What Role Can Avatars Play in e-Mental Health Interventions? Exploring New Models of Client–Therapist Interaction

Abstract

In the burgeoning field of e-mental health interventions, avatars are increasingly being utilized to facilitate online communication between clients and therapists, and among peers. Avatars are digital self-representations, which enable individuals to interact with each other in computer-based virtual environments. In this narrative review, we examine the psychotherapeutic applications of avatars that have been investigated and trialed to date. Five key applications were identified (1) in the formation of online peer support communities; (2) replicating traditional modes of psychotherapy by using avatars as a vehicle to communicate within a wholly virtual environment; (3) using avatar technology to facilitate or augment face-to-face treatment; (4) as part of serious games; and (5) communication with an autonomous virtual therapist. Across these applications, avatars appeared to serve several functions conducive to treatment engagement by (1) facilitating the development of a virtual therapeutic alliance; (2) reducing communication barriers; (3) promoting treatment-seeking through anonymity; (4) promoting expression and exploration of client identity; and (5) enabling therapists to control and manipulate treatment stimuli. Further research into the feasibility and ethical implementation of avatar-based psychotherapies is required.

Innovations in Practice: Avatar‐based virtual reality in CAMHS talking therapy: two exploratory case studies

“…Feedback suggested that the externalization of internal thoughts, feelings and experiences helped the young people express how they were feeling. Although we are limited in reporting findings from two cases, their experiences align with those from previous research into avatar-based counselling Rehm et al, 2016;van Rijn et al, 2017van Rijn et al, , 2018. A key theme from this research centred around the software allowing young people to express themselves outside of 'just using words all the time' .…”

“…In a qualitative study exploring Swedish CYP's views of community health clinics, CYP expressed preferences for utilizing activities within sessions to help their engagement, communication, and choice to disclose: younger adolescents spoke about using nonverbal ways to express their thoughts and feelings (Persson, Hagquist, & Michelson, ). Digital avatar‐based therapies may provide a creative outlet for expression, akin to play therapy (van Rijn, Cooper, & Chryssafidou, ) and be a medium of communication for the CYP and therapist to share within therapy (Rehm et al., ).…”

Efficacy of Self-Management Smartphone-Based Apps for Post-traumatic Stress Disorder Symptoms: A Systematic Review and Meta-Analysis

“…Avatar-based technology facilitates several therapy approaches, as it can substitute face-to-face contact with a clinician. According to Rehm et al (2016), two concepts exist of how to include avatars into therapy: On the one hand, the patient interacts with an avatar, this was used as an effective tool in Virtual Reality Exposure Therapy (e.g. Cárdenas and De La Rosa, 2012 for PTSD), and as the embodiment of a real clinician or a supporting tool for self-management technology (e.g., Pinto et al, 2016 for depressive symptoms).…”

A Feasibility and Acceptability Trial of Social Cognitive Therapy in Early Psychosis Delivered Through a Virtual World: The VEEP Study

“…The community interacts in the simulated world using either text-based, 2-D and/or 3-D graphical models called avatars (20). Although underresearched, virtual world platforms have the potential to reduce communication barriers and improve access to support and treatment in people with mental health disorders (21).…”

“…One of most widely used virtual world environments is the online and freely available social world Second Life©. Second Life© has been used as a virtual world platform in healthcare education, delivery, and engagement and has considerable potential in delivering psychological therapies (21,22). For example, Second Life© has been used to treat social anxiety and has been found to be feasible and acceptable with effects sizes potentially comparable to face-to-face Cognitive Behavior Therapy (CBT) for Seasonal Affective Disorder (23) and in treating social cognition problems in autism (24).…”