My initial experiments tested how theories of cognitive development can predict the types of media contents that scare children of different ages. For example, we have shown that because of their “perceptual dependence,” preschool children are more likely to be frightened by something that looks scary, even if it’s not harmful, than by something that’s life threatening but looks benign. By the age of eight or nine, children are more likely to be frightened by realistic or real content and less likely to be frightened by fantasy.
We have also demonstrated that young children are more likely to be reassured by nonverbal means, such as by being provided warmth and comfort; whereas older children are more readily helped by verbal explanations, such as those that truthfully minimize the severity of a threat or that teach effective prevention strategies. These early studies used only short excerpts of very mild media stimuli, so that we wouldn’t risk harming children.
More recently I have been studying the longer-term emotional consequences of exposure to frightening media. To explore these, we examine the retrospective reports of adults who have encountered scary media in the past. We find that intense fright reactions to media are almost universal and that they often include sleep disturbances, unwanted recurring thoughts and images, and anxiety in situations related to the media presentation. For example, it is not only common for people to feel anxious in the ocean years after seeing Jaws, many of them also remain uncomfortable in lakes and pools – where there is no probability of encountering sharks! Recent research in neuroscience, on the nature of emotional memory, gives clues to the reasons for these apparently irrational reactions. I am continuing to look at the nature of long-term memories of fright reactions, and am now beginning to look at retrospective reports in children as well, to get a fuller idea of how these reactions play out in childhood.
While keeping one foot in research, I am now spending more and more time bringing my findings to children, parents, teachers, and other caregivers. In 1998, I published a parenting book titled “Mommy, I’m Scared”: How TV and Movies Frighten Children and What We Can Do to Protect Them. And in response to media requests for advice on helping parents help their children cope with news of terrorism or the war (or whatever happens next), I have written an illustrated children’s story book. In Teddy’s TV Troubles, a little bear is scared from something (unspecified) that he saw on TV. He turns to his mother and together they go through a series of activities that help children overcome their fears. I also maintain a website (www.tvtroubles.com), where I provide updated information on these issues, and where both books are available for purchase.
Cantor, J. (1998). Mommy, I’m scared: How TV and movies frighten children and what we can do to protect them. San Diego: Harcourt.
Cantor, J. (2002). Fright reactions to mass media. In J. Bryant & D. Zillmann (Eds.), Media effects: Advances in theory and research (2d ed., pp. 287-306). Mahwah, NJ: Erlbaum.
Cantor, J. (2004). Teddy’s TV troubles. Madison, WI: Goblin Fern Press.
Cantor, J. (2004). “I’ll never have a clown in my house!” – Why movie horror lives on. Poetics Today, 25(2), 283–304.
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upon perceptions of Internet therapy. The experimenter hypothesized that users of this kind of service would rate higher positively framed wed pages rather than negatively framed ones. A recency effect, as opposed to a primacy effect, was also expected across the conditions. The recency effect refers to items presented last to have the greatest influence upon perception, whereas the primacy effect refers to items presented first having the greatest influence. Participants viewed a mock Internet therapy web page for one minute across four conditions (negative primacy, negative recency, positive recency, positive primacy). Each web page contained the same information except for the manipulation content. A questionnaire assessing perceptions of the web page found perceptions of Internet therapy to be rated low. When analyzing perceptions of the experimental pages versus different (unknown) one, participants tended to prefer the experimental page rather than a different one except in the negative recency condition. The low ratings of Internet therapy may have been due to weak manipulation content, participant sophistication, and/or that approximately half of the participants were psychology majors. Future research is advocated in this area to explore the benefits and risks for both the client and therapist.
Internet Therapy: Framing Effects And Internet Therapy
Internet therapy is a growing field (APA, 1997; Smith & Reynolds, 2002; Ruiz, Drake, Glass, Marcotte, & Van Gorp, 2002) that provides services at the convenience of one’s computer. More therapists of varied educational backgrounds are beginning to provide these services (Manhal-Baugus, 2001). Clients may be attracted to the anonymity, cost of service, and convenience. The anonymity, however, may damage the strength of the therapeutic alliance (Cook & Doyle, 2002), which is key for therapy. Most Internet therapy is conducted through either e-mail or online chatting, and, therefore it lacks visual cues necessary for the therapist (Smith & Reynolds, 2002; Manhal-Baugus, 2001; Cook & Doyle, 2002). The web site, however, is visual and therefore may be designed so that marketing techniques, such as framing effects, might influence whether the client decides to utilize the service.
Donovan and Jalleh (1999) have operationalized framing as equivalent values presented to decision making groups in positive or gain terms, or in negative or loss terms. Positive framing elicits more favorable perceptions when concerned with consumer products (Dononvan & Jalleh, 1999; Smith, 1996), whereas Meyerowitz and Chaiken (as cited in Donovan & Jalleh, 1999) and Wilson, Wallston, and King (as cited in Donovan & Jalleh, 1999) suggested that negative framing does so concerning health behaviors. Rothman and Salovey (1997) suggested that loss frames are more effective for disease detection, whereas gain frames are disease prevention and health enhancement. Negative information, as asserted by Smith and Petty (as cited in Buda & Zhang, 2000) may be processed more carefully because it is attention grabbing and receives more criticism than positive information.
Aside from the valence of the frame, one or none of the two order effects may occur. Primacy effects occur when information presented first in a sequence has the greatest influence upon perception, whereas recency effects occur when information presented last in a sequence has the greatest influence. Krosnick and Alwin (1987) suggest that when presented with a visual stimulus, a primacy effect should occur. Since the information is first, it establishes a standard for comparison for the information to follow. In addition, this information is not in competition with other information, and it is therefore processed more deeply. Buda and Zhang (2000), however, hypothesized that a recency effect should occur because the information is more available in working memory. They found that a recency effect resulted in significantly greater ratings of product attractiveness than did a frame presented first.
Perceptions of information may also be affected by credibility of the source. Via the Internet, there is an inability to personally verify the therapist and therapist’s credentials and competency (Smith & Reynolds, 2002). Rieh and Belkin (1998) claim that even the URL suffix on the web address affects credibility. It was found that “.com’s” were perceived as less credible than “.gov’s,” “.edu’s,” and “.org’s.” So if this is the case, there is a user-friendly web site that provides a list of Internet therapists called Metanoia (http://www.metanoia.org), which is a “.org” and should therefore be perceived as more credible than going straight to a “.com.”
Web design also affects credibility judgments. A process to assess a web site’s credibility has been proposed by Wathen and Burkell (2002), placing the most significance upon the design of a site. Next, the message is evaluated, which includes items such as referrals, posted credentials, and interactions with the source influence this stage. Finally, one must assess the relationship between the message content and one’s self. One has to determine if the information being viewed is what is being sought. Critchfield (as cited in Wathen & Burkell, 2002) proposed a formula to determine credibility of a web page:
Information + good site design + attractive graphics = positive credibility judgments
Research also has shown that face-to-face interaction allows the source to have a greater influence upon credibility (Campbell et al., 1999).
Internet therapy, for the most part, lacks face-to-face interaction with the exception of video conferencing. Regardless of the mode, however, it is not possible for the therapist to fully assess the client’s mental state and provide a proper treatment plan (Smith & Reynolds, 2002). Day and Schneider’s (2002) results argue against the latter. Outcome was measured across three modes: face-to-face, video conference, and two-way audio via telephone. The problems treated were body image, family relationships, other relationships, self-esteem, and work/school issues. Among the three modes there was no significant difference in outcome, reinforcing the potential strength of Internet therapy.
Cook and Doyle (2002) also provide research supporting Internet therapy through observing the therapeutic alliance. The alliance is important because of its relationship to therapeutic outcome. Therapeutic alliance scores, as measured by the Working Alliance Inventory (WAI; Horvath & Greenberg, 1986), were viewed across Internet therapy clients and traditional face-to-face clients. Significant differences were found for the goal subscale and the composite score of the WAI of the Internet clients. These results suggest that a healthy alliance can be established over the Internet.
The alliance, in addition to other issues concerning Internet therapy, has
been addressed by certain professional organizations (ISMHO; International Society
of Mental Health Online, 2000; ACA; American Counseling Association, 1999).
The ISMHO addresses issues under three categories: informed consent, standard
operating procedures, and emergencies. The emergencies category claims that
the therapist must devise a plan with the client as to the course of action
in the face of an emergency. To allow for standard operating procedures therapists
are told to follow the same procedures such as utilized through face-to-face
therapy. Finally, clients should be informed about the therapist, the process,
possible risks, possible benefits, alternatives, safeguards, and proxies.
The American Counseling Association (1999) is an organization dedicated to the growth and promotion of the counseling profession. This association also establishes an Internet therapy code of ethics through three categories: confidentiality, establishing the online relationship, and legal considerations. The therapist must discuss confidentiality risks with the client and make strong attempts to minimize the risk. This may be done through e-mail encryption and utilizing secure web sites. Establishing a healthy online relationship may be further observed by the five subdivisions the ACA proposes: (a) appropriateness of online counseling, (b) counseling plans, (c) continuing coverage, (d) boundaries of competency, and (e) minor or incompetent clients. Legal considerations pertain to state laws and their possible regulations of online services and liability insurance. The key concern here lies in whether a therapist providing services to a client outside of his state should operate according to the edicts of his state or to that in which the client resides.
Surveys were sent to state attorney generals by Koocher and Morray (2000) to determine the state of Internet legal regulation. The 51 United States attorney generals were chosen because they are principal law enforcers. Forty-one surveys were returned. Of these, three (7%) claim to have laws regarding psychotherapy via electronic modes, such as the telephone and Internet. None of the attorney generals, however, specified any of these regulations. Nineteen (14%) attorney generals, despite the lack of laws, claimed to have regulatory control on Internet practitioners over state lines. Seven (17%) claim to have received complaints about Internet therapy over state lines.
Other studies (Smith & Reynold, 2002; Manhal-Baugus, 2001; Maheu & Gordon, 2000) have also displayed concern about legal regulations, specifically concern for therapy over state lines. If the Internet therapist is practicing from a state other than that of the client, concern arises of under which states’ edicts the therapist should practice. Manhal-Baugus specifies concern with the grievance process for the client. These matters may be especially strained considering that many therapists may not even be licensed in the state of the client.
Fifty-six Internet therapy practitioners were surveyed by Maheu and Gordon (2000) to gather information on the practitioners’ backgrounds, communication devices, and clinical therapies. The practitioners were licensed and registered to provide psychotherapeutic services. Seventy-eight percent claimed to have provided services to clients residing outside of their state where they were licensed, with 73% claiming to have ethical concerns regarding these services. Seventy-four percent were unclear of the telemedicine statutes in their states, and only 50% had made arrangements for a potential emergency. The median charge of practitioners who charged a fee was $50-$60, with 55% of the sample providing services for free.
Many factors, such as distance, anonymity, price, and convenience, attract clients to Internet therapy. Risks also exist that may negatively affect the health of a therapeutic relationship. In addition, since the potential for service initially may be affected by web page design, marketing may affect perceptions of these services. The present study examines whether framing, primacy, and recency effects influence perceptions of Internet therapy. Users of these services are expected to rate positive framed web pages better than negatively framed ones. In addition a recency effect is expected among the positive and negative frames. Finally users of a negative recency framing effect will remember more about the site.
Ninety undergraduate students from an urban Northeastern college participated in the study. The mean age among participants was 19.7 years. Seventy-seven percent of participants were female and 23% were male. Different ethnicities were represented among participants. Approximately 46% indicated they were Caucasian, 18% were African American, 1% were Asian, 16% were Hispanic, and 20% indicated “Other”. Participants also were of different class ranks, approximately 33% were freshmen, 41% were sophomores, 19% were juniors, and 6% were seniors. In addition, participants came from different majors of study. Approximately 51% of the participants were psychology majors. The remainder represented an array of 19 other majors. Participants were solicited on a voluntary basis in several undergraduate courses.
Printouts of the homepage of four web sites, which were created by the experimenter using a free website builder, contained identical content except for the manipulation. The identical content contained the therapist’s full name, years of experience, links to other pages within the site (e.g. services and fees), a list of some issues (depression, anxiety, relationship problems, and phase of life) that are treated, and assurance that the user’s problems will be relieved. The manipulation consisted of both valence of content (positive versus negative) and positioning of the content on the web pages (primacy versus recency). The two positive valence web pages listed the positive aspects of Internet therapy, positioned either at the beginning of the web page (PP, positive primacy) or at the end (PR, positive recency). The two negative valence web pages proposed a hypothetical stressful situation, ending with the therapist’s claim that the situation will be ameliorated. This situation was positioned either at the beginning of the web page (NP, negative primacy) or at the end (NR, negative recency). In addition, an informed consent and demographic form were included, as was a questionnaire in regards to perceptions of Internet therapy (included in Appendix).
Participants were greeted by the experimenter in a classroom and were randomly assigned to one of four conditions. Being seated at desks, the participants were first asked to fill an informed consent. After the experimenter received these completed forms, the web pages, which determined the condition, were distributed and viewed for up to one minute. The participants were told that they would be giving feedback on a page created by a professor’s colleague. When the time limit expired, the web pages were collected and a questionnaire was distributed to measure the perceptions of Internet therapy. Once the questionnaires were completed, the experimenter collected it, and debriefed the participants about the nature of the study.
As a manipulation check, recollection of five items of each web page was used to assess whether participants recalled the manipulated material. On a seven-point Likert scale, participants rated confidentiality and security along with eight other concerns about Internet therapy: cost, discount, credentials, name, speed, location, gender, and satisfaction. Overall perceptions of Internet therapy were also assessed across four conditions (PP, PR, NP, NR) on a seven-point Likert scale. Participants, in addition, rated their perceptions concerning their beliefs of whether a healthy relationship can be established with a therapist over the Internet.
The descriptive information provided by the participants may be found in Table 1. Of this information, confidentiality (M = 6.4, SD = 1.44) and security (M = 6.22, SD = 1.67) were rated as their highest concerns of Internet therapy. The lowest rated concerns, of the 10 provided on the assessment were the therapist’s gender (M = 2.94, SD = 1.94) and whether a discount (M = 4.02, SD = 1.99) as offered for services.
For the manipulation checks, a Chi-square analysis of condition × recall, ?2 (3, N = 90) = 24.18, p < .001, was significant.
A one-way ANOVA was used to reveal the subjects’ perceptions, F (3, 86)
= .40, p = ns. Using a seven point Likert Scale, perception means within each
condition were as follows: Mpp = 2.86, Mpr = 2.87, Mnp = 2.50, Mnr = 2.86.
In terms of healthfulness of the Internet therapy relationship, a one-way ANOVA across the four conditions revealed no significant difference, F (3, 86) = .61, p = ns. Means of these perceptions within each condition were also calculated (Mpp = 2.81, Mpr = 2.65, Mnr = 3.00, Mnp = 2.54).
A series of repeated measure ANOVA assessed participants’ perceptions of the experimental web page versus a potential future page. The first question explored whether participants would prefer using the experimental web page versus a potential future one for him or herself. A 4 × 2 (framing effect x web view) design was employed with web view being the repeated factor. No main effect, F (1, 85) = 2.43, p = .13, was found, however, a significant interaction, F (3, 85) = 2.74, p < .05, was found between the negative primacy and negative recency conditions (see Figure 1).
The following question explored whether participants would prefer for a friend the experimental page versus a future one. A 4 × 2 (framing effect x web view) design was employed with web view being the repeated factor. No main effect, F (1, 86) = 2.61, p = .11, was found, however, a significant interaction, F (3, 86) = 2.71, p = .05, between two pairs of conditions, negative recency/positive recency and negative recency/negative primacy was found (see Figure 2).
The third question explored whether participants would prefer for a family member the experimental web page versus a future one. A main effect, F (1, 86) = 4.08, p < .05, was found, however, a significant interaction, F (3, 86) = .80, p = .53, was not.
The final repeated measure ANOVA analyzed the means of the three previous questions across the conditions. A main effect, F (1, 86) = 4.24, p < .05, was found, yet, there were no significant interactions, F (3, 86) = 2.66, p = ns.
The experimenter expected that participants in the negative recency condition would recall more about the web page than the other conditions. Results, however, contrary to prediction, showed that participants in the two positive valence conditions recalled more about the web page, specifically the manipulation content, than the two negative valence conditions. When viewing recall within each valence, there was no strong difference. The positive manipulation content, therefore, lends itself to recall and the participants’ attention, whereas there must be something distracting about the negative valence.
The hypothesis proposed by the experimenter, that the positively framed web pages would be better rated than the negatively framed ones, was not shown to be statistically significant. This may have been due to internal validity constraints like the manipulation content not being strong enough. Participants’ perceptions for potential use of a future internet therapy web page versus the experimental web page, however, tended to more favorably rate the experimental page. These perceptions measured potential use by the participant, friend, and family member, with an overall mean of the three lso being calculated.
When analyzing data across the three potential users (participant, friend, family member), three of the four conditions (NP, PP, and PR) tended to rate the experimental web page more favorably than a potential future one. Participants in these conditions must have found something appealing about the experimental page, since it was rated better than a potential future one.
In addition, a main effect was found more favorably rating the experimental page versus a future one. Perhaps the participants feel safe with what they see, and are skeptical of what other web pages may be found on the net. The negative recency condition was the one condition that tended to rate the use of a future page more favorably than the experimental one. This may have been due to a weak manipulation, in addition to perhaps the information remaining fresh in the participants’ mind when completing the assessment.
Neither the expected recency effect nor a predicted primacy effect among both the negative and positive conditions were statistically significant. Participants in the negative recency condition were expected to remember more about the site compared to the other conditions, however, they did not.
Regardless of one’s condition, overall ratings of Internet therapy were poor, as were perceptions regarding the possibility of a healthy alliance being established with a therapist over the Internet. These poor ratings may have been due to 51% of the participants being psychology majors, and having some knowledge about what contributes to a healthy therapeutic relationship. Also Internet therapy may seem foreign to someone that has not encountered the concept, considering that one traditionally thinks of therapy occurring solely in an office.
Research, however, does support the use of Internet therapy. Client participation has been found (Day & Schneider, 2002) to be higher when services are provided from a distance rather than face-to-face. Internet services also allows for treatment to be extended to underserved populations such as individuals with mobility restrictions, rural individuals with disabilities, and prison inmates with chronic illness (Gluekauf, Pickett, Ketterson, Loomis, & Rozensky, 2003). Stamm and Perednia (2000) claim that individuals may also be attracted to Internet therapy because it is more cost effective than face-to-face therapy.
One must keep in mind that the participants overall rated Internet therapy as a poor service. The participants rated confidentiality, security, and credentials as major concerns on a seven point Likert scale (see Table 1). Legal concerns (Smith & Reynold, 2002; Manhal-Baugus, 2001; Maheu & Gordon, 2000) and the lack of visual cues for the therapist to work with (Smith & Reynolds, 2002; Manhal-Baugus, 2001; Cook & Doyle, 2002) also serve as grounds for questioning the positiveness of Internet therapy. Considering these concerns regarding this booming industry (APA, 1997; Smith & Reynolds, 2002; Ruiz, Drake, Glass, Marcotte, & van Gorp, 2002), further research must be done for the benefit of both the client and the therapist.
American Counseling Association. (1999). Standards for the internet. Retrieved October 10, 2003, from http://www.counseling.org/site/PageServer?pagename=resources_internet
American Psychological Association Ethics Committee. (1997). Services by telephone, teleconferencing, and Internet. Retrieved November 17, 2002 from the World Wide Web: http://www.apa.org/ethics/stmnt01.htm
Buda, R., & Zhang, Y. (2000). Consumer product evaluation: The interactive effect of message framing, presentation order, and source credibility. Journal of Product and Brand Management, 9, 229-242.
Campbell, M.K., Bernhardt, J.M., Waldmiller, M., Jackson, B., Potenziani, D., Weathers, B., & Demissie, S. (1999). Varying the message source in computer-tailored nutrition education. Patient Education and Counseling, 36, 157-169. Abstract retrieved October 30, 2003 from EBSCO database.
Cook, J.E., & Doyle, C. (2002). Working alliance in online therapy as compared to face-to-face therapy: Preliminary results. CyberPsychology & Behavior, 5, 95-105.
Day, S.X., & Schneider, P.I. (2002). Psychotherapy across distance technology: A comparison of face-to-face, video and audio treatment. Journal of Counseling Psychology, 49, 499-503. Retrieved November 13, 2002 from PsycINFO database.
Donovan, R.J., & Jalleh, G. (1999). Positively versus negatively framed product attributes: the influence of involvement. Psychology and Marketing, 16, 613-630.
Gluekauf, R.L., Pickett, T.C., Ketterson, T.U., Loomis, J.S., & Rozensky, R.H. (2003). Preparation for the delivery of telehealth services: A self-study framework for expansion of practice. Professional Psychology: Research and Practice, 34, 159-163. Retrieved April 15, 2003 from PsycINFO database.
Horvath, A., & Greenberg, L. (1986). The development of the working alliance inventory. In L. Greenberg & W. Pinsof (Eds.), The psychotherapeutic process: A research handbook (pp. 529-556). New York: Guilford Press.
International Society for Mental Health Online. (2000). Suggested principles for the online provision of mental health services. Retrieved October 30, 2003, from http://www.ismho.org/suggestions.html
Koocher, G.P., & Mooray, E. (2000). Regulation of telepsychology a survey of state attorneys general. Professional Psychology: Research and Practice, 31, 503-508. Retrieved October 29, 2002 from PsycINFO database.
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Maheu, M.M., & Gordon, B.L. (2000). Counseling and therapy on the internet. Professional Psychology: Research and Practice, 31, 484-489. Retrieved October 29, 2002 from PsycINFO database.
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Rieh, S.Y., & Belkin, N.J. (1998). Understanding judgment of information quality and cognitive authority in the www. In C.M. Preston (Ed.), Proceedings of the 61st ASIS Meeting. (pp.279-289). Silver Spring, MD.
Rothman, A.J., & Salovey, P. (1997). Shaping perceptions to motivate healthy behavior: The role of message framing. Psychological Bulletin, 121, 3-19.
Ruiz, M.A., Drake, E.B., Glass, A., Marcotte, D., & van Gorp, W.G. (2002). Trying to beat the system: Misuse of the internet to assist in avoiding the detection of psychological symptom dissimulation. Professional Psychology: Research and Practice, 33, 294-299.
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In March 2004, five additional PhD students were admitted and the program hit full swing. Those enrolling are mid-career professionals from organizations as different as California State University, DeVry University, Pepperdine University, Hawaii Pacific University, The University of LaVerne, Gateway Computers, Stanford Medical Center, the Walt Disney Company and Coca Cola. Fielding’s Socratic and distributed model allows the students to continue to work in their respective professions while gaining their PhDs.
The Fielding program in psychology is now approaching its thirtieth anniversary. Fielding’s new Media Psychology program is a proud addition designed for professionals coming from a wide variety of disciplines who want to study the effects of media on human behavior and address the convergence of media, technology, communication, art, and science.
Psychology is fundamental in the world of new media for understanding media impact on society, and in developing media-centric products and services affecting our lives. The program was launched after five years of offering the Media Psychology course within Fielding’s Clinical Psychology program. The program was designed following the recommendations of the APA Media Psychology Division 46, Task Force Study of Psychology and New Technologies completed in 1998, coupled with extensive research regarding programs that address media studies.
Operating though its first year, the PhD in Media Psychology has attracted a core of professionals who work in entertainment, publishing, education, science and health and telemedicine services, public policy and government consistent with the findings of the APA task force study. In addition, following the trends in using media in distributed learning and in the classroom, a significant number of the students are interested in furthering the development of distance and distributed education as well as using media in the classroom.
Half of the students are university faculty or IT professionals, which is also consistent with the larger trends. As the Internet develops increased use of pictures, graphics and sound, and as we learn more about sensory psychology and the synesthetics of learning, entertainment, and media, the more the importance of media psychology is apparent.
The curriculum is composed of the acknowledged requirements for the PhD in Psychology, including 79 units of requirements, plus comprehensives and a research centric dissertation. The media psychology concentration is 24 units, including media ethics. Specific courses may be located at www.Fielding.edu.
Fielding has a regular psychology faculty of approximately thirty, plus several specialists serving as adjunct faculty who have been added who have particular expertise in media.
There are a number of programs in Media Ecology, Media Studies, and Media Communications. This new program in Media Psychology is a milestone both in psychology and in the recognition that psychology if foundational in education, entertainment, commerce, health services, telemedicine, public policy, and telecommunications. This is a twenty-first century program. It is built on a solid foundation of research and planning. It is a program whose time is here.
For information regarding admission to the program please contact Bernard J. Luskin, EdD, Director, Media Psychology and Media Studies Programs, bluskin@Fielding.edu. Admissions information may be obtained from Tiffany Chan, Admissions Counselor, (800) 340 1099, email@example.com.
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beginning to emerge as a viable tool for a wide range of clinical and research applications. Continuing advances in VR technology along with concomitant system cost reductions have supported the development of more usable, useful, and accessible VR systems that can uniquely target a variety of psychological, cognitive and physical disorders and research questions. Virtual reality integrates real-time computer graphics, body tracking sensors, audio/visual/touch displays and sensory input devices to immerse a participant in an interactive computer-generated virtual environment (VE) that changes in a natural way with head and body motion. The rationale for VR applications designed for these purposes is fairly straightforward. By analogy, much like an aircraft simulator serves to test and train piloting ability, VEs can be developed to present simulations that assess and treat human processes and performance under a range of stimulus conditions that are not easily (or safely) deliverable using traditional methods. What makes VR application development in therapy and rehabilitation so distinctively important is that it represents more than a simple linear extension of existing computer technology for human use. VR offers the potential to create systematic human testing, training and treatment environments that allow for the precise control of complex, immersive, dynamic 3D stimulus presentations, within which sophisticated interaction, behavioral tracking and performance recording is possible. When combining these assets within the context of functionally relevant, ecologically enhanced VEs, a fundamental advancement could emerge in how human functioning can be addressed in many healthcare and scientific disciplines. This potential was recognized early on in the prophetic statement by VR pioneer, Myron Kruegar, that, “…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.”
It could be conjectured that Virtual Reality offers certain general attributes or “ingredients” that would appear well matched for a range of Mental Health and Rehabilitation approaches. These might include exposure, distraction, enhanced visualization, and interaction with dynamic stimulus presentations (whether with objects used in the course of procedural skill training or virtual “humans” for social treatment purposes). Each of these attributes, alone or in combination, can be exploited to address certain clinical/research objectives. These are also the ingredients in current VR scenarios that have shown some of the best initial effectiveness at this early stage in the technology’s development. In this regard, VR applications have shown promise for: graduated exposure therapy for anxiety disorders, pain distraction for burn patients, reducing negative chemotherapy responses, visualization methods for eating disorder/body image disturbances, navigation and spatial training in children with motor impairments, functional skills training in persons with developmental disabilities and autism, and in the assessment (and in some cases, rehabilitation) of memory, attention, spatial skills, and executive cognitive functions in populations with CNS dysfunction. Functional VR training scenarios have also been designed to test and teach instrumental activities of daily living such as street-crossing, automobile driving, meal preparation, supermarket shopping, use of public transportation, and wheelchair navigation. The therapeutic targets chosen thus far reflect an informed appreciation for the unique assets that are available using VR tools and these initiatives have formed a foundation of work that provides support for the feasibility and potential value of further VR development for a new realm of healthcare applications.
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four elements: [technological] devices, practices, media, and everyday knowledge, with the lattermost being where “all the elements come together. . . ” (Flick, 1995, p. 83). He believes that “the social sciences are theoretically and empirically dealing with these [technological] devices, their uses and consequences, and are stimulating discussions in the media and in everyday life about these consequences. . . ” (Flick, 1995, p. 81). The interplay between the social sciences and media in his thinking is evident.
This process is an endless loop. Social science research engines produce new information. Media takes pieces of the findings and catapults them to the public. In doing so, media inevitably contributes to the forming, re-shaping, and transforming of social understandings. Flick believes that “the theory of social representations offers a model for the genesis and transformation of social knowledge and its function in communication and interaction” (Flick, 1995, p. 83).
Aspects of this media-inclusive process can also be turned under the social researcher’s microscope. Bernard Luskin (2003) referred to the knowledge-generating side of media psychology, while writing for The National Psychologist in a recent article entitled “Media Psychology: A Field Whose Time Is Here.” Luskin points out how “effects research,” is at the heart of media psychology, including study of “how the various news and entertainment media affect and are affected by audiences, audience demographics and audience numbers” (Luskin, 2003, p. 4-B).
Recently, a lively discussion took place on the division’s listserv among Betsy Carll, Stuart Fischoff, Bernie Luskin, and others. An important point conveyed during this exchange was that, historically, media-centered empirical investigations have not been the sole purview of Psychology. If psychologists do not train their research eyes on media-related topics, other disciplines and academic departments – the field of communications, to mention only one – will certainly do so.
Division 46 needs to be instrumental in highlighting important media psychology research findings, as well as active in discussions of the impacts of social science research, thus shaping the resultant social understandings. We can spotlight some of the products and people who are producing empirical investigations related to media and psychology, as well as the effects of that information, once it is brought to public awareness.
In order to encourage and publicize media-related research findings, The Amplifier
will begin regularly featuring a selection of media research activities and
findings, in a “Research Corner” column. Eventually, the printed
material will be supplemented with additional research information placed on
the website, as well as, perhaps, on the listserv, or by providing opportunities
for reader dialogues on a selection of topics.
Likewise, the Division’s Convention programming has and will continue to feature a selection of interesting and timely research topics and discussions. Our convention program for 2004, thanks to Co-Chairs James Bray and Jean Cirillo, looks to be outstanding and can be viewed elsewhere in this issue.
Other Changes, Inside the Division
Watching the world around us, we witness a persisting bleed of print media with electronic technologies. It would serve us well, as the Division of Media Psychology, for our communication vehicles to reflect these media trends in society-at-large. One way to project the image we want to express is through evolving our divisional communications. You have seen the leading edge of this change in the Spring Amplifier, as we begin moving toward meaningfully blending divisional print and electronic communications. Editor Mary Gregerson has diligently been ushering this process along. With website changes now evolving under Richard Bedrosian’s virtual guidance, we can look forward to an increased mix of hard copy and electronic materials. Please pass along your comments about these changes to either Mary Gregerson or myself.
In February, the Board made a decision to proceed with a review and changing of our divisional bylaws. This work is long overdue, in that, as far as I could tell, the last major by-laws revision by occurred in 1993, although there have been some amending of selected items since then. I have appointed an ad hoc committee for this purpose, chaired by Secretary Dr. Pauline Wallin and consisting of Past President Dr. Elizabeth Carll, President-Elect Dr. Peter Sheras, as well as Member-at-Large Dr. Charles Spielberger, Membership Chair Dr. Rochelle Balter, who has special expertise in legal matters, and your current President. Since the work product of this committee may likely not be completed until into 2005, the need for CONTINUITY between presidential years is apparent once again, in accordance with one of the presidential themes for this year.
We have also taken steps to more fully integrate our divisional budget with the APA accounting system. This INFRASTRUCTURE CHANGE will allow for smoother, more efficient processing of divisional expenditures and will also facilitate more frequent, accurate, and timely tracking and reporting of our divisional income and expenditures.
Changes Outside the Division, With Other Psychologists
The important role media plays in issues of importance to psychologists and APA, in general, is slowly becoming more generally recognized. There is a clear mandate for psychologists to become more media savvy and proactive, in order to expand the public’s awareness of issues that are near and dear to them. One realization of this occurred at the recent APA-sponsored State Leadership Conference in March. There, a joint brainstorming session was held for the state psychological associations’ Public Education Campaign (PEC) Coordinators and Business of Practice Network (BOPN) representatives. This session aimed at facilitating the creation of more effective ways for promoting the state and national “Psychologically Healthy Workplace Awards.” Media was seen to play a key role, both in publicizing the award winners, and also informing business leaders about the relevance of healthy workplace “best practices” to their organization’s overall performance. Influencing corporate “social understandings” of the relevance of healthy workplace criteria to business processes and results is essential to the success of this program.
The same is true, with regard to healthcare issues. Meredith Cary is busy formulating some very exciting ideas in the realm of telehealth, about which you can learn by reading her article elsewhere in this issue.
As the world around us changes, so must the division also change. Inevitably, the future will be ever-changing and different from our familiar past.
Flick, U. (1995). Social representations. In J. A. Smith, R. Harre’, & L. Van Langenhove (Eds.), Rethinking psychology (pp. 70–96). London: Sage.
Luskin, B. (2003). Media psychology: A field whose time is here. The National Psychologist, September/October, 4-B.
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Media psychology is enjoying great popularity in the sense that the media, in general, has become such an integral part of lives of all Americans. At the same time, this popularity has lead to more generalization about what media psychology really is. Is it psychological perspectives on the media, the psychological impact of the media on audiences (for instance the recent APA suggestion to ban advertising directed toward those under the age of 8 on developmental grounds), or psychologists appearing in the media? While it is clearly the case that the broadest definition of “Media Psychology” covers all these areas, our division must choose an appropriate focus for our activities.
At this moment, I would identify the following major areas to examine or continue our efforts in the coming years. The first is the use of technology, telemedicine and public education. The internet and broadcast media, especially, influence how people think about their health. Who is speaking, how the messages are crafted, and who is listening are important considerations for evaluating and even managing the impact of psychology science and practice on the populace.
A second major area has to do with the influence of media images on our culture. The advent and expansion of reality TV, psychological advice programming, and the portrayal of violence are altering how people see each other and the world. I am old enough to remember that the first television programs reported on real events (historical events, sports, breaking news). Now, however, television actually creates many of the events and reports them as real. The creation, selection and editing of material is a powerful tool in influencing public opinion and behavior.
A third area to examine is how we as psychologist need to behave toward the media as experts, consultants, researchers and critics. With so many opportunities to become involved in media activities, what distinguishes the unique contributions of media psychologists? What guidelines do we follow, or should we follow, and how do we train ourselves to be maximally useful and effective?
It is my hope that over the next two years we will continue our efforts in these areas. I would love to hear from you about your ideas. We already have activities ongoing in all these domains. I will speak specifically about some of these programs in later columns. In the meantime let me hear from you on the listserv or back channel at firstname.lastname@example.org.
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In this spring issue President Lou Perrott has instituted a Research Corner, another future oriented initiative that profiles a distinguished researcher in media psychology. As the first Research Corner media psychologist, Dr. Dorothy Cantor, Professor Emeritus at the University of Wisconsin, has written about her work on children, violence, and the media, a topic of particular interest to Division 46 members, as well as provided the cover to her new book on children and the media. We congratulate Dr. Cantor and appreciate her work and the article she provided for The Amplifier readers.
In addition, student manuscripts are also being featured in this research/education issue. For the summer issue, three student psychologists have submitted empirical papers that are available en toto online. Louis Mora, BA, whose work with his faculty advisor was also chosen for the New Members’ Corner, provides an empirical research project which followed his honors thesis on how presentation, or framing, affects readers’ responses to Internet therapy sites. A graduate student, Florette Cohen, and her colleagues demonstrated empirically how contextual presentation of political messages influences preference for candidates, a message quite apropos for this election year. In a companion article posted online another graduate student, Mark Landau, established the connection between fear of death, exposure to 9/11/01 terrorist attack related stimuli, and support for the current President. We thank Dr. Hirsch for her work with Mr. Mora and Dr. Solomon for his mentoring Ms. Cohen and Mr. Landau. We are only just beginning to form the empirical basis for this intricate field called media psychology. Surely these three student contributions shall only be the peak of the mountain.
The last article available en toto online exemplifies the fruitfulness of publishing
in The Amplifier. This article, reprinted with permission from the peer-reviewed
Journal of Social Distress and the Homeless, emanated from a series of previous
Amplifier articles that now Div 46 President Lou Perrrot had edited. Those Amplifier
articles were based upon presentations at the 2002 APA Annual Conference in
Chicago, Illinois. Furthermore, a book is being written based upon these articles
and presentations. Therefore, I encourage those speaking at the 2004 APA Annual
Conference in Hawaii to submit manuscripts, based upon their presentations,
for the winter Amplifier.
Thus, this summer Amplifier, more than the spring issue, extensively utilizes online possibilities not feasible in a hard copy version. Our field is burgeoning. Multi-media outlets help convey the veritable explosion of materials in our field of informatics. This combination of arts and sciences with media is our future in Division 46 Media Psychology. Come join and join in!
Students and their advisors as well as nominations for Research Corner recipient and for New Member recognition should send materials to The Amplifier Editor at email@example.com.
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With this expansion came easy access to previous print issues and broadcasts. As a result, the news media not only influences current events, but also provides a historical backdrop. Therefore, accuracy and excellence in the reporting of information is especially important as the news archives reflect the collective memory of society. Having established the News Media, Public Education, Public Policy (NMPEPP) Committee in 2000 and promoted the development of the News Media Recognition Award, it has been rewarding to see the evolution over the years.
The first News Media Recognition Award for excellence in the reporting of psychological information and research was presented to Marilyn Elias, USA Today, at the Media Town Hall Meeting at the 2002 APA Annual Convention in Chicago. Subsequent recipients were Andi Gitow and Peggy Girshman. Currently, the committee is in the process of selecting the 2004 recipient to be announced at the APA Convention in Hawaii.
NMPEPP has also supported and sponsored the development of professional programs focusing on the news reporting of psychological information and related issues. For the 2004 APA Convention in Hawaii, NMPEPP supported Division 46 organizing an interdivisional crosscutting program on “Media/ICT, Psychology, and World Events”, which is co-sponsored by Divisions 35, 46, 48, 52. The program is scheduled for Friday, July 30th, 10 AM-11:50 AM in room 323A in the Hawaii Convention Center.
At the 2000 APA Convention, NMPEPP sponsored a symposium on children, media, and violence, which also addressed legislation and the impact of violence in video games on children. In retrospect, this was timely, as in 2003 Division 46 proposed a resolution to APA on violence in video games and interactive media, which is currently making its way through the review process. In 2001, a first of a kind symposium was sponsored on psychology, news media, and public policy for promoting social change. In 2002, a symposium on terrorism also focused on the impact of the news reporting of violence and terrorism.
NMPEPP would like to thank the Division 46 board for its continued support over the years.
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encourage investigation of age in which children comprehend persuasive intent,
examine the impact of advertising on gender, race, ethnicity, and culture, and encourage research on media literacy
3) Provide public education to parents and professionals
Support CE programs for psychologist on media literacy
Educate psychologists about potential ethical challenges working on advertising to young children,
4) Recommend that the Children’s Advertising Review Unit (CARU) of the Council of Better Business Bureaus publicize its guidelines widely,
5) Recommend that psychologists take a central role and implement effective advertising media literacy curricula for schools from 3-12 grades
6) Recommend that all forms of advertising be restricting in school environments serving children 8 years and under (research shows that children under 8 years cannot differentiate between persuasive content and programming),
7) Recommend research of advertising and commercialization in schools
There were significant discussions about the manner and timeliness in which Council has been informed about significant policy and financial arrangements made for key staff such as more than $500,000 of holiday bonuses ($750/employee and taxes were paid) for all members of staff. Additional compensation arrangements given to some executive staff was discussed. Council noted that staff has been very hard-working and in great likelihood would have supported the bonuses, but comments were made that Council wants to be notified in advance of such expenditures, rather than after the fact.
An additional item which caused significant discussion and closed door sessions was an item in the Washington Post on Friday Feb. 20 which announced the severance package past-CEO Ray Fowler was given when he left APA. The discussion largely focused upon the details and the overall amount of this package because Council had not been given this information in advance. Comments made at Council affirmed support and appreciation for the dedication and work of Dr. Fowler.
APA reversed the trend of financial difficulties of the last few years and is not operating in a deficit.
The President’s Task Force on Governance had its report accepted by Council. The Task Force looked at ways of better utilizing members of Council so that they can more effectively carry out their broad oversight responsibilities.
Council shall review and update its list of priorities at least every 3 years; CSFC will recommend a process to do this update; the latest of the top priorities will be included in each year’s Council agenda book; and new business items will include the list of these priorities so that the maker of a motion can identify the applicable priority which the item addresses.
Council approved that no matter may be placed before the Council for its vote unless the item has not been disseminated to Council members, in its final form and with a response from the Board of Directors, at least 30 days prior to the meeting at which the matter is scheduled to deliberated.
APA membership is aging and more of our members enter the Life membership category. The Membership Committee has developed out a process for psychologists who meet the criteria for life member to pay less each year for five successive years until they are completely dues exempt. A similar process in which the dues will be steadily increased for the first five years of membership is being worked out for new members of APA.
APA Practice Organization has a new category of members, who pay a special assessment called “constituents” and are not able to vote.
APA is making efforts to begin recruiting members earlier and also to recruit of persons of color. Currently, APA membership is increasing slightly, but at a much lower rate than it has done in the past.
REPORTS AND UPDATES:
Establish the Task Force on the Assessment of Clinical Competencies in Professional Education and Training.
Council established a Working Group to develop policy recommendations on same-sex families and relationships based upon the extant literature.
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Presentations and Interviews:
Kimberly S. Young, PhD, has appeared in several media outlets over the last few months including “USA TODAY” for a story on online infidelity, “The Washington Times” for an article on cybersex addiction, the Associated Press for an article on child online safety, and in “Rolling Stone Magazine” for an article on video game addiction.
Douglas A. Gentile, PhD, and his colleagues J.C. Rosser, Jr., P.J. Lynch, L.A.
Haskamp, A. Yalif, and L. Giammaria in January 2004 presented the paper “Are
Video Game Players Better at Laparoscopic Surgery” at the Medicine Meets
Virtual Reality Conference, Newport Beach, CA. Numerous interviews and articles
about this research have appeared, including “USA Today” and “The
New York Times.”
Nancy Kalish, PhD, was quoted about her book Lost and Found Lovers: Facts and Fantasies of Rekindled Romances in “Redbook,” “First for Women,” and “Canadian Living.” Pending stories including her work will appear in “AARP,” “The New York Times,” and the CBS TV affiliate in Los Angeles.
Books and Chapters:
Gentile, D. A. (Ed.) (2003). Media violence and children. (In series Advances in Applied Developmental Psychology, I. Sigel, Series Ed.) Westport, CT: Praeger Publishing.
Carll, E. K. (Ed.), (2003). Psychology, news media, and public policy: Promoting social change. American Behavioral Scientist, 46(12). (Special issue on news depiction of community events and social issues)
Carll, E. K. (1999). Violence in our lives: Impact on workplace, home, and community. Boston: Allyn & Bacon.
Carll, E.K. (in print). Violence and women: News coverage of victims and perpetrators. In Cole, E and Daniel, J.H.(Ed.). Featuring females: Feminist analyses of media. Washington, DC: APA Books.
Simon and Schuster just published the paperback version (hardback published last year) Zen And The Art of Falling In Love by Dr. Brenda Shoshanna, nom de plume for Brenda Lukeman, PhD.
Nancy Kalish’s book on Lost and Found Lovers: Facts and Fantasies of Rekindled Romances and some of her research has been APA approved for home study CE credits through ce-credit.com. The link is on her web site home page, lostlovers.com.
Gentile, D. A., Lynch, P. J., Linder, J. R., & Walsh, D. A. (2004). The effects of violent video game habits on adolescent aggressive attitudes and behaviors. Journal of Adolescence, 27, 5-22.
Carll, E. K. ( 2003). News Portrayal of Violence and Women: Implications for Public Policy. American Behavioral Scientist, 46(12).
Carll, E. K. (2001). Psychology and the News Media: Reflections on a Ten Year Initiative. The Independent Practitioner, 21(1).
Irene Deitch, PhD, was invited by the Department of Psychology at the College Of Staten Island-City University Of New York to be guest of honor and invited speaker at the Department of Psychology Graduation Ceremony on June 3, 2004.
Douglas A. Gentile, PhD, was named Institute of Science and Society Research Fellow, Iowa State University.
Mary Banks Gregerson, PhD, was invited to judge the Spring 2004 Student Fair at Northern Virginia Community College, Loudoun County Campus.
Kimberly S. Young, PhD, is the 2004 recipient of the Psychology in the Media Award by the Pennsylvania Psychological Association (she previously won in 2001). In addition, she was an invited panelist the American Psychiatric Association's annual conference for a symposium on online gaming addiction.
Dr Brenda Lukeman, under the name of Dr. Brenda Shoshanna, is offering talks, workshops and seminars in the community and at colleges based upon her book Zen And The Art of Falling In Love. Her website is www.brendashoshanna.com, phone (212) 288-0028, and email firstname.lastname@example.org.
Kimberly S. Young, Ph.D., Executive Director, Center for Online Addiction has just released a new two cassette audio program for therapists entitled, "Techno-Family Therapy: A Clinical Guide for Treating Internet-Addicted Children". Part One outlines warning signs and risk factors of Internet addiction and Part Two outlines a comprehensive treatment plan for recovery from a family systems perspective.
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But the problem goes beyond scientific skepticism, and, ironically, it is not helped by high profile tragedies that get linked to media violence (e.g., copycat crimes, school shootings). Although such highly publicized “media effects” stories suggest an immediate, direct effect of media violence on people, these stories probably do more harm than good because they perpetuate several myths about media effects. Dispelling these myths will allow us to come to a deeper understanding of the effects of media. In this brief article I address two central myths (others can be found in Gentile & Sesma, 2003).
Myth 1. Media effects are simple and direct.
Although each of us can recall a time when we experienced a simple, direct media effect (e.g., you see a pizza advertisement and immediately crave pizza), this is not typically how media effects occur. Even when media, such as advertisements, are specifically designed to influence behavior, they are usually designed to work in a subtle and cumulative manner. This helps to mask a remarkable power. For example, research demonstrates that attitudes and purchasing behaviors can be altered by as few as three exposures to an ad (Woodward & Denton, 2000). Yet, we do not feel our opinions changing as we watch or drive past advertisements. Therefore, we should not expect media effects to be simple or direct, and if we do, we will probably fail to notice many of the most typical and most powerful media influences.
Myth 2. The effects of media violence are severe.
Because the media usually only report on media effects when there is a tragedy, many people equate media effects with atrocities. However, it is true that most people who watch media violence never seriously injure other people or themselves. Since they have not committed seriously violent acts, many people draw the inference that media violence has no effect. Yet this misses the point. Violent media can have many effects.
The largest effect of media violence is probably not individual instances of violent behavior, but the “culture of disrespect” that it has helped to foster (Walsh, 2001). Violence is the endpoint on a continuum of disrespectful behavior. For example, in 1998, there were 35 deaths in schools. As terrible as that is, that same year there were 257,000 serious injuries, 990,500 thefts, 1,562,300 reported fights, and 18,000,000 incidents of bullying (Modzeleski, 2002). If we only look for the effect at the extreme, we may miss the more typical, less extreme (but still important) effects.
Furthermore, while most of the attention about media violence has focused on aggression, aggression is not the only outcome of media exposure.. In fact, any time you have ever laughed, felt excited, become scared or otherwise aroused while watching a movie, you have just been affected. Emotional and physiological reactions to violent media are media effects. We even wish to be affected – after all, who wants to watch a “boring” movie? Among children, the most typical media violence effect may actually be fear (Cantor, 2003).
We must understand that everyone might be affected, but not in the same way, and that we might only recognize the effects in extreme cases. Recent advances in theory on media effects can help get beyond these persistent myths (e.g., Carnagey & Anderson, 2003; Gentile & Sesma, 2003; Potter, 1999). Once we recognize how these myths have distracted us, it may become easier to engage in constructive dialogues about media effects as well as open up new avenues for research.
Cantor, J. (2003). Media and fear in children and adolescents. In D. A. Gentile (Ed.), Media violence and children. (pp. 185-204). Westport, CT: Praeger Publishing.
Carnagey, N. L., & Anderson, C. A. (2003). Theory in the study of media violence: The general aggression model. In D. A. Gentile (Ed.), Media violence and children. (pp. 87–106). Westport, CT: Praeger Publishing.
Gentile, D. A. & Sesma, A. (2003). Developmental approaches to understanding media effects on individuals. In D. A. Gentile (Ed.), Media violence and children. (pp. 19–37). Westport, CT: Praeger Publishing.
Modzeleski, W. (2002, May). Threat assessment in schools: Training materials for U.S. Secret Service and U.S. Department of Education.
Potter, W. J. (1999). On media violence. Thousand Oaks, CA: Sage Publications.
Walsh, D. A. (2001). Dr. Dave’s cyberhood. New York: Fireside.
Woodward, G. C., & Denton, R. E. (2000). Persuasion & influence in American life. (4th Ed.). Prospect Heights, IL: Waveland Press.
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Although we send a wide range of material to the news media almost exclusively by E-mail and post everything we do on our Web site (www.cfah.org), the technology remains pretty basic—reading, thinking and writing—and the technique short, accurate and readable.
We cull the best new research from 30 behavioral and social science journals and translate articles into clear concise news stories, distributed on an embargoed basis to health reporters. Among the topics HBNS covers are: addictions, adherence to medical advice, aging, and behavioral aspects of bioterrorism, cardiovascular health, chronic illness, depression, diabetes, diet, exercise, HIV/AIDS, post-traumatic stress disorder, social determinants of health disparities and stress. The news packages are sent out twice or three times a week to a list of about 850 health and science journalists, and are posted on the EurekAlert! and NewsWise Web sites.
In addition, the news service covers for immediate release relevant scientific meetings, speeches and events in Washington and Baltimore.
Besides covering the work of researchers whose studies might otherwise languish on a dusty shelf, HBNS publishes a monthly issues briefing called Facts of Life, which provides background material on a single topic to reporters in the form of text that can be reproduced whole or in part. Recent topics have included job-induced stress, contraception, sleep, obesity and physical inactivity—all from the point of view of how non-medical factors influence our health.
HBNS also maintains a list of experts on social, psychological, behavioral, economic and environmental health who can respond to immediate inquiries from journalists.
The weekday morning Health Behavior News Digest is distributed by e-mail and posted on the CFAH Web site, containing lead paragraphs and URLs of that day’s health and behavior reports appearing in the nation’s leading news outlets. It keeps both researchers and reporters up to date on the latest findings and controversies in the field. (To sign up for it, please E-mail email@example.com)
In 2003, HBNS distributed more than 300 stories, garnering about 2,000 media placements. In 2004, the news service plans to focus more narrowly on the research that can help individuals improve their behavior by taking specific action and to start disseminating the underreported results of systematic evidence reviews.
The value of our news service is simply this: there is a demand by consumers for information about their health, a need for policymakers to have data upon which to act, and an ever smaller supply of journalists to provide scientific news on their own. We fill that void.
Ira R. Allen is vice president for public affairs of the Center for the Advancement of Health.
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stimuli can be presented systematically to the patient in controlled stages. As the patient becomes desensitized to anxiety-provoking stimuli, the scenes can be made more challenging, so that the patient overpractices and gains a sense of mastery. The results of several clinical controlled studies completed over the past nine years show virtual reality exposure therapy is an effective and useful tool for the treatment of a variety of mental health disorders. Several groups have performed controlled clinical trials for claustrophobia, fear of heights, flying, and public speaking, and posttraumatic stress disorder due to motor vehicle accidents with all groups comparisons producing the same results: virtual reality exposure is more effective than imaginal exposure (visualization) for specific phobias and appears equally effective to in vivo (real-life) exposure. Most patients require eight to twelve sessions of therapy which includes an intake session, and sessions focusing on breathing retraining and cognitive coping techniques before beginning virtual reality (VR) exposure. Most groups agree that VR is best used as an adjunct to traditional cognitive-behavioral therapy, and not as a replacement of those techniques.
Other phobias being treated clinically with virtual reality include generalized social phobia, fear of driving, and panic disorder with agoraphobia (PDA). In a multi-center study by groups in Milan, Italy, Seoul, Korea, Quebec, Canada, and San Diego, California, initial results show that patients with PDA who receive VR-enhanced CBT require 33% fewer sessions than those treated with traditional CBT. This is an exciting finding and the study is ongoing to replicate these results with a larger controlled trial now underway.
A second group of disorders, eating disorders and obesity, are proving a successful second target for virtual reality exposure. Most who suffer from eating disorders develop body image distortion and dissatisfaction. In the past, paper and pencil tests (akin to imaginal exposure for phobias) or mirrored rooms (akin to in vivo exposure) have been used to treat this aspect of the eating disorders. Again, virtual reality provides a welcome middle ground. Used in combination with cognitive-behavioral therapy, obesity, binge-eating disorder, anorexia, and bulimia have all been treated successfully in controlled trials using VR in Europe. The patient’s actual body can be digitized into the virtual world and other three-dimensional bodies contained in the world can be manipulated to represent the patient’s “ideal” body and “perceived” body, and these can then be compared to the actual body. Environmental cues concerning food and eating activities are also presented to the patient.
Many groups are realizing the necessity of adding an objective measurement of treatment success in VR. Physiological monitoring tools include heart rate variability, respiration rate, skin resistance, skin temperature, and brain wave activity. As the patient learns to calm physiological responses to phobic stimuli, self-efficacy increases and a sense of mastery occurs. As Rachman determined in the 1970s, a person must become both objectively (physiologically) and subjectively (with using subjective units of distress [SUDS] 0 = no anxiety and 100 = maximum anxiety) aroused during exposure in order for desensitization to occur. This is necessary in order to change the fear structure stored in the brain, and allows full emotional processing to occur as Foa confirmed. A more recent trend involves having individuals immersed in a VR world while undergoing functional magnetic resonance imaging (fMRI) both pre- and post-treatment to determine neuroanatomic changes which may occur.
A third area that has shown great strides in VR is in the area of pain management. Health psychologists can help patients undergoing painful medical procedures to deal with them more effectively by placing them in virtual worlds during these procedures. Controlled trials have used VR for women with breast cancer and children with cancer during chemotherapy treatments. This has resulted in a reduction in such side effects as nausea. In addition, during wound care for children who have suffered burns, a recent study showed VR to be a more effective distractor than playing Nintendo. This resulted in significant reductions in both pain perception and physical discomfort.
Several researchers are beginning to explore providing virtual reality over the Internet. As bandwidth capabilities continue to increase, this is becoming a real possibility. In addition, Internet-based worlds and videoconferencing are both being used to treat social phobia and agoraphobia. In the case of social phobia, Internet-based worlds which utilize real-time audio provide immediate feedback and reinforcement, both positive and negative, so that patients can practice social skills under the supervision of the therapist, with the therapist able to determine what skills might need further improvement in role play exercises. Videoconferencing also allows the patient to practice social interactions in a manner that seems less overwhelming than face-to-face interactions. In the case of agoraphobia, therapy can begin over the Internet prior to the patient being able to leave his or her home and drive to the therapist’s office. Prior to this, the patient had to choose a therapist near their home.
At The Virtual Reality Medical Center, with offices in San Diego, Santa Monica, and Palo Alto; we are developing and implementing new technologies to further enhance clinical services and research, and are training graduate students to incorporate these tools into their therapeutic protocols. The key will remain to use these tools as an adjunct to traditional therapies and not as a replacement of these therapies. Caution must be used when applying these technologies with vulnerable populations and, as always the clinical need must drive the technology. With the advent of these technologies, however, we hope to be able to serve a wider majority of the population at need.
Brenda K. Wiederhold is at the Interactive Media Institute
Mark D. Wiederhold is at The Virtual Reality Medical Center
6160 Cornerstone Court
San Diego, CA 92121
Toll Free: 1-866-822-8762
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These recently identified mental health colleagues have been authoring books, publishing articles, being interviewed by the media, conduct workshops and training their associates within the line of cinema/film/reel/movie therapy.
This batch, however, has been misidentified and/or mixed with two other distinct groups leading the public either dismiss their credible work or the academia to minimize the importance of its application in education and therapy.
The first group is so called “lay cinema therapists” advising the reviewers of their products “to watch this so-and-so movie and feel better on so-and-so feeling.”
The second group is overly psychoanalytical mental health providers who do not do anything but “analyzing” movies. This newly identified group of educators and therapists, therefore, have difficulty expanding the concept regardless the credibility of their work.
Cinema/Film/Reel/Movie therapy is not a therapy per se. It is, however, an excellent tool for supportive, dynamic and cognitive-behavioral approaches. It may be implemented on general hospital behavioral inpatient units, partial care programs and outpatient clinics. The therapists apply it in individual, family and group settings. Clergy, congregations, business, schools and higher education, courts along with prisons are settings in which the modality is easily, economically and successfully practiced. Recently a few PhD students have been engaged in research projects studying of its “evidence based” practicality.
Further information may be reviewed at www.cinematherapy.com, the data base website of this exciting tool. Its members consist of the US, Canadian, Mexican and overseas academicians, administrators, art therapists, behavioral coaches, educators, physicians, psychiatric nurses, psychiatrists, psychologists, social workers, students, teachers and therapists.
Fuat Ulus, MD
Behavioral Health Unit
Millcreek Community Hospital
An Affiliate of Lake Erie College of Osteopathic Medicine
Erie, PA 16509
Tel: (814) 868-8270
Fax: (814) 868-8274
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