The technological developments we see today set a whole new view of life as we know it. Starting with the Industrial Revolution, and getting to robot assisted mass production of goods, we get to use intelligent machines in order to make life easier and evolve as a species. And psychology is not an exception. Ever since ELIZA was developed to simulate a psychotherapist in the ‘60s (try it for yourself here) computers have been widely used within clinical psychology and psychotherapy. Today, we will be talking about the efforts of the Clinical Psychology and Psychotherapy School of “Babeș-Bolyai” University of Cluj-Napoca, Romania in pursuing Virtual Reality (VR) and Artificial Intelligence (AI) research and practice excellence.
The Department of Clinical Psychology and Psychotherapy of “Babeș-Bolyai” University of Cluj-Napoca, Romania was born right in the aftermath of the 1989 Revolution, under the initiative of “Aaron T. Beck” Professor, Ph.D., Daniel David, as a desire to produce research excellence, much needed after the dark years of the communist regime. Therefore, professor Daniel David had completed a postdoctoral program at the Icahn School of Medicine at Mount Sinai, USA, and the Albert Ellis Institute, where he had direct contact and training in the most recent developments in the clinical domain and the field of psychotherapy. After returning to Romania, building upon the experimental tradition of the School of Psychology in Cluj, professor Daniel David, along with his colleagues, have initiated a Clinical Psychology and Psychotherapy School, based on rigorous experimental foundations, and aligned to international standards, following the evidence-based and scientist-practitioner/clinical science paradigms.
The Robotics and Virtual/Augmented Reality Psychotherapy Platform – THE MATRIX PLATFORM – represents an Excellence Center of the International Institute of Advanced Psychotherapy and Mental Health Studies and reunites a multidisciplinary team consisting of clinical psychologists, MDs, IT professionals, and graphic designers. The Institute is included in the MERIL Platform, an inventory of the “most excellent research infrastructures in Europe, of more-than-national relevance, across all scientific domains”. The MATRIX Platform offers solutions regarding treating Autistic Spectrum Disorders with the help of robots, or VR therapy for various clinical conditions.
More about the Clinic’s activity we will discuss with professor Daniel David.
Mr. David, thank you for accepting our invitation. Firstly, tell us a bit about your background. How did you get into Psychology and Technology assisted therapy?
I hold the Aaron T. Beck professorship at Babeş-Bolyai University, Cluj-Napoca, Romania and I am the president/director of the International Institute for the Advanced Studies of Psychotherapy and Applied Mental Health. I am also director of research at the Albert Ellis Institute (AEI) and an adjunct professor at the Icahn School of Medicine at Mount Sinai in New York. As a clinician, I am a diplomate/supervisor at the Albert Ellis Institute (AEI) and the Academy of Cognitive Therapy. My first exposure to psychology and technology took place in the USA, where I have witnessed how such technologies could be used effectively for anxiety disorders and/or pain control. From there, I have fully embraced the paradigm and I am continuously developing it with both paradigmatic and frontier research, with my team in Romania.
What is the focus of your research?
I work in the field of clinical cognitive neurogenetics sciences with implications/applications for evidence-based psychotherapies. In this general paradigm, the use of technology is a constant presence. As I presented elsewhere (see here), my “current research is focused on the role of cognitive mechanisms, both explicit (e.g., autobiographical memory) and implicit (e.g., implicit memory; priming) in generating subjective/emotional (cognition-emotion relation), behavioral, and psycho-physiological human responses, more specifically, on the role of (a) rational/functional and irrational/dysfunctional beliefs and (b) response hopes and/or expectancies on various psychological and medical outcomes related to mental health and cancer. When clinical trials are used as research instruments the analysis employed is typically multilevel, concerning: (1) outcomes (i.e., efficacy and/or effectiveness); (2) theory/mechanisms of change (both psychological and neurobiological); and (3) economical aspects (e.g., cost-effectiveness, cost-utility). A specific research interest includes the theory and practice of cognitive hypnosis/hypnotherapy as part of the cognitive neuroscience paradigm and the use of technological developments in psychotherapy (i.e., virtual reality therapy; robotherapy)”. Technology is part of our life, so it should be part of our professional life too.
How does the public see technology-assisted therapy? Are they open for it, or rather fearful? Could you provide us with a clinical example?
It should be clear that technologically-enhanced psychological treatments are not new treatments. For example, in order to practice virtual reality/augmented therapy or robot-based psychotherapy one has to be trained in classical psychotherapy (recommended cognitive-behavioral or other evidence-based psychotherapies). During this classical training, one is taught how to do clinical assessment (to identify the problems), clinical conceptualization (to explain the problems), clinical interventions (e.g., psychological treatments to solve the problems), and how to build a good therapeutic relationship (to create the whole context to defining/explaining/solving the problems). Now, if you have a good therapeutic relationship (e.g., including trust) and one is generating a comprehensive clinical conceptualization (which leaves place and/or emphasize the role of technology) then there is no opposition to the use of technology in psychotherapy. On the contrary, the patients are happy and interested in using it. It is like in medicine: why would one refuse an investigation with the most advanced technology when the benefit for his/her health is clear to the patient? We just have to make it clear, wisely!
How does the AI/Robot assisted therapy for Autistic Spectrum Disorders (ASD) work compared to other therapies? What are the outcomes and results of such therapy?
ASD patients, as compared to typically developed children/adults, have difficulties in learning from other people (e.g., various social/communication skills) by using basic mechanisms as imitation/turn-taking/joint attention. Therefore, they have social problems (e.g., interpersonal relations, communication problems, preseverative behaviors etc.). However, it has been observed that they are more open/interested in artificial agents (e.g., robots). From there, it is a small, but important, step in wanting to used artificial agents (e.g., robots) to teach them various social skills that could not be learnt easy by the regular route (i.e., teaching by humans). We are involved in a big DREAM Project, supported by the European Commission, in investigating these aspects and in designing a new robot-based psychological treatment for ASD. The trial is ongoing and we will have the final results of this first landmark trial by the end of 2018. However, the applications of robot-based psychotherapy are more complex (e.g. other clinical conditions, robots as companion/monitor for aging population, educational platform, etc.); please see for example another project in which we run a clinical trial – the Help4Mood Project – in using Avatars for treating major depressive disorder patients. For more details and a paradigm setting article in case of robot-based psychotherapy please see David, Matu, & David (2014): Robot-Based Psychotherapy: Concepts Development, State of the Art, and New Directions, in International Journal of Cognitive Therapy.
How about the VR Based Therapy?
Virtual reality/augmented therapy is another somehow older story. It started by the end of ‘80s-beginning of ‘90s in the field of anxiety disorders (virtual realities have origins in ’50s-’60s). We know that one of the best techniques in the treatment of anxiety disorders is exposure (with relapse prevention). However, sometimes it is difficult to be implemented and/or it is very costly. For example, in case of a plane phobia, exposing the patient during a real flight may generated panic attacks of patient (difficult to handle in the plane), the other passengers may be unsatisfied, and it might even interact with the flight plan (e.g., forced landing due to a medical crisis). However, if we run it in a virtual environment, everything could be controlled from the computer. A more recent extension is related to implementation skill training/problem solving in virtual/augmented reality, rather than only in vitro (i.e., imagery) and/or by role playing with the psychotherapist. However, recently our group extended the application of virtual/augmented reality to other psychological areas. For example, we are doing cognitive restructuring in virtual/augmented realities, which are more ecological (here and know) and potentially for efficacious. For more details and a paradigm setting article please see David, Matu, & David (2013): New Directions in Virtual Reality-Based Therapy for Anxiety Disorders, in International Journal of Cognitive Therapy.
What would you tell to a new graduate interested in technology assisted therapy? What would be your advice?
First, get a very serious and rigorous training in evidence-based psychotherapies (the gold standards are cognitive-behavioral psychotherapies). Then, during the training, you may ask and/or pursue independently (e.g., by workshops, time-limited training) training in technologically-based psychotherapy. It is not only related to robot-based psychotherapy or to virtual/augmented reality therapy. It can also include the use of internet/web-based psychotherapy, gaming, apps etc. Please see the Research section of the website of the Albert Ellis Institute for a brief synopsis and examples. For training, our International Institute for the Advanced Studies of Psychotherapy and Applied Mental Health (http://www.psychotherapy.ro) could also be a good choice.
Ioana Piscoi
Currently a first year Master Student of Clinical Psychology, Counselling and Psychotherapy at "Babes-Bolyai" University of Cluj-Napoca, Romania, Ioana is interested in developing her skills to become an ACT Therapist. She is particularly interested in the field of Personality Disorders and Techlonogy Assisted Psychotherapies, wishing to pursue a PhD in the future.
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