Will Virtual Therapy Get More Men And Women To Open Up About Sexual Assault?
The 21st century is slowly but surely becoming the futuristic place we’d always imagined it be — we now have flying drones, self-lacing Nike sneakers, and caregiving robots, such as this bear-shaped nurse from Japan.
One could argue we have modern-day computers to thank for that. Back in 2005, a year after Facebook was launched, clinical psychologist Frederick Muench, the director of digital health intervention and psychiatry at Northwell Health, first noticed how much more individuals were willing to disclose to their computers than they were to humans. He didn’t understand why at first, but then found it was partly due to the fact people online, as anyone who has been trolled will tell you, have the option to be anonymous.
Muench believes we can use this aspect of the internet to improve mental health care: The promise of anonymity can entice more people to share their troubles and seek treatment online. To this end he’s proposed a series of companies that specialize in online interventions for psychiatric illness, with one finally taking hold in 2008: Mobile Health Interventions. A separate, but similar endeavor from Roni and Oren Frank echoes Muench’s beliefs, that digital platforms can increase access to health services. Only their company, Talkspace, champions cost-effective therapies too — an especially unique opportunity for low-income populations, where issues like mental illness and sexual assault occur at higher rates than they do in high-income groups. In fact, starting summer 2016, Talkspace will donate 500 months of therapy to low-income people in need.
Today there are more than three billion people online, by Time’s count, and nearly two-thirds of American adults on social networking sites, like Facebook, Twitter, and Instagram, according to the Pew Research Center. So it’s no surprise researchers and developers have teamed up to try to use the internet to better understand human behavior and to make us happier and less lonely.
In December 2015, for example, the National Institutes of Health announced a multi-million dollar project to develop robotic devices that “contribute to the health and well-being of our society,” in the words of the program’s director Dr. Grace Peng. Their particular devices are designed for elderly, visually impaired, and young people. And BodAI is building anatomically-correct humanoid robots that read emotions and interact accordingly. Their Bods can also inhabit a virtual world where they can go on adventures with humans. Think of The Sim, only way more personal.
These may sound like farfetched projects best left to science fiction, but the truth is that we’ve already developed stronger relationships with our computers than we have with some other humans in our lives.
Consider the experience of Jenna Wortham, who wrote recently in The New York Times Magazine about how much more honest Americans are with their phones than their doctors. Years of using period-tracking apps such as Clue, she revealed, have given her “an extremely accurate understanding of how my body works: when I’m likely to experience cramps and breast pain, when to skip yoga and social outings because I’ll need more sleep.” Initially, she was skeptical of these apps. But the password-protection made her feel comfortable enough to be honest about her true feelings.
“ All my life, my doctors tended to be vague, making my bodily functions seem ultra-mysterious, when in fact they are just individualized, and easily understood with the assistance of software,” she wrote. Her phone knows her better than her doctor does.
Digital versus conventional therapy
During Talkspace’s inaugural clinical conference on April 5, Muench and his fellow panelists discussed the many ways humans can connect with their machines. He was the one to suggest the wider net mobile and virtual health technology casts could be especially helpful for survivors of sexual assault.
Survivors are often hesitant to open up about their abuse, Time reported, and this can be for various reasons. They may not want others to know, not know what constitutes as rape, or have a genuine fear of police or of giving up control once they tell their story. That’s certainly the case for domestic violence, Muench said. Research has shown 16 percent of survivors will disclose their experience to a computer while only 1 percent will tell a traditional therapist. A virtual space, on the other hand, offers survivors and others who may be hesitant to try therapy both anonymity and a freedom from judgement.
That’s not to say it’s better than traditional therapy outlets. To Muench, there’s no need to compare the two. For one, he has not seen a study that definitively says face-to-face is better, at least not yet. And two, the internet and various apps are simply offering an alternative to what’s customary — neither is better or worse.
A study published in the Journal of Affective Disorders found internet-based interventions for depression were equally beneficial as in-person therapy, while a study from the University of Zurich found patients suffering from depression were satisfied with both online and conventional therapy. However, each of these studies include small samples and nothing can be said for sure until both forms of therapy are tested in larger clinical trials.
"The bottom line is 90 percent of people with diagnosable mental health disorders don't seek in-person care and many of those can treated through digital therapy, whether it’s an automated app or a therapist reaching out, when they may not have otherwise received it," Muench said.
Log on to find relief
Virtual therapists could be especially helpful for low-income populations in the U.S., which have substantially worse health care and health outcomes compared to their wealthier counterparts. These men and women are at higher risk of multiple chronic health issues, mental illness, substance abuse, and disability, The Commonwealth Fund found.
In 2014, The New York Times reported “women in the lowest income bracket, with annual household incomes of less than $7,500, are sexually victimized at 3.7 times the rate of women with household incomes of $35,000 to $49,999, and at about six times the rate of women in the highest income bracket (households earning $75,000 or more annually).” What’s more, women living in rented properties were sexually victimized at a little more than 3 times the rate of women living in their own or a family member’s home.
It’s a group that could benefit from online programs the most, and yet they are harder to reach. In a clinical trial focused on treating substance abuse with the online programs offered by his company, Mobile Health Interventions, Muench found that most of his users were white women. A 2014 Pew survey on internet users shows that the online audience is nearly balanced between genders, but that there are racial differences. The survey found that 85 percent of white Americans are online versus 81 percent of African-Americans and Hispanics. Not a big difference, but according to the Urban Institute, 30 percent of Hispanics, 22 percent of black or African-Americans, and 6 percent of other non-whites live on incomes less than 200 percent of the federal poverty level.
When looking at user’s income level, Pew found 77 percent of those making less than $30,000 each year are online compared to 85 percent of those making up to $50k; 93 percent making between $50 and $70k; and 99 percent of people who make $75k and more.
Muench hopes that virtual therapy users will diversify over time, when there’s more evidence that it’s effective.
"I think as the field advances, the focus will be to try and understand how to engage people and in a way that is confidential,” he said.
The end of stigma?
As more people embrace virtual reality, some have suggested we’re finally getting ridding of the stigma associated with mental illness. Muench, who admits he is in the minority, does not agree.
“The stigma is attached to people who seek help, not the overall stigma or disorder,” he explained. “Human beings are judgemental. When you know someone has an addiction or disorder compared to someone who doesn’t, it fuels a reaction.” The effort to reduce stigma, he said, “has to be based on more global acceptance and create a culture and how it will be treated.”
That is the case with sexual assault: After a woman is abused, some people still ask what she said or wore, implying that she was “asking for it.” And there are persistent myths that men can’t actually be raped, and those who are victimized are even less likely than women to report it.
“When something gets out in the world, it’s hard to take it back and people judge people,” Muench said. “Privacy and confidentiality is still paramount, and I think [virtual therapy] will help people work on problems in private and at their own pace.”
In that sense, the virtual endeavors Muench and others are pushing begin to seem urgent. If stigma isn’t going anywhere any time soon, then the very least we can do is help people feel OK for seeking help.
Correction: This article originally incorrectly stated two statistics: that 17 percent of sexual assault survivors disclose to a computer, and 95 percent of people with diagnosable mental health disorders are treated through digital therapy. It's 16 percent of survivors and 90 percent of people don't seek in-person care, and may turn to digital therapy.