Navigating the ethics of Internet-guided self-help interventions.

Internet-guided self-help (IGSH) programs have proliferated recently to treat common mental health problems such as anxiety and depression. However, technology has outpaced the development of ethical guidelines for this mode of delivery. We examine ethical challenges in this new space, including defining the role "guides" play in treatment, crisis management, and user selection and screening. IGSH programs can provide safe and ethical care when they (a) coordinate care effectively with other systems; (b) provide competent and well-defined guidance; and (c) reach users that are appropriate for and well-educated about the services they are going to receive. We argue that jurisdictional practice constraints and outdated regulatory and ethical guidelines may impede the ability of IGSH programs to maintain or even improve performance when faced with greater demand, larger populations, heterogeneous settings, and the desire for large-scale dissemination.

Developing a Novel Measure of Body Satisfaction Using Virtual Reality.

Body image disturbance (BID), considered a key feature in eating disorders, is a pervasive issue among young women. Accurate assessment of BID is critical, but the field is currently limited to self-report assessment methods. In the present study, we build upon existing research, and explore the utility of virtual reality (VR) to elicit and detect changes in BID across various immersive virtual environments. College-aged women with elevated weight and shape concerns (n = 38) and a non-weight and shape concerned control group (n = 40) were randomly exposed to four distinct virtual environments with high or low levels of body salience and social presence (i.e., presence of virtual others). Participants interacted with avatars of thin, normal weight, and overweight body size (BMI of approximately 18, 22, and 27 respectively) in virtual social settings (i.e., beach, party). We measured state-level body satisfaction (state BD) immediately after exposure to each environment. In addition, we measured participants' minimum interpersonal distance, visual attention, and approach preference toward avatars of each size. Women with higher baseline BID reported significantly higher state BD in all settings compared to controls. Both groups reported significantly higher state BD in a beach with avatars as compared to other environments. In addition, women with elevated BID approached closer to normal weight avatars and looked longer at thin avatars compared to women in the control group. Our findings indicate that VR may serve as a novel tool for measuring state-level BID, with applications for measuring treatment outcomes. Implications for future research and clinical interventions are discussed.

Designing virtual environments to measure behavioral correlates of state-level body satisfaction.

Virtual reality (VR) offers a unique method for eliciting state-variable fluctuations in body satisfaction and associated behaviors by allowing near-perfect control over environmental factors. Greater variability in momentary body satisfaction is associated with more problematic eating behavior and cognitive styles predictive of eating disorders. The field currently lacks a model for understanding environmental variables and everyday events that tend to influence fluctuations in state body satisfaction. This study proposes a model of state-level body satisfaction and presents a method for measuring changes as they occur. We aim to investigate body comparison, selective attention and body checking behaviors in relation to self-report levels of state body satisfaction. We additionally assess interpersonal correlates of state body satisfaction using VR to measure personal distance between subjects and avatars of varying body sizes. 80 female college students with varying levels of weight and shape concerns will be exposed to five virtual environments designed to elicit varying levels of body dissatisfaction: (a) an empty room; (b) an empty beach; (c) a beach populated with avatars; (d) an empty party scene; (e) a party scene populated with avatars. Self-report body satisfaction was measured immediately following each exposure. A tracking system automatically tracked subjects' head orientation and body translation to measure visual gaze and personal space behavior relative to each virtual human within the environment. Data collection is currently underway and expected to be completed by May 2013. Preliminary data and development of the VR model for state-variable assessment will be presented.