The Intersection of the Internet and Psychology: The Role of Online Interactions in Terms of Mental Health

From Helping Give Away Psychological Science at the University of Maryland, College Park. Team: Tony Li, Farnaz Ahmed, Austin Chau, Carrie Hill, and Wilson Lazo-Salmeron.

The Intersection of the Internet and Psychology
This page covers various topics in relation to mental health and the internet through the topics of online mental health care and the negative effects of the internet. With the internet becoming a core part of society and an influential source of social development among youths, this page is a collection of those effects.

Online Mental Health Care
The internet is adapting in terms of the roles and services it provides to people. More specifically, an open branch of accessing mental health facilities and support. Moreover, online platforms have the benefit of advocating for psychology resources and improving mental well-being. For instance, blogging or posting mental health concerns, locating assistance, and overall spread of awareness.

As a result, mental health care has been a prominent discussion on online formats. For example, the distinctions between face-to-face therapy and online therapy are widely mentioned, which researchers conclude there are no significant differences between the two. Instead, online therapy may propose greater advantages (e.g., flexibility and accessibility), improving the efficacy rate of online services. Additionally, as individuals recover from the Covid-19 Pandemic, online services are in great demand and adapting to the needs of clients. Finally, there are benefits of the internet being openly available, such as patients receiving immediate feedback with their diagnosis, treatment, and health.

In-Person vs. Online Mental Health Care
The use of accessing mental health services through online techniques, otherwise defined as "telemental health," has been increasingly popularized in recent years. Various methods include telephone calls, video conferences, and other non-person communication. Despite this popularity, there have been concerns regarding the effectiveness of psychological interventions. More specifically, there is apprehension about detecting nonverbal behavior, awareness of the client's tone or emotions, and reduced social connections. Thus, research is unclear whether or not these concerns are prevalent in online therapy formats and if they affect the quality of intervention. A systematic review was employed to examine the differences between face-to-face therapy and telephone treatment.

Precisely, 15 studies that focused on mental health intervention were gathered for analysis. Researchers plan to analyze themes, such as disclosure, attentiveness, listening skills, participation, among other factors, between face-to-face therapy and telephone therapy sessions. In regards to disclosing sensitive or personal experiences, no significant differences were observed throughout the 15 therapeutic studies. While utilizing self-report measures, clients expressed no significant changes in the therapist's attentiveness to the client. In reality, a few clients indicated higher levels of attentiveness during phone-to-phone therapy. Furthermore, the therapist's listening skills were also reported to be higher during telephone therapy sessions than in-person therapy. Finally, there are mixed results concerning participation, in which there were no prominent distinctions between face-to-face therapy and telephone sessions, while other studies concluding telephone sessions improved participation.

Ultimately, this systematic review established no notable differences between telehealth and in-person therapy, suggesting that therapy is a flexible process that may be accessed in a variety of contexts. Consequently, with the Covid-19 pandemic ongoing, the use of online telehealth practices is more essential than ever. Finally, future research may explore the long-term effects of online therapy or understanding the context of Covid-19 clients.

Another systematic review explored the differences between Internet-delivered cognitive behavior therapy (ICBT) and face-to-face delivered cognitive behavior therapy (CBT). A total of 13 studies were selected, representing cases of social anxiety, depression, body dissatisfaction, and more. Researchers compared the process of intervention, patient outcomes, and similarities of client's condition between ICBT and CBT. Overall, the meta-analysis indicates insufficient significant differences between the two formats of CBT. In other words, ICBT and CBT are similar in effectiveness, concerning topics such as social anxiety disorder, depression, body image issues, and more. Thus, the minimal differences between the two treatments are consistent with previously stated research regarding in-personal and online mental health, both being effective resources. Therefore, the results of this meta-analysis may support the expansion of creating more online mental health services while establishing ICBT as an effective alternative to CBT if needed.

Additionally, a randomized clinical trial further explored the effectiveness of online vs. in-person therapy regarding health anxiety. Specifically, internet-delivered cognitive behavioral therapy (ICBT) and face-to-face cognitive behavioral therapy (CBT) interventions were used to treat health anxiety or anxiety disorders in general. The outcomes focused on the progression of anxiety before and after treatment and supplementary outcomes, including health economics, reported adverse events, and other discussions. Ultimately, the findings indicate no significant difference between ICBT and regular face-to-face CBT. Despite ICBT therapists reporting spending 78% less time with patients than CBT therapists, both treatments achieved significant reductions in general anxiety amongst clients. Therefore, the results actively demonstrate both in-person and online mental health care as functional meanings of seeking treatment.

Effectiveness of Online Therapy
A systematic literature search explored to understand the effectiveness of internet-based cognitive behavioral therapy (ICBT) in treating psychiatric disorders, which include depression, generalized anxiety disorder (GAD), panic disorder, obsessive-compulsive disorder (OCD), post-traumatic stress disorder (PTSD), adjustment disorder, bipolar disorder, chronic pain, and phobias. Furthermore, other medical conditions, such as diabetes mellitus, and comorbidity were explored. Overall, various studies examined established positive outcomes from ICBT treatment. For instance, ICBT assisted patients in understanding their illness, especially in circumstances involving psychosis. Consequently, this improvement also positively impact social connections, reduced stress levels, and greater cognition and life satisfaction. Thus, the findings support ICBT being an effective mode of treatment of various mental health disorders. Additionally, the cost-effectiveness of ICBT makes this treatment suitable, which is further convincing to implement for clients interested.

Randomized controlled trials (RCTs) have also observed internet-delivered CBT (ICBT) is an effective means of treatment for health anxiety. Specifically, within the trials, individuals with anxiety were examined, and attrition rates of ICBT lesson plans were also collected. Ultimately, the trials concluded impressive reductions in anxiety behaviors and symptoms, supporting the ICBT as a beneficial intervention for participants. Despite these promising results, participants adhering to the online treatment program and lesson plans were low. Therefore, future research may consider alternative strategies to increase adherence to the intervention. In the meantime, implications still revolve around incorporating ICBT as a valuable resource for those seeking therapy.

Another randomized controlled trial evaluated the effectiveness of telephone-administered short-term cognitive-behavioral therapy (T-CBT), with an emphasis on treating depression. T-CBT operates by mobile phones to overcome external barriers with the objective to consult beneficial mental health outcomes. Researchers assessed patient health outcomes through questionnaires, surveys, and other measurement forms. Consequently, T-CBT offers a flexible, cost-effective service that assists with the improvement of mental health, specifically in depression.

Covid-19 and Mental Health Services
Over 100 psychotherapists were surveyed concerning their transition from in-person treatment to online psychotherapy shortly after the pandemic forced work from home requirements. Within the assessment, psychotherapists were evaluated by previous use of online therapy, forthcoming complications, and their general attitudes toward the new format. Overall, the majority of therapists indicated somewhat positive attitudes towards online psychotherapy. Moreover, they suggested potentially utilizing the online platform in future sessions.

Loneliness is an ongoing epidemic. However, with the COVID-19 pandemic, loneliness has escalated largely due to lockdowns, social distancing, and social isolation. As a result of limited and reduced social contact, loneliness and isolated thoughts are looming across society. Consequently, teletherapy has become a temporary solution in combating lonely thoughts. Not only does therapy assist with social isolation, other discussion topics include economic barriers, unknown atmosphere, and heightened anxiety symptoms. Despite the rise of covid-related mental health services, economic barriers and community resources prevent numerous individuals from seeking help, especially impoverished communities, minorities, and other underprivileged individuals. Nevertheless, mental health services are being adjusted to become openly available, along with therapists adjusting their techniques to focus more-so on Covid-related issues.

The Covid pandemic is a distressing period for countless individuals, with spikes in fear and uncertainty. Although there are several unknown factors, there are a few activities individuals can practice to maximize their control and safety in regards to their mental health and covid misinformation. For instance, staying informed and educated about Covid information while also recognizing the importance of self-care and limited media exposure. Moreover, individuals may take breaks from overwhelming news, stay connected to loved ones, and monitor their physical and mental health.

Self-Diagnosis and Treatment
In the rise of virtual health service and apps, new technologies have given more autonomy to the patient without reliance on traditional doctors or mental health care providers. Self-diagnosis and treatment have become more and more common as technology further develops. These apps and services have also opened the dialogue about its effectiveness compared to more traditional methods and about healthism of contemporary medicine. The traditional healthcare model places the doctor as the authoritative figure, however, as patients become more involved with their own health, the doctor's medical authority and the doctor-patient relationship have increasingly disputed. Although patients have more control of their treatment, they may be overwhelmed with an excess presence of information, in which future research may focus on studying.

Social Media is a powerful source of information for health and treatment advice. Specifically, individuals have reported utilizing Social Media for self-management strategies and health-related assessments. Furthermore, the transfer of health communication and intervention is another positive means of social media. Diabetes and common mental health disorders (CMHD), such as depression, anxiety, and stress, were observed for information-seeking individuals. Ultimately, the internet is an opportunity to explore information, advice, and communication concerning mental and physical health concerns.

Hotlines
Here is a list of credible mental health hotlines just for reference as they are another popular form of mental health treatment.


 * Disaster Distress Helpline (SAMHSA): Call 1-800-985-5990 or text TalkWithUs to 66746
 * National Suicide Prevention Lifeline: Call 800-273-8255
 * Physician Support Line: Call 1-888-409-0141
 * Crisis Textline: Text TALK to 741741
 * Veterans Crisis Line: Call 800-273-8255 or text 838255

Negative Effects of the Internet
The internet is an open realm of resources, connections, and activities. Although the internet has numerous opportunities for positive change, there are still harmful effects present in society. Specifically, misinformation and internet addiction are two consequences that stem from internet usage. Spreading misinformation is a common act demonstrated by individuals in which people share inaccurate information for various reasons, such as considering the perceptions of other viewers, personal research, and alternative motives in deceiving others.

On the other hand, internet addiction research has shown a diverse of complications with health, whether it is mental, physical, or social health. Although internet addiction is ongoing, cognitive processes are heavily influenced. Consequently, individuals may be susceptible to mental health disorders, such as depression, anxiety, and paranoia.

Overall, the adverse effects of the internet are a compelling issue that is gradually impacting society. Despite what is generally known, research is of utmost importance with understanding specific processes involved, short and long-term effects, and further explanation of why people engage in maladaptive internet behaviors.

Misinformation
The internet can be a major source of deception and misinformation. In order to analyze the cognitive processes that one goes through when deciding to spread information online, there are four questions that must be asked. These questions revolve around the consistency of a message, the coherency of the message, credibility of the source, and finally the general acceptability of the message. Using these questions to understand the spread of information online can assist in obtaining answers for why people spread misinformation, and how it can potentially be stopped. Misinformation is defined as inaccurate or false information, that has been posted with the intent to deceive, or make people believe that it is true. Similarly, disinformation is also false information, posted with the intent to mislead people, commonly used by governments in an attempt to challenge their perceived rivals. Finally, propaganda is misleading information that is biased and used to promote something in the political sphere. These distinctions are important because the internet has allowed these different types of false, or biased information to spread at unprecedented rates.

Misinformation in the healthcare sphere is particularly problematic because the dissemination of false information can prevent or delay effective care in ways that have life-threatening consequences. Accurate, scientific information may be eclipsed by all of the false information that spreads so quickly online. The wildfire-like spread of misinformation online has started harmful trends such as the anti-vaxxer movement and the popularization of the term "fake news" that can be used to describe anything that people do not agree with. Another huge threat of misinformation is the fact that it is increasingly difficult to prove that false information posted online is in fact false. This is unique to the internet, because in traditional media such as newspapers and radio, it is easy to verify the publisher and author of the source. With online material, it is often self-published and determining source credibility is difficult. When people are afraid, they can be more susceptible to misinformation. Thus, once the false information gains traction, it is difficult to correct and can go on to impact even more people.

One study surrounding the use of social media for information sharing found that 60% of respondents had shared misinformation online. Additionally, nearly 85% of participants stated they would post misinformation in the future. Interestingly, the top reasons stated for sharing misinformation were the perceived characteristics of the information and self-expression or socializing. Notably, some of the reasons that were not ranked highly included accuracy and authoritativeness. In terms of demographics, the study focused on a population of students in Singapore. Specifically, the study found that women had a higher prevalence of sharing misinformation or intentions to do so. Furthermore with demographics, undergraduate students reported sharing misinformation frequently compared to graduate students, likely due to undergraduate students being more involved in social media. However, despite the alternative intentions, curiosity and aims to seek related information were ranked favorably, indicating certain populations do not have malicious motives. Overall, it appears as though many people do not care if they are spreading inaccurate information, rather they focus on how their online friends are perceiving them.

Internet Addiction
One common form of internet addiction is Internet Gaming Disorder (IGD). Cognitive behavioral therapy has been considered to be an effective treatment for IGD in the past, however more research needs to be done to understand the underlying conditions that cause this addiction. One study that focuses on IGD found four underlying cognitive factors that can contribute to the disorder. These factors include: (1) beliefs about game reward value and tangibility, (2) maladaptive and inflexible rules about gaming behavior, (3) over-reliance on gaming to meet self-esteem needs, and (4) gaming as a method of gaining social acceptance. These cognitive factors reveal an underlying overvaluation of game rewards and identities, as well as a desire to adhere to maladaptive game rules. Understanding these cognitive factors more will assist with gaining a deeper understanding of different reasons for internet addiction.

Internet addiction has been referred to in the past as a serious public health problem around the world. One study investigated the relationship between internet addiction and stressful life events & psychological symptoms among students in China. The study revealed that internet addiction was significantly associated with stressors from interpersonal problems as well as school-related issues and anxiety. Additionally, negative coping styles for these problems can also increase the risk of internet addiction. The study suggests that there is a high prevalence of internet addiction among Chinese internet users, and calls for more research done on the topic of mental health issues and internet addiction.

Addiction to the internet can cause several negative outcomes, including but not limited to, failure in personal relationships, risk of depression, changes in sleeping patterns, ignoring responsibilities, impulse control disorder, and a range of other behavioral, social, physical and psychological problems. Moreover, internet addiction is especially problematic as the rates have been rising especially in children due to the easy accessibility of the internet. A study of internet use and addiction in Korea discovered that children whose parents underestimated the risk of the internet were at a greater vulnerability for internet addiction. Consequently, it is advised that parents should make it their responsibility to learn about the dangers of internet addiction and thus limit the time their children spend online. Nevertheless, research is continuously being conducted to observe the impacts of internet addiction in children, and what parents can do to create a change.

A research study was designed to measure the connection between internet addiction and various psychopathologies, such as suicidality and depression. Over 30,000 Freshman students completed the study in its entirety. Questionnaires assessed the participants' involvement with the internet, depression criteria, paranoia, and more. On average, participants were 18 years of age with nearly equal gender populations. As a result, moderate to severe addiction was significantly correlated with negative mental health outcomes (e.g., depression, paranoia, suicide, and psychoticism). Specifically, depression and internet addiction had the greatest association. Not only was internet addiction linked to adverse mental health outcomes, but it was also related to somatic symptoms, which are characteristics of common medical illnesses. Ultimately, the results are consistent with previous literature stating that internet addiction can have a moderate to severe impact on individuals, with specific attention focusing on deteriorating mental, physical, and social health.