La tecnología y el proceso terapéuticoun enfoque multidisciplinario y mixto en el contexto de fobias de animales pequeños

Resumen

The therapeutic process and the influence of numerous factors on its outcome have been widely studied by many researchers in the clinical psychology field (see Norcross, 2002 for a review). With the introduction of new technologies to the therapist's office the therapeutic process may change. Different factors influencing the therapeutic process might evolve as well as some new factors related to technology characteristics might appear. It is increasingly recognized that innovative technologies have strong potential in Mental Health (MH) field (Botella et al., 2012). In the area of technology-mediated MH field, innovative technologies such as Virtual Reality (VR) or Augmented Reality (AR) have demonstrated for several years to be applicable for different MH disorders. More specifically, VR has demonstrated a great potential in different MH applications, and has been effectively used in differ MH disorders such as anxiety disorders or emotional induction (e.g. Opris et al., 2012; Powers & Emmelkamp, 2008 for reviews). Also, recently introduced Augmented Reality (AR) technology demonstrated its clinical effectiveness as a treatment tool for small animal phobias (e.g. Botella et al., 2011). New technologies provide therapists with a wide range of MH services and functions to support their therapy and assessment activities. Also, new technologies allow patients to have an easier access to MH services and enhance their engagement in the treatments (Coyle et al., 2009) due to the strong representational and immersion capability of these technologies; and the standardization of health care. However, a critical but still rather unexplored issue consists in how these technologies actually support their intended users in their respective (but closely related) activities; how they are actually used; and how they modify the therapeutic process. Indeed, on the one hand, technologies can have positive effects on the therapeutic outcome when the functions offered provide better support to patient and therapist activities during the therapeutic process. On the other hand, technologies can have negative effects if their design does not consider requirements related to the therapist and patient activities. The aim of this dissertation is to study the potential influence of new technologies, more specifically Augmented Reality (AR), on the therapeutic process from the two following perspectives: mixed and multidisciplinary perspectives. This research project aims to explore the possible influence of technology on the AR therapies, investigating from different methodological perspective (i.e., mixed perspective), and applying findings from the different fields (i.e., multidisciplinary perspective) such as Clinical Psychology (CP); Human-Computer Interactions (HCI); and Computer Supported Collaborative Learning (CSCL). Two main research questions were used as axis to organize this research work. First axis corresponds to understand the influence that the specific technology has on the different aspects of the therapeutic relationship, such as therapeutic activity of both patient and therapist; collaborative relationship between the patient and the therapist; and therapeutic alliance constructed between two actors. Second axis corresponds to clarify the role of technology on the influence on some important MH field factors such as enjoyment, presence, anxiety, and clinical outcome. To answer these research questions six empirical studies were performed. The contributions of this research can be classified in terms of both theoretical and methodological contributions. The theoretical contribution corresponds to both, the application of mixed and multidisciplinary approach in understanding of technology-mediated therapeutic activity, and to proposition of technology-mediated therapeutic process model that presents the main factors that influence the dynamic of this process. With regard to the methodological contribution, we proposed two tools that allowed evaluating the Augmented Reality technology in terms of collaboration and presence. First, the development of the Therapeutic Collaborative Scale (TCS) corresponds in our opinion to a cost-effective tool to measure the collaboration between the therapist and the patient. Second, the development of the Augmented Reality Presence (ARP) questionnaire allowed providing a questionnaire adapted to the therapeutic context and flexible for evaluation of other Augmented Reality applications. Finally, the dissertation reflects itself the application of user-centered design approach that allowed developing a new prototype of Augmented Reality Exposure Therapy tool for small animal phobia treatment. Based on the studies realized in this dissertation, future studies can be performed in order to explore the issues of new technologies of phobia disorders in children population, validate the augmented reality presence questionnaire, and explore the influence of new technologies in other anxiety disorders. Botella, C., Bretón-López, J.M., Quero, S., Baños R.M., García-Palacios, A. et al. (2011). Treating cockroach phobia using a serious game on a mobile phone and augmented reality exposure: A single case study. Computers in Human Behavior, 27(1), 217-227. Botella, C., Riva G., Gaggioli, A., Wiederhold, B.K., Alcaniz, M. Baños, R.M. (2012). The Present and Future of Positive Technologies. Cyberpsychology, Behavior & Social Networking, 15(2), 78-84. Coyle, D., Doherty, G. (2009). Clinical evaluation and collaborative design: developing new technologies for mental healthcare interventions. In Proceedings of CHI, 2051-2060. Opris, D., Pintea, S., Garcia-Palacios, A., Botella, C., Szamoskozi, S., David, D. (2012). Virtual reality exposure therapy in anxiety disorders: a quantitative meta-analysis. Depression and Anxiety, 29, 85-93. Powers, M.B., Emmelkamp, P.M.G. (2008). Virtual reality exposure therapy for anxiety disorders: A meta-analysis. Journal of Anxiety Disorders. 22(3), 561-569. Norcross, J.C. (2002). Psychotherapy Relationships that Work: Therapist Contributions and Responsiveness to Patients. University Press, Oxford.