[Current Topics in Psychology]

 

A.P.A. Convention Highlights

American Psychological Association
119th Annual Convention - Washington, D.C.
August 4-7, 2011


These edited reports were originally posted to the Current Topics, Therapy Online, and Cyberpsychology list-servs, August 2011.  

2011 Convention Highlights:
2011: eHealth Odyssey | Googling, Twittering, Poking | Zimbardo: Reflections + Enduring Lessons from 40 Years Ago: Stanford Prison Experiment Opening Ceremony/Keynote
Avatar-based Treatments | Canine Cognition: Chaser | Aaron T. Beck @90 | CCBT | Seligman: Flourish | Psychology, Technology, Virtual & Augmented Reality | Relationships 3.0
POKE ME: How Social Networks Can Both Help and Harm Our Kids | 'Monastic' Psychology Studies | Telehealth and Telepsychology Licensure - Barriers and Possible Solutions


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"Asynchronously Live" from Washington, D.C.



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*DISCLAIMER*
I was very careful to take accurate notes during these presentations (including several pithy verbatim quotes), using handouts and/or photos of graphics to verify my notes. I apologize for any remaining errors or typos, and will be happy to immediately correct any mis-quotes, mis-attributions or mis-spellings brought to my attention. I welcome presenters' submission of additional online references which are relevant to (or mentioned in) these reports. Thanks, and... Enjoy! I hope you find this slice of psychology interesting and informative.

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APA CONVENTION REPORT #1

August 3, 2011




[Capitol Building at Dusk - APA 2011]

Asynchronously Live from Washington!

Following is my first report, "asynchronously live" as the events are still happening and what I'm about to describe took place only minutes ago.

These are immediate, quickly-typed reports in an effort to present things the day they are happening, to share the information and excitement and try to impart a "flavor" of the events. I will include photographs as I polish these "live drafts" into edited/proofread form and turn some of it into articles online. I can't post the photos from here, but will let everyone know when I've updated/honed the articles, with photos, editing, etc. In fact, you'll be the first to know.

And now, without further adieu, here comes APA Convention 2011!
 
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Greetings from Washington DC. I’d love to be able to begin with a nice blue-sky day by the monuments, but I arrived to persistent rain. No matter, more time to finalize and strategize.

This year promises to see many more mainstream presentations (the major divisions and invited speakers) which involve technology, particularly Internet and computer-assisted applications (from therapy to healthcare record keeping to a much more widespread interest in the fast and furious societal and generational changes and their interaction with the “new media”, “social networks”, and the new marketing.

APA Net Lounge - Convention 2011 The "Net Lounge", with Wifi, charging stations, family areas, and applications


There will be several events I will attend in an effort to hear some of the most prolific researchers and practitioners and educators, addressing the “big themes” of our day, some like past days (evil, violence, positive psychology, ethics in the changing world) and some drilling down and reporting out on applied application of things like virtual reality therapies. I reported on one a few years back (use of VR with PTSD in the military), and one of the presenters is back with a new panel, which I expect to be quite interesting; one of the panelists at one symposium I’m attending is using VR as an adjunct in drug addiction treatment – not sure of the details now because it hasn’t happened yet, but you’ll be the first to hear about it.

I always love to hear from the living legends who are presenting. There are of course many, but only a few are truly revered like some of them who present here over the 119 years. (I have to confess; I missed the first 100 of them). Big names of extraordinary psychologists: Seligman, Zimbardo, Beck (who was unable to attend last year but is here now celebrating his 90th Birthday), and others ...

Plus I want to get to at least one panel by the presenters I know to have been focusing on “online mental health” for a long time, and are passionate about it. I won’t name names… you’ll see. (And here’s your chance to unsubscribe if you don’t want the few days of posts, or go from journal to daily if you want reports 'hot off the press' - yes, I know I'm so old fashioned to type in narrative and use email! -g- )

Thursday, I'm going to a presentation being introduced by the undisputed master of “Internet-Based Mental Health Applications”, who suggested this (and it sounds interesting!) – on “2011: an eHealth Odyssey”. Hey! I gave a presentation in 2001 entitled: 2001: A Cyberspace Odyssey. (Still on my website.)

“Googling, Twittering, and Poking – Helping Psychologists Take Advantage of Web 2.0 - and an APAGS (student) presentation on their New Media Resource Guide. There’s an interview with Zimbardo (there are 3, honoring 40 years since the Prison Experiment and taking a long perspective on it. I’m not sure which is the one I’m attending, but one of them for sure. Also Thursday: The Opening Session, Keynote speaker being Claude Steele of Columbia U (“Whistling Vivaldi”) and a reception with the editors of new APA journal I’m happy to see launching: Psychology of Popular Media Culture.

Friday I will likely see (and report on ) Zimbardo doing “Stanford Prison – Enduring Lessons…” (Congress?)

Friday afternoon tentatively: “Avatar-Based Recovery Using Immersive Virtual Environments to Supplement Substance Abuse Treatment” – I think many will be interested in this, including me.

Possibly some media psychology related events (like “Future of Media Psychology”) … possibly some fun things, like...

“What a Dog Teaches us About Cognition”… I’m really looking forward to this, after a different presentation a few years back ( http://www.fenichel.com/dogthink.shtml ) sparked my renewed interest in “canine cognition”. Different presenter, so should be a nice complement. “Chaser and Her Toys”

Aaron T. Beck at 90 – with Frank Farley – coming soon (also Friday) – unfortunately directly opposite Keely Kolmes, who is going to give a presentation I am sure will be great, on the "21st Century Media".

Social Hours – yay – and a night at the Newseum (a museum of journalism and media, a la Washington DC, Smithsonian, etc – a serious exhibit)

Now just hoping to be awake enough to see the computer screen – lots of presentations.. There’s more Sunday, but that can wait. Time to catch some sleep to be conscious for the first day.

And so, the 2011 Convention begins! It seems very much a part of the 21st Century, both in content and feel.

Must be getting old, but I remember audiences baffled by browsers… and there wasn’t even Facebook. Can you imagine?!

Regards from our nation’s Capital, where it is empty and rainy, with only psychologists (so it seems near the Convention Center) – and no politicians in sight! (*I’ll let others make the jokes & connection.)

“Dr. Mike”

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"Asynchronously Live" from Washington, D.C.



APA CONVENTION REPORT #1

August 4, 2011

Greetings from Washington, and the APA’s 119th Annual Convention. On this once-again sunny day in D.C. there were a full day of events leading up to the official “Opening Ceremony”, from which I’ve just returned. Surprising myself, I managed to attend even more than I was expecting this first day, and really enjoyed both the presentations and the informal conversations and chance meetings with friends and colleagues. I’ll try to stay focused on the events themselves, but will say that I was amazed by the warmth and cordiality of Philip Zimbardo and some other luminaries of psychology. (I finally got to thank Zimbardo for sponsoring me as a plenary speaker on “Cyberspace Psychology” way back when, during his APA Presidency. Felt good…)

As I envisioned, there is a definite and persistent theme of technology in the service of people, with the APA Convention itself (in the huge Convention Center) set up with family-friendly and special-needs friendly facilities, and several “laptop charging” areas (which I observed heavily in use, with as many people seemingly walking around with laptops as with phones/”smart devices”). The big buzz among members was how “cool” a new APA app is, allowing hundreds of pages of convention activities to be organized on the small screen (or computer screen). There is also a very futuristic “Net” area with comfy seating and WiFi. Not to mention the constant references by presenters to “the new media” and “social media” and “apps” and Facebook (especially), as well as the power (and permanence) of Google search information and the power of social-like networks really meant to serve as both c.v. and discussion group tool – i.e., Linked-in. The list goes on. Topics reflected new advances in practice, education, and research. (Coincidentally, in 2001 the presentation I chaired at the invitation of Zimbardo was titled “Cyberspace Travels for Psychological Researchers, Educators & Practitioners [ http://www.fenichel.com/cybertravels.shtml ] As the opening ceremony would later remind us, psychology encompasses these various aspects: education, research and practice. It seems to me we have arrived in the 21st Century now, with much more acceptance and integration of technological tools in our daily lives, including our work as well as our indulgences. With that as context:



Invited Address:
2011 – An E-Health Odyssey – or, the Internet As the Instrument for Behavior Change

Lee M. Ritterbrand

Dr. Ritterbrand was introduced by Azy Barak, who is widely considered the preeminent researcher and bibliography-keeper in the area of Internet-facilitated applications for mental health. Dr Ritterbrand himself has been extensively involved with both studying and implementing cutting-edge applications.

A scene from 2001: Space Odyssey set the stage, with the omnipotent computer “Hal” dictating the terms by which the humans must abide, and expressing understanding that they had plans to squelch him, which he would not allow.

The audience shared reactions and Dr. Ritterbrand honed in on how that clip speaks to the fears of a computer “taking over – being able to think and act on its own. One can not fight technology of course, and Ritterbrand quoted Freud (shown in a sketch by Dali looking very much like Steve Jobs!) who was well-known for his love of antiquity but not necessarily for his suspicions (like Chaplin’s) of technology, industrialization, etc: “If there had been no railway to conquer distance my child would never have left town and I should never need to telephone to hear his voice”.

On to “e-Health” generally, and some of the computer applications (online now) which are seen as having a huge potential impact on our thinking about programs. Ritterbrand sees a continuum of Internet offerings, ranging from offering information online to deployment of “robust systems”, such as those he will describe. His presentation used multi-media - not Powerpoint, as some inquired about – but I and others have requested some further information and photos of some of the links he projected onscreen.[ I will add links and/or photos as I polish these “asynchronously live” reports into articles, and now I focus on getting these reports out within hours of their happening, while people are still buzzing about today’s events. ]

Ritterbrand presented a scrolling list of mental health sites, so long he only showed a small part of it. The applications/web destinations include the availability of online counseling – “using computers to have a discussion with someone, usually real-time or asynchronous”. There are a great many online groups as well. He cited one as particularly interesting – http://apps.facebook.com//healthseeker – which is “actually a gaming platform”. And there are gaming-oriented sites or interfaces, such as games for health projects like www.medplaytech.com .

There is also a growing number of virtual applications, found for example in systems like “Inworld Solutions” or on SecondLife, where one employs an avatar. (He, like some, finds himself getting “kind of lost”, making this route effortful.)

Lastly there is the pervasive “wireless apps explosion” All kinds of statistics show “significant growth” over the past 12-24 months in terms of customer use, leading some (like Wired magazine) to declare “The Web is Dead”. Not quite so, however, as total use by percentage of communication tools/devices may be diluted, some areas of Internet use are growing, in part reflecting, including for example video sharing. [My take on this is that “devices” are immediate impulse gratifiers and data senders, computer monitors *may* be easier on some eyes and ears.] In any case, it is clear (including among convention goers at APA” that mobile app use is “on the rise” relative to “web consumption”. Understatement. A search he did yesterday found 720 iPhone apps at the moment.

Now when it comes to "Internet Interventions" the debate tends to be focused along the lines of “guided” versus “fully automated interventions”. [Each has unique benefits and risks, imho.] His group is working towards developing the “completely automated app”, the main argument being that is “not limited by human factor”. [Like Hal or Spock might argue?] On the other hand, he knows the evidence is strong that one cannot simply use something which “works” offline and take it online with the same results. He cited Dr. Barak’s meta-analysis of clinical online applications, and a book, “Hands on Help”

As to benefits Ritterbrand cited several articles about “Internet Intervention Modes”, and described his focus on “mechanisms of change”.

Dr Ritterbrand discussed “issues of access” (including a large chunk of Australia).

Then we were treated to some screen shots of some of the products he’s been working on, including an automated system of self-monitoring and self-educating oneself in the pursuit of improved sleep skills – among insomniacs. In addition to this Shut-I application there’s another product geared towards engaging children suffering from pediatric encopresis: Ucanpooptoo. I spare the details…

Running now to a related presentation, this by Ali Mattu, a psychology Intern and active member of APAGS (APA’s group for graduate students).




 
Ali Mattu

SYMPOSIUM 1184: Googling, Twittering, and Poking – Helping Psychologists Take Advantage of Web 2.0 and the APAGS New Media Resource Guide.

One co-presenter could not be present, but Ali Mattu was quite prepared and gave a very engaging and crisply paced presentation, fielding some interesting audience questions (mostly non-student psychologists) .

As the title suggests, there were 2 parts to this, a general overview of this Web 2.0/3.0 global culture, and secondly an introduction to the APA/APAG’s forthcoming guide to new media.

Actually, this presentation was organized into 3 parts: 1) The Times Are Changing 2) Be Like Gaga and 3) Sword of Gryffindor [Would you belief spellcheck just corrected my spelling of Gryffindor – but still won’t accept “spellcheck”? Love it!]

OK, keeping it brief since this is pithy (and again the handouts weren’t available and I’m awaiting receipt by email)…. And there are some other great events today still.

My interpretation/experience:

1. The Times are a changing - of course noted as a bow to Dylan, who Mattu quoted as a good parallel to this generation, a time of revolutions, hope & change. Not only is the new technology constant, and lifestyles adapting and adopting, but it can be scary to see just how easily anything we ever posted (or anyone else posted about us or using our photo) can be found – “forever”. Even though he’s old enough to remember life without Internet (“the last generation”), he gets “shocked and scared” when he sees historic posts from 1990’s blogs. And then there’s Facebook as both a social network and public bulletin board. He showed some humorous (but true) slides about someone giving excuses to his boss about where he was the day before and someone else emailed a photo of him in a rather unflattering outfit which he had himself posted the day before.

"So how *did* people here find out about Marsha Linehan's story?" (One person said "front page of the NY Times" everyone else mentioned an online source.) The times they are a changin’. That point made.

Some discussion on “New Media”, one of the foci here – and must it be an “opposite” to “old media”? There are complete revolutions: Google... Wikipedia.

Here he cited evidence of these being reliable resources, along with the NY Times – online. (Research apparently shows the quality of Wikipedia at par with print encyclopedias! I will post the link if it’s part of his handouts.

Oh, and there is Linked-in, "social networking for professionals". In part “an online c.v.” And Twitter: “Broadcasting to the world”. Of course egos can be bruised if you follow someone and they don’t follow you back (he said in mock hurt)... But more broadly, “Twitter is like a pulse.”

Some Q&A – on microblogging, lifestyles versus “tools”.

Some web metrics:


[For some fascinating web metrics and research on social media and generational preferences, see
Larry Rosen's 'POKE ME']

Mattu mentioned some of the new apps for “speaking” with someone 3 feet from you. (!) Plus of course the new Apple Lion Facetime...

A quick reference to Sparrow's work on group memory: “We are no longer memorizing things we can look up”. We are altering our memory strategies.

Again we are reminded that “We all have a digital footprint”.

We're almost out of time, so quickly now:

Part 2 – Be like Gaga – Which is what? Drawing our focus where *she* wants, her act, not her “real life”. She “has mastered the use of social media but is directing attention where she wants it.”

Part 3 – Ok, why/what: Sword of Gryffindor? Harry Potter fans know of course. A few ventured guesses. Answer: because it takes in the power of anything trying to destroy it. Therefore: “use it only if it helps out”.

Summarizing – from part 1 – Google yourself, get google alerts, know you leave a footprint. Be careful. (He cited Keely Kolmes’ informed consent for online practitioners). And now - imagine a slide of Star Trek's Enterprise - Boldly go. “Don’t be afraid”.




I wasn’t expecting to get to go to this today, but was glad I did!
 
Phil Zimbardo and Wade Pickren

Interview with Phillip Zimbardo, by Wade Pickren (Toronto)

Before the event I had a chance to chat briefly with Dr. Zimbardo (f2f) and I was impressed how he seemed so calm and healthy. He looked well. I was thrilled to see this, and to hear him reflect on his life experiences and influences. Tomorrow, on the 40 year anniversary of the Stanford Prison Experiment, he will present for 2 hours on that now-classic psychology experiment, with co-presenters who were crucial players in that event.

Zimbardo was introduced and encouraged to reflect on various key events in his academic or personal life. And Zimbardo, who has often reflected on growing up in the South Bronx and breaking all kinds of molds and odds, spoke in detail about early family life, his journey from thinking about people as single systems rather than parts of social systems, etc.

Zimbardo had been teaching at NYU – in 1960. Earning $6000 a year. Why NYU. Students could get great educations for free at City College, or head towards Judaic studies at Yeshiva, or got to NYU – “for people in therapy and mothers who didn’t’ want their children to go away”. (I went there! And find it funny, not offensive. Fwiw) - Everyone seems to be speaking about Woody Allen today….

Back to the 60’s. Zimbardo was poor despite teaching, as he couldn’t live in NY on that salary even then. So he moonlighted at Barnard, and began thinking he didn’t want to spend his entire life in the Bronx (where NYU had a campus at the time). At the same time, “It is life in the trenches which has done me well….”

Question – How did he end up at Stanford – is it true Leon Festinger picked him up in a gold-wing Mercedes?

A: Not exactly, but he was actively wooed by Festinger and NYU was being unresponsive to his pleas for promotion – “publish more, teach more, research more. And I did.” [skipping some detail] He didn’t actually even apply to Stanford but ended up being courted – in New York. He was in awe when they told them they really wanted him although he didn’t apply: “This is the way we do it…. What do you want?” His reply: “Give me a ticket and sunglasses. I’m there.”

And “that’s what transformed me from a little kid in the Bronx to the big leagues.

Zimbardo grew up dirt poor, with a father who wanted to be a hedonist but found it hard with 4 kids. Especially as he wasn’t working, best friend’s kid’s a prostitute, etc.

It shaped him in several ways. “In general I think poor people and immigrants are typically situationist [*Keynote on this topic] We believe that social factors have a powerful impact.” As opposed to dispositionalism – free will: everything comes from within”.

Moving back in time again – it’s 1938/39. “I’m a very popular kid. I worked very hard to be popular.” But he was sickly. He spent lots of time in hospital, with serious illness himself (whooping cough?) and (being poor) in places where there were all types of diseases around him. He was in hospital for 5 months and was feeling lonely, this popular youth, because “poor people don’t have telephones” and few friends visited. He learned he was unable to depend on the doctors, or family, or friends. Really he didn’t know what would become of him as he was a victim of “genetic roulette”. Over 5 months “all my muscles atrophied”. He was tall and blue-eyed and skinny and (although being of Italian descent) people were calling him “dirty Jew”. He determined he was going to show the world and be successful. He kept changing schools though, going from popular to shunned, and ended up in college captain of the track team, class president, and then later APA president. “It’s all part of the big plan”.

He was shunned? Yes, “I endured it by developing asthma, so severe we moved back to the dirty Bronx (from N. Hollywood High school where the family briefly moved). He attended several schools in the Bronx too, one where the little boy next to him turned out to be Stanley Milgram.

"There we are, 2 situationists doing research at Yale, on attitude change and [Festinger’s] dissonance theory." He did his doctoral study on this topic.

Meanwhile, before becoming a luminary among Ivy league psych departments, back in the Bronx “my audience was essentially always my mother. Nobody else in my family finished high school much less college. She didn't want to know about dissonance theory [...but listened]" .

In 1953 his first paper as a junior was on the integration of blacks versus Puerto Ricans in the South Bronx (think 1950’s, Sharks & Jets!)

Flash forward to Stanley Schachter arranging a meeting in NY for a quick interview (Yale), a formality…. “He had 3 questions: 1. Can you run rats? [He had some wise-guy answers ready but did not say them.] 2. Can you build equipment? [Yes] 3. Can you start this summer?” He was shocked (no pun intended). A year later he published a paper with Neil Miller, as lead author.

Years later Zimbardo learned that the faculty was in fact split on hiring him. (at Yale). They declared him "likely to fail" and "embarrass his race". He grew incensed: Suma cum laude, Phi Beta Kappa – why would he fail? They assumed he was black because he was captain of the track team. True story.

Meanwhile he goes home to his mother and tells her the story of his being hired to run a rat lab and she is horrified. Actually she had a rat phobia. “We had them in the apartment. She told me, ‘you’re supposed to exterminate them, not make them smart!'”

Final question (for now) – Can he speak to his thinking now, 40 years later, about the prison experiment?

A: Actually tomorrow there is a
2-hour session with videos and the woman Zimbardo married, after she made him stop the experiment.

Social issues are all around us, and in the 60’s there were turbulent things happening, Nixon was lying about leaving Vietnam ‘with dignity” and then bombed Cambodia….

As a professor he taught a course where the first half semester students had to offer up social topics and he would work with them the second half on designing studies. The students chose prisons, and one proposed building a mock prison in the dorm. The class role-played how it might go. There were some strong reactions (about cruelty and naturally cruel personalities), an attempted seduction of a guard, and once again Zimbardo found himself confronting both a person and a situation.

Warp speed… back at NYU “what I really got out of teaching was... I had to cheat. I’d say ‘I wonder what would happen if...” And then do a study to find out. “Like the Lord of the Flies phenomenon”. He still uses some slides he made for that class, to “use teaching to get ideas for research and then use research to get ideas for teaching”….

[One of my mantras in grad school was “Research informs practice while practice informs research”. ]

As The Lucifer Effect: Why Good People do Evil Things (paraphrasing maybe?) describes, Zimbardo believed that when actually doing the prison study it was important for there to be an arrest – a sudden surrendering to “the system”. “He was and is interested “in what situations do people give up freedom voluntarily?”

Answer: “Shy people”. He became really interested in this phenomenon (and I read his books on this as a grad student – at NYU!). Zimbardo thinks that “a shy person is their own prison guard”. Furthermore, “as long as the punishment for rebellion is high enough, ultimately you give in”.

In 1972 Zimbardo did a lit review on shyness and found no research beyond age 13 (in pediatric literature), nothing on shy adults. So he organized a "shy student class" of 12 which met at night. He developed questions and encouraged the students to help with the lit review by reaching out to find information. “We can’t do it; we’re shy!” he was told. But it got done, along with help from his wife at Berkeley, and their findings have been replicated many times since, suggesting that of 10,000 people, 40% of people are in some way shy, highest among Asians, lowest among Israelis.

So Stanford opened a "shyness clinic". It became an even better example of “intellectual cheating” than what he did at NYU – “Out of research comes educations and out of the education comes research.”

QU – Quick thoughts on the Heroic Imagination project?

A- (smiles) I have obviously become known as Dr. Evil”. The Lucifer effect was ‘really about evil. Why good people do evil things. It was grim”. As a witness in the Abu Ghraib prison torture investigations, he had access to 1000’s of reports and images. It was “an example of the Stanford Prison Study, exponentially worse.” What happened to people at Stanford? “What happened to… me – as superintendent of the prison, not just collecting data.” He found himself taking notes in the manner of prison talk, “little actual psychology – what does that say about me, down in the dungeon?” He referenced Chapter 15: “The system”

“What and who creates the change? It’s the system. The power is with the system. During the prison experiment, I was too close to it. But then Abu Ghraib drove it home.” He’d see notes with orders to “treat prisoners like dogs”, etc.

But in focusing on the evil side, “we’ve been ignoring the “good side”. How to resist evil. How to promote health. There is little systematic research and heroism is not about some trait but “it’s an action”, made by people who make sacrifices on behalf of others. And they do it. (“Altruism is heroism lie – no real risk or cost.”)

So now "I’d like to leave evil behind and become like the good witch of the East – or West".

Final thoughts: “My whole life has been a conflict between being future oriented – which is why I’m here – and present hedonistic, which is fun!”

His site:
heroicimagination.org

==

Quickie reports now…

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Celebrity Psychologists and the Media:

Drs. Kumar, Farley, and Joffe-Ellis were on hand to pay homage to Albert Ellis with respect to his relationship with "the media".

His widow Debbie Joffe-Ellis has always been strong and devoted to such tributes, but she apologized for being somewhat drained; her mother died last week. Another loss… But the show went on, with many powerful memories and anecdotes.

I’ll just add a few now, to complement the other bios and tributes I’ve written.

Dr. Kumar opened with a favorite quote: Glasser (of “reality therapy”) said that “Albert Ellis is comparable to Albert Einstein. Einstein introduced us to the world of physics; Ellis introduced us to the world of psychology”

Dr. Joffe-Ellis apologized, slightly teary-eyed but declaring that “I feel my husband (Ellis) pushing my ass and my mother would want me to here too…)


Selected anecdotes:

At age 17 Albert Ellis handed in an English essay titled “I am not a parrot” and declaring how rote memory was useless. The year before he denounced the topic – an essay about sports – writing a limerick like “essay” on “this thing called sports” which predated his famously funny song adaptations.

Ellis, much like Zimbardo in this respect, grew up spending a lot of time alone and lonely in hospital. He too developed ways to self-entertain.

Ellis was “not afraid of being controversial, and the media loved it”. REBT evoked a lot of passion, and his ideas were described as “ingenious ways of overcoming his own suffering and misery”. As an adult with an adoring press entourage, Ellis enjoyed the attention, but not for personal fame but for advancing his ideas. In turn the focus (op cit “Be like Gaga”) was on his theory – and he was not a safe bet for prime time (due to language constraints” but his Friday night $5 open house sessions, where he insisted on volunteers with actual problems rather than role-playing – was described as “the best entertainment in New York – and the cheapest”. So the press loved it, and when he said something totally unexpected and/or controversial they loved it more. And he did not attack or belittle anyone – he was merely passionate and opinionated (“right”, I think he would say, as I reported on his discussion with Ellis a few years back).

A media magnet (this session “media” oriented) – “He was electric. Sparks flew off him when he spoke... Al wanted his life to be a work of art, and it was. And the media gravitates towards that."

History bit:
In 1956 Ellis was jeered and booed at an APA convention, his therapy ideas dismissed (in the heyday of psychoanalysis) as “superficial” and "harmful".

Ellis acknowledged the influence of Adler, whose work never really was completely developed. OTOH, Ellis “knocked Freud off the thrown”. He was widely condemned for embracing “liberal sexual attitudes” and “the press loved it”. His wife saw him as a “pioneering feminist – encouraging women to be assertive, not aggressive”. And then there’s humor. “He was compared to Woody Allen. But I don’t agree. Al was funnier, and more handsome.”

[Brief recap of ABC – which was understood and embraced by the public with media covering it; Emphasis on his pioneering “self help approaches” and self empowerment. The media loved it all]

Finally Farley spoke briefly, recalling the wake of Ellis’ death and all the accolades. He was “a strong voice for freedom of expression” in addition to an advocate for self help. “Educational and Entertaining”. And the media loved him.

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Last for today, actually the OPENING CEREMONY.

[Photo: Panel/Funkadesi}

Musical opening with Funkadesi. [YouTube/Clip]

Welcome by Melba JT Vasquez, APA President (2011)

The introduction included a bow to all the new family and tech-friendly rooms and apps, including links to (G-d forgive me!) “Facebook and Tweeter” and an interesting “digital photo booth”.

The theme for this year, and Convention (presidential programming) is “Social justice and how it can be supported by Psychological Science”

We are a very diverse organization, not only demographically but in terms of focus on science vs practice, education vs research, and so on.

There are working groups happening now including one on “Guidelines for Telepsychology” and one on “Effectiveness of Psychotherapy” . There is also a committee (described by CEO Norman Anderson ) looking at APA governance , looking forward.

Honored guests were acknowledged, including a delegation from Norway and a psychologist who has invented a system of allowing a person without sight to see. We were invited to tour the APA’s HQ here in Washington. Past leaders were acknowledged and applauded, along with a leader of Mexico's psychology organization. Consistent with the overall theme of diversity...

An award for lifetime achievement went to Florence Denmark who leads a delegation to the UN, and a second award went to
James M. Jones, author of Prejudice and Racism, proponent of a multi-layered “TRIOS"perspective, and widely known for his work on 'The Social Psychology of Time'.

KEYNOTE ADDRESS

Claude Steele

This year’s keynote was eminent social psychologist and author Claude Steele (“Whistling Vivaldi – And other clues to how stereotypes effect us and what we can do”.)

The premise and focus of the address was that there are both stereotypes and self-expectations which account for certain groups habitually doing “worse” on specific tests (e.g., women and some higher-order math tests; African-Americans on some cognitive tests). His experience demonstrated that (basically) when one hears that “you’re not expected to do as well as group X on this test” it becomes self-fulfilling prophesy whereas if told they’ll do as well, they may (performance jumps). I found myself thinking about Zimbardo’s experience, perceived at one time as a Jew and another as black, without ever meeting him or knowing his capability”

In college, seeing the discrepancies in test results, he found himself asking when the first time was that he actually was self-aware of being black. Last day of school, 3rd grade, comparing summer plans and realizing he’d have only one afternoon a week access to the local pool. “Why?” “Who are us?"

He was beginning to think about "identity contingencies".

They’re everywhere. Who are we, what are our expectations and motivations? Psychology? “We use MRI’s now; we’re a neuroscience really... He recalled finding himself on the defensive when interviewing with a new dean, and there really was no need to defend social psychology, but he felt the need.

So then, later on he learned about Brent Staples, editorialist for the New York Times, recalling: At the U of Chicago, he found that if he was dressed casually and walking normally (albeit large statured) people would be afraid of him and cross the street or change path. His reaction: He learned that if he whistled Beatles Tunes or Vivaldi, the attitude towards him changed.

With some Gladwellian “Blink”-like implications, Steele said there is a dynamic he calls “stereotype threat” which people develop, almost an inoculation against expecting to be treated according to some stereotype despite one’s own unique qualities. Now if women were primed to do well on some math test, or blacks on some matrix task or whatever, they perform better, sometimes equal to the “better” group. Tell white or black people, “here’s a math test; Asians typically do better on it, but do your best. There’s an impact. But there was a surprise finding too – “The strongest impact was among those with the highest desire to do well.” [Think: Zimbardo's experience. Expectation, motivation, past experience, context.]

For Sandra Day O’Connor, when Ruth Ginsburg joined the Supreme Court, “it was night and day… she felt ‘normal’, not ‘the embodiment of women’”. It changed the contingencies.

Meanwhile, having to face an “identity threat is like having a snake loose in the house”. You need signs to downgrade the probability that you’re about to be bitten. One is vigilant,

Remedies? Engage in positive things: “Do the best you can to correct cues so they don’t reflect negative stereotypes” (Think: Whistling Vivaldi)

A final note/announcement by Dr. Vasquez: Longtime APA leader and Past President, Dr. Pat DeLeon is retiring this year as assistant to Senator Inouye of Hawaii, after many years of service and advocating for mental health policies. Some applause, wishes for a great convention, and an invitation to stick around a while for some post-show Funkadesi...

Good night from Washington. A long day today and a longer one tomorrow

------------

APA’s 119th Annual Convention
Asynchronously Live, Day 2

Yes it was a long day. I can’t believe I was out at great (indoor-type) events all day!

So now, for anyone who enjoys the immediate, “asynchronously live” postings as the dust settles and psychologists are still buzzing about the deep thinking and words of wisdom from luminaries like Ellis and Zimbardo, and Farley too… masters.

Friday, 5 August 2011
Washington, D.C.
 

Dr. Phillip Zimbardo spent an hour yesterday sharing his perspective on life as a survivor of poverty in the Bronx. Today he reflected his take-away from the Stanford Prison Experiment - and how he has transformed from that kid in the Bronx and that hard-core situationist who ended up running a legendary experiment at Stanford University. On this 40th Anniversary of the 4 Stanford Prison Experiment, Zimbardo he has much to share, including memories, lessons, videotapes, and some of the key participants in running the study - and ending it.

This was multimedia presentation to be sure, from computers, word-wide web (which just celebrated its own 20th anniversary this week) and videotapes made from within the "prison" - presented by a true original master. For sure, a show.

{ Just in from Alexander in Moscow - he would like Zimbardo to know how well received he was in Moscow, by psychologists there.}

Real-time multi-tasking. See? It sure works for me!

CONVERSATION HOUR #3103 - A Very Special Event


Phil Zimbardo 201140th Anniversary of the Stanford Prison Experiment


Philip Zimbardo: 40th Anniversary of the Stanford Prison Experiment



ENDURING LESSONS 40 Years Later


The presentation began to the sound of Santana’s music: “Evil Ways”.

Zimbardo had with him, live or on video, the original “cast” from the Stanford Prison Experiment including his research assistant at the time (now a social psychologist), Craig Haney. Zimbardo narrated (live and on media) actual videos of the Prison Experiment, describing events from beginning discussions about the importance of realistic initial arrests to the details of why it had to end abruptly. Zimbardo illuminated the role and impact of the woman who convinced him to stop the experiment after only 6 days: Dr. Christina Maslach. She is here now too, and is the wife of Phil Zimbardo.

Through reflection and a fascinating multi-media presentation, Zimbardo described his own “transformation” in understanding how good people can do evil things, from the Prison experiment to Abu Ghraib, which was “exponentially worse” than the Stanford experiment. His narrative takes us from the first says of the experiment, through its aftermath, and into his present focus on "heroic imagination".

Zimbardo said that he knows his reputation for some is Dr. Evil, for all the heat and light the Stanford prison experiment hath wrought. However, he has to decided to “change his evil ways”. (Get it?) And now, he said, “I’d rather be the good witch of the East – or West”.

--

An introduction to the panel was next accompanied by a split-image slide of each participant at the time of the experiment, and more recently: Craig Haney (U-Santa Cruz), Christina Maslach UC-Berkeley), and Scott Plous (Wesleyan). While Zimbardo was the researcher and warden, Haney also played a key role in the study's day to day implementation, while Dr. Maslach was the one who convinced and inspired Zimbardo to end it - and to reflect upon the experiment's impact, personally and professionally. Dr. Plous has spent years organizing and presenting the mountains of archival material. Zimbardo noted that much of the media being used here today has now been turned into a documentary DVD, entitled Quiet Rage, produced by the team which created the piece about Milgram's study, "Obedience". Today to re-experience some the images, scenes, and memories, the panel would watch and listen along with Zimbardo and the audience, and react.

In terms the conclusions he has drawn, Zimbardo acknowledged that for some it might seem a bit like hearing Al Gore’s “Inconvenient Truth”, but there are important lessons to be drawn from examining a few inconvenient realities which nevertheless clearly shape the way we think: 1. The power of stories 2. The Power of Images 3. The Power of Technology

Dr.
Scott Plous was then introduced by Zimbardo. Plous' role with the documentation and dissemination of material dates back to 1999, when he offered his assistance at preserving, organizing, and sharing myriad records and artifacts to document this (in)famous experiment. Plous has gotten some interesting feedback over the past decade plus, running the gamut from reverence and gratitude, to organizations such as Amnesty International quickly expressing interest, to various critiques and criticisms. In particular he gets emails saying in effect "It's not a real experiment! There's no control group!" No matter, apparently, that "experiments often are covering new ground...[and] rarely does a study require an independent variable. But we had one: guards, randomly assigned..." Moreover, Zimbardo said as some images appeared onscreen, "Situations matter." He referred also to one other example of this: the famous Asch/conformity experiments. "Under certain circumstances people will harm others."

People have complained "the guards were given permission". But 1) they were not explicitly coached to be cruel and were in fact initially given guidelines against excessive cruelty; and 2) "Under certain circumstances it takes surprisingly little to get good people to do bad things."

[Note: Zimbardo's book, The Lucifer Effect: Understanding How Good People Turn Evil, describes the arrests, prison environment, and other aspects covered by this presentation today, in great detail, with photos and annotated bibliography.]

Some comments by Zimbardo accompanying the slide show:


-An ad was placed in local papers seeking 75 volunteers (with the final selection ultimately randomly assigned to a group)

-- As described in the book too, "it was imperative" that the arrest process be realistic, to simulate the feeling of "surrender[ing] freedom, and no way out except parole. They can't just say 'I quit' "

-- Prisoner 8612, onscreen, was the first to be arrested, "frisked and cuffed and put in the car."

[On screen: a video of a dissenting viewpoint by a 'prisoner' - "They were taking this experiment too seriously!"]

-- The last arrested was the first to break down [in 36 hours, 14 August 1971] -- Like Abu Ghraib, the situation began with taking complete control and escalated through a hierarchy of oppression, from "degrading things" and forcing push-ups for minor infractions, to "moving towards more intense treatment".

-- The 'chief guard' (now a social psychologist) played a pivotal role. [video of stripping a student wearing a paper bag over his head]

-- The guards wore dark glasses, "like a mask". Image of guard in video: "I needed to be the worst, most cruel prison guard that I could be. [I studied] how to humiliate people". While not explicitly told to be cruel, he decided he needed to "ramp up the harassment. The warden's not stopping me.

-- Next clip: a student truly "freaking out" - cursing, screaming, "I want out!" Guards were beginning to feel their power in controlling the minutiae of daily life, "like a puppeteer".

-- When prisoner 4106 freaked out, he was placed in solitary confinement. When he sought to incite a rebellion, "he is totally rejected".

So, "why did we and the study end after only six days?" The answer begins with
Christina Maslach, who is here today to tell us firsthand what she saw and how she reacted:

"What really got to me was seeing a group being led down the hall to the bathroom, with bags over the head. It was... dehumanizing. I couldn't watch it!" Shattering the adrenaline and excitement of how powerful this laboratory had become and what an amazing experiment this had turned out to be, etc., she was seeing it with fresh eyes (something Zimbardo sees in retrospect was needed). A respected colleague and friend (who Zimbardo had expected to be duly impressed by the experiment), she told him soberly "I'm not sure I want to have anything to do with you, if this is the real you. You've changed." Zimbardo had become totally immersed in the system, if not actively, then through his detachment and lack of action.

Zimbardo: "So what was I to do with this woman who challenged my newfound authority?
I married her the next year, August 10, 1972, in the Stanford Church - and we made two lovely daughters and lived happily ever after."

In introducing Craig Haney, Zimbardo asked what some may be thinking, "So who complies? The majority of us."

--

Craig Haney

Craig Haney spoke next, his presentation framed by a quote: "The arc of history is long, but it bends towards justice." His studies, and his life among the guards and prisoners, led Dr. Haney to become a strong advocate for reform and humanization within the prison system. He presented many graphs and tables underscoring how in California (especially) and as a nation, our prison system houses disproportionately more incarcerated people as a percentage of population - for example 726 Americans per 100,000 in prison, compared with 143/100,000 in the UK and Wales, 550 in Russia, 116 in Canada, and only 58 in Japan.

Haney said that he took away from the Stanford Prison Experiment three profound lessons:


  1. Context matters. You can lead good people to do bad things.
  2. Prisoners are people. It seems simple but we can dehumanize prisoners.
  3. Mis-treatment has consequences. We saw profound consequences even in 6 days. Think about long-term...


It was a "remarkable learning experience", so much so that it shaped his life, and directed him towards work in real prisons, such as Washington State Penitentiary. And yet, despite his passionate desire to "spread the word", as his data illustrated, incarceration rates in the US have continued to explode, despite the occasional wins in court for humane treatment. However, in California there was an explicit court ruling to the effect of prison being about punishment, and nothing more. A slide proclaims "The Death of Rehabilitation". On the Federal level, one court found (in 1995) that solitary confinement may be akin to psychological torture. In a ruling on behalf of prisoners, with Supreme Court Justice Kennedy in the majority citing inhumane conditions, Justice Scalia dissented, saying this was "perhaps the most radical [institutional reform order] issued by a court in our nation's history." [Brown vs. Plata/Coleman]

The audience was shown slides of newspaper headlines, and photo of tiny cells with barely enough space for a toilet and sink. Then " something new was added to cells: roommates." Soon seen in the news: prisoners sleeping on floors, and in triple bunks in converted day rooms. The warehouses are full. In addition to the general disregard for conditions, "prisons became a default institution for the mentally ill" as psychiatric patients were sent back into communities under the program we came to know as "de-institutionalization"

And the trend continued, not towards humanizing conditions but towards adding armed guards, electric fences, etc., making sure all the prisoners were "under gun cover". Prisoners chained together while awaiting transport. Placement 23 hours a day in "SuperMax" cells.

It can be discouraging to observe: We began to lose sight of the 3 principles (above) - context, humanity, consequences. Haney and others have been fighting in the courts. Despite research and literature reviews on trauma, and other "evidence"' of societal harm supposedly done in the name of justice, inequity continues, untreated mental illness is rampant, and court decisions in favor of prisoners have not been complied with. The sense was that prisoners are not supposed to be Club Med, and "this wasn't group therapy", although some small implementation of policy changes happened, such as suicide checks by guards every 30 minutes.

Context matters! With respect to Dr. Maslach coming into such a system, her context was the real world of ethics and humanity; she was not caught up in the excitement of discovery as were the experimenters. People think she was really cool But she felt isolated too:

"It's scary. You feel alone. You feel like a deviant." [Think Asch.]

Imagine what you might do if you just walked into something like this. "Things matter too much.... Something serious is happening here." More context: "There were two important facts: First I was late [into the event's formative dynamics]. Second, I was an outsider. I didn't have any role within the prison. Unlike the others i was not a part of it. I gave no consent. I wasn't a prisoner or guard or therapist or warden. I didn't have an assigned role. I wasn't there every day. The situation changed gradually, every day. Every day escalated a little bit.... In some sense I saw it differently." In a way, she felt like the prisoner who was a late entrant, who went on a hunger strike, demanded to know what the hell was going on here, and declared 'I'm not going to take this!'. But he was actually acting like a prisoner, rebelling, starting a strike. Unfortunately, "it didn't work out well for him". But then too, "I was reacting more in terms of my relationships with the people doing this and trying to figure out how this could happen." She also reflected on some of the nuance which came out of the Milgram studies, like the difference between dissent and disobedience.

Some other thoughts. First, on one hand, "nobody ever told tough guard John Wayne to stop." A point to consider. Secondly, "on being given the label or hero, or ethics person...a few points. People say, Oh My G-d, this was so unethical! The human subjects committee would never approve. Wrong. They did approve. The researchers, in gaining approval, were required to put in place health planning, legal documents, [etc.]. What's happened is that more ethics requirements [now] are 'front-loaded' rather than involving scrutiny of ongoing things. It didn't matter here though, as it was reviewed - prior to the events unfolding."

The take-away? "Just don't do this kind of study again. We haven't learned the lesson - We need to understand more about behavior."

In terms of career, Dr. Maslach draws upon her own experience and is pursuing her interest in "the psychology of dehumanization - How is it possible that people can treat others in ways which are inhumane? How often does it happen that helping professionals move to a more cynical, dehumanizing attitude?" [Fortunately not a lot; and according to Milgram's estimate, only a fraction of 1% disregard humanity.] Maslach has interviewed (real) prison guards and become aware of some mechanisms she can now describe as "dehumanization in self-defense", as when they speak of "#30 in the next room" rather than a person with a name. And then there is "'detached concern'. Could that work?" She spoke with some professional workers about the notion of detached concern and was told, "we call that burnout". When she started surveying others she found "a huge response and recognition" of the 'burnout' factor.

Obviously, Maslach reflected, the Stanford Prison Experiment was a part of what motivated her chosen pursuits. That and something else. She recalled hearing George Miller's legendary APA address. He spoke not about all his research or accomplishments but about the need to "give psychology away". This message/mantra has moved many psychologists. (And right "here & now" too!) It's one thing we can do to get out the word about people as people. Now with technology to promote popular access, if a story is compelling (and "ideally with images") it can be shared widely, and perhaps for good.

Scott Plous spoke a bit about the web site(s) He was the founder of socialpsychology.org, which in its own rite is an excellent online resource (which I have recommended to students and on my own site). On this site one can also find a section, complete with photos and other media, specifically on the Stanford Prison Experiment. According to some web stats, both the main site and the Stanford Prison Experiment site receive a great number of visits, of sustained duration, with viewers exploring deep into the site. There is quite a range and depth of material.

Zimbardo returned to presenting some of his past and recent experiences, noting that between the Stanford University library, and Akron University, they have "all the memorabilia... [And] We just found a new box."

Zimbardo was known in the 1970's for his research on "shyness", one of the two interests (along with time perspective) which have long intrigued him. [ In the case of the SPE, " We were all stuck in the immediate PRESENT of that intense situation."] Zimbardo described how "we took away people's freedom of association, mobility...Some did this voluntarily. They called themselves "shy". It appeared that among this population, people " internalized both the guard and the prisoner." He soon realized there was virtually no research on adult shyness. A student suggested a "shyness clinic" and this was brought to fruition in 1975. ("To me this is more important than the legacy of the SPE.") He was also increasingly interested in "time perspective", how our sense of time gets distorted. [See: www.timeparadox.com] Other notions, such as that of hedonism (vs. the "future-oriented" life style) also have greatly influenced him. He noted that in Southern Italy, as opposed to the North, there is no vocabulary word for "will be". "So of course they are present-hedonistic [oriented]" He's also paying attention to the challenge of "curing" PTSD, and use of "positive framing".

Returning to the theme of how it is that good people end up doing evil things, Zimbardo commented, "We know there are 'bad apples'. But there are also good apples thrown into barrels of bad apples... [which] creates and maintains these situations." There are 3 levels of consideration - the individual disposition, the situation, and the interaction. "Let us celebrate the few people who resist."

And with that, Zimbardo ended by presenting his newest project, Heroic Imagination. He sees 2 types of evil: 1) the evil of action; and 2) the evil of inaction. There are 3 parties involved, typically, as with the bully, the person being bullied, and "all of us who look the other way". He sees 'heroism' as something which can be promoted, and he has a model for this:



Zimbardo outlined some of the working goals of his Heroic Imagination Project (on which he would be speaking about the next day, with fellow advocate Frank Farley) and presented some of what is known about heroes while also noting how very little research actually exists today.

Zimbardo's goal is "to inspire a culture of integrity rather than a culture of complicity".

--


Still to come: 3 separate International Panels on telepsychology, Computerized CBT applications, and human/computer integration in treatment (e.g., VR for treating phobias and PTSD). And "online relationships" and relationship-seeking.


--
 

Avatar-Based Recovery Using Immersive Virtual Environments



Avatar-Based Immersive VR Treatments
SYMPOSIUM #2186: Ivana Steigman, M.D., Ph.D., Richard Wexler, Ph.D., Albert ("Skip") Rizzo, Ph.D.


Here today is a distinguished panel who individually and collectively represent some of the most fascinating and promising applications of virtual environments. Representing both university based laboratories and private developers, speakers treated the audience was to an in-depth look at some of the most promising and popular products, with discussions about efficacy as well as demonstrations of a wide variety of computer-based applications.

Panel co-chair Richard Wexler introduced the session by observing that "VR is here... today." He cited some fascinating web metrics. Imagine, for example, 2 billion of the Earth's nearly 7 billion inhabitants are now online. There are a Billion accounts which have been created for virtual worlds, 350 million of them created within the last 6 months. One half billion people are active users of virtual worlds, and 3 billion + hours weekly are spent on Virtual game environments online. Over 500 universities are now involved in VE research and application development, and over 500 video conferencing systems have been set up to facilitate interaction between doctors and returning Veterans.

So - what is Virtual Reality? According to Jaron Lanier, who coined the term in 1987, "VR is a consciousness-noticing machine" [cit. "You Are Not a Gadget" 2010] In practice, Virtual Reality is "a computer simulated interactive environment that appears and feels to users as if they are relatively immersed in a real environment."

Its use is not restricted to gaming or mental health treatments, of course. Case in point is the IBM program in which employees are being trained using 3D virtual conference rooms and simulations of real-world work situations.

There are 4 basic types of VR - flat/public (like SecondLife), flat/secure (like inWorld Solutions offers as a VR-based clinical tool), immersion/public, and immersion/secure. Immersion (using goggles, etc.) seems "virtually better" in term of realism. Flat Secure can be HIPAA-compliant.

One emerging challenge is adaptation for use on mobile platforms.

What's an Avatar? An avatar can be described in several ways. The word itself suggests

There are a number of advanced applications as well.

Why does VR work? The physiological answer is "Homuncular Flexibility" and mirror neurons. The brain readily accepts the avatar as an extension of oneself. And what can it offer?

VR promotes:

-- A feeling of Sense

-- A sense of shared presence, sharing a space

-- Depth and breadth of information

-- Engagement

-- Connectiveness

-- Interaction

-- New abilities

Additionally, studies (e.g., New York Academy of Sciences) are demonstrating the value of using VR in conjunction with functional MRIs (fMRI) to further elucidate some of the neural activity within the brain or spinal cord.

Meanwhile, use has exploded (virtually) in terms of gaming:

-- 1/2 Billion people spend at least 1 hour a day playing online games

-- The average young person in a country with a strong gaming culture will spend 10,000 hours playing games by age 21 (Carnegie Melon U)

-- Collectively, "gamers have spent 5.9 million years solving virtual problems in 'World of Warcraft'" (Jane McGonigal)

In summing up this overview, Dr. Wexler noted the range of VR Applications we already see:

-- Medicine & Therapy

-- Clinical Psychology

-- Education

-- Entertainment

-- Government

-- Organizations & Workplace

-- Arbitration & conflict resolution

-- Solving Real World Problems

The benefits of Virtual Environments for Behavioral Healthcare are numerous. With more than 25 years of research & development, costs are down and access is up. "VE's are currently used for prevention, coaching, training, evaluation, treatment and rehabilitation."
Enhanced, integrated systems are "on the horizon".

For the clinician and referring physicians, there is the prospect of improved clinical outcomes and more rigorous documentation of progress. Patients see faster progress and are easily engaged, plus there are benefits in terms of convenience as well as reduced stigma. The practice owner has the potential for increased revenues and scalability, while governmental agencies can reduce both short- and long-term costs. Finally, schools too can benefit in terms of improved educational outcomes and potentially lowered costs within Special Education.

--

And with that, the next speaker was introduced: Dr. Ivana Steigman, who had been the director of clinical design and research at inWorldSolutions and recently assumed a similar role as VP of BehavioralContent and Design for Thrive Research.

Ivana Steigman

Dr. Steigman began by focusing on how virtual modalities are responsive to clinical needs. On the clinician side, for example, we are looking at increased effectiveness and increased patient compliance. Tracking progress and maintaining records becomes easier too. On the patient side, they too can see increased success along with easy access to care. ("Access is a big word!") Also, VR/VE treatments are "ecologically valid" as they feel real and are highly engaging. In contrast, with the "traditional approach", patients may be seen once a week and be engaged by a variety of tasks such as recall, discussion and role-playing. But then they are on their own, untracked, until the next session.

In telemedicine applications, virtual environments may seem very much "real-world" (such as a practitioner's office, conference room, or battlefield simulation) or may be more fantasy-involved, like a Dragons and Dungeons. Applications tend to be immersive and avatar-based. At inWorld Solutions and OLIVE, they ran a pilot program in 2009 which utilized VR/VE components as part of a methadone treatment program, and entailed pre-test sessions and daily check-ins. In 2011 Thrive and OLIVE/InWorld introduced a full implementation: an Avatar Based Recovery Program. The program employs an interactive learning module as well as an online forum and VR support groups. As it is "all online", there is far less paperwork, and more accurate record-keeping.

The audience was shown a demonstration of one such application, an 8-week, VR-based AA group treatment platform. Avatars are seated in a circle. "My name is Kelly and I'm an alcoholic." "I'm Steve. I do have a bit of a problem..." I asked if all these avatars were actual, real participants. Answer: yes, and all from different cities.

Dr. Steigman spoke about the "behavioral wellness" orientation of Thrive (which is parent company to several projects and products). They look at 5 wellness domains. For each they establish a baseline, for example in the areas of sleep and stress. Step 2 is formulating a contract and goals. Session results are "tracked digitally - no more 'progress notes'."

The programs offer integrated support for cell phones, for example providing reminder calls when needed: "You haven't checked in today." Users are tracked and assessment summaries are generated. In addition to the direct treatment activities, a "psycho-educational treatment model" provides patients with interactive information modules (as is the case with many of the VR/VE programs seen throughout this and other sessions). Again, in terms of validity and engagement, the contexts may be a bar/tavern setting (for alcoholism issues), social settings, and other relevant contexts.

Next, a presentation on "Clinical Virtual Reality" applications, by Dr. Skip Rizzo, of University of Southern California and the Institute for Creative Technology.

Skip Rizzo

This presentation was dense-packed with both research findings and multi-media demonstrations of some fascinating VR applications for health/mental health treatments. Beginning with a sample of one of the most promising new tools, "Virtual Iraq" from the Neuro Sim Lab, several other applications were demonstrated, including one with obvious value to Physical and Occupational Therapists. [A clip shows a girl in front of a screen with an avatar image imitating her movements and helping her to improve her range of motion. You can see a screen shot of this in the lower left of the title image, above.]

Aside from being engaging and effective, it is "cheap and easy!" to implement. Moreover, there is a real value in being able to get systems into home settings and allowing access and connection to professional clinicians, remotely.

The current project areas of the Clinical VR Research Group include:

-- Psychological Disorders, PTSD, and Pain

-- Cognitive Assessment & Rehabilitation

-- Motor Assessment & Rehabilitation

-- Virtual Patient Clinical Training

Dr. Rizzo next presented a "TechnoCentric" definition of Virtual Reality:

"Virtual Reality integrates realtime computer processing, interface technology, body tracking & sensory displays to support a user to interact with and/or become immersed in a computer generated simulated environment. Within such controllable, dynamic and interactive 3D stimulus environments, behavioral action can be motivated, recorded and measured."


In contrast, a "HumanCentric" definition of VR: "...a way for humans to interact with computers and extremely complex data in a more naturalistic fashion."

Rizzo presented an extensive list of virtual reality assets:




Next a history of VR Application Research & Development was outlined, from 1994 - when the focus was on simple phobias - to 2011, where applications address many areas, including addiction, ADHD, Alzheimers, Autism, Balance Disorders, Cerebral Palsy, Neglect, Pain Distraction, Phantom Limb, PTSD, Stroke, TBI, Parkinsons, Spinal Cord injury, and more. In particular, aside from simple phobias, many treatments have evolved for various forms of anxiety disorders. Recent VR applications feature such "cue exposure treatment" tools as simulated airline terminals (for fear of flying) and contextual environments which relate to social phobias, PTSD, and substance abuse. A treatment module deployed in Spain was also presented, where patients with claustrophobia were presented with a computer-generated image of a room becoming smaller and smaller.

Numerous journal articles and NIDA/NIH studies were cited, suggesting the value of stimulus control in treatment protocols using VR. In addition, the responses of the Subjects and treatment participants were instructive. In a study on smoking cessation, for example, most found the study "interesting and useful" and some noted how they "didn't realize there were so many triggers that caused them to want to smoke" and emerged determined to cut down on smoking, and/or to master the cravings to smoke. Similarly, there are contexts such as a "virtual casino" to address compulsive gambling.

Various meta-analyses have found that "VR outperforms imaginal" treatments, and is "as good as in vivo" desensitization approaches. Research also suggests that virtual treatments have lasting impact post-treatment, in the real world.

In the time remaining, the audience was treated to demonstrations of some of the applications. In addition to Virtual Iraq and Virtual Afghanistan, increasingly deployed by the military, there is also the Sim Coach for vets, which is designed to be natural and supportive. In the segment which was shown, a calm and relaxed military man is sitting on a porch with a cup of coffee. He speaks in a Southern accent and explains to the viewer that "I'm still just a piece of software, but I'm getting better all the time." He then shares that in terms of his adjustment, "things just aren't as satisfying as they used to be." He goes on to describe some of the symptoms and problems which are common to soldiers, besides himself. Not only does he educate, but he provides links (such as to AA) and can provide automated referrals to local treatment resources. Development of applications such as this, and Digital Homestead, "is where the action is. "

This was quite an amazing display of both the potential, and the established track record, of VR/VE applications. It has come quite a long way since the early days of simulated spiders and other phobia-oriented "exposure therapy" applications.


 

Invited Address #2305: Chaser and Her Toys: What a Dog Teaches Us About Cognition
John W. Pilley, Ph.D., and Chaser - Part 2 of a series on Canine Cognition, here a focus on memory.

                        Chaser the Border Collie


At the APA Convention 2 years ago I attended a popular presentation by Dr. Stanley Coren, where he shared a great deal of historic research, referencing cognitive processing models and developmental (human) notions such as "object constancy" and other concepts from Piaget and learning theory, along with some slides from experiments and some engaging video clips of some talented dogs (including a border collie on a skate board). Coren also traced the role of genetics (breeding) and compared different breeds. Today's presentation was focused on one particular set of memory and reasoning skills and centered on one very talented border collie in particular: Chaser. And .... Chaser was there too (above), although she did not "perform" live. Instead, her incredible skills were presented through numerous video clips (home-made, mostly).

As Dr. Pilley noted at the very beginning, "Obviously people love dogs".

This was a fun event; one could watch in awe and be appreciative of Chaser's cleverness and memory skills (seemingly well beyond some humans!) as well as coming away more informed about border collies. Dog lovers in general were definitely enjoying the behavior, demeanor, and "intelligence" of Chaser. And clearly both dog and owner are devoted to each other.

(For more on cross-breed comparisons as well as several additional controlled laboratory studies I'd suggest the 2009 presentation by Coren on
How Dogs Think.)

Dr. Pilley first referenced Kaminsky's 2002 report on
Rico, who could learn over 200 names of objects. A key finding, which placed Rico's learning apart from simply recognizing a few commands and object names, was how he learned by exclusion. "Exclusion learning does not depend on associative factors. It requires a higher cognitive level."

Research into children's language acquisition posits that young children acquire "referential understanding" when they reach the stage of knowing that objects have names - and they're taught with cues." One researcher (Markman) was not convinced it was so simple; for example, 2 words might (in the beholder's mind) perhaps be combined into one morpheme (sound byte) and that could be learned as one entity rather than having learned 2 separate words and their meanings. In any case, Dr. Pilley's own extensive research with Chaser "confirmed the findings of the Kaminsky team" - namely of learning through exclusion.

There were ooh's and ahh's among the dog-loving audience, as Dr. Pilley showed some home videos of "Chaser and Papa". He recalled what the breeder told him when he first adopted Chaser: "If you give your heart she will give you her mind." Clearly they struck that deal!

Pilley described 4 studies he conducted:

-- Experiment 1 "demonstrated Chaser's ability to learn a proper-noun name of over 1000 objects."

-- Experiment 2 "demonstrated that two word commands like 'fetch ball' were independent - that both the verb and noun had semantic meaning."
   [Later clips showed Chaser either tapping or fetching things, and following 2-step verb-subject commands handily.]

-- Experiment 3 "demonstrated Chaser's ability to learn common nouns - words that represent categories, such as ball, frisbee, and toy."

-- Experiment 4 demonstrated Chaser's ability to learn words by means of exclusion - inferring the name of an object based on its novelty among familiar objects that already had names."
   [For example, if she had 10 toys in front of her, 9 of which she knew, and was asked to fetch the new one, she'd pause a moment and then decide the 10th must be the object which was named.]

Dr. Pilley presented his criterion for learning, which consisted of 8 consecutive trials where Chaser had to correctly identify a series of named objects. In this study, if Chaser failed any one of the 8 trials, she started over again and was given additional training until the criterion was met. In the end, statistically significant findings were obtained in all 4 experiments.

[Slide of Chaser in the family room in the typical border collie stance, and with fixed gaze.] "They can assume this stance for a long time." Next we saw Chaser herding sheep, as taught by Pilley: "Bring her here girl. Good Girl!" Chaser at times now will "herd a toy - as a surrogate".
Video clips showed Chaser performing more and more complex tasks, including 2 and 3-step commands :"Drop, drop... Back-stand-stay". Then, standing in the classic stance, she responds to 1... 2... 3.... (waiting still), Go!

It gets better and better...

The training and research began when Chaser was only 5 months of age. Pilley assessed her memory of toys every month for 30+ weeks. He made up names for the dolls, plush animals, and other toys until he had accumulated over 1000 toys, in 16 large Tupperware tubs. Did she really learn the name of every toy? "Yes, with 95% success."

"Find ChaCha... Find Candy... Find Sweet Potato... Find Snow.... Good girl! Find Roast Pig... Find White Moose...." And Chaser could do much more than finding and retrieving, too. (Multi-step commands to find and place a paw or her nose on a toy, recognizing a bird sound, more.... as they say: amazing.)

As Chaser began to accumulate accolades such as "world's smartest dog", and was widely cited as having a documented vocabulary of 1022 words. This captured media attention, as well as numerous online clips (Youtube, etc.) Pilley next showed a "more professional" documentary of sorts, which you can see a versions of below, as presented on ABC News, Feb.9, 2011. (Titled, aptly, "An Amazing Dog").

The background: Astrophysicist Neil Degrasse Tyson (also known from PBS NOVA) was invited into the home, to judge for himself if this Chaser was as smart as all the buzz made out. As he was a big strapping stranger, unknown to Chaser, he was asked to have a seat on the couch and speak softly at first, so she would not be afraid. The only other advice was about the importance of reinforcement, to keep her engaged, such as praise ("Good girl!") for her performance. Once settled in, Pilley left the room, so he could not in any way exert an influence. It was just Tyson and Chaser - and a camera behind the couch where toys were scattered, to show her at work and prove nobody was helping her. As you'll see in this brief excerpt, Tyson and Chaser got along famously: "He was so excited. Chaser was doubly excited." They did multiple trials in which Chaser repeatedly scored 9 out of 9. See for yourself. Here's the ABC report:


Chaser: An Amazing Dog

Finally, Dr. Pilley ended with some more home videos, with Chaser following multi-step commands, beyond simply finding and fetching, such as get/bring/paw, nose on ABC, and even responding to the cue of a bird sound.

One can learn more about Chaser not only on YouTube - where many other animal studies, Chaser stories, and a famous Australian border collie are all easy to find - but also on Dr. Pilley's (and Chaser's) own website:

www.chaserthebordercollie.com


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CONVERSATION HOUR #2362 - A Very Special Event

A Hero of Psychology - Aaron T. Beck at 90


Aaron T. Beck at 90 - APA 2011

What an event! After being unable to attend last year's convention, this year he was back - in fine form, in a room packed to the rafters, replete with birthday balloons and several jumbo-sized birthday cards circulating around with audience of fans, friends, colleagues, and family too, joining in to honor this legend. Dr. Beck not only answered questions posed by Dr. Frank Farley, interviewer extraordinaire, but he took audience questions and also shared some of his latest projects and theoretical thinking. Yes, at 90, he has many new projects which he is pursuing. God Bless! So here now, aside from the celebrations, are some reminiscences of personal and professional experiences, from his beliefs about beliefs to his meeting with the Lama, memorable events, and personal stories he has accumulated over many years in the course of his prolific life and career.

More to come... No time between super events at opposite sides of this stadium-sized Convention Center, and back-to-back conferences. So much to choose, so little time between presentations! But where there's mindfulness and luck... Lots of great events!

CLICK HERE FOR FULL REPORT

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[Quick note mid-Saturday, Day 3]

This morning (way too early!) I attended back to back presentations beginning with a very impressive presentation by Kate Cavanagh, author of "Hands On Help", who elaborated on her experience with the health care system in the UK, which in fact prescribes computer based cognitive therapy as a preferred treatment modality.

I've just come from a second panel chaired by Elizabeth (Betsy) Carll on virtual and augmented reality applications, in clinical, educational and military contexts. I was thrilled to hear all the discussion of "context" and also "security".

I sprinted across the vast convention center to make it to a presentation by Martin Seligman on his *new* theory of positive psychology, which he describes as "generic" and presented in a new book, "Flourish". I can't believe this but swear it's true - in some chit chat he doubted I'd ever get a really good photo of him (modestly saying how difficult it is) - I told Seligman, "Think positively! I can't believe I just said that to Martin Seligman!" :-)

I ran into several valued friends and colleagues, too. Not much sleep recently, and just wolfed down my first bite to eat today; now heading back out to the festivities to see a panel on Internet experience. Won't come up for air again for a while, but have a lot of links to share - both sites and YouTube clips.

Must run..
Michael


APA CONVENTION REPORT #3
August 6, 2011 – Saturday
Washington, D.C.
 

First up today was a presentation that was strongly recommended by a respected colleague, an invited address by Kate Cavanagh, author of “Hands-on Help”, an acclaimed book Amazon called a “must read”, about online mental health programmes. (OK, U.S. spellcheck; “programs”.) She is from the UK, and began with a very warm note about her introduction to the scale of APA conferences and expressing the hope we’d understand her funny accent.. She was fine, and the only difficulties in fact were with the wireless connectivity in the room, ironically. Time flew and she apologized for not presenting more (including some online demos) but one hopes she will return (and perhaps we can scrape up a hard-wire connection). She encouraged interaction with this vocal American audience of psychologists, so many questions were asked. Yes it ate a bit of time but also was evidence of what a hot topic she was presenting and how many buttons were pushed by the many points she covered. “Well done you”.
 

Kate Cavanagh

Clinical Health Psychology Grand Rounds:
Computerized Cognitive Behavior Therapies – Turning on, Tuning in, and (not) Dropping Out.


The first of 2 parts was to be “setting the context” and an introduction to Computerized Cognitive Behavior Therapy. (To me, who has recently published “Context is everything”, I was thrilled to hear the attention to context.) The second part, time permitting, was to be on the dissemination of implementation of these programs.

After apologizing if her first dose of American (Starbucks) coffee sets her a-twitter, Dr. Cavanagh said she would like this to be interactive and wanted first, confronted with a large room full of a diverse collection of American psychologists, to “take the temperature”. How many in the room are predisposed positively towards the concept of computerized CBT programs? Many hands went up. Negative? Not one hand.

Noting that her usual context is UK health system utilization, she knew the statistics are quite similar in several dimensions to the American numbers. In the UK approximately 1 in 5 suffers from some sort of depression or anxiety. One third seek help. One in 10 Americans report depression with a total of 18% reporting depression, panic or GAD [global anxiety disorder] Thus the overview of US prevalence is very close to the UK’s. There are slightly more US residents who seek treatment. The perception in the UK is that “there just are not enough resources for those who might benefit” from some sort of treatment program. There is currently underway a huge government initiative in the UK - IAPT (Increasing Access to Psychological Therapies) which has a goal adding 3500 specialists in CBT and other evidence-based treatments for mild-to-moderate disorders, within the next four years.

Part of the solution is seen as derived from deployment of "Computerized Psychological Therapies", which offer a number of advantages and characteristics:
  1. They offer structured programs with the opportunity to use patient input to make at least some treatment decisions
  2. They are accessed via computing devices, usually through the Internet (PC, smartphone, IVR, Tablet/iPad)
  3. They can be accessed within a healthcare practice or at home, supported and monitored by trained healthcare staff

The range of "guided self-help" definitions extends from around 1 hour of therapist time per week, to 5 hours with a coach/support worker. Typically there are brief, remote, weekly support sessions.

Today's focus will be on one type of web-based resource: Guided Self Help. This may include things like: - Psycho-education - Assessment of problems, with feedback - Action plans and goals - Guided change techniques - Homework

Generally there is a narrative or therapist plus a case study component. There may be an additional email or real-time consultation component.

The context of British service delivery is that it includes prescription of evidence based treatments for some presenting problems, including CCBT. (Computerised Cognitive Behavioural Therapy)

The UK's NICE (National Institute for Clinical Excellence) has put a great deal of resources into researching and supporting the “Stepped-care model” - roughly in US terms the sort of list of approved procedures our insurers approve (or not) based on cost-benefit, efficacy, and safety factors. CCBT is a recommended treatment of choice for low intensity therapy for depression and anxiety - but not PTSD.

There is a long history of computer-assisted therapy activities, for example going back to the Eliza era where the technology allowed for “natural language” and the persona was that of a "humanistic therapist." In the 1970’s this was being undertaken using things like the Commodore 64 computer, pressing buttons for feedback.

By the 1990’s there was mounting evidence (Bloom, 1992) of efficacy, and moreover, that “graded exposure does not appear to require interaction with a therapist in order to be successful”. By 2000, Kirkby et al at the U. of Tasmania (Australia) were reporting promising results with their CAVE program (Computer-aided vicarious exposure) for obsessive-compulsive disorder.

At present, there is lots of use of
avatars. You can manipulate facial expressions, settings, and individualized features. For example, in a virtual environment “I could have practiced this presentation today”.

One example of a popular application is
Fear Fighter, an 8-session program to address panic and anxiety. There is a strong evidence base to support its efficacy. Another program with strong evidence supporting its efficacy is Beating the Blues. Dr. Cavanagh proceeded to give a demonstration: “The U.S. Debut!”.

The interface is very attractive and user-friendly [as you can see if you follow the link above], and today we were shown "the US version" - where the dialogue was in American as opposed to proper English but otherwise identical. One is greeted by some vignettes of people who might have familiar feelings: “I couldn’t cope”; “I have no energy”. Narrator: “One in five suffers from depression or anxiety… CBT breaks the cycle” There are several descriptions and vignettes and continues: “It teaches you the causes of anxiety and what you can do to overcome it. It can help you feel better even if you’re already on medication.” Eight sessions, once weekly.

The automated explanation for the new patient/client instructs him/her to choose a password to log in with, and then underscores that it is “really important” that the user completes their weekly project and carry out the activity since “research shows 3 times more benefit when doing the projects”. Next was “Bob’s story”, describing how the program “gave me the confidence to recognize my own feelings.” Another example: A woman was in a car crash and consequently avoided being in a car. Now [shot of her in car] she’s driving again. Another woman “I just feel a lot calmer”. “Get your first session now!” Another pitch or two (from the program) and Cavanagh paused to take the pulse again of the audience and elicit some feedback and reaction from the first American psychologists to see this.

Question: Who buys this? Who is the marketing aimed at?

Answer: In the UK primarily it is marketed to professionals. The patient may get a ‘scrip for this rather than for medication. So it is a case of getting it known and used.

Question: Is it free?

Answer: In the UK it is, for the user. We get our health treatment through the NHS (National Health Service). We pay for it through taxes.

Comment: This certainly is a slick production and well-marketed. Personally what I like about it is the built-in information-seeking component.

Comment/Question: Yes, the video is very well done. It may be convincing to us. But what about lower SES clients? In rural areas access is not great. What about poor people?

Response: Poor people can't have access?
In the UK services are made available, in community service settings.


Question: Is this treatment offered through primary care providers? I'm assuming they meet with a professional... is there any research on the importance of access to an actual provider?

Answer: There is limited research on these specific barriers. Clinical expertise locally generally addresses barriers.

Back to slides and the presentation

Beating the Blues, developed by Dr. Judy Proudfoot and Utrasis, was described a bit further, in terms of its many features which research has shown to be engaging and effective. It is a program several presenters this year - American as well as British, have cited. sited.

Beating the Blues is a program "designed for usability. It’s designed for people with limited computer skills". It too is an 8-week course. The first step is an introduction and overview meant to engage and inform the user. Included is a strong educational component such as built-in lessons about the nature of stress and ways to address it. The program is designed to address both cognitive and behavioral components in ways which are easily understandable. Session summaries, homework projects ("really important") and progress reports are all built-in to the program. (One example of a homework project which was shown: "Look for evidence against your inner belief"; another was "record reasons for successes") In the final module there is a session devoted to action planning and relapse prevention.

Session 1 - Demonstrated on the screen: the interface ("designed by a multi-professional team" and developed over a four year period).

There are 5 buttons with faces - each has a vignette such as the ones sampled earlier. One might start with this “psychoeducation” activity. There are case examples involving warmth and genuineness too (Rogers' humanistic factors). And there are progress graphs and charts.

Next we were shown a number of research studies which yielded strong findings, so much so that the National Institute for Health and Clinical Excellence and NHS had to take notice (particularly given the Stepped-care mandate) and accept the evidence in support of CCBT. It is now listed as a Step 2, "low-intensity psycho-social intervention" [One of the characters in a CCBT module, incidentally, was shown saying something to the effect of "by the way,even if you are taking medication already, you may still benefit from this program."]

The 2004 Proudfoot et.al. study (Journal of British Psychiatry) used
Beck’s Depression and Anxiety scales as pretest and outcome measures - along with Health Service usage. There were 276 Subjects. Post-treatment results included evidence of “increased self-efficacy, mastery, coping, and ‘learned resourcefulness’. [Intrigued by the latter term, later this very day, by twist of fate, I had the chance to ask the legendary Martin Seligman- of 'learned helplessness' fame, if he was involved with or knew of ‘learned resourcefulness’. He recalled a popular paper of some 30 years ago. Obscure, he said, but an interesting concept! ]

Given the results, there was a determination that the cost effectiveness/benefits were potentially very great due not only to the cost and efficacy of treatment but also to mitigation of problems such as lost employment. Dr. Cavanagh and colleagues completed similar studies with large Subject groups (e.g, Cavanagh et al, 2007, with 510 participants). Consistently, Beating the Blues was found to be an effective tool for treatment of depression as part of routine primary care. "It doesn't just work,"Cavanagh found, "but clients generally have have a positive experience" to the extent that 90% found the treatment either helpful or very helpful, and 80% said they would recommend it. In Cavanagh et al's (2009, Cognitive Behavioural Therapy) study, only one person said the program was not at all helpful.

Proudfoot and Cavanagh were joined by many other researchers in researching the efficacy of this program. Cavanagh's popular book (Hands-on Help) included a systematic review of 175 studies, and again, the evidence was persuasive. It should be noted that a study by Cavanagh and colleagues in 2007 found efficacy in the treatment of a wide range of presenting problems, beyond depression.

Azy Barak also conducted a broad meta-analysis which was consistent with Cavanagh's findings.

One last study was mentioned: the recent and oft-cited study by Cuijpers et al (Clinical Psychology Review, 2010) which found no difference (within their own study) between guided and self-administered CCBT programs.

Some positive CCBT factors were reviewed. For example, there is an increased range of choices. The program provides more flexibility and increased confidentiality. The computer "hasn't had a bad day". The responses are absolutely consistent. The program doesn't decide on a hunch to switch gears and try a new approach not done before. Users report an increased sense of self-efficacy ("learned resourcefulness" as they master tasks and situations while also learning strategies and useful information.

And here, amid the many positives, Cavanagh paused to underscore that no matter how "evangelical" she may seem to be about this particular treatment protocol, she is "also a scientist" and there is simply overwhelming evidence now which cannot be ignored.

Some limitations were in fact noted too, such as "technophobia" which negates the value of the tool within 'the shiny box'. Similarly there is the issue of 'inaccessibility' - not in the sense of the program or online access not being available (as referenced by an earlier question, above) but where, for example, someone has an inability to read. Some see limitations in the formulations and solutions the program offers, some see the consistency as a negative rather than positive, while still others have difficulty meeting expectations, accepting credibility, or sustaining motivation without a greater level of support.

Summing up:


--

Another round or two of audience Q & A ensued, where some provocative questions were posed.

QU: What about use of this program in combination with 1:1 therapy? Answer: "There is some evidence of increased efficacy with some provider contact, but it depends on the program."

There are a great many
computer-assisted psychotherapy programs out there, including also the well-researched Good Days Ahead "interactive program for depression and anxiety" produced and written by Jesse H. Wright, co-written by Andrew S. Wright and Aaron T. Beck. While designed to be "50-50" - self-help plus used in conjunction with a professional clinician - research has shown similar results comparing 50-50 use with computer-only (home) use. A third option exists too, which would be to use the program to sustain skills learned in treatment, after therapy sessions end.

With so many possibilities still, "lots more research needs to be done."

QU- This has been very impressive. One concern, possibly, about depression. Is there any way to alert someone who appears to be at high risk?

A: Contingency planning is generally "managed with local protocols." Some programs include self-management procedures, others have more interactive monitoring processing. Beating the Blues has a built-in suicide indicator which triggers prompt to call one's provider.

From a development point of view, is there not perhaps an over-reliance on video? I find it can be (1) costly; and (2) limiting in terms of all the creative animation - for example ensuring representation of diverse people and so forth. It doesn't seem to add anything.

A: "You're right. At one end we have stark programs; at the other end there are lots of 'bells and whistles'. What is the best combination?"

QU: Contextual question: The world gets smaller and smaller. We have more and more reliance on computers. The next generations will be the users [of these programs]... I watch people with over-reliance on computers, devices, tablets, all day... Could it hinder 'people skills' given that people are already spending their entire days on computers?

A: I share some of your concerns about that. We're looking at that, and seeing some interesting findings. For example, people with more avoidant presentations may be drawn to a purely self-administered program... I'm not convinced a Utopian world would be 100% computerized treatments.

QU: There is also an impressive resource in Australia -
anxietyonline.org.au - which offers programs tailored to OCD, phobias, weight control, eating disorders... [See too the Australia-based Beacon portal for a comprehensive listing of online applications - for computer and now mobile devices as well, organized and rated by a panel of health experts.]

Dr. Cavanagh has clearly engaged this audience and gotten her wish - to take the pulse of this APA audience while delivering this dense and fascinating presentation. But time has flown and time is nearly up. Would the audience like to see more demonstrations? Clearly yes. And so there was just a brief introduction to Part 2 - now turning from guided self-help programs to "pure" self help CCBT programs on the Internet where no human support is offered at all. In general there is a weaker evidence base with regard to clinical outcomes.

So what is known about completely self-administered CCBT programs?

On the plus side, "there is some evidence that 'pure' self-help can be beneficial for some users." Moreover, fully automated interventions extend reach and reduce expenditure of resources. However, "low return visit rates are found in casual visitors to unmoderated CCBT programs." In contrast, guided self-help programs (where the user has access to both the CCBT program and a therapist/coach) there is some evidence of effectiveness for both anxiety and depression, higher return visit rates, and a 68% completion rate, reported in one study (Kaltenthaler et al).

---

Unfortunately, before getting further into demonstrations, time had completely expired on today's presentation. Yet, quite a lot had indeed been presented, and surely the audience had seen and learned quite a bit - while offering up a great deal of reaction and feedback as to the reactions and concerns of mostly-American psychologists.

The discussions go on, along with the burgeoning of new research and practice directions.

Dr. Cavanagh's website:
www.sussex.ac.uk/iwl

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Next up: Seligman on “Flourish” and PERMA. If it sounds cryptic, me too... at least at first.

I’ll do my best to make it clear – but essentially his new book “Flourish” reflects his latest revision to his own model of "positive psychology". There are some primary aspects. Within each aspect there are “elements”, with components within the elements. It takes some concentration and graphics to "get" the new lexicon and model, but certainly followers of Seligman's illustrious career can appreciate the depth to which he develops and presents his ideas.


Invited Address #3158: Martin Seligman: Flourish

Martin Seligman - 2011

Dr. Martin Seligman was introduced by APA past (and possibly future) President, James Bray. Dr. Bray noted that while many know of the legendary contributions to psychology, not many know of the breadth of Seligman's interests and skills - for example being a "world class bridge player...online". Seligman took the podium, thanked Bray for the introduction and said that indeed, he plays bridge online several hours every day.

From bridge to ancient philosophy, Seligman focused on the point in time where philosophy merged with Freud and the resultant emphasis was solely "to reduce suffering.... a profound moral and political error." How many of us lie in bed worrying about either how to go from -8 to -5,or from +2 to +5?

So what is worthwhile to promote? Wellbeing. What is wellbeing? That is the substance of his new book, Flourish, and his new 5-factor model, PERMA.

Even thinking positively, it would be impossible to describe fully in the course of one lecture, much less 'here', all of the research and nuance involved in this newly-broadened model of well-being and its teaching. I therefore defer to Seligman, his book, and his website for a more detailed and annotated explanation of the many concepts and acronyms within PERMA and Flourish. Hopefully this will at least convey some of the "main idea".

Suffice to say, Seligman presented many charts, graphs, and diagrams pertinent to his latest theoretical overview. He described it as "the most important change in my thinking".

Seligman said that he would like to see well-being as a national goal. Already one country has been utilizing a well-being index, and 23 countries are now looking specifically into "the Flourish Factor".

Noting that supposedly "proven" fad diets end up being useless (as the weight typically returns, and then some) and how even lottery winners who suddenly experience great 'happiness' typically return to their baseline after 3 years, Seligman believes the potential durability of PERMA to be unlike that of any diet. In fact, he is so 'positive' about this model of wellbeing and the potential for widespread adoption - "it is measurable, teachable and even 'gameable'" - that he has set a goal of global implementation by 2051. "That seems reasonable", he said, no matter if he and others present in the room today might not get to see it first-hand.

The road to well-being is premised on the PERMA model, which consists of 5 elements, or " the 5 PERMA Pillars":

Fleshing out the PERMA pillars a bit:

Positive Emotion entails "optimism and positive health".

Engagement refers to ones use of "Signature Strengths"

Relationships are seen in terms of Active Constructive Responding (ACR).

Meaning is defined as "Belong to and Serving Something Bigger than Self". Concerns also: Altruism vs Pleasure

Accomplishment involves GRIT - never giving up, getting the job done. He cited one example at West Point (military academy) and another in a high school setting.

A few general comments. First, there is much more to Positive Emotion than a label. It refers to "subjective well being... people choose to be happy." As for books and articles about so-called "positive psychology: "Please don't put a smiley-face on the cover. There is much more to positive psychology." Engagement. He looked around the room and joked that probably 70% are 'in flow', while the other 30% are immersed in fantasy. If you ask people what they are thinking, 80% will say 'nothing'.

Is 'health' an "element"? Is 'responsibility'? Here he referred to available resources and questionnaires at his site,
authentichappiness.org.

One of the nice things about PERMA is that it is "gameable". He understands how much people love games, his own example being 4 hours a day playing bridge. Australia has many games and as a table revealed, "Denmark leads the list" in terms of adopting some version of PERMA/Flourish. They even have a national index: the Wellbeing GDP.

"I made a list of 20 things my grandmother didn't know about positive thinking. Look at optimism - something I did for about 30 years... You can be depressed, have cancer, and still have positive health. It seems a contradiction." He cited a number of studies in healthcare which suggested that the presence of subjective factors (e.g., optimism) decrease the cost of healthcare. He noted too the Japanese concept of (phonetically) "eegagai" - reason for living.

Where health assets are greater than risk factors one can see improved health. Notwithstanding the "giant Lipator industries" a proper focus might more productively be, Seligman said, teaching positive health. He mentioned how the US Army is working with 29 health data bases going forward, including psychological records. 1.1 million people.

"Close your eyes and think of something you hate doing, at least once a week." Next, he would recommend taking the Signature Strength Test on his website, and then doing something using your greatest area of strength, as the test identifies. Using strengths to act positively. Seligman bemoaned some of the common approaches to problems, taking particular issue with marital therapy. It's 'the worst therapy possible', he believes. "People are miserable, they lie to you, they lie to each other..." and essentially what the 'treatment' does is teach them to fight better. Is this a worthwhile goal, he wonders, "to turn an insufferable marriage into a barely tolerable marriage"? He thinks not.

Seligman presented his 4x4 model of active vs. passive, and destructive vs. constructive. This is a framework in which he sees more validity. Example (one he's given before and which I have previously reported) - A spouse comes home to announce a big raise at the job, as a reward for great work. The active/constructive says "You know, I was reading your plan it really is wonderful!" The active/destructive says "Oh great, now we're in a higher tax bracket." Passive/constructive says 'congratulations dear, you deserved it', the end. Passive/destructive says "What's for dinner?"

These reflect some key elements within his framework. He is trying to teach active/constructive communication skills within the military. He has (as usual) been using his own techniques and after a while focused on this technique he found his own son asking, "Is this really you, Daddy?" Some aspects which are a good fit with the military include his notion of GRIT, never giving up - and also aiming for authentic happiness. He cited some studies and noted that "self-discipline counts for twice as much variance as IQ". So he and the Penn Resilience Training project have been focused on schools. His goal is "to teach teachers the skill of PERMA". [Here I feel compelled to add that Sir Michael Rutter last year tore into the notion of "teaching resilience like the ABC's" in schools, saying it is "bound to fail". Maybe there's a huge difference between the two foci, and certainly PERMA is not rote learning like the ABC's - but a discussion between these two on the topic of
resiliency might be very interesting! Certainly for schools and educators.] Seligman's program, as he described it, entails training diverse samples of students, led by teachers, in learning "decision-making and resiliency".

Working within large organizations may indeed seem daunting. Seligman recalled a meeting he was called to at the Pentagon, where a senior officer "growled at me", there's all this suicide, and panic... what does psychology have to say about that? Well... there are always people 'at the edge' who fall apart, and their lives are ruined. In the middle are people who are resilient. At the other end are those who adopt the posture, "if it doesn't kill me it will make me stronger" - sometimes leading to what he terms 'post-traumatic growth'. Back at the Pentagon, General Casey ordered that positive psychology and resiliency were to be taught and measured throughout the entire military. Great. So Seligman asked, "Now what about the teachers? You have teachers?" "Yes! 45,000 drill sergeants educating 1. 1 million soldiers." Seligman showed graphs of the first study results, and they were impressive in terms of averting suicides in particular. He can't speak yet as to PTSD applications but noted that the Robert Woods Johnson Foundation is going to be producing a huge amount of data soon.

Other applications? "Measuring building wellness should be a national, planetary goal."

A primary intellectual controversy he observes at the moment has to so with the concepts of well being and happiness. He was told, 'all of well being feeds into a common path which is happiness', but he disagrees. He believes there needs to be a 'dashboard' rather than just a single measure of life satisfaction. PERMA has a lexicon - over 2000 words to reflect a range of feeling - love, hate, etc. There are over 45,000 photos too, and collaboration with Facebook and Twitter. They have the ability to take live readings of PERMA, such as was done during the recent mining rescue in Chile. Researchers found the Chile PERMA rates went up but not those in Argentina. Something seems to have been tapped. And "we are in a privileged position. The world is changing from a pathology focus. " Again, Seligman would like to see his model widely utilized in schools especially, and in the military. The Penn Resilience Training project (PRP) has already yielded some significant results, as illustrated for example in charts and graphs of grades obtained by 9th grade English Language Arts students taught PERMA - whose escalated grades remained stronger than a control group into the 10th grade as well. There were also positive results within the military context, where overall sense of well being as well as suicidal acts and gestures were dependent measures and the results were very promising.

Finally, Seligman briefly described the measurement process, which is one of the strengths of PERMA. There are both subjective and objective ratings. One can see results either through a 'dashboard' or single-subject lens. And PERMA is gameable in addition to measurable.

--

One final note. In looking afterwards for more information on PERMA Games, I came across Seligman's European site which features very recent presentation notes and graphics - from a conference in Zurich, just before this (APA) conference (July 2011). It is very current - all about the model and research of Flourish and PERMA. And it also presents several of the charts and graphs referenced above plus a list of Seligman's other online sites. Available (as a .pdf/Acrobat file) at:

Positive Psychologie: The Search for Well Being (July 2011)

--

And now, off to another forward-looking presentation, this on "Innovative Technologies for Psychological Intervention, Consultation and Training".

Hmm, I could swear I presented a similar sounding topic - yes I did! In 2002, with John Suler, Azy Barak, and David Nickelson
: Cyberspace Travels for Psychological Researchers, Educators, and Practitioners Still worth a read! How far have we actually traveled, as a culture and as a discipline? Let's see... something called Facebook, this thing called social networking, Twittermania, wireless "smart" devices everywhere, Kindle, iPads, advances in computer programs, virtual environments, and a few other not insignificant developments.

So, off I go to get the sense of where we are and things to come, from a 2011 perspective.

[color line]  



Invited Symposium #3234 – Innovative Technologies for Psychological Intervention, Consultation and Training

               Psychology and Technology 2011

       Drs. "Skip" Rizzo, Hunter Hoffman, Elizabeth Carll, Timothy Lacy, & Jon Cabiria


The symposium chair, Elizabeth K. Carll,Ph.D. introduced today's topic with an overview of technological applications and their impact on psychologists' activities in particular, ranging from training to consultative roles to applied clinical practice. She noted in particular the increasing use of powerful tools which utilize "augmented reality", and "virtual reality" applications in particular. Across a broad range of clinical activity, new tools are available, and are clearly impacting the way in which psychologists approach treatment.

The first to present was "Skip " Rizzo, Ph.D., of USC and the Institute for Creative Technologies - Clinical Virtual Reality Research Group, addressing today (among other things) "The Birth of Intelligent Virtual Humans in Clinical Virtual Reality. The Clinical VR Research Group today has 4 affiliated labs, each with a particular focus: The VRPsych Lab, whose logo pictures Freud wearing immersive VR goggles; the NeuroSim Lab; Motor Rehab Lab, and Virtual Patient Lab.

Dr. Rizzo had just given a presentation the day before - with a different panel, with a particular focus on
avatars and virtual environments. Those following this topic may want to take in (virtually) that presentation as well. One thing he presented on both occasions is important contextually, and bears repeating: his definition of "Virtual Reality".


Virtual Reality Definitions

TechnoCentric Definition:

"Virtual Reality integrates realtime computer processing, interface technology, body tracking & sensory displays to support a user to interact with
and/or become immersed in a computer generated simulated environment.

Within such controllable, dynamic and interactive 3D stimulus environments, behavioral action can be motivated, recorded and measured."


HumanCentric Definition:

"...a way for humans to interact with computers and extremely complex data in a more naturalistic fashion."




Virtual Reality as a Simulation Technology

Dr. Rizzo presented a series of photographs and futuristic images of VR apparatus, across time, beginning with the 1st Link- Aviation Simulator (appearing much like an arcade-sized airplane with a built-in simulator screen) , from 1929. That was a grandaddy of today's Virtual Reality. Tracing the history from then until now, we are soon in the early 1990's, with huge displays, children embracing computers and keyboards and games, all sorts of headgear for virtual reality, and an explosion of technological advances in general. A slide depicts images and a quote from that time period: "Virtual Reality arrives at a moment when computer technology in general is moving from automating the paradigms of the past to creating new ones for the future." (Myron Krueger, 1993). This, Rizzo shared, " influenced me".

In 1994, VR really got its start in a major way with the introduction of its use in "exposure therapy" treatments. And it has been developing, gaining in use and applications, and consistently found (in both research and clinical practice) to offer powerful and effective treatment tools.

Several of Virtual Reality's Assets were listed and described:



From the early days, like 1994 - when the focus was on simple phobias - to 2011, where applications address many areas, including addiction, ADHD, Alzheimers, Anxiety disorders, Autism (e.g., social skills training; Cobb et al, 2002), Balance Disorders, Cerebral Palsy, Neglect, Pain Distraction, Phantom Limb, PTSD, Stroke, TBI, Parkinsons, Spinal Cord injury, and more... Clearly there is great power and more potential still, with constant innovation and applied research. Far more realistic and customizable than the early treatments for simple phobias, recent VR applications feature such "cue exposure treatment" tools as simulated airline terminals (for fear of flying) and contextual environments which relate to social phobias, PTSD, and substance abuse. A treatment module deployed in Spain was also presented, where patients with claustrophobia were presented with a computer-generated image of a room becoming smaller and smaller.

Now, an intriguing on-screen image asks: What about Virtual Humans?

In terms of realism, there is variability across the programs, and many times humans still appear as static characters who 'pop in' - for example as 'distracters' in the simulated classroom environment where children learn to better master their focusing skills. Still, both background and participant representations have gotten extremely realistic in a variety of applications, and as was pointed out by Richard Wexler in an earlier presentation on avatars and VR/VE, the brain can readily accept these presentations as real, or at least real enough.


Virtual Humans

We can see several examples of virtual environments in numerous contexts, including the workplace, public speaking venues (e.g, Grillon, Riquier, Herbelin & Thalmann, 2009), airports, combat situations, medical settings and more.

In general, historically, Clinical VR has used 'virtual people' mainly as:

-- Background Props

-- Exposure Stimuli for Treating Anxiety Disorders

-- Cognitive Attention/Distraction

-- a means to foster "Faux" Interaction
-- a vehicle to promote Avatar Interaction with other real people (i.e. 2nd Life)


Recognition of the value and utility of VR/VE applications is clearly on the rise, as demonstrated by a bar graph showing the yearly number of publications on 'avatar/autonomous agents' and 'VR/VE', according to the COPUS (2009) database.

Positive outcomes of clinical applications have also been on the rise. Botella et al (2007) for example, followed 36 patients being treated for Panic Disorder and Agoraphobia using a VR/VE treatment protocol. The results were not only significant, but for some perhaps an 'eye-opener': "Virtual Human Exposure as good as the real thing!" A preliminary study by
Klinger, Bouchard, et al (2005) had found similar comparability in using CBT vs. VR treatment for Social Phobia. Rothbaum et al (2008) reported significant results in a study of virtual environments used to address fear of public speaking . A screenshot was shown of Virtually Better, a pioneer in VE/VR development, and the acclaimed Virtual Iraq. Finally Rizzo shared a collage of images from ICT's 'Virtual Humans Portfolio' which ranged from various military personas, to a museum guide, a gunslinger, and a large assortment of virtual patients.

Virtual Patients

Another new and valuable implementation of VR technology is seen among programs which, unlike immersion of patients into controlled and self-contained environments, are designed to enable physicians, medical students, psychologists and other health professionals to gain practice and hone skills through interaction with virtual patients. One can interact with a life-size virtual patient (VP) locally, interview a VP via the web, or visit a VP in Second Life. Lok et al (2008-2011) have been doing research in this particular area, and the results are promising. In addition to things like general diagnostic interviews and developing 'bedside manners', there area specialized models to hone in on different types of typical patient presentations: An image is onscreen of a virtual teen saying "I don't want to be here!" Another virtual patient suffers from PTSD. A third VP is the victim of sexual assault.

Dr. Rizzo noted that our brains seem to readily act with VR, and in turn the applications are becoming ever more adept at seamlessly responding to us, for example through voice recognition, and reading of gestures. His own research (Rizzo, Parsons & Kenny, 2010) has led to his finding that "clinicians buy in" as well, and ask the same questions that they might ask of a real human before them.

And this led to the final piece of Rizzo's presentation, a look at some of the work being done at ICT, including one project in particular he feels 'is where it's at': Sim Coach. [The slide shows some virtual soldiers, and states the goal: "Breaking Down Barriers to Care in Military Personnel and Their Families".] We are shown a demonstration, and we join a virtual veteran, siting on his porch with a cup of coffee, talking to us in a calm voice with a soothing Southern US accent: "I'm still just a piece of software but I'm getting better all the time.". He looks and sounds realistic, and engenders trust. A screenshot of the entry page: The dialogue screen to the right of our page host asks for some basic information "to get to know you better.... I think I can help you better if I know where you're coming from."

A report of the military's Mental Health Advisory Team (2009) was referenced, with the data reflecting widespread concern among soldiers serving in Afghanistan, that their careers might be hurt if they sought behavioral healthcare, they would be treated differently, blamed for their problem, seen as weak, etc. The numbers were so striking - up to 50% of respondents indicating those beliefs, that military leadership mobilized to find some method of providing acceptable treatment. General George W. Casey Jr. wrote (American Psychologist, 2011): "Facing statistics like these, we must ensure that our efforts to become psychologically stronger are not thwarted by a culture adverse to even the word psychological." [Casey also was highly receptive to the ideas of Seligman, who speaks of 'positive health' training for the military - this is described in detail elsewhere on this site, in a separate report.]

One solution: SimCoach. The summary of benefits onscreen now describes "an intelligent, interactive Virtual Human Agent program...Designed to attract and engage Service Members and their significant others who might not otherwise seek help (stigma, lack of awareness or a general reluctance to seek help).". A goal is to "create an experience that will motivate users to take the first step to empower themselves with regard to their healthcare (e.g., psychological health and traumatic brain injury), general personal welfare.. [and encouragement to take] the next step towards seeking more formal resources that are available with a live provider. " (For example, the program might refer to a health professional or to AA). A goal is to "support users' efforts to understand their situation better, explore available options and initiate the treatment process when needed.... [Notice is given that] SimCoach will not provide diagnostic or therapy services."

More information from the military's perspective is available via
this link. More online information and materials pertaining to SimCoach, is also available from the ICT project page.

Back to the demo. Similar to Beating the Blues and some of the other programs demonstrated earlier by Kate Cavanagh (who presented on computerized CBT programs using virtual environments) one has the ability with SimCoach to choose from some icons or 'buttons' depicting a virtual person, and select a character you're most comfortable with. Onscreen now: the army avatar is talking softly and calmly as he offers "3 things which can help... here's some links to help you....If you want you can register and save this conversation."

Sample virtual person #2: "Are you concerned about your drinking?" Links to contact the local AA are offered, and also "I could refer you to some people..." And as the presentation wound down, a few last screen shots showed some of the range of hardware being used, as well as a shot of "The Digital Homestead... the future of home-based care... advanced displays... low-cost interaction... 3D... "

Time was up, and this was quite an immersive experience in its own rite! A final comment was certainly well-received, by this audience comprising a wide swath of psychologists, young and older, clinicians, researchers and 'old fashioned therapists' of every stripe. Dr. Rizzo ended, after all this vision of a new and dazzling world of opportunity with the simple statement that "nobody's saying this replaces good clinical practice. Technology is a tool." Amen to that.

And with that his final slide thanked Dr. Carll for organizing this event. And she returned to the podium, thanking him in turn. She asked the audience, "How many people have used VR?" Many hands went up. Carll commented that in 2003 no hands went up in response to that question. [FWIW - I like to recall that in 1999 when I presented on Cyberpsychology, the questions I heard were 'What's a browser?' and 'How do you get a home page?' And for context, in 2003 there was still no such thing as... Facebook! Yes, the times they are a'changin! ]

And with that Dr. Carll introduced the next speaker, a pioneer in the area of VR-based pain-distraction (U. of Washington, HIP Lab).

Hunter Hoffman, Ph.D.
Virtual Reality Applications for Pain Management


Dr. Hoffman spoke today about one aspect of VR application which had not been focused upon elsewhere today, relating specifically to an important healthcare area: pain management. He presented a look at one application in particular which has proven very promising in use with burn victims:
Snow World.

SnowWorld

He began with a video clip showing children who had been badly burned, like the one pictured above, engaged in 'pain distraction' activity during the extremely painful time when their wound dressing is changed. With extensive burns, we are told, one must constantly remove burnt tissue or it will become infected. In fact, burn wound care can be so painful that morphine is inadequate for pain control. Even the thought of wound maintenance is so painful that often one sees strong negative reactions in just being told it's time to change a wound dressing. Not only is the procedure intensely painful physically, but "it is the only time patients see the wound...it rivets their attention and makes it worse. So the VR blocks the patients view of the real world [and] the instruments of pain."

The SnowWorld program takes the patient away from what is happening in the room to an immersive environment with snow drifts, snowmen, penguins, and all sorts of cool, frosty images. "Their attention is focused on the virtual world". There are specialized, customized immersion goggles, and even applications from within a water-treatment chamber.

Onscreen: a boy is en route to wound care, and rather than panicking over the impending pain announces with some bravado, "Watch out, you Snowmen!"

And it's not only applicable to children. A video clip shows a soldier who has been burnt all over, in serious pain, but in the clip is immersed in a world of penguins and snow, with a Paul Simon music soundtrack accompanying the visual experience.

Not only is it the case that "patients report less pain in SnowWorld" but MRI's confirm a physiological impact along with the subjective reports: there are fewer 'pain signals' observed in the brain compared with the same procedures happening without the VR intervention.

Several efficacy studies were shared, and the results were quite impressive, such as a 40-50% reduction in reported pain. (e.g.,
Hoffman and Patterson, 2005)

Several other studies were cited, including one on VR vs. Nintendo as a distractor (VR 'won') and other studies which added a 'cognitive measure' beyond reports of pain and physiological evidence such as fMRIs. (e.g., "How much time do you spend thinking about pain?")

A few final points which come out of the extensive and growing research base:

1. "VR works best with the patients who need it most."
2. VR is not only effective, as had been predicted, with mild levels of pain, but can be dramatic in the treatment of high levels of pain as well."

--

With that, Dr. Carll thanked the speaker for a fascinating look at "the future of pain management" and the notion that perhaps much of this future might be non-pharmaceutical.

And the next speaker was introduced, and is someone who can speak authoritatively to issues of both health and military applications. A psychiatrist and former officer with the US Air Force Medical Support Agency - and long-time advocate of VR treatments- he retired from the military in 2010 and is now medical director of
Behavior Imaging Solutions.
[You can see his 2009 APA presentation while still serving in that capacity here, where he was part of a panel along with Richard Wexler, Les Paschall, and Stephane Bouchard, who was unfortunately not able to attend today's presentation as planned.]

--

Timothy Lacy, MD
Behavior Imaging: Innovative Technology for Assessment, Consultation, Supervision, and Treatment


Dr. Lacy began with the proposition that "all of us rely on assessments of brain function. We don't always observe it directly. What we see does not always reflect reality."

The Problem:

- Mental Health Providers Rely on Behavioral Observation
- Behavior seen in the Clinic does not equal 'Real Behavior'

We are relying on memory ... or family members reporting without personal bias." [e.g., in the case of someone in shock or otherwise unable to respond verbally.] We as clinicians and behavioral scientists rely heavily on visual observation in clinical assessment and treatment. At the same time, "the behavior observed in the clinic may not reflect the behavior that occurs in one's natural environment.

Dr. Lacy shared that his efforts stem in part from personal experience, as his son has a serious disability (autism) which involves behavioral components which in the past had been managed primarily with a stew of medications. But that masked behavior rather than allowing it to be observed and more appropriately addressed. A doc was called in to work with non-verbal treatment approaches, and it looked like a 'successful' session after 4 hours of observation and some on positive interaction. But 'it wasn't real', as the young man was heavily drugged during the 'evaluation'. This was a false snapshot ('behavioral image') of true daily-life functioning. It is this context which adds fuel to his passion for seeking realism, data, and validity in assessment and treatment/supervision - as well as for utilizing effective tools to document and address behavioral health / mental health needs.

Today Dr. Lacy will focus on "2 areas still posing problems for clinical practice and supervision" - areas which also require a "leap of faith" that what is being assessed is 'real.

It is his goal to develop 'a possible technological solution' for the purpose of

1) enhancing clinical care and supervision; and

2) supervision of psychotherapy.

In Lacy's view, applications need to be inobtrusive - in general - to support ecological validity and validity. Additionally, for clinical supervision and consultation activities, one needs at a minimum, 1) to securely store the data, and 2) a secure way to share it with a clinical therapy supervisor.

In the case of psychotherapy supervision, there are a few key points, particularly germane to home-based ABA-based therapies:

- Most therapy is not observed

- Competencies are not observed/documented

- Current video systems are cumbersome and expensive

THE SOLUTION:
Dr. Lacey went on to describe the system/package he has been developing at Behavior Imaging Solutions - a "proprietary 'out of the box' solution. Lacy went on to illustrate the types of hardware which might be involved in video capture (from iPhone and Flip videocams to dedicated videocams), the process of providing feedback (through secure/compliant means), and utilizing the end result. He used as an example a course of treatment drawing on Applied Behavioral Analysis (ABA), where assessment of the 'real' and accurate behaviors under treatment are so essential. (It is a treatment of choice for severe autism in particular.) With ABA, treatment is dependent on a clear analysis of actual behavior, in terms of understanding the 'ABC' dynamic: Antecedents of Behavior, Behavior itself, and Consequences.

ABC- behavior snapshot

The videocam and software Lacy described have proven to be effective tools for "behavior imaging", providing 'on-demand capture via remote control with the push of a button', time buffering capability, ability to tag and mark video, automatic uploading, and security/HIPAA compliance. The web-based component entails an interactive, browser-based interface allowing 'anywhere, anytime access' and facilitating a secure online consultation and records environment. One can upload, organize, tag, utilize secure messaging, and maintain custom folders. Once data has been collected there are easy interface modules for data review and annotation.

Dr. Lacy mentioned a 2009/2010 study by the US Air Force with results suggesting the value of online ABA supervision. An ongoing focus has been on supporting home-based ABA, and supporting also ABA Therapy Supervisors and families/tutors. He described a study which utilized Flip cams as a means of gathering behaviorial data, and displayed a diagram of how families, tutors and ABA supervisors can asynchronously interact via the Behavior Connect platform. He displayed a map demonstrating how 5 Certified (ABA) Therapy supervisors are serving 31 families nationwide at present. A survey was done among these 5 supervisors, and their ratings of the system were as follows:

Clinically Sound: 100%
Effective Delivery: 80% (~ 4 out of 5 in this small sample)
High Value: 100%
Easy to Use: 100%

In terms of supervision (as opposed to treatment), trainees and supervisors utilize the HIPAA compliant server for sharing web-based supervision records, using encrypted video, tagged events, and various permission and feedback forms.

Current users include: behavior health clinics, medical schools, universities, hospitals, school districts, state Depts. of Education, the US Dept. of Defense It is utilized presently in 5 countries, and 31 states. Dr. Lacy concluded by asking us to think about all the potential applications, from psychiatric residency programs to daily clinical practice. For example, perhaps a patient with OCD is too ashamed to talk at length about their hoarding behavior. Non-obtrusive recording of behavior around the home might be instructive and offer a more-informed basis for understanding behavior.

--

Dr. Carll recalled the power of a videotape being brought into a session, and the impact of seeing aggressive, negative behavior 'disappearing'. She thanked Dr. Lacy, and introduced the final panelist to present today, Dr. John Cabiria.



Jon Cabiria, Ph.D.
Augmented Reality: New Technologies for Immersive Approaches to Therapy


Dr. Jon Cabiria would round out the presentations today with a look at Augmented Reality: What it is (as opposed so some of the immersive virtual reality applications which have been discussed), how it can benefit psychologists and clients, and future directions for research.

Within the context of 'the interface of human experience and technology'- almost verbatim the prevailing functional definition of 'cyberpsychology'! -Augmented Reality has distinctive characteristics.



Augmented Reality


What is Augmented Reality?

As illustrated above, AR is seen as residing along a continuum of experience, ranging from fully 'real', immediate, non-manipulated experience to fully immersed virtual reality. In between one can find both 'augmented' reality, where a virtualized component is introduced, and 'augmented virtuality', where a predominantly virtual environment is augmented by (Real life) reality. Specifically


Augmented Reality


- is a process by which digital images are overlaid upon real world spaces

- combines real and virtual images into one 3D display

- lets people interact and manipulate these digital images as if they were in real space



In everyday experience, both on the web with big-screen viewing and on smart phone (and tab) devices as well,there are several good examples - one is onscreen now - of '3D-ish' city maps and tagged streetscapes. [Layar-augmented reality is getting a lot of attention - Layar is the cleverly-named mobile mapping-tagging browser/application for anyone who wants, needs, or doesn't want to know about that. It allows 'smart phones' to display tagged and photo-realistic maps for seemingly infinite purposes.


I am reminded of sites on the big screen (computer w/monitor, which many do prefer!) - tagging shared media, tagging a whole lot on social networks like Facebook, location tagging with Foursquare and foto-tagging on Flickr ... and that's only a few of the F's).

       Streetscape Screenshot


On the (big) screen above we are seeing Streetscapes. After several sessions I've been to covering virtual environments, on the screen here, I am immediately is: it's crisp and photographic, like only "real" video or digital or film media that I've been seen. It's the reality of some (recent?) moment, captured photographically in detail. Augmented, in this case by the tagging capability all over the streetscape, and the ability to productively tap into the tagged community's shared knowledge. Example, "You can filter by tag". Let's say you're downtown somewhere while you're traveling. You tap into the Streetscape and see the local neighborhoods. With tags all over the place. Filter/search say for 'coffee shops' in general, or 'coffee shops with wi-fi', and it will take you there. Virtually, of course, Via augmented reality with tons of marketing, user, and and technological assistance. :-)

Having seen this on the big screen there (and '
here'), I can tell you that not only is the view of the street really sharp, and the 3D-ishness nice too. But it really gave the feel of sitting in a cafe and looking out into the street through 2 panes of glass window. A lot going on out there. All tagged! (I find myself forever repeating, context is everything.) Moving on to....

---



The Virtual Conference Room

Moving from Augmented Reality now, one notch over towards the other end of the 4-point Mixed Reality spectrum into

Here we are shown a sort of CGI'ish, very realistic (and very lovely and well appointed) conference room. It's very realistic, but it's augmented virtuality.

Dr. Cabiria noted, as had Dr Rizzo earlier 'here', as had Dr. Wexler yesterday:

"It doesn't take much to fool the mind." He added that this can happen within a matter of seconds (the shifting of mindset into accepting what's seen as 'real').

Samples along the reality spectrum are onscreen again. Now we see...


Virtual History

He scrolls a plot of land over time... let's say, the Coliseum or Stonehenge or New Orleans and the image shifts. Time Machine. Augmented reality.



Virtual Anatomy


Here we see some amazing images. My immediate visceral reaction to one: 'A skeleton attached to a body!' But I was distracted by the red circle around the ribs. What it shows is a not-animated, real youth with a carve-out of his mid-section (virtually only!) so one can clearly see his drib structure. Another is again a real person's near-complete image with a computer-guided zoom-view of his lungs, in particular, merging the real rest of him with a slice of virtual. Augmented Reality. Imagine the medical implications.

.

Ending this virtual tour along the mixed-reality continuum, Dr. Cabiria shared onscreen some of the myriad choices in hardware out there these days. [Including Kinect. -g-]

Imagine if you can... an iPad screen full of digitalized, 3D cityscapes with gazillion of user provided tags etc. On the other tablet we see someone in beautiful snowy Central park holding up an AR view from exactly where she stands so holding up the screen looks like she's got in the lens of a camera. Maybe she does.

There are wide variety of goggles out there, some rather stylish, some customized for just one eye or for partial immersion/partial in vivo vision, or something like that. Gone from this collection are the clunky, sometimes very elaborate complete VR immersion goggles we see, for example, with the hospital-based pain management program described earlier. In addition to the goggles, a wide assortment of video cams where show onscreen.

Dr. Cabiria noted that in part, our readiness with all the hardware is "one of the reasons for the growing popularity... we already have the hardware."

Flash to a super closeup of a virtual eyeball with a the center of their eye consisting of what I'd describe as a greenish-tinted concentric test-pattern display. The latest cool contact lens? Not exactly (yet). It's a contact lens with a camera (so a computer and beyond can see exactly what you see). It's also a display screen so you can be driving your car on Mars - no, I mean - well, yes, one can be immersed I suppose in 2-way virtual visual eye contact and data. Great implications for research, but not for driving - yet.

Software


Cabiria was spot on, and I'm sure speaking for many technology adopting/adapting APA members, across generations and demographics, when he paused and noted: "When AR hits APA we know we've arrived." There definitely have been larger audiences and more informed comments and questions at this year's technology and Internet related events - for practitioners, students, educators and researchers.

Dr. Cabriria briefly mentioned QR codes (used to generate images - little pixelish-looking code boxes used in the implementation of markers and tagless markers...



Therapeutic Settings


Clearly of great interest to psychologists here today (and students/interns/others too), is the use of VR/VE in therapies. Most of have heard about the history of early VR-based treatments and the classic simple-phobia types (e.g., spiders) which were used in the first days applied behavioral health with augmentation &/or virtualization. Today we were shown the '2.0 version' in effect, awesomely realistic realtime views of the patient's outstretched arm (100% real, or real as can be with video). Suddenly on the hand: Spider! big and fuzzy... I suppose/hope this was at the highest level of exposure - thus a success story! Yes, VR treatment with phobias has a long strong evidence evidence base. [As Kate Cavanagh noted earlier, some virtual treatments are prescribed in the UK as the treatment of choice, based on efficacy data.


Implications

Cabiria presented some varied branches, or interest areas of psychology, and the implications of all this new technology across daily-life domains.

Social Psychology: His list of implications began with online identity management. This term comes from John Suler's classic Psychology of Cyberspace a decade + ago - before Facebook & Twitter although at the peak of some engaging online VR communities. Hot topics then: flaming, trolling, emoting behavior, etc. I wonder how much has changed but change is everywhere and diverse. I would call this area of research social cyberpsychology and I might imagine and hope for some cybersociologists out there a well.


Canabria mentioned some other 'classic' works which still provide great grist for social psychology research mill. Among them Prensky's (2001) treatise on 'Digital Natives', and still going back further in techno-virtual time, Toffler's 1970 'Future Shock'.

Cognitive Psychology :

Here we begin with "our perceptions of the world and people around us, and the meaning we give to these new relationships with people, objects, and sensations, which are a blend of real and virtual.

Attention:


When reality is augmented, what does it demand of our attention?
To me that is the heart of it. What are we attending to, for how long, using what resources, how effectively, with what tools?


Neuroscience:

Are we re-wiring our brains? (How? How fast? Adapting to what?) Which lead to a big implication of all this evolution/revolution with technology and Internet...

Evolutionary Psychology:

"How are our most primitive stimulus/response mechanisms responsive to ever-increasing modern advances that change the way we are programmed to relate to ourselves, each other and the world around us?"


But Dr. Cabiria left us with take-away: some links to explore as home work, to supplement this text-only report. (It's You Tube - fun, not real work at all to watch - Check out Hans Rosling, and Augmented City.

Here is Hans Rosling's 200 Countries, 200 Years, 4 Minutes - The Joy of Stats - Incredibly brilliant and educational - and an amazing demonstration of augmented reality:



And here now is a 3D clip.

The widely acclaimed Augmented City.

* Requires SIMPLE red/blue cellophane 3D glasses. See this great example of augmented reality here now if you'd like - cyber room service



Check it out, the bigger the screen the better. No goggles or immersion suit needed for the 3D clip - but you do need to use a simple old-fashioned 2-color set of 3 D glasses. I picked up some old cardboard 3-D glasses- one red one blue 'lens' - and watched this video. I would say it is 'impressive' and would add as my last editorial comment that we in the US have among the slowest (and narrowest) broadband on earth. In more Internet-developed countries there must surely be some additional and amazing uses of the technology we already have - but with great video streaming so that the connection is not obtrusive (op.cit Dr. Lacy's point)

Cabiria: "It's coming. It's here to stay."
And back to the present here and now...

Our session is up for today. :-)

Dr. Carll thanked the presenter, and reflected - referring to the busily tagged StreetScene - what amazing implications, clearly for marketing too. Walking down the street and an image pops up inviting you inside for a cold Perrier...

Yes the wave of technological advances and human adaptation continues. Finally now in the few remaining moments, questions? S Audience Q & A

Question: I'm really interested in the boundaries an ethics issues. Is there anything out there to simulate situations which may arise?

Answer (Rizzo): It may require a 'small leap', but people are working with licensing boards on developing some training tools. You can't really anticipate the provocative patient for example, or train for every possibility. In medicine, one can come up with sophisticated training tools, for example using 'standardized actors'. In part, who has the research contracts impacts the collective research: "a matter of funding"

Question: How could someone like me get access to technology?

Answer (Cabiria): One quick and easy way: Second Life. Although it is 'clunky'. There's a learning curve, true, but people do adapt. A study done in 2008 found examples of a gay/lesbian population reporting that they "felt more real in the virtual world and more inauthentic in the real world...once you get past the clunky interface there's a lot you can do.

Question: Is the software free? I'd like to create a virtual office where I can interview clients with an avatar.

Answer (Lacy): "Second Life is not secure - but it's cool. A bit cartoonish, fun to fly around...InWorld Solutions and others are designing modules and platforms for clinicians. Web-based services. Instead of buying the equipment, you can subscribe to the service. We're not there yet, but soon.

Answer/comment (Rizzo): Your biggest obstacle [trying to make a home-made virtual office] is wanting to author your own content. You can do that using existing platforms like Virtually Better and in World Solutions. Rizzo said development costs, from that perspective, are high right now, part of the problem at this point of time being 'just selling it'.

Comment (Lacy): Dr. Lacy agreed: some of the really robust and well researched programs, such as Virtually Better and Virtual Iraq, made it through design, research, development and deployment only because the team were well funded and could afford it.


And back to the present here and now...

Our session is up for today. :-)

So much has been presented these past few days by experts at the cutting edge of VR/VE applications, and now AR, AV - immersion and subtle, interactive and informational There is a great deal to process still. I've learned a lot thanks to these great presentations - hope you have too!


Next up for me: Online relationships and love...

--
 

Invited Address #3340 – Relationships in the Age of Web 3.0

Relationships 3.0

Gian C. Gonzaga, Ph.D

Dr. Gonzaga was introduced by Heather Patrick, Ph.D. (NIH). Dr. Gonzaga is the director of Research & Development for the online dating service, eHarmony, but will be addressing the nature of compatibility and sustained relationships in general. Considered an expert in the area of "relationship science", Dr. Gongaza will share with us some observations about "the changing face of relationships" and some of the findings which have emerged from his research into the dynamics and predictors of healthy, enduring relationships.

Dr. Gonzaga began with a disclaimer, namely his being "unconditionally biased" when it comes to eHarmony. He heads the laboratory research projects and believes in the findings of his and other studies. However, other than to describe his line of research into relationships, and provide some context, he assured us that this was not going to be a commercial pitch, and his talk today would be on "theoretical and scientific evidence" in support of his relationship research, as well as eHarmony's real-world (and laboratory) efficacy studies.

In the world of dating, especially...

"Technology is changing the way relationships are formed,"

Relationships don't just happen, nor do they last without some necessary ingredients. (As he avoids being a commercial, I'll now avoid referring to 'chemistry'.)

Dr. Gonzaga's research has led him to look not only at the matching process in terms of leading to an initial date, but at the elements of enduring and rewarding relationships: "the way they're maintained and the way they're improved."

To begin with, Gonzaga noted that 'Technology changes relationships' - it impacts on how relationships are (1) formed (2) maintained; and (3) researched.

In terms of where married couples first meet, a graph onscreen reveals an increasing trend upward, since 2008, towards meeting online (in general, along with another line showing the eHarmony numbers). Work and friends are big sources too, but like school, have trended down as online meetings trend up. Today there are all varieties of destinations and "platforms in technology" which allow applications to run. There is constant evolution.

A little web history

Web 1.0 - it was "driven around content that came from the top down"

Imagine: a guy goes into a music store and asks what they have. "Anything ever released." Once but a fantasy, along came iTunes. It happened.

Web 2.0 - Around 2003. "A big change. It was no longer top down. It's the era of Facebook. The era of YouTube." It leveled the field. It's 'open'. It's 'bottom up'. It's focused on relationships between individuals rather than delivering information.

Web 3.0 - Actually it is still forming, but has been evolving since 2000. "It's about open source and pliable interface. " It is both top down and bottom up. And it is a "web that learns". One of the best examples is Amazon.com. "It gives you recommendations based on your input." That, he said, is where eHarmony began, along with other user-tailored services, such as NetFlix.

From a relationship point of view, as a slide summarizes, Web 1.0 was all about information (e.g., Psych Info) while Web 2.0 allowed such things such as dating services offering "personalized introductions". And then there was Facebook, making it easy to make contacts and find friends. Web 3.0 allowed eHarmony to way to collaborate and to contribute to what he referred to as The Changing Landscape - in terms of the way one can form relationships, maintain a relationship, and also research relationships.

A little eHarmony History

Onscreen is the declaration: An Insight Started eHarmony: Many marriages face a significant handicap from the start.

Dr. Gonzaga explains: "A lot of marriages are to the wrong person!"

As it happens, his company founder was a clinical psychologist with 35 years experience of responding to patients' marital struggles. He saw the situation as one where he only came into the picture "after the relationship was ruined".

[There must be something real here! One of the world's most renowned social psychologists,
Martin Seligman also has spoken - here, 4 hours ago! - about marriage therapy being thankless and ineffective: too little too late. Of course, in contrast there are 'positive' and active relationship styles and Seligman encourages using strengths and channeling the positive; Dr. Gonzaga's goal is to try to proactively 'match' compatible couples based on strong evidence.]

There are many reasons, Dr. Gonzaga continued, that people end up with the wrong partner. There are fewer opportunities to find a partner, and to get to know a partner. And people get married too quickly, and for the wrong reasons. For example: "People sacrifice long-term compatibility for short-term attraction"

From this formed the original idea for trying to improve the odds of compatibility. And although this may sound like an advertisement - Gonzaga joked that he's aware we've all been bombarded with ads featuring idyllic and ecstatic couples who met through eHarmony - the research which supports the concepts about compatibility is applicable to all relationships, particularly meeting and dating of course.
The original idea was that there are predictable things that couples share - that when they have things in common there's a better chance of compatibility. Shared values, shared ideals.

Also, "we like to be right... If others share our views, we like them. The more similar, the easier to understand each other: One of the basic components of building intimacy." You're similar.

What is Compatibilty?

( We are now seeing the slide you can see above. )

The eHarmony model of compatibility assumes:

"There are shared characteristics that can make a relationship strong" - notably personality, values and interests.

Conducting research on initial compatibly and long-term relationship [marriage] success can get "a little tricky".
To begin with, "you need to let people get married to see how it works. And, at the beginning of marriage everyone is happy." Only with time do we see underlying stressors and compatibility issues placing a relationship at greater risk. Of course, even in a great long-term relationship, conflict is inevitable - but it gets worked out, even if it can take an hour before figuring wht the conflict is about. Sometimes, over the years, misunderstanding can grow...

Dr. Gonzaga presented several on screen references to frame the history of compatibility research. First came the empirical evidence that "similarity between relationship partners predicts relationship quality" (Gaunt, 2006, Russel & Wells, 1991). Next we can see how similarity "provides consensual validation of attitudes and beliefs which promote attraction." (Byrne, 1971; LaFrance & Ickes, 1981). Finally, "Similarity promotes better understanding and effective communication between partners "(Burleson & Denton, 1992; Keltner & Kring, 1998). And it "coordinates a couple's responses responses to the environment". (Hatfield, Cacioppo, & Rapson, 1994; Kemper, 1991).

The list of references continues, underscoring how enduring couples are "more similar than average" and how they may set about to elect similar partners ("assortative mating") . And how "couples may converge, or become more alike over time." (e.g., Anderson, Keltner, & John, 2003).

An important note, big and bold onscreen: No study has prospectively investigated assortative mating in psychological characteristics
Gonzago noted that he takes comfort in eHarmony's low [known] divorce rate (even if nobody can 'prove' the key to long-lasting love).

With that Dr. Gonzago presented three recent studies, on (1) Personality matching (2) Proximal Processes; and (3) the Potentiation Effect

Study #1

Prior to eHarmony, said Gonzago, nobody else had focused on personality characteristics.

Four hundred seventeen married couples who met via eHarmony.com and later married participated in this study. At the time of assessment, they'd been married an average of 32 months (range 26-56 months). Apologizing again and understanding we are seeing an awful lot of their 'deliriously happy couples' in advertisements these days, he noted that they now have helped bring together 40,000 couples.

To assess 'relationship satisfaction' eHarmony used what they found to be best, the Dyadic Assessment Scale (Spanier, 1976). Each couple completed the eHarmony relationship questionnare 3 times, assessing such things as Personality (e.g., warm, clever), Emotional tendencies (e.g., happy, anxious), and Interests (e.g., movies, shopping).

The results suggest that similarity can predict how satisfied one will be 3-4 years down the road.

[I do believe author Malcolm Gladwell has some thoughts on this as well, worth reading : Blink. It changed the conceptions of many psychologists! He cited research demonstrating that we can predict within only minutes whether couples are likely to be together years in the future.]

eHarmony has extensive data on match choices and their research affirms that "people tend to pick partners more similar to themselves." Do couples 'assort'? "We all tend to be alike" and may share a 'stereotyped personality". But again, what might predict long-term compatibility?

Gonzago has become convinced that "similarity is the lynch pin". Citing a study by Anderson, Keltner et al, 2003, he noted the adaptive function served by social interactions, and how for example "validation is best communicated directly... and how understanding is most relevant during discussions We know how our intensity during arguments is greater than in neutral discussions. What fuels this social interaction effect? Two possible reasons for this effect were identified:

* The Proximal Process: "Similarity in broad traits promotes similarity in interactive experience"

* Potentiation: "Similarity in broad traits enhances the positive effects of good relationship skills"


Study #2:
Similarity in Personality and Emotions in Married Couples (Gonzaga, Campos, & Bradbury, 2007)


Now we look at one of the venerable topics within personality theory: traits. We know from mountains of research that traits influence emotion and that variations can be seen between different groups, for example extroverts being more prone to exhibit positive affect.

This second study involved 172 married couples. The question was: Are couples similar in personality? In emotional experience? What they found is that "personalities were more alike than was their emotional similarity. Yet there were some qualitative aspects too, and the question was raised as to whether emotional similarity may be a 'mediating factor' in a triangle, between personality similarity and relationship satisfaction. Overall it was found that "relationship satisfaction is positively related to similarity".


The Proximal Process Model

Similarity in broad traits predicts similarity in emotional quality in the moment


Study #3:
Social Interactions and Relationship Functioning in Married Couples (Setrakian & Gonzaga, in prep)


According to the Potentiation Model, relationships move from early connection through shared personality and interest factors - similarity - to an emotional connection which is mutually pleasurable, and then... how do shared social interactions grow into building blocks for lasting relationships?


Potentiation Model:

Similarity in broad traits predicts similarity in emotions


Increased understanding should enhance the effect of good social skills


Here we approach the foundation-building for healthy and happy long-term relationships. How to harness the shared personality/temperament factors and use our emotional and social skills to maintain the relationship:

Two hundred married couples, first marriage no children, wife under age 35, minimum 10th grade education, greater L.A. area.

Time's almost up, and these methods are hard to explain quickly (and now!) but...

Couples have a discussion under one of two conditions, social support vs. capitalization - experienced respectively as either supportive (Partner provided comfort) or using "Capitalization" (partner responded enthusiasticallly towards my good event - again exactly as Seligman just described - as the 'active/supportive' communication.)

This was a controlled laboratory study, though it was pointed out that "Lab ideas don't always work in the field".
Their results were analyzed through the filter of whether similarity, which we know to be a big factor, can moderate the perceived 'responsiveness effect' - that is the impact of capitalization, conflict resolution, and support elicitation. Their findings were described as 'robust though with mixed results in mediating the main factor, similarity.

CONCLUSIONS:

"Similarity", Gonzaga said, "doesn't make you a better partner. On the other hand, does it moderate attitudes? Yes. In males."

We know that Responsiveness matters in social interactions, that Similarity does not predict improved responsiveness, and that Similarity moderates the effect of responsiveness in males (but not females)."

In sum:

*Similarity is a powerful predictor of relationship success

* There are two potential routes: proximal process and potentiation

* Social interactions are critical in how similarity effects relationships

* Relationships deepen through increased understanding

* Partner selection is important because convergence is minimal.

And one more thing - oops, time is up! - Quickly then: Use the web as a tool!

-- Technology provided a platform for the application of basic research, BUT
-- The ideas that work in the laboratory don't always work in the field
-- The type of system he promotes is 1) Robust 2) Scalable 3) Palatable

Finally: "Technology can help facilitate a new era of research"

No doubt!

For me, anyway the 'takeaway' is: Similarity is a key factor in easy 'understanding' and resonating/reflecting similar feeling [tone], and revving up pleasure with shared activities and interests. Basic personality compatibility is the starting point, a foundation. Proximal process is about our personality 'similarity' basically, how alike we are and how we can use our collective attitudes and attributes to enjoy situations when together. Once a relationship is growing more intimate, the Potentiation Process begins.

It's no longer just about personalities matching on 'broad traits' at first, but also how they potentiate - bring out - the mutual joy. (or not) With broad similarity and shared world views, it is easier to 'be yourself' because you're feeling understood and veering towards that state of thinking in terms of 'we' very easily, as there is ongoing connection at several levels, emotionally. That's the perfect scenario. A well-functioning, happy couple is similar in personality and mutually reinforce the good feelings of emotional and personal connectedness, across situations. And that is my synopsis and take-away. YMMV. ['your mileage may vary']

I'll bet you weren't expecting to hear terms like proximal and potentiation in a talk about relationships and Love! But this may be the real thing. The new language of love. The pherenome of explanations as to why we initially attract, connect, and maintain healthy relationships.

       ....

 
Invited Address # 3378
Larry D. Rosen, Ph.D.
POKE ME: How Social Networks Can Both Help and Harm our Kids


Things unknown - pre Y2K


I posted about this earlier. This is the presentation all about how the web is utilized by different generations: preferences, time allocation, etc. Lots of research citations as well as some fun facts. This is really fascinating to me: See the
FULL REPORT HERE

APA CONVENTION REPORT #4

August 7, 2011 – Sunday
Washington, D.C.

Still to come on Sunday: Dr. Frank Farley, with graduate psych students Heather Jennings and Tamara Smith-Dyer, discussing the future of psychological science. Following this a distinguished interdisciplinary panel will be here to address a topic about which many mental health professionals have a lack of clarity: Telepsychology licensing issues – barriers, possible solutions, and the state of the healthcare legal/regulatory system at this point in time. An important topic by a savvy panel. If anyone knows the current state of the licensing/reciprocity quagmire, they do. First up today:
 

CONVERSATION HOUR #4035 – Examining Psychological Science – Some Inconvenient Truths in the New Monastic Order

       Drs. VK Kumar and Frank Farley - APA 2011Tamara Smith-Dyer and Heather Jennings - APA 2011
V.K. Kumar, Ph.D.[Chair], Frank Farley, Ph.D., Tamara Smith-Dyer, M.S., & Heather Jennings, M.A.


Dr. V.K. Kumar introduced the panel, and the first to present was Dr. Frank Farley.

Dr. Frank Farley is a past-President of APA and quite a number of its Divisions. He is well-known for his interest and activity in the Media Division, has been part of countless historic conversations with greats in the fields of clinical and social psychology (several appearing “here”), and recently an outspoken advocate for heroism. Today he has assembled a panel to address the pithy question of how to keep psychology aligned with science and rigorous research standards for the benefit of both media and the general public.

JPSP - Journal of Personality and Social Psychology - is the #1, most cited Psychology journal. APS' Psychological Science is “the most widely dispersed” among the media, internationally, frequently used as source material by Newsweek for example (with Newsweek now being owned by the Daily Beast). Looking at the trends in demographics and the journal articles being produced, Farley ends up with “some very serious concerns”. He does quite a lot of media appearance (CNN, etc.) and interviews of all stripes, often representing established psychology.

What has caught Farley's attention, as he observes how his input is sought and channeled, is that a lot of the demand for psychology perspective is in relationship to stories being aired "for shock value". He sees that it is mostly the 2 journals which are most cited by the public and the media.

Two years ago Farley studied big media distributors of news-based stories – a wide swath including CNN, New York Times, and John Stewart. He analyzed what they said in their stories and tracked down the sources. It was “shocking”. He found that the source of headline-grabbing psychology stories were often obscure single studies, or surveys.. It seemed “almost monastic” and we who are presented in one chunk to the general public, via big media - we are living in the monastery.

Farley himself has quite a bit of history with surveys, and is known for his research on risk-taking (and 'Type T' - thrill seeking - personality). He recalled giving a survey to a group and asking them, 'would you like to drive in the Indy 500?' Nearly all the male students replied yes. Can this be generalized to a news story highlight how 'everyone' would like to race? What about women? This finding is a good example of how a story may be lured by the 'OG Effect' - over generalizing. It is endemic.

Up onscreen goes a long list The Sample 'Convenience samples are everywhere.' A good example is using a college class as subjects. This is akin to what Farley calls the 7-11 Sample, reflecting the convenience store approach - and producing "knowledge of convenience.

We need to leave the monastery! Speaking of which, Farley recalled the old parable of monks arguing over how many teeth a horse has. For hundreds of years this was a debate! Suddenly the idea emerged: Why don't we go and count them?

A long list of threats to meaningful research went up on the screen. Here are some of them, in case my notes or the presentation doesn't get to a specific or favorite research topic:

-- The sample: 711 and knowledge of convenience
-- The balance of validity - internal, external
-- Generalizability
-- Replication and Replicability
-- The 'decline effect'
-- Fishing for Fisher's magic numbers
-- The 'file-drawer effect'
-- Confirmation bias

-- Less than peeress peer review
-- The measures, the assessments
-- The settings, the simulations
-- The brain, the hothouse, the correlation, and the Manic Rush to Inference (MRI)
-- Reductionism Redux and the Great Causal Confusion
-- Science Citation Index vs Citizen Citation Index
-- Psychological science - famous but ineffectual?
-- The scale of influence - societal or individual?

Having addressed sampling and validity, the next key issue is that of generalizability.

Aside from the OG effect (over-generalization) there is also the question of whether a study is replicable. Farley's study involved the 2 most-read psychology journals. First, in terms of replications, he notes that in Psychological Science there are no replication studies, as "everything is new. We want new." In general, "we don't replicate much" and this can have grave consequences. For example, Stanford University researcher
John Ioannidis posits that 90% of medical studies are wrong - or significantly exaggerated. We find that "if something is replicated, it often contradicts the original study but gets no attention." Farley questioned APA journal publishers about replication and was told 'we don't replicate much'. Would they be interested in "direct replications" of important studies? "Probably not." On screen is a small graph showing the 'decline effect', with a curve plotting evidence and it's saliency erosion over time.

Other issues: Fishing for Fisher's Magic Numbers... author created materials, lab vs. real-world setting, sufficient data to support replication, and...

The file-drawer effect - "All that research that gets done and sits in a file drawer. Some great finding comes along, and it causes a buzz, and replications - and they never see the light of day.... Journals want to be at the cutting edge and the problem is: it can cut both ways."

There is the additional issue of how to view huge studies, like Glass' metanalysis, which "include every study" but overlook all those studies in the file drawers. There can be what Hans Eysenck called 'meta-silliness' as well.

Then there is confirmation studies - 'confirming your own beliefs', basically. Related, one can also find 'selective reporting'.

Does quality always prevail? Not necessarily. Addressing sometimes 'less than peerless peer review' it seems that name recognition and other factors enter into what gets published as well. One study took some already-published journal articles, ostensibly 'fit for publication' and submitted them to Psychological Review with different author names attached to the articles. Some were rightly discovered as having been already published; others were simply rejected. Were they not seen as (still) valid? "Without validity, what have you got?"

The brain, the hothouse, the correlation, and the Manic Rush to Inference (MRI)

Apropos this clever mnemonic, "Everyone's now rushing to the brain", observed Farley. "Now all of human behavior can be found in the tiny amygdala." There may be nothing wrong with a study's data or design, but if the take-away message fits the story need, out comes a 'been there, done that' story, and the press picks it up and puts it out all over the place - the 'origins of love', say. This rush to inference is "reductionism redux... the great causal confusion."

Nobel prize winning physicist Niels Bohr was quoted here: "Every sentence I utter must be understood not as an affirmation, but as a question." [He too was skeptical of flashy but invalid research: 'Your theory is crazy, but it's not crazy enough to be true.']

Which brings us to:

Complexity, simplicity, & Lord Rutherford's Dictum : "If you can't explain it to your local bartender, it has no chance of being true." Keep it simple.

And there is the issue of a Science Citation Index vs. Citizen Citation Index. What is the citizenry learning? Is a study only 'inward-looking... from inside the monastery?

Finally what can we make of how psychological science can become famous - but ineffectual? Divorce rates don't go down. Incarceration rate are way up? Towards what end does the research go?


Tamara Smith-Dyer

Smith-Dyer described a study in which 231 studies in an APS journal were reviewed. The study resonated with many of the points which had been mentioned earlier in terms of sampling and methods - and highlighted in particular the extent to which participant characterized (or not) in article abstracts. The 'big picture', as summarized on screen:

Participant Characteristics

Negative Findings

Positive Findings

Study Materials Used


With respect to the materials/instruments used in studies, it was found that instrument reliability coefficients were reported in only 22% (of 51) studies, and validity data reported only 8% of the time (N=18). Finally, description of special settings or equipment were rarely reported. Smith-Dyer noted also that random assignment is reported less than 50% of the time where such a technique would be appropriate.

Heather Jennings, M.A. was the last presenter, and she described a similar study which looked this time at the Journal of Personality and Social Psychology, the most widely cited of psychology journals within the public domain. The results basically paralleled those found with the APS journal. What they found was "a bit more description in the abstracts but still a high convenience sample." The studies which were published generally provided better reliability and validity sampling. And a final interesting observation: Ninety-three percent (93%) of studies reported in this journal were done in a laboratory setting. Zero were done in real-world settings.

Time was rapidly expiring but the panel responded to a few questions and comments:


Question/Comment: Why is it being done this way? And... what are the alternatives? Also context is important: A journal on aging, for example, is not likely to publish studies using college students...

Response (Dr. Farley): "The concern driving this project is the media - what the public is learning."

"Are we too narrowly focused? OK, we could call it the Journal of College Student Research!" We are getting a distorted view. We can hear about a big new study in the news and run it down, and find it's based entirely on 47 college students.

Are we truly 'giving psychology away'? With what is actually being reported out, "As Greg Kimble would say, 'maybe we should take some of it back'! "

And now...it's time to dash off across this huge center, to my last event of this year's convention.
 

Symposium #4105:
Telehealth and Telepsychology Licensure – Barriers and Possible Solutions as Psychology Adopts the Psychotechnologies




Marlene Maheu - APA 2011Licensure Panel - APA 2011

Drs.Marlene Maheu, Stephen DeMers, Dena Puskin, Joseph McMenamin, & Patrick DeLeon


Here now, it's Sunday morning and nearing the end of this year’s APA convention. Over the last few days - happily for me and others who made a point of tuning into technology, psychology, and 21st Century experience - we have witnessed this year, the beginning of the 2nd decade of the century and millennium, far greater and broader interest in areas of 'tele-psychology', technology-assisted consultative activities, and a wide rage of Internet/computer facilitated activities. More research. More access. More applications. All good. But questions remain: In terms of professional practice, is it appropriate and legal to offer regulated professional services across state lines, or 'on the Internet'? Under what circumstances? Why or why not? What are the risks - and benefits? Who wins or loses in terms of 'access'?

The various professional and ethical codes endeavor to promote 'best practice' and protect the public. That said, we live amid a tsunami of changes in everyday life experience: new research, new technologies, new applications and new needs. One can now seamlessly transcend borders of all sorts as we find - and offer - all kinds of services and products. Some practitioners see this as a godsend, others are wary of 'doing something illegal' or jeopardizing one's license or insurance, or worse. Many out there simply just 'do their thing', with and without licenses, no worries. That's the broad context.

With all the ambiguity and mixed messages about the presence or absence of license portability, legality of cross-state professional practice on the Internet, ethics and insurance issues, and the still-ongoing debate over “where Internet consultation actually takes place”, here we have the ultimate panel of experts to provide some grounded, evidence-based information.

The panel today includes government and licensing board leaders, a physician/attorney specializing in litigating professional/licensing/ethics cases, an online psychology provider/trainer, and an APA Past President- who is an attorney/psychologist who also works on staff for a U.S. Senator with a strong record in the healthcare area. They offer an informed perspective, to say the least.

Introducing the panel: Marlene Maheu, Ph. D. (chair)


The first speaker is Stephen DeMers,Ed.D., Executive Officer of the Association of State and Provincial Psychology Boards, the ASPPB, which is now celebrating its 50th year. The title alone hints at the complexity of the whole 'system' of licensing, in the US essentially a '50-state octopus' [my term] with 50 sets of law and regulation, local and regional professional boards, and myriad ethical codes. Here to sort some of it out we have a distinguished panel of experts.

Stephen T. DeMers, Ed.D.
TelePsychology Practice Within A Regulatory Minefield: Outdated, Inconsistent and Inadequate Rules Across States & Provinces


So what is the ASPPB? It is NOT a license board itself. Rather, it supports member boards throughout the US and Canada, and it supports the EPP (nationally accepted test of core competencies).

A brief history of psychology licensure:

-- In 1888 the US Supreme Court authorized professional licensing by States.

-- In 1892 the American Psychological Association was founded

-- In 1912 All U.S, States had Medical Practice Acts

-- In 1945 the first Licensing Law for psychologists was adopted.

-- In 1953 the APA adopted its First Ethics Code

-- In 1961: The Association of State & Provincial Psychology Boards is born.

-- By 1977 all 50 States had Licensing Laws.


Now, some key points about professional licensing in the U.S.:


Basic Facts About Licensure

* Professions are regulated by the States

* There is no 'national' License


* Most laws have transitioned from title to practice acts

"You can NOT do the things described as being within the purview of a profession."
- unless you are licensed to practice that profession.


If someone says they are a “life coach” but is providing psychological services,
they are practicing psychology, "whether they call themselves a psychologist or not."


"LICENSING LAWS ARE DESIGNED TO PROTECT THE PUBLIC, NOT THE PROFESSION"




Clearly the idea of public protection is widely shared and understood. But it is equally true that many aspects of the license system scheme, as it is now, may not be responsive in today's world, to needs of practitioners willing to provide (in new ways) nor to people seeking help (in new ways). When can one help? When must one not?

Outdated aspects of Licensing Law

The laws:

-- Assume licensees only provide services within boundaries of jurisdiction

-- Assume provider and client only interact within jurisdiction

-- Assume provider establishes a professional relationship with client including identity of all parties, treatment/service plan, fees, limits, etc.

-- Assume licensee practicing in another jurisdiction will obtain license in that jurisdiction

-- Assume licensing board has authority only over providers licensed in that jurisdiction providing services to clients in that jurisdiction

One question Dr. DeMers said he is often asked: 'How many days', or 'how long' can one can practice somewhere without a license?

Answer: It varies.

Inconsistent Aspects of Licensing Laws:

* Many, but not all licensing laws allow temporary practice by persons not licensed in that jurisdiction

* Rules for temporary practice vary

* Number of days varies from 0 to unlimited with 30 days most common

* Notification/registration with board varies from advanced authorization for specific service to no notice required

* Scope of practice allowed under temporary authority varies from consultative or forensic work to full range of psychological services

Next:

Inadequate Aspects of Licensing Law

* No clear understanding of which licensing board has jurisdiction to adjudicate complaints

* Home jurisdiction often constrained because services provided outside their boundaries

* "Visited" jurisdiction may feel responsible for consumer but may have little to no authority to discipline someone licensed in another jurisdiction

* Most licensing laws do not describe limitations, parameters, or special requirements for delivery of competent/ethical telepsychology services

So now,

"What's a Psychologist Interested in New & Expanding Models of Practice To Do?"

Option A. Simply ignore the laws since they are out of date.

Option B. Skirt laws by flying "under the radar"

Option C. Challenge the laws by flaunting unlicensed practice

Option D. Support Efforts to Update & Improve Telepsychology Provisions in Licensing Law.

And what options are there for licensing boards?


Unrealistic or Ineffective Approaches

-- Get licensed in any jurisdiction where you provide services. In DeMers' opinion, it may be an 'unrealistic' approach to tell practitioners to go out and get licensed everywhere they practice, and an unacceptable burden.

-- Practice in all jurisdictions based on your "home" license; this would be unacceptable to licensing boards and state legislators

-- Adopt a "national" psychology license.

One step toward portability may be the CPQ - the ASPPB's 'Certificate of Professional Qualifications', considered a tool for 'licensure mobility' as it may help facilitate reciprocity or acquiring a new state license. The IPC (Interjurisdictional Practice Certificate) was launched "to standardize temporary practice". ASPPB created a 'credentials bank' and is currently working with jurisdictions on Universal Application. Finally ASPPB is participating in a joint APA/ASPPB/APAIT Task Force on Telepsychology Guidelines. Their vision for the future clearly seems to embrace the need for improvement and change.

Finally, the question: "What Can I Do Now?!"

Suggestions:

1. Learn about the variations in rules and regulations across the various states related to temporary practice (there is some flexibility to practice temporarily right now)

2. Obtain nationally recognized credentials that promote mobility to facilitate relicensure & enhance recognition as a competent/ethical practitioner.

For a look at specific licensure requirements by state/province/territory, licensing board contact information, and a look at any of the forms or credentials referenced above , the link to the ASPPB website, described as 'one stop shopping' - for (free) information on licensing issues and tools:

www.asppb.net

____________


Next to present, introduced by Dr. Maheu as a longtime 'advocate for tele-health': Dr. Dena Puskin, from the US Department of Health and Human Services, Health Resources and Services Administration (HRSA).


Dena S. Puskin, Sc.D.
Nursing and Medical Licensure Initiatives: Implications for Psychologists


First Dr. Puskin reminded the audience, after the focused presentation on U.S. psychology boards, that another organization also has a stake in our state licensing board system, in this case medicine. Their licensing boards are supported collectively by the Federation of State Medical Boards.

Dr. Puskin is mindful of a diversity of arguments across a spectrum of interests from both medicine and psychology, and will presenting here now some of the findings and recommendations made by HRSA in the document titled,
Health Licensing Board Report to Congress . [.pdf file - opens in separate window] ,

License Portability - History

First, to provide some context, Dr. Puskin provided a brief history of Congressional action in support of 'portability' as a means of increasing access to care. Milestones include:

* Health Care Safety Net Amendments of 2002, PL 107-251, Section 102

* 2006: Appropriation to implement Section 102 - authorization of the   Licensure Portability Grant Program (LPGP)

* LPGP announces 3-year grant awards

* Federation of State Medical Boards (FSMB) and National Council of State Boards of Nursing (NCSBN) are the first grantees

* FSMB received a second LPGP award in 2009 and a third grant in March 2010 under the American Recovery and Reinvestment Act of 2009 [PL111-5-ARRA] to expand their program

* The Wisconsin Department of Regulation and Licensing also received funding under ARRA


License Portability - Definition

What is License Portabilty?

A system that extends the privilege to practice a health profession in multiple states through agreements that recognize individual state and territorial jurisdiction while facilitating a process for obtaining and maintaining licenses in multiple jurisdictions.

What emerged from the two LPGP grant recipients, however, are two different models.

There is the “nurse model” we’ve heard about and emulated for a number of years (as psychologists, and with endorsement by the APA). And there is a second model, very different.

The first is a Mutual Recognition Model - the NCSBN Model.

The Nurse Model is based on an interstate contract. They are licensed in their home state with a licensure privilege to practice in other “compact” states which are remote to them and 'subject to the remote states' practice laws and discipline'. Compact states continue to 'operate single licensure models.

There are currently 24 Nurse Licensure Compact (NLC) States which participate. The thing is, "it’s very hard to implement." Only the home state can take “direct action” in license complaints but remote states can issue “cease and desist” orders and/or pursue home-state license revocation.

"Disciplinary action can be taken by both the home state or the state where the patient is located at the time of an adverse incident [remote state]."

Benefits: Access! And it helps states with enforcement. It clarifies authority to practice across state lines, "simplifies and streamlines the burden of obtaining multiple licenses, thereby enhancing mobility of nurse workforce, improves access to nursing services, enhances ability of licensed nurses to respond to disasters or change in demand for services, and enhances ability of Compact states to exchange the most current and accurate investigatory information, facilitating appropriate disciplinary actions."

Challenges/Barriers: Control. Loss of authority. Cost of Implementation/Loss of Revenue. Plus union concerns about potential “strike breaking” (despite no evidence of this.)

The second model is about "Expedited License Endorsement and Administrative Simplification: the FSMB Model."

The Physician’s Model was put forth to meet different needs and priorities, perhaps, and was very extensively promoted. (As some context: aside from differences in practice considerations it is an axiom that 'Nurses do not have the financial clout of the medical profession'.) In any case, it's a different model. A look at a map with incidence of multiple-state licensure for physicians is quite compelling, with numbers ranging from the 20s to 70s, percentage-wise in terms of multi-licensure. The ease of obtaining the actual licensure (as opposed to portability) appears to be a goal which was fulfilled.

Some of the highlights of the 'Physician's Model' include Uniform Online Application (UA), a centralized credentialing system (FCVS), and - importantly - 'expedited endorsement': "a method of setting criteria to approve a valid license of another state. In general, the process accepts a license issued in another state that was verified and sets requirements for endorsing a license granted from another state".

What is the Uniform Application (UA)?

At its core, the UA "Captures basic questions of a state's license application":

-- Licensure History

-- Identification Data

-- Possible Malpractice Claims

-- Work Experience

-- Medical and Graduate Medical Education

The Federal Credential Verification Service (FCVS) is designed to provide 'primary-source verification' of personal, educational, and professional credentials. It is currently accepted by 63 of the 69 state medical and osteopathic boards. The FSMB has created a new credentialing verification, with a 'fast track' feature launched in February 2011, expediting licensure for both the applicant and the Board.

Challenges/Barriers to FSMB Initiatives:

* Cultural and historic lack of comfort in accepting the licensure process of another state;
* Lack of uniformity in criteria for awarding licenses; e.g., criminal background checks;
* Additional administrative costs associated with traditional out-of-state physicians;
* Lack of uniformity in state confidentiality laws.
* Cost of Implementation of UA/FCVS
* Lack of authority to control own budget or innovate - umbrella boards;
* Lack of human and economic resources to implement technological advances due to current substantial reductions in state budgets.


And finally, the status of the Licensure Portability Grant Program:

- The program is administered by the Office for the Advancement of Telehealth, Health Resources and Services Administration

- A new competition is anticipated for FY 2012 - subject to Congressional appropriation

- The competition will be open to all relevant disciplines

- The Announcement for grant competition is expected in Fall/Early Winter, 2011-12


Finally: An announcement of the availability of funds will be available on the HRSA website:


http://www.hrsa.gov



Marlene M. Maheu, Ph.D.
Telehealth Licensure for Practice via Internet and Smartphone: The Case for Telepsychology Education


Dr. Maheu, herself a pioneering advocate for tele-mentalhealth (especially video based) treatments, presented an overview and snapshot of Telehealth/Mental Health history, and held up as a worthy goal "a free VTC platform that is as secure and reliable as the systems funded by NIH and NIMH", after 50 years and millions of dollars spent in R & D. And... "what if that system could be as reliable as the large institutions such as the VA and the military, where they have admittance, nurses, and full IT staff to support each call? "

The answer is: we do have effective systems.

[Apropos: At yesterday's panel on
technology & psychology , Military/medical expert Timothy Lacy discussed hardware & software 'out of the box' solutions for data-collection and supervision/consultation activities, while Jon Canabria presented a tour of new software and hardware.]

Dr. Maheu has observed the progress of telehealth, and been a staunch advocate since 1995. She now promotes 'best practice' online, as director of the TelementalHealth Institute, which provides training and consultation in the practical and legal/ethical issues surrounding telehealth services. .

Beyond the basics many of us are familiar with - secure video/text/data feeds, the need for HIPAA compliant hardware and software which address privacy, security, record-keeping requirements, etc. - there continue to be revolutions in technology and lifestyle, and ever-increasing interest in finding or providing quality, qualified professional services - particularly online. Online or off, both healthcare professionals and their clients are more mobile and interconnected than at any time before.

We are Re-tooling...

With onscreen images of a physician doing rounds, device in hand, Dr. Maheu noted that "everything that we do today is changing due to technology". If we choose, we can stay in the office, "but clients may demand we're available via technology". Apart from the idea of 'therapy' on tiny screens [in public?] there are many applications already suitable and in use. Now a screen shot of the Galaxy Samsung - "a small tablet that fits in the lab coat, for the ER doc." It's a big time-saver. You can call in specialty docs immediately... "So what are we doing?" (as practicing psychologists)?

A quick look at Google hits for things like 'counseling' - online - gives testimony to the popularity and acceptance. And it's already abundantly clear to anyone in a populated area the extent to which people are constantly attached to their 'smart' devices.

Here we are shown a great cartoon of a man (picture this!): smart-phone in one hand, smiling, and with a 3rd hand appended to his head between his eyes. The caption has him matter-of factly explaining to another man: "I decided to have the surgery because I need the extra thumb for text messaging."

[Does this not ring true?]

Meanwhile, on our end, as current, professional and ethical service providers, Maheu asked: "Are we really doing what we need to be doing?... How many here have trained in email therapy?" [One hand]

A slide asks, 'What's the Problem?'

Well, to begin with there are the legal/regulatory/ethical uncertainties. There is 'no sheriff in town'.

Yes it's true there is "tons of data supporting efficacy, but studies typically are within hospital settings, not with individual private practitioners."

Some of the factors confronting independent rather than institutional care providers:

* No IT Staff, Nurses, Admins

* No time for it all

* Consumer Naiveté

* Consumer Deception

* Loss of Trust

* Malpractice Limitations

A long list of 'Telemental Health Guidelines & Standards' is displayed, going back to 1998 and using terms such as 'Telepsychiatry', 'Internet On-line Counseling,' 'Patient-Physician Electronic Mail', 'Technology and Social Work Practice', 'Telepsychology', 'Telemedicine', and (my favorite), "psychologists providing psychological services via electronic media" - from the Canadian Psychological Association (2009).

The APA is working on new policies, but it is expected to take another 2 years for them to be published and implemented. And there is the Australian ethical code, which may serve as a good example. Also, we as a profession, Dr. Maheu emphasizes, "are not a one-trick pony". There are many ways in which we can evolve and modernize, including coming up with new and effective self-help tools.

[Agreed! A presentation on
Computerized CBT demo'd new, & effective, evidence-based self-help and guided self-help programs, including one for depression co-written by Aaron T. Beck. Within the U.K. system, CCBT is not only allowed but prescribed as a treatment of choice!]

There are many ways in which psychologists work creatively with technology. Maheu for example partners with organizations to implement a smoking-cessation program. The program involves meeting first face-to-face and then implementing remote services. Remote, but still within the state. Maheu reflects: "It is possible to practice legally now, without violating ethics... How many out-of-state clients do we need?"

And on that note, the final presenter is introduced: Dr. Joseph McMenamin. He is a former internist/ER doc who turned from there to law, was admitted to the Virginia bar, and is now specializing in litigation, risk management, and telehealth liability law.


Joseph McMenamin, JD, MD
Mobile Health: Legal Issues for Mental Health Practice


Dr. McMenamin began with his perspective and advice: "It is important for practitioners to be aware of how members of licensing boards see themselves. They see themselves as the police. Their goal is to protect the public. "

True, "we can debate how much 'protection' the public wants or needs." There is also an underlying factor he terms The Online Pharmacy Phenomenon. It is easy to get Viagra, opiods, whatever, without any one entity claiming regulatory authority to control it.

While most psychology boards tend to be conservative, Dr. McMenamin suggests becoming familiar with one's own state's definitions . Often regulations include language where the definitions are "broad...by design". Then look at how, say 'coaching' may "come under the banner" or a profession's scope of practice.

And there's another factor: protectionism. He told a story of being (as someone 'not easily shocked') recently taken aback by a specialist colleague's 'tirade'. Speaking of territorial or protectionist considerations, this gets us into an interesting area, at least for the legal profession: 'sovereignty of the states'. We (the people) "gave power to States to avoid omnipotence of the Federal Government and its ability to tyrannize people.

Finally, "[Dr. Maheu's] point is well taken - the need to be everywhere may be overstated. Although - for example with emergencies - there needs to be some slack."

Seeming to me (still) very much a balancing act of public safety, best/ethical practice, risk management and compliance...

And now to a few reactions and thoughts from the panel's distinguished designated discussant, former APA President, psychologist, attorney, and US Senate staffer...


Patrick H. DeLeon, PhD, JD

Dr. DeLeon began by saying 'Aloha!' and then thanking the panel, saying he liked the format, including the discussion with Q & A at the end.

A few points:

DeLeon said he knows from his experience in the Senate what states can do. "Change does come - eventually."

DeLeon restated and expanded on what had been said before:

" The purpose of licensure is to protect the public. It is not to protect your practice or ward off competition. "

Given this backdrop, DeLeon recalled a time when a high failure rate on a dentistry exam sparked concern - especially as the failure was among certain groups only. Change happened - once the courts got involved. Here was an instance of the licensing body itself being reminded of the purpose - protecting citizens, not choosing who gets to be licensed for any other purpose.

Dr. DeLeon next recalled a meeting in 2000, when he was APA President. He was down South "arguing for license reciprocity" but he was faced with "passionate argument;" - This is my domain, my turf, my friends...

Does the Federal Government have the power to impact harmful licensing provisions within a state?
"Where commerce is involved... we can override states at the drop of the hat". Meaning, there are consequences when states ignore Federal regulations. Want Highway Funds? Implement speed limits. Want aviation rights? No smoking in the plane.... [Note: Dr. De Leon retired from his Senate position in 2010.]

Some thoughts on the future:

DeLeon envisions the Supreme Court getting a healthcare case and ruling that States have rights to implement their own health systems.

Court decisions can cut both ways, in terms of providers. It is not so many years ago, in the case of psychologists, that only MD's were empowered testify as experts in mental health. That has changed, while other anachronisms remain. DeLeon reflected on a few elements in play:

       * "Every health professions has core disciplines, national exams, and shared skill areas."

       *  Under Medicaid, who can be a medical director of a hospital? Physicians and dentists.

       *  Note to psychologists (as a psychologist/lawyer) : "Lawyers think that way: 'Give me a problem and I'll fix it.'"

       * "Change takes time".

As times change, so do concepts, institutions, and terms. Remember 'HMO's'? (under Reagan). Quiet change happens, sometimes in dramatic ways: SAMSHA, for example is now talking about extending services (substance/alcohol treatment) to native Americans. And the next Surgeon General of the Army? The first female. A nurse. Now that will be a revolution in healthcare delivery.

"Years ago we would drive to watch someone's TV! Not like
Rosen's picture - texting, and iPads.... The big question was: Whose TV do we watch and what kind of hot dog should we get!"

With that, Dr. Maheu opened up the panel for a brief Q &A with the audience.

Comment: " This is the most distinguished panel on telehealth licensing I've ever seen."

Question: Where does one go to access individual state regulations?

Answer: Go to the
ASPPB Website and on the left [Quick links] choose Specific Licensure Requirements by State/Province/Territory (Handbook) To get it you need to fill in a short form - in the blank field enter 'provision of telehealth'. [Dr. McMenamin agreed that this site is 'the best first-place to look'].

Two other general references were recommended:

Center for Telehealth & e-Health Law

practicecentral.org

And now a note to those who may be contemplating practicing something, somewhere, without a license: New Hampshire and Kansas have omnibus licensing boards, and the other states have dedicated boards.

Question: Should you be doing consultation online? Psychologists need to do that!
Answer: (Dr. Puskin/HRSA): SAMSHA is now developing technical protocols.

Question: We hear about licensed professionals going online but calling what they are doing 'coaching' or 'consultation'. Some feel that is enough to avoid licensing issues. I've heard it said also that 'online services are the same as someone driving on the Interstate to meet with a doctor in a nearby state. No problem there, right? And so, when the same patient drives 'on the Internet Highway' to seek treatment, it should be considered the same, the patient is driving somewhere and agrees that the meeting is happening in the counselor's office, 'there', or 'in Cyberspace'. Finally, there are now self-guided tools, like online CBT programs. with limited, perhaps distant, professional support. Any thoughts on any or all of all this?

Answer#1 [Psychologist/Attorney]: As for the self-guided CBT, or with a therapist, the ethical issue is that of limits of competency.

Answer #2: [Board executive - Regarding the rationales and rationalizations for declaring online communication to take place where the client 'drives' to, via the the Information Highway] "They exist in a physical place. How they get there, I don't care."

Answer #3 - DeLeon - "That's why we're in a state of evolution. "

Answer #4 - DeMers - "There are practice models. It's not the licensing boards' mission to restrict. On the other hand, if psychology dies [as it is no longer recognizable as a unique profession], there will be nothing left to license!"

"There are tremendous numbers of unserved people. I'm not against distance education. I'm against bad distance education."

Question: I was stuck by response by so many people to Hurricane Katrina. Other than the Red Cross, is there no way to vet who was actually qualified to volunteer help?

Answer: (Dr. Puskin, HRSA) - We've just completed our 3rd guide, actually. We know: "People of good will want the same thing." (To help!) In the immediate aftermath, "you have to figure out the system flow, economic flow..." In formulating guidelines, you want to develop a model to implement. We can ask, do we have a hybrid model?

QUESTION: "Where is the political will to 'step off the curb' now, as opposed to 3 or 5 years from now? What can we do now? Where is the pathway we want? We're not there to improve access to quality care! We need to remove barriers. "

ANSWER/Comments (Dr. McMenamin, Healthcare litigation/risk management) - First, to the earlier question [about responding to out of state queries as 'consultation'] - You can at least lessen the risk: 1) Issue disclaimers; 2) Keep it general

But.... "I would urge caution and avoid providing services to a place you're not licensed" Not only won't the argument about not actually being in the client's state hold, but also "you may void your malpractice insurance."

Comment (Dr. Maheu): APAIT [insurance] has a variation on this: We will not cover you - in court - if you are acting 'illegally', although they will defend you before a licensing board.

Comment (Dr. McMenamin) : "If it's a disciplinary matter, you're in double trouble." You're facing charges of both 'standard of care' violations and 'unauthorized practice'. "The impact on a jury is likely minimal in terms of license authority, but the jury may go ballistic if bad care is involved."

Comment (Dr. DeMers): And there's another variation: Some will say, there is no specific policy on telehealth so I'm not violating anything! Or, there's this theory: California cannot prosecute you from Virginia... They won't bother you so you'll just proceed as "a fly under the radar".

"I don't know one person who has been pursued by a licensing board for practicing online... but you don't want to be the poster case."

Comment (Dr. Maheu): And ... international practice? Let's say US and Canada.

Response (Dr. McMenamin): It's not likely Canada is going to come and get you, although it may be not particularly wise. In Europe actually, there is a license portability system but it needs to be applied to every country to be effective. There is a framework in place for an International treaty. [It's online, though not easy to find.] And despite the issue of license acceptance, there still may be, within the EU, requirements of getting work permits.

A few last thoughts about other countries' systems were quickly shared (e.g., Brazil), but the session's time was running out.

And for me that concludes my APA 2011 feast of fascinating events. This was certainly a panel which could definitively respond to the questions we and the general community of practitioners are increasingly asking. Definitions may be broad, institutional change may be slow, but at the same time we are immersed in some very exciting and rapid transformation all around us.

I sincerely thank the many wonderful people who took the time to share and prepare... And that is the end of my convention reports for this year, asynchronously live from Washington, APA's 119th Annual Convention.

Best Regards!

--



Michael Fenichel, Ph.D.

Current Topics in Psychology - Continously since 1996



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INDEX OF 2001 APA Convention Articles:
Behavioral Telehealth | E-biz of Mental Health | 2001: A Cyberspace Odyssey

INDEX OF 2002 APA Convention Articles:
CyberSex & Cyber-Infidelity | Beck & Ellis 2002 | Behavior Therapy | CyberPsychology | E-Ethics

2003 Convention Highlights: Full Text | Beck 2003 | Quality of Online Health Info | Sternberg's Vision

2005 Convention Highlights:   Opening Session | Pioneers of Behavior Therapy
Distinguished Elders of Psychotherapy | Legends Discuss Psychology | Online Clinical Work | Town Hall Meeting

2006 Convention Highlights:
Opening | Online Psychotherapy & Research | Psychological Vital Signs | Advances in Cognitive Therapy
Brok on Chaplin | Conversation with Aaron T. Beck - 2006 | Dr.Phil | 21st Century Ethics | Media: Town Hall '06

2007 Convention Highlights:
Humanizing an Inhumane World | Opening Session | Albert Bandura | Linehan, on Suicide
Psychology's Future | Conversation with Aaron T. Beck - 2007 | Evil, Hate, & Horror

2008 Convention Highlights:
Grand Theft Childhood | Opening | Malcolm Gladwell | College Success, Love, Hate, More | My Life With Asperger's
My Space, You Tube, Psychotherapy, Relationships... | Aaron T. Beck - 2008 | The Mind and Brain of Voters

2009 Convention Highlights:
Internet: Pathway for Networking, Connecting, and Addiction | Opening | Virtual Psychology & Therapy | Q&A with Zimbardo
Seligman: Positive Education | Future of Internet Media | Sex, Love, & Psychology | How Dogs Think

2010 Convention Highlights:
Online Support Groups & Applications | Evidence & Ethical Practice | Opening Ceremony | Sir Michael Rutter: Resilience
Group Memory | Psychology in the Digital Age | Steven Hayes: What Psychotherapists Have that the World Needs Now


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