Therapy in Virtual Environments: Are the Rights and Responsibilities the Same as in the Real World?

There has been a steady increase in the use of therapy for psychological disorders in virtual environments (VE) and using computer-assisted treatment over the last decade. Do the same guidelines and ethical standards apply as they do in the in-person world? A study published in Telemedicine and e-Health has taken on this challenge.

Virtual reality (VR) platforms for the diagnosis and treatment of psychiatric disorders are becoming more widely accepted. These approaches range from immersive environments (with head-mounted displays) that may include sensory stimuli such as audio and olfactory stimuli, designed to give patients the sensation of being completely inserted into a virtual environment to to desktop three-dimensional virtual environments where participants interact in the form of avatars that are controlled by the participant through the mouse and keyboard.

VR has been used in the treatment of a number of psychological issues such as, stress management and pain management or disorders like, eating disorders, anxiety disorders, some autism spectrum disorders, cognitive impairment and treatment and diagnosis of neurological conditions such as stroke and brain injury. The most widely used and successful VR application is VR exposure therapy used to treat phobias and trauma related disorders like PTSD.

Yellowlees and colleagues reviewed the literature on VR treatment and point out that while VEs have great potential for use in the provision of mental health services, “further research is needed to assess the safety of VR approaches and identify any risk factors for patient populations that may be incompatible with this modality of treatment. There is evidence that some general safety issues exist with exposure to some VR applications, both physical and psychological nature but the evidence is mostly anecdotal and empirical research is limited in this area. Treatment via VR may be less clinically appropriate for some patient populations than others.

The authors reviewed the current standards and ethical principles including security, privacy and confidentiality issues for treatment via telemedicine and drafted the Clinical Guideline Recommendations for Mental Health Treatment in Virtual Environments. The authors state that the rights and responsibilities of treatment apply equally even if the person is represented by an avatar in a virtual environment. They argue “that the rights of avatars are analogous to those of the individual controlling it, so that then logically we must treat the avatar as an extension of the self. Thus, treatment standards and ethical guidelines for patients seeking treatment in a VE should mirror those of typical clinical practice in the in-person world. In any clinical setting, clinicians must follow the laws of their field and other existing guidelines.”

Therapy in Virtual Environments—Clinical and Ethical Issues
Telemedicine and e-Health