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The Internet as a credible source of information on mental health?

A recent study shows that 61% of American Internet users sought information on their health or that of a loved-one on the Web and up to 22% of them searched for information on mental health (Fox, 2009). Web-based information influenced 58% of American Internet users in their health-related decision-making (consultation, treatment), while three-quarters of users admit not checking the sources used by the Websites (Fox, 2006). Unfortunately, studies show that information on mental health available on the Web is not always of high quality. According to Bremner, Quinn, Quinn, and Veledar (2006), 75% of Web sites on trauma and anxiety disorders do not cite their sources, 42% of them post erroneous or incomplete information and 6% even present dangerous information. Given the fact that many Internet users determine the credibility of the information based on the Web site’s visual aspect, the language used and the ease of navigation (Toms & Latter, 2007), psychologists should be aware that imprecise or erroneous information does not only reach a very large audience, but also tends to be taken at face value.

The Internet as a diagnostic and referral tool?

Few people with mental health disorders consult mental health professionals (Wang et al., 2005). With its low operating costs and its capacity to make information available to the greatest number of people, the Internet, as a tool, has thus a significant prevention potential. From a public health perspective, early detection coupled with referral to local care structures may be beneficial.

While several Web sites post lists of mental health disorders symptoms, others go as far as providing an unofficial diagnosis by means of an online questionnaire. Although such sites may be extremely helpful, special attention should be clearly paid to the wording of unofficial diagnoses so as not to induce an adverse effect or provoke a severe emotional reaction in the absence of a professional capable of intervening. The questionnaire provides only a tentative diagnosis in the form of a suggestion; an official diagnostic can only be obtained from a trained professional. Where possible, a differential diagnosis should be included. Furthermore, the individual should be urged to obtain a confirmation of this diagnosis from a trained professional.

Online interventions?

Online therapies may be conducted by various means, including e-mail, videoconference or real-time text. Studies about online treatment of post-traumatic stress disorder, for example, demonstrate a significant reduction of symptoms, as well as the presence of a strong therapeutic alliance and a low dropout rate associated with these therapies (Knaevelsrud & Maercker, 2007). The effects of this therapy seem to be maintained over time, since symptom reduction remains even a year and a half later (Wagner, 2007). Nevertheless, users of such therapies may complain about the lack of human interaction (Lange et al., 2003). Studies involving graduated exposure in the form of virtual reality (Gerardi, Rothbaum, Ressler, Heekin, & Rizzo, 2008) are also being carried out, though this line of research is currently limited to case studies. Adapting virtual reality to certain traumatic situations that are more complex or personal may require further research and development.

Studies show that online therapy is more effective than wait list or supportive therapy, though other findings must be published before one can determine the effectiveness of online therapy compared to more classic and established approaches (Knaevelsrud & Maercker, 2007). One potential limitation is that the Internet may not be appropriate for all forms of therapy (e.g. psychodynamic therapy). Furthermore, these Internet-based approaches to therapy must also meet the ethical standards of the Canadian Psychological Association.

Conclusion

The field of mental health is faced with numerous challenges, several of which the Internet may be able to meet, at least in part. Today, patients and their loved ones can benefit from information, advice, preliminary diagnosis and referral services and even online therapy. These resources will probably become more and more available in the years to come. While these developments are viewed as positive advances, they can also adversely impact the mental health of Internet users if their quality is poor. International certification is one way to mitigate such risks and is becoming the norm (www.hon.ch).

Psychologists should ensure that the information available on the Internet is of high quality in order to achieve a positive impact. The Internet should not be a substitute for existing practices; instead, it should be used in combination with them as a complementary tool. Though the Internet offers new possibilities, it also offers new problems to solve (effectiveness of approaches, biases, the danger posed by poor practices, etc.). Should the mental health professionals rise to the challenge of addressing some of the limitations of Internet-based information and interventions, the Internet may offer a powerful new tool to reach larger numbers of people in need of treatment.

RÉFÉRENCES

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Si certains chercheurs pensent que la cyberdépendance est une nouvelle forme de dépendance sans drogue, d’autres spécialistes sont persuadés qu’il ne faut pas s’alarmer si on trouve que notre adolescent passe trop de temps devant internet ou sa console de jeux. Véronique Fima-Fromager, directrice de l’organisation Action Innocence France, nous donne son avis sur la cyberdépendance et tente d’éclairer les parents inquiets de ce nouveau phénomène.

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