later insertion into the Quiz.
Self-Help Resources
The self-help materials listed below are appropriate for patient education. They can be printed out and given to clients, or their addresses provided to them.
Mental Health Net: Self-Help Book Online
The Self-Help Book is a searchable 1000-page book by Clayton Tucker-Ladd, Ph.D. which covers the origin of problems and what self-change techniques work well with specific problems. The book is divided into 15 descriptively-labeled chapters, and the search engine handles keyword and concept searches.
American Self-Help Clearinghouse
The American Self-Help Clearinghouse Guide helps consumers locate real-life support groups available in their local communities.
SelfHelpMagazineThis online magazine, one of the oldes on the Internet, is produced by mental health professionals and designers who donate their time. A wide range of topics are covered with a focus on education and self-help. A free e-newsletter is also available.
Psych Web
Psychology Self-Help resources on the Internet including links to online brochures and pamphlets.
American Psychological Association Help Center
Includes information on work, family, relationship, and mind-body issues.
REQUIRED QUEST EXERCISE: 14
Self-Help Resource
Go to Mental Health Net: Self-Help Clearinghouse and find a self-help group. In the search engine window, type in Anxiety. This will display about 5 groups. True or false: the displayed groups include one or more 12 step programs.
Record the answer for later insertion into the Quiz.
Professional Organizations
All of the major mental health professional organizations have a web site with information for members, and often for consumers as well.
Yahoo Mental Health Organizations
contains an extensive list of organizations ranging from the Academy for Eating Disorders to the Washington Mental Health Counselors Association
The Encyclopedia of Psychology
has a listing of psychology organizations
REQUIRED QUEST EXERCISE: 15
Professional Organizations
Go to Yahoos Mental Health Organizations and click on Professional. True or false: these organizations are listed in alphabetical order.
Record your answer for later insertion into the Quiz.
Online Mental Health Journals
PSYCLINE Guide to Psychology and Social Science Journals on the Web
Armin Gunther, Universitat Augsburg, is the Webmaster for this collection of over 1900 journals with an online presence. Note that most of the journals have only titles or online abstracts. But a few of these are E-Journals which publish full-text articles online.
REQUIRED QUEST EXERCISE: 16
Online Journal
Go to PSYCLINE and find an e-journal on trauma by clicking on next to E-Journals. This will display the entire list of over 100 online journals. True or false: one such journal is titled Analytic Journal of Trauma and Abuse.
Record your answer for later insertion into the Quiz.
Mental Health News
Mental Health Net: Headlines, Articles and Editorials
Many people rely on the internet for staying up with late breaking developments through news sites because they are updated in a timely fashion. And that applies to the mental health field as well where there are sites that filter news for mental health topics.
Includes links to articles and Daily News Summaries from
- HealthScout @ Mental Health Net
- MHN's Daily News Summaries
- Alcohol, Drug, & Tobacco News
- Individual.com
Online Mental Health Seminars
Web Forums
While these online discussion forums are not organized as formal seminars with presentations, they still perform the same function of allowing professionals to exchange research findings, conference announcements, news, practices, controversies, and problematic cases. Online mental health seminars cover cases, research, new publications, and conferences on a wide range of specialized topics, such as serotonin reuptake inhibitor antidepressants (e.g., Prozac), Jungian therapy, and PTSD. Mental health professionals participate in online seminars to expand their personal knowledge and refine their professional skills.
Four types of online seminars (which means they are conducted over the Internet) are available: Web Forums, Mailing Lists, Chats, and Newsgroups.
Web Forums
A web forum is in essence a bulletin board that is available on a web page. These include threaded discussions where you can see all previous postings and can post your own message.
Behavior Online
A good example of a web forum for mental health professionals is
Gilbert Levin, Ph.D., a Professor of Epidemiology and Psychiatry at the Albert Einstein College of Medicine, coordinates this site. Behavior Online offers an ongoing series of web forums, including Clinical Case Conferences and seminars on Affect Theory, Classical Adlerian Psychotherapy, Cognitive Therapy, Control Mastery Theory and Self Psychology, Ericksonian Therapy, EMDR, and several other topics. A master clinician/teacher of each orientation presents and moderates discussions. These conferences are open only to mental health professionals and graduate students. Pick out one Behavior Online web forum and read the threaded discussion.
REQUIRED QUEST EXERCISE: 17
Mental Health Web Forums
Behavior Online's homepage describes itself as "the gathering place for Mental Health and Applied Behavioral Science Professionals." True or False?
Record your answer for later insertion into the Quiz.
Mailing Lists
In Mailing lists (also called listservs) postings are e-mailed to all members of the mailing list. To become a member of a mailing list, you must subscribe to the list. This requires sending the mailing list an e-mail. Most mailing lists are very clear about how to subscribe and unsubscribe. Mailing lists can generate anywhere from a few e-mail messages a day to hundreds. With most e-mail programs, it is possible to set up filters to put all mailing list correspondence in a separate mailbox.
Frequently Asked Questions on Listservs
To learn more about mailing lists, go to the
Virginia Commonwealth Univerity
Mental Health Mailing Lists
Below are search tools which will enable you to locate mailing lists on mental health topics.
InterPsych Professional Forums
InterPsych is a non-profit organization of mental health professionals committed to disseminating information. It hosts 50 mailing lists with over 10,000 participants. Mental health professionals doing research, scholarship, or clinical work in the area are invited to join these e-mail seminars. A few are open to non-professionals.
Topica Searchable Directory of E-mail Discussion Groups
Topica is the most comprehensive directory of mailing lists-over 90,000 as of this writing. Mailing lists are located by Topica's mailing-list-gathering-robot so new ones are added regularly. However, not all mailing lists for mental health professionals seem to be included. There is a brief description of the list, including a sample message, administrator profiles, and availability of archived messages.
Dr. Grohol's Mental Health & Psychology Resources Online
John Grohol, PsyD is the webmaster. The site includes both mailing lists and Usenet Groups for professionals and consumers. They are listed in several of the categories such as Medical Disease, Grief and Loss, and Alcoholism and Substance Abuse.
REQUIRED QUEST EXERCISE: 18
Mailing List
Go to InterPsych Forums and find a professional mailing list you would consider joining. True or false: forums on Latin Psych and Hypnosis appear at the very top of the listing.
Record your answer for later insertion into the Quiz.
Newsgroups
Newsgroups (also called Usenet) are a vast bulletin board system on the Internet organized into discussion groups that cover a wide variety of topics, including mental health issues. They have titles such as
alt.abuse.recovery
sci.psychology.psychotherapy
DejaNews created a powerful search engine for newsgroups that has become a part of Google. Its database includes more than 20,000 active discussion groups, and 138 million articles. It also allows you to post to newsgroups, view an author's posting history (e.g., what newgroups they've posted to), and conduct advanced searches by dates or within one newsgroup.
Their Basics of Usenet provides how to instructions.
Dr. Grohol's Mental Health & Psychology Resources Online
The site includes both mailing lists and Usenet Groups for professionals and consumers. They are listed in several of the categories such as Medical Disease, Grief and Loss, and Alcoholism and Substance Abuse.
REQUIRED QUEST EXERCISE: 19
Mailing List
Go to Dr. Grohol's Mental Health & Psychology Resources Online and find a support group for a mental health problem (e.g., abuse, addiciton, OCD) that is a newsgroup. True or false: adult survivors of abuse is listed under abuse support groups.
Record your answer for later insertion into the Quiz.
Chat
An IRC Tutorial
In a chat, people interact in real-time with messages exchanged instantaneously. Some chats require the installation of free software. Below is a link to a tutorial on the IRC software usually used in chats.
But more and more sites are using web-based chat programs which allow one ot Chat is not a major professional communication tool at this point in time.Perhaps when videoconferencing becomes readily available, such real-time communication will become more useful for professional communication.
The PsychNet-UK site below will enable you to locate chats on mental health topics such as depression, anxiety, relationships, etc.. Note these are not oriented toward professionals.
Mental Health Chat Rooms
Telehealth
Telehealth is likely to become a significant part of the future of health care. Although terms such as online therapy and cybertherapy are sometimes used interchangeably, the broadest term to describe the full-range of mental health services that can be provided using telecommunication technology is behavioral telehealth. Telehealth is the use of telecommunications and information technology to provide access to health assessment, diagnosis, intervention, consultation, supervision, education, and information across distance. Behavioral telehealth is simply the application of the same technology to provide behavioral health service. Telehealth includes the delivery of mental health services via the Internet but also includes telephone, television, video, and fax. There is a convergence of functions and hardware in the telecommunications field. Videoconferencing, for example, can be conducted over the Internet using cameras connected to computers, or the data can be sent over telephone lines, or over a closed proprietary Intranet.
The U.S. government already heavily invests in telehealth-over 20 billion dollars in 2000 (mostly in the military). Congress specifically included funding for $200 million per year for telemedicine reimbursement in Medicare. (Unfortunately, many government projects use the less inclusive term telemedicine to describe this expanding field.) There are telehealth programs in nearly all of the states and provinces of the United States and Canada.
The first telehealth projects date back 40 years ago when, in 1959, the University of Nebraska School of Medicine began experimenting with a closed-circuit television link to provide psychiatric and other health services between the Nebraska Psychiatric Institute and Norfolk State Hospital. Through the 1970s, with federal financial and technical assistance, a number of rural projects were developed that relied on satellites or dedicated video connections to supply mental health services. In the late 1980s, military and correctional institutions began experimenting with telehealth systems.
However, these were small scale attempts. Many feel telehealth is about to take off as a means of delivering professional service:
This most recent attempt to bring telehealth service delivery into mainstream health care service delivery is fundamentally different from prior attempts. Although barriers and challenges to the adoption of telehealth have been discussed since its inception, only in the last few years has a solid consensus emerged as to what those barriers are and just how they should be addressed. That consensus, coupled with consumer and commercial demand for affordable telecommunications technology, has spurred health care communications and other manufacturers to develop affordable, user-friendly systems. Finally, legislators, seeing affordable technological options, hearing consensus around both barriers and solutions, and receiving requests from undeserved constituents that the government help implement such solutions, have begun to act to ensure that telehealth technology becomes a significant part of the continuing evolution of health care. Telehealth and the Evolving Health Care System: Strategic Opportunities for Professional Psychology, by Kathleen M. Kirby, Patrick H. Hardesty and David W. Nickelson, Professional Psychology: Research and Practice, December 1998 Vol. 29, No. 6, 527-535
REQUIRED QUIZ ITEM
Telemedicine: 20
According to Marlene Maheau, Ph.D., in Telehealth-Call to Action,
For our specific purposes as psychologists, telemedicine will revolve around a) telephone b) videoconferencing c) e-mail d) fax.
Record your answer for later insertion into the Quiz.
REQUIRED QUIZ ITEM: 21
Terminology
Which term is the most inclusive for describing online and telecommunication assisted delivery of services a) cybertherapy b) online therapy c) behavioral telehealth d) Internet-based psychotherapy
Record your answer for later insertion into the Quiz.
Online Therapy
The first attempt to use the Internet for delivery of therapy actually dates back to 1972 at a demonstration of a psychotherapy session between computers at Stanford and UCLA. The earliest known organized service to provide mental health advice online is
Ask Uncle Ezra
a free service offered to students of Cornell University in Ithaca, NY (named for Ezra Cornell, the University's founder) which has been in continuous operation since September, 1986.
Fee-based mental health services offered to the public began to appear on the Internet in mid-1995. Most were of the "mental health advice" type, offering to answer one question for a small fee. David Sommers, Ph.D. was the first to establish a fee-based Internet service which which was based on establishing long-term, ongoing helping relationships, communicating only via the Internet. From 1995 through 1998, Sommers worked with over 300 persons in his online practice, spanning the globe from the Arctic Circle to Kuwait. Sommers employed Internet technologies for e-therapy, primarily e-mail with encryption but also real-time chat and videoconferencing. He no longer delivers service over the Internet.
Another early explorer of online therapy was Ed Needham, M.S., who established his "Cyberpsych" IRC chat service in August 1995, and was the first to focus exclusively on e-therapy interaction via real-time chat. He worked with 44 persons from 1995 to 1998. He too has discontinued his online practice.
Metanoia
Martha Ainsworth maintains a web site that describes what services online therapists offer, ranging from e-mailed answers to questions to 2-way video, and she also runs credentials checks to make sure they have the licenses and degrees they claim.
She reports that in the fall of 1995, when she first did a search, she found 12 e-therapists practicing on the Internet. By May 1999 her database had grown to include over 250 private-practice websites where e-therapists offer services, and the new e-clinic represent collectively nearly 700 more e-therapists. And the number is growing.
Terri Powell conducted a survey study of therapists listed in the Metanoia Directory of Internet Psychotherapists. While a small sample of 13 limits generalizability, she summarized her findings as follows:
Providers of online mental health services are likely to be seasoned professionals attached to colleges and universities...This survey found that the average online counselor is a 48 year old male and a psychologist with 15 years of traditional clinical practice experience. He's been in online practice for almost 2 years and calls his service "advice giving." When you visit his website, you'll find that he uses some sort of encryption software to protect your anonymity. In order to reduce fraud and exploitation, his credentials have been authenticated. Our composite counselor thinks the availability of online mental health services increases clients' access to mental health professionals, especially clients living in remote areas or suffering from disabilities. Online Counseling: A Profile and Descriptive Analysis by Terri Powell
Despite the increasing numbers, use of the Internet to provide psychotherapy is controversial. Even most therapists who deliver services via the Internet do not claim that what they are doing is psychotherapy. Most clearly state that the exchanges are educational rather than therapeutic in nature. Traditional psychotherapy does not seem to be part of the online offer of mental health services. Yet there is little doubt that many people have been helped, some profoundly, by interacting with mental health professionals over the Internet. Martha Ainsworth's commitment to furthering online therapy by managing a web site devoted to this subject (Metanoia discussed earlier) is based on her personal e-mail based online therapy which lasted 2 years without ever seeing or talking to her therapist.
Online Therapy--Not Yet
I would compare it to keeping a journal in that every day when I wrote him an e-mail I explored my thoughts and feelings in great depth. But usually when you keep a journal it doesn't talk back to you. He challenged me. The fact that we communicated by e-mail, I think, made me feel like he was inside my head and present in my life.
Metanoia ABC'S of "Internet Therapy"
She has reviewed the key issues surrounding the provision of mental health services over the Internet including ethics, confidentiality, legality, and effectiveness on her site
The Metanoia site presents 4 issues what you need to know about e-therapy, including which of the following: a) Is e-therapy right for you? b) Is the e-therapist qualified? c) Is my privacy protected? d) all of the above
Record your answer for later insertion into the Quiz.
John Grohol, PsyD, has been a leading proponent of what is increasingly being called e-therapy. He has published a series of articles on best practices in the field.
He is chief operating officer of HelpHorizons that offers e-therapy adhering to the standards evolving among mental health professionals involved in exploring the potential of this approach. The site also contains information about e-therapy developments.
REQUIRED QUIZ ITEM: 22
Telehealth Target
In Dr. Grohol's Definition & Scope of e-therapy, the idea of "coaching," helping a person address specific concerns with specific skills is similar to: a) e-mail helping b) e-therapy c) telephone counseling d) chat therapy
Record your answer for later insertion into the Quiz.
Another example of online therapy is
Eating Disorder Recovery Online
Jeanne Rust, a licensed therapist, offers both individual and group therapy by e-mail and phone.
Cyberpsych: Mental Health on the Internet This is a roundtable discussion covering the spectrum of online mental health issues including online therapy with:
- John Grohol,PsyD researcher and a founder of HelpHorizons.com
- Russ Newman,PhD clinical psychologist, attorney and executive director for professional practice for the American Psychological Association
- Gregg Bloche,,MD attorney, psychiatrist, professor and co-director of the Georgetown/Johns Hopkins Joint Program in Law and Public Health
- Richard Sansbury,PhD Internet psychotherapist who has also practiced traditional therapy for more than 20 years
- Martha Ainsworth Web consultant reads excerpts from her own on-line therapy.
As an example, click on the site
Eating Disorder Recovery Online
Jeanne Rust, a licensed therapist, offers both individual and group therapy by e-mail and phone.
REQUIRED QUIZ ITEM: 23
Delivery Modalities
Which of these telecommunication modalities is being actively explored as a vehicle for delivery of mental health services: a) telephone b) videoconferencing c) e-mail d) all of the above
Record your answer for later insertion into the Quiz.
Online Virtual Reality Therapy
Virtual Reality Exposure Therapy
Virtual Reality Exposure involves exposing the patient to a virtual environment containing the feared stimulus in place of taking the patient into a real environment or having the patient imagine the stimulus. A team of therapists and computer scientists developed a treatment for fear of heights (acrophobia) that was shown to be very effective in reducing acrophobic subjects' anxiety and avoidance of heights, and in improving attitudes toward heights. You can see some of the graphics they created for this treatment and learn more about the research on this approach at the Emory/Georgia Tech Biotechnology Research Center site.
The developers note that this virtual reality approach is particularly amenable to telehealth:
Virtual reality exposure therapy is appropriate for networked delivery of clinical psychology and psychiatry services to remote locations. Since the patient is receiving therapy within a virtual environment, the clinician conducting the therapy session could be present physically or participate via computer networks from a remote location. Underway are projects to simulate PTSD-related experiences of Viet Nam veterans for a desensitization program.
REQUIRED QUIZ ITEM: 24
Virtual Reality Therapy
In Virtual Reality Exposure Therapy, the authors state that:
Virtual environments differ from traditional displays in that computer graphics and various display and input technologies are integrated to give the user a )a cathartic experience b) an unlearning experience c) sense of presence or immersion d) contact with repressed memories.
Record your answer for later insertion into the Quiz.
Rural Mental Health
One major application of telehealth involves the provision of services to people living in rural, remote, and even wilderness areas.
Clinical Applications of Telehealth in Mental Health Care by B Hudnall Stamm
provides an overview of the current state of the art, with case examples on rural mental health.
REQUIRED QUIZ ITEM: 25
Telehealth targets
Which population has not been targeted for telehealth based interventions: a) seniors b) psychoanalytic patients c) disabled d) rural dwellers
Record your answer for later insertion into the Quiz.
Ethical and Legal Issues in Telehealth
The ethical status of telehealth is now being reviewed by many professional organizations. For example, the Ethics Committee of the American Psychological Association issued a statement in 1995 and revised it in 1997 indicating that the APA Code of Conduct "has no rules prohibiting such services". The statement highlights issues of confidentiality and adhering to state licensure regulations in the provision of such services. A special committee is preparing a more comprehensive examination of the implications of telehealth for the practice of psychology.
Services by Telephone, Teleconferencing, and Internet
Concerns include the fear that it will be impossible to ensure confidentiality on the Internet and worry that therapists working by computer may not be able to monitor patients closely enough or intervene quickly in a crisis such as a suicide attempt.
The International Society for Mental Health Online (ISMHO) was formed in 1997 to promote the understanding, use and development of online communication, information and technology for the international mental health community. After considerable discussion and debate, they published
Suggested Principles for the Online Provision of Mental Health Services
Their guidelines address many issues that apply to all forms of therapy but have a unique application to online modes of delivery, such as
1. Informed consent
- Potential benefits
- Potential risks
- Alternatives
- Safeguards
2. Boundaries of competence
- Ensuring competence in clinical topics
- Ensuring competence in online delivery of therapy
3. Requirements to practice
- Conformity with state practice guidelines
Then some guidelines have been developed to address specific ethical issues in online delivery of therapy.
- Structure of the online services
- Turnaround time
- Privacy of the counselor (The therapist's right not to have email or other communications disseminated.)
Other ethical guidelines for online therapy have also been published including:
Guidelines for the Clinical Use of Electronic Mail with Patients
Kane Beverly, Sands Daniel Z. Journal of the American Medical Informatics Association. 1998; 5: 104-111.
Standards for the Ethical Practice of WebCounseling
National Board for Certified Counselors
Ethical Standards for internet On-line Counseling
American Counseling Association
But state regulations vary from state to state, and by virtue of state-based licensing system for mental health professionals, guidelines developed in one state would only apply to therapists licensed in that state. The patchwork of licensing regulations has functioned as an impediment to dissemination of telehealth initiatives. In California, the Telemedicine Act of 1996, while mandating some forms of payment for telemedicine, does restrict the provision of mental health services to patients within the state boundary.
REQUIRED QUIZ ITEM:
State Regulations26
State regulations on telehealth a) are uniform in all 50 states b) apply only to mental health professionals residing in that state c) vary from state to state
d) b and c
Record your answer for later insertion into the Quiz.
Online Resources on Telehealth
Online Web Forums
BehaviorNet: Online Clinical Work
The Behavior Net site hosts an ongoing web forum led by Leonard Holmes,PhD which explores these issues
John Suler,PhD also hosts a Psychology of Cyberspace web forum on BehaviorNet. John Suler,PhD. also has a web site on the Psychology of Cyberspace which includes a section on Psychotherapy and Clinical Work in Cyberspace.
Mailing List
ISMHO maintains a mailing list with discussion about current issues and events in the delivery of online mental health services.
Organizations
Two telehealth organizations address behavioral telehealth.
The American Association of Telemedicine Service Providers
has established an interdisciplinary working group on mental health.
The American Telemedicine Association
does not have a specific mental health committee but addresses behavioral telehealth issues in some of its standing committees.
Online Articles
There have been many articles in the popular media on online therapy, and an increasingly popular name for this approach is e-therapy.
E-Therapy: History and Survey
Another review of online therapy is in the article,
Internet therapy and self help groups - the pros and cons
by Storm A. King,PhD & Danielle Moreggi
TelehealthNet has links to many online resources and telehealth professionals, including a free online newsletter Telehealth News which covers the latest developments, projects, and resources in the utilization of telecommunication and information technology in healthcare.
For another view of how online therapy might unfold in the future, see
Using the Internet in the year 2005; Three Scenarios
by Storm A. King,PhD
Online Assessment
Background
Psychological testing is also being impacted by the Internet. Already, there are many online interactive tests, such as the Goldberg Depression Inventory.
Other online tests are self-scoring and include interpretation guidelines. Most have not demonstrated reliability and validity, and have not been normed for different populations. They should be used cautiously. A review of the
APA Ethical Principles of Psychologists and Code of Conduct section on Evaluation, Assessment, or Intervention reveals many deficiencies in how these tests have been developed. For example, section 2.05 states:
2.05 Interpreting Assessment Results
When interpreting assessment results, including automated interpretations, psychologists take into account the various test factors and characteristics of the person being assessed that might affect psychologists' judgments or reduce the accuracy of their interpretations. They indicate any significant reservations they have about the accuracy or limitations of their interpretations. How can this be done in an online test if the tester never sees the patient or knows his/her unique cultural and educational background?
In addition, it is imperative that confidential information be sent via a secure server or encrypted to protect a client's confidentiality. Despite these concerns, use of the Internet for psychological testing will undoubtedly expand as part of the whole telehealth movement.
Interactive Tests Available on the Internet
NYU Department of Psychiatry The NYU Department of Psychiatry maintains online tests for Depression, Anxiety, Sexual Dysfunction, Attention Deficit Disorder, and Personality Disorders
However, most of the tests available online are for personal growth rather than identification of psychopathology. You can see online administration, scoring, and interpretation in action with the
Keirsey Temperament Sorter a test which is based on the Jungian personality typology. Or try the
Emotional Intelligence Quotient
which is based on Daniel Goleman's work on emotional intelligence.
The Queendom
site lists many online tests, some of which offer interactive scoring.
EXERCISE: Take an interactive online test on one of the above sites
Other Online Assessment Resources
Mental Health Net: Assessment includes links to psychology test publishers, instruments, professional organizations, journals, mailing lists and other online assessment resources, although very few actually involve online testing.
REQUIRED QUEST ITEM: 27
Assessment
On the Mental Health Net site, select topic: Healthcare and Related Fields, subtopic(s): Mental Health Professions -Psychology -Assessment. Link to Professional Assessment and find a site featuring "Resources for locating psychological and educational tests..." The name of this site is a) Psychology Internet b) Assessment Net c) ERIC Clearinghouse on Assessment and Evaluation d) none of the above
Record your answer for later insertion into the Quiz.
The ERIC Test Review Locator
allows you to search for citations to reviews of educational and psychological tests and measures.
The Internet is also being used to send test results for computer scoring and interpretation.
Internet Addiction
Description
Internet addiction has been been the subject of increasing clinical interest, although it remains a controversial topic. While some argue that the Internet is merely a communications medium and cannot be compared to addictive stimuli like drugs and alcohol, others point to the growing number of individual cases related to overuse of the Internet seen in psychotherapy practices. Similar problems have been reported with overuse of video and computer gaming before the arrival of the Internet, so it not the Internet per se that created this type of problem.
One of the first articles documenting excessive dysfunctional Internet usage that merited clinical attention is case study of a 43 year old woman preoccupied with chat rooms which eventually destroyed her 17 year marriage.
Addictive Use of the Internet: A Case that Breaks the Stereotype by Kimberly Young, Ph.D.
Internet addiction includes not only excessive chat room participation, but several ways that people spend too much time online to the detriment of their social and financial well-being. Below are some examples where cases of problems related to Internet use have been documented:
- online gambling
- online shopping
- day trading
- cybersex affairs
- adolescents and online gaming
- children and violent computer games
cartoon about cyberaffairs
cartoon about online shopping (Copyright New Yorker)
Cases of people who get into deep financial trouble in online auctions have been reported. Dysfunctional use of the Internet by children as well as adults can result in diminished participation in the family.
The Net Effect: Internet Addiction and Compulsive Internet Use
David N. Greenfield, Ph.D of the The Center for Internet Studies conducted and published study with ABCNEWS
The results, presented at the American Psychological Association Meeting in 1999, showed that
- Nearly 6% of the 17,251 persons surveyed meet criteria for compulsive Internet use.
- Over 30% report using the Net to escape from negative feelings.
- The vast majority admitted to feelings of time distortion, accelerated intimacy, and feeling uninhibited when on-line.
REQUIRED QUIZ ITEM: 28
Internet Addiction Impact
According to David N. Greenfield, Ph.D in The Net Effect: Internet Addiction and Compulsive Internet Use
The key areas that seem to be impacted by addictions including Internet addiction are a) marriages and relationships 2) employment 3) legal/financial area 4) all of the above
Record your answer for later insertion into the Quiz.
The Internet appears to be a growing problem in the workplace. Psychologist Michael Fenichel,PhD described some clinical observations about persons who present for treatment with computer-related issues:
tend to have pervasive and characteristic cognitive styles which include a sort of "multi-tasking" with high-speed processing, and a loss of mid- and long-term goal directedness, diminished length of attention span, disrupted patterns of living (e.g., eating), and detached or disturbed social relationships, often using the computer as the focal point for all contact with the world.
"Internet Addiction": Addictive Behavior, Transference or More? There is no official psychological or psychiatric diagnosis called Internet addiction. The most recent edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) does not include such a category. To become an official diagnosis, "Internet Addiction Disorder" must be shown by research that it can be reliably diagnosed, and that the diagnosis correlates with outcome, treatment results, histories, and prognosis (to establish external validity). Many have argued that it is closer to pathological gambling which is an Impulse Disorder rather than a type of substance related disorder. Already studies are establishing a connection between problematic Internet use and DSM-IV Axis I Impulse Disorder. For example, a study of 20 individuals with problematic Internet use was conducted where problematic Internet use was defined as (1) uncontrollable, (2) markedly distressing, time-consuming or resulting in social, occupational or financial difficulties and (3) not solely present during hypomanic or manic symptoms. The researchers found:
All (100%) subjects' problematic Internet use met DSM-IV criteria for an impulse control disorder (ICD) not otherwise specified (NOS). All 20 subjects had at least one lifetime DSM-IV Axis I diagnosis in addition to their problematic Internet use; 14 (70.0%) had a lifetime diagnosis of bipolar disorder (with 12 having bipolar I disorder).
Psychiatric features of individuals with problematic internet use. Shapira NA, Goldsmith TD, Keck PE, Khosla UM, McElroy SL. J Affect Disord. 2000 Jan-Mar;57(1-3):267-72 REQUIRED QUIZ ITEM: 29
Problematic Internet Use
In Psychiatric features of individuals with problematic internet use, the authros define problematic internet use as (1) uncontrollable (2) markedly distressing, time-consuming or resulting in social, occupational or financial difficulties (3) not solely present during hypomanic or manic symptoms 4) all of the above.
Record your answer for later insertion into the Quiz.
REQUIRED QUEST: 30
Internet Addiction Research
Go to the PubMed search page and conduct a search for Internet addiction research articles. True or false: articles are listed by author, but NOT in alphabetical order.
Record your answer for later insertion into the online CE quiz.
Assessment and Treatment
Assessment
Researchers have worked to establish the first criterion--the constellation of symptoms that constitutes Internet addiction. Psychologist Kimberly S. Young conducted a three-year study of Internet abuse reported in Internet Addiction: The Emergence Of A New Clinical Disorder, which was presented at an APA Meeting. Based on her findings and her extensive clinical experience with this problem, she has proposed a definition which involves having four or more of the symptoms listed below during the past year.
1. Do you feel preoccupied with the Internet or on-line services and think about it while off line?
2. Do you feel a need to spend more and more time on line to achieve satisfaction?
3. Are you unable to control your on-line use?
4. Do you feel restless or irritable when attempting to cut down or stop your online use?
5. Do you go online to escape problems or relieve feelings such as helplessness, guilt, anxiety or depression?
6. Do you lie to family members or friends to conceal how often and how long you stay online?
7. Do you risk the loss of a significant relationship, job, or educational or career opportunity?
8. Do you keep returning even after spending too much money on online fees?
9. Do you go through withdrawal when off line, such as increased depression, moodiness, or irritability?
10. Do you stay online longer than originally intended?
Dr. Young has created an interactive online test for Internet Addiction based on the above criteria , although reliability and validity data are not reported.
Interactive Online Internet Addiction Test
Exercise: Take this test to see what are the major behaviors involved in Internet use-related problems
Dr. Young also has tests on her site for other Internet-releated problems including:
- Cybersexual Addiction
- Obsessive Online Traders
- Compulsive Online Gambling
- Online Auction Addiction
- A Partner's Addiction
- A Paren's Assessment of Child's Internet Addiction
Treatment
John Suler,PhD has proposed a treatment approach that is based on the observation that
People become "addicted" to the Internet, or act out pathologically in cyberspace, when they have dissociated it from their f2f (face-to-face) life. Their cyberspace activity becomes a world unto itself. They don't talk about it with the people in their f2f life. It becomes a walled-off substitute or escape from their life. Bringing Online and Offline Living Together: The Integration Principle
Internet addiction, like all others types, entails isolation from others and prioritizing of the compulsive activity over all other aspects of life. Dr. Suler goes on to propose some interventions that integrate online and off-line worlds.
- Telling online companions about one's offline life
- Telling offline companions about one's online life
- Meeting online companions in-person
- Meeting offline companions online
- Bringing online behavior offline
- Bringing offline behavior online
Dr. Young, who founded the Center for Online Addiction, leads an online self-help group for Internet Addictions. Although some would compare this to holding an AA meeting in a bar, she has been able to engage people in re-evaluating and altering their patterns of Internet usage using this approach. She believes that, as with other addictions, it is first necessary for the person to break through their denial. However, she reports that Internet addiction does not require abstinence for a healthy and life-enhancing recovery. The Internet can be a personal and professional resource when used appropriately. Her treatment approach focuses on
finding a balance between Internet use and other life activities. The treatment model is similar for eating disorders or controlled drinking programs. The focus being to identify triggers which onset binge-behavior and re-learning how to use it in moderation.
How do You Treat Internet Addiction?
Dr. Young's book, Caught in the Net, describes therapeutic interventions and provides practical self-help tools.
Controversies
There are no accepted guidelines as to how to distinguish "normal" enthusiasm from "pathological" preoccupation. Storm King asked a crucial question: We don't know whether the Internet can actually make someone addicted or alternatively if those who are overusing the Internet already have a vulnerability to such behavior.
Is the Internet Addictive or are Addicts Using the Internet? by Storm A. King,PhD
Stanton Peele,PhD has also raised questions about the validity of the concept of addiction. He argues that the disease model does not explain the dysfunctional aspects of such behaviors and is not scientifically based, even when applied to substances such as alcohol and cocaine. Why aren't people who spend a lot of time reading called "book addicts" instead of people affectionately calling them bookworms?
REQUIRED QUIZ ITEM: 31
Stanton Peele
On the Stanton Peele Addiction Web Site, Stanton Peele,MD a) introduces the term Internet Addiction into the clinical literature b) criticizes the disease model of addiction c) argues that the term Internet Addiction should only be applied to persons working in the computer field d) none of the above.
Record your answer for later insertion into the Quiz.
Internet Addiction Guide
As mentioned previously, not all researchers and clinicians support the idea of Internet addiction. They question the necessity for a unique diagnosis, pointing to the lack of such diagnoses for television addiction, telephone addiction, etc. One such researcher is John Grohol,PsyD who has been a vocal skeptic of Internet addiction as a distinct disorder.
But is clear that people have lost their jobs, flunked out of school, and gotten divorced because their Internet use consumed all their time. Such extreme cases demonstrate the need for therapists to pay attention to Internet use in their assessment.
REQUIRED QUIZ ITEM: 32
Internet Addiction Definition
Internet addiction a) is a new diagnostic category in the DSM-IV b) is a media-created term that has no clinical validity c) only applies to individuals who work in the computer field d) is a new clinical problem documented in case studies and other research.
Record your answer for later insertion into the Quiz.
Additional Resources
John Suler, Ph.D.'s site on the Psychology of Cyberspace contains a good overview and links to other websites on Internet addiction
Computer and Cyberspace Addiction
by John Suler, Ph.D.
The APA Monitor recently published a special issue on Psychology and the Internet
with an article entitled Is Internet addiction real? as well as articles on Rural Telepractice, the Internet as a tool for self-exploration, and the Digital Divide.
Reformulating the Internet Paradox: Social Cognitive Explanations of Internet Use and Depression by Robert LaRose, Matthew Eastin, and Jennifer Gregg. Journal of Online Behavior
This online article presents a new study indicating that the previously-found relationships between online activity and depression is limited to novice users. As users become more experienced with the Internet and their competence improves, the hassles that the Internet itself presents recede. Moreover, users become more skilled at getting social support from others online. These factors lead to improved, not reduced, mental health.
TechnoStress
Definition
Larry Rosen, Ph.D., and Michelle Weil, Ph.D. define "TechnoStress" as any negative impact on attitudes, thoughts, behaviors, or body physiology that is caused either directly or indirectly by technology. One well-documented form of TechnoStress is the escalating problem of information overload, colloquially called "data smog."
In his book Data Smog: Surviving the Information Glut David Shenk claims that just as fat has replaced starvation as this nation's number one dietary concern, information overload has replaced information scarcity as an important new emotional, social, and political problem. Up until recently, the production, distribution and processing of information all remained pretty much in synch. People could receive and think about information at roughly the same pace it was generated and disseminated. But in the mid-20th century, the introduction of computers, television, satellites, and Internet have created a condition of hyper-production and hyper-distribution that has surpassed human processing ability, leaving us with a permanent processing deficit.
David Shenk "Buckle Up"
Multitasking Madness by Larry Rosen, Ph.D. and Michelle Weil, Ph.D.
The impact of information overload is particularly apparent in the workplace as more and more people spend their time at work sorting through e-mail, voice messages, and web pages while their day is interrupted by ringing phones, dinging e-mails, and squealing fax machines. As they describe it in their online article,
You walk in the door at 8:02 a.m. to be greeted by your secretary. She hands you a stack of 18 "While You Were Out" slips that she has transcribed from your voicemail. You glance at your overstuffed briefcase in one hand, your laptop in the other, and the stack of folders under your arm. You consider trying to squeeze the messages between two available fingers. "Oh, wait," she says, and she points to three Federal Express packages. No way to carry it all now, so you head off to unload the work you brought back from home.
Your desk looks like a war zone-and your side lost. A quick glance at your computer reminds you to check your e-mail. What? 26 messages! How can that be? You checked it before you went to bed last night and spent 45 minutes answering all the messages. As you read your e-mail, you flip through yesterday's mail. The phone rings, and as you half-listen to one of your employees you scroll through your e-mail to decide what to answer now and what can wait until later.
Your day has just begun, and already you are exhausted. You feel like an octopus, with your arms and brain moving in multiple directions at the same time. By the time you have finished your work day-technically eight hours later (ha!)-you will have started and stopped dozens of tasks. The phone, the fax, the beep of an incoming e-mail all wrench your mind from what you are doing and thinking. When you finally return to your work, often you have lost your train of thought. Finding it again takes extra effort and time that you don't really have. They report a study in which employees of Fortune 1000 companies averaged 178 messages a day and 3 interruptions an hour. Technology intrudes regardless of whether one uses a computer or purchases new technology. It is omnipresent: microchips are implanted in cars, coffee makers, VCRs, and other tools people use everyday. People who don't feel comfortable with technology often feel inferior and intimidated, and that their boundaries are being invaded.
Symptoms of TechnoStress
TechnoStress can make people feel their memory isn't as good as it used to be as they lose track of what they wanted to do or say. Getting a peaceful night's sleep becomes difficult as their overstimulated minds buzz and chatter, and enjoying laid back recreational activities is disrupted by preoccupation with to do lists, calls, errands, memos, etc. Headaches, irritability, GI discomfort, heart problems, and hypertension can also be related to TechnoStress. Dr. Rosen, who has conducted research on human-computer interactions in the workplace, maintains, "Our brains aren't wired to 'multitask' the way our computers are. We're testing the limits of our human abilities."
In addition, information technologies allow people to work 5 PM to 9 AM as well as 9 to 5. And home life is further interrupted by technologically-captured moments as the phone rings with a charity call during dinner, television, radio and TV blare in the background often unattended to, and family members retreat into their private "Techno-Cocoons." As Drs. Weil and Rosen describe in:
A Conversation with Drs. Weil and Rosen
The modern family is isolated, with each person wrapped in his or her own "Techno-Cocoon." Just take a look at the typical family looks at the end of the dayMom preparing dinner while checking the answer machine, head glued to the portable phone while she returns calls. One child is playing games on the computer in his bedroom, another is talking on her own phone, and the youngest is playing Nintendo. Dad comes home later from work and goes immediately to the computer. And the kids seem to know so much more about computer technology that their parents are feeling intimidated and inadequate. In many homes we are seeing a loss of communication and a major shift in the power balance in the family. Gene Ondrusek,PhD, chief psychologist at the Scripps Memorial Center for Executive Health, and other guests describe a similar concept they call "urgency addiction": the impact of having life be technologically-driven by devices that operate without need for sleeping, eating or socializing. They see the potential for cell phones, e-mail and the Internet to make "urgency addicts" out of all of us. The scientific understanding of the body's response to this assault on the mind is still in its infancy, but it draws upon Hans Selye's classic work on stress--but where individuals get addicted to their own adrenaline.They not only live on the edge of constant crisis, they seem to prefer life that way.
The cutting edge of technology.
Coping With TechnoStress
We need to learn new ways to cope with the constant demand to learn new skills, meet speedier turnaround times, and be accessible 24 hours a day. The pace of technological innovation and intrusion into our lives is unprecedented, and there needs to be a radical re-thinking of how we relate to technology. Yet managed appropriately, technology can enhance both the quality and efficiency of everyday life.
Drs. Weil and Rosen offer some tips to help people manage the information flow:
- Sift and trash-Try to focus on the information you really need instead of news blips that distract. Think critically and separate the gems from the dross.
- Set limits-Ration the time you spend watching television, listening to the radio and cruising the Internet. Designate the best times for people to call or fax you.
- Respond on your own time-Disable the e-mail ding and turn off the ringer on the fax machine. You can respond after you've finish
- Relax when technology makes you wait-Instead of getting irritated while your e-mail boots or a company's telephone system puts you on hold, use that time to rest or tend to small tasks.
- Use the technologies that work for you-You don't have to acquire every new technology. If beepers and cell phones cause you stress, stick with voice mail.
- Schedule time away from information-Set aside slots for exercise, sports, dinner with friends and family vacations.
Their book
TechnoStress: Coping With Technology @WORK @HOME @PLAY
offers additional stategies for coping with the detrimental effects of technology on health and well-being at work and home.
REQUIRED QUIZ ITEM: 33
Technostress
In Data smog: Newest culprit in brain drain, it is reported that researchers are finding that problems stem from people's a) overuse of technologies b) misuse of technologies c) from technology's ineffective presentation of information d) all of the above.
Record your answer for later insertion into the Quiz.
Technophobia
Surveys show that 85% of the population feel uncomfortable with technology. Only about 10 to 15% of the industrialized population are Eager Adopters. Hesitant "Prove Its" make up about 50 to 60% of the population, and the Resisters 30% or so. A study by Dell computers (1) identified 55% of Americans as technophobic. The percentage of the population who are becoming hesitant and resistant is increasing: Over a three-year period, clerical workers became more hesitant and resistant toward technology while managers and executives became more resistant.
42-month Study of Business Attitudes Show Clerical Workers, Managers and Executives Becoming More Hesitant and Resistant Toward Technology by Larry D. Rosen & Michelle M. Weil.
In their study, which is available online
Adult and Teenage Consumer Users of Technology: Potholes on the Information Superhighway? (1995). Journal of Consumer Affairs, 29(1), 55-84.
Drs. Rosen and Weil point out the detrimental effects of technophobia:
avoiding technology may prove problematic. A report by Krueger (1991) showed that workers who use computers on their jobs earn 10 percent to 15 percent more than those who do not even after holding education, income, occupation, and other characteristics constant. Another examination of the same data by Boozer, Krueger, and Wolkon (1991) found that minority workers were less likely to use computers on their jobs than white workers. The same study found that minority workers were much less likely to be exposed to computers in school or at home than white workers even after adjusting for family income. These studies suggest that avoiding computers can be very costly! Studies (2) have shown that the key psychological factor determining resistance to technological change is the person's perceived ability to use a product successfully (termed self-efficacy by Bandura (3) .
Having taken this course is one way to enhance your confidence in using the important information technologies available on the Internet!
Copyright David Lukoff, Ph.D.
Take The Exam |
