Psychological Perspectives and Challenges towards Information

Technology and Digital Health Interventions

Thomas Ostermann

Department of Psychology and Psychotherapy, Faculty of Health, Witten, Herdecke University, Germany

Keywords: Psychology, Psychotherapy, Digitalisation, e-Health, m-Health.

Abstract: Psychology is a quite young discipline in the field of medicine. Established from Wilhelm Wundt in the

second half of the 19th century it very soon got its first contacts to information technology. This keynote

outlines the relationship of psychology and information technology from the very beginning in the fields of

clinical and educational applications and human interaction aspects and illustrates the current development

towards a field of digital mental health. In particular, the use of Virtual Reality as a an approach in the

treatment mental disorders and diseases such as Anxiety disorders or Parkinson’s disease, the therapeutic use

of AVATARS in patients with auditory verbal hallucinations, the predictive power of digital drawing

applications i.e. to detect Alzheimer’s disease, or the attitude to robots in the health care system are spotlights

illustrating the growing interaction of these domains which are addressed in this keynote. But also critical

questions on the impact of digitalization on human identity i.e. in child development, working environment

or in the increased use of wearables and smart applications in leisure time fostering a need of quantification

of life are touched.

1 INTRODUCTION

The terms “Telemedicine”, “E-health” and “M-

health” have become an integral part of almost all

health care systems with the advent of modern

information technology. While telemedicine refers to

the diagnosis and therapy by bridging a spatial or

temporal distance between doctor, therapist,

pharmacist and patient or between two doctors who

consult each other by means of telecommunication,

E-Health describes the integrated use of information

and communication technology for the design,

support and networking of all processes and

participants in the health care system. The term M-

Health defines the support of medical procedures and

health care measures through mobile devices such as

smartphones, tablets or other mobile technology such

as body sensors (Ostermann, 2017).

A recent bibliometric analysis of worldwide

scientific literature in m-health from 2006–2016

found a noticeable increase in publications in the

period under review (Sweileh et al., 2017). Today

these approaches are summarized under the umbrella

“digital health interventions” (Allgaier et al., 2020).

2 HISTORY OF DIGITAL

HEALTH INTERVENTIONS

2.1 A Forgotten Pioneer

From the historical perspective the first step into

digitalisation in health care was done by Semen

Nikolaevich Korsakov, an officer in the Department

of Statistics in Russia. In 1832, he invented

mechanical instruments he called “Machines for the

Comparison of Philosophical Ideas” (Shilov &

Silantiev, 2015) which very much resembles the

concept of Karl Steinbuch’s “Learning Matrix” from

the early years of biological cybernetics almost 130

years later (Steinbuch, 1961). Based on the method of

information storage in punch cards, he was the first to

apply them in patient care almost a century before the

first punch card systems were used. Although his idea

was a more general one, he adopted it against the

background of the cholera epidemic of that time: to

find a suitable (homeopathic) drug for patients

quickly and efficiently (Ostermann, 2015).

In principle his idea can be described as follows:

Every drug is characterized by a number of

symptoms. These are marked on a wooden board by

Ostermann, T.

Psychological Perspectives and Challenges towards Information Technology and Digital Health Interventions.

DOI: 10.5220/0010468100070012

In Proceedings of the 14th International Joint Conference on Biomedical Engineering Systems and Technologies (BIOSTEC 2021) - Volume 5: HEALTHINF, pages 7-12

ISBN: 978-989-758-490-9

perforations or holes at an appropriate point, so that

each drug receives its binary code on a wooden board.

If a patient now describes his symptoms, a comb is

created with needles at the corresponding points of

the symptoms. If this comb is stroked over the

wooden plate, the comb clicks into place exactly

where a medicine is provided with the corresponding

"symptom holes": the machine "stops" and the

medicine can be identified (Fig.1). This process is

repeated until all drugs have been "combed through".

The principle is graphically illustrated again in Fig. 1.

Figure 1: Semen Korsakoff's “Homeoscope” (adapted from

Velminski & Ernst (2008)). The comb has needles at points

4, 5, ... representing the patient's symptoms and correspond

to the drug “E”, which has perforations at the corresponding

points.

However, his idea was forgotten and it took

almost 90 years before punch-card systems patented

by Hollerith in 1889 (Wahl, 2018) were introduced in

health science and in particular in psychology.

2.2 Early Psychological Use of Digital

Health Interventions: Punch-cards

Psychological research very early took advantage of

the punch-card system they quite early were used to

analyse census or opinion poll data as documented in

(Bingham, 1922) or (Gage & Remmers, 1948). While

these approaches mainly focussed on data procession

and counting, psychological research also used this

technique for automated calculation of statistical

measures such as correlations. between the age of

imprisoned persons in relationship to test scores of

the Rorschach test in which the perceptions of

inkblots (i.e. “it looks like a bat”) were analysed using

psychological interpretation (Pescor, 1938).

But also more complex statistical procedures at

the time like computing biserial correlation

coefficients (DuBois, 1942) or sorting and scoring of

questionnaire inventories i.e. the Minnesota

Multiphasic Personality Inventory (Manson &

Grayson, 1946) were performed using punched

coding cards. An illustration from the original

publication of Manson & Grayson (1946) in

displayed in Fig. 2.

Figure 2: “XO card (front view)” for the item “Once in a

while I think of things too bad to talk about” of the

Minnesota Multiphasic Personality Inventory from

(Manson & Grayson, 1946).

2.3 Mainframe Computers in

Psychology

With the emergence of mainframe computers in

science starting from the 1950th, psychological

research also made use of this new technology.

Figure 3: IBM 701 operator's console. Retrieved from

https://commons.wikimedia.org/w/index.php?curid=13301

780. Dan-Flickr: IBM 701.

According to a survey of computer usage in 109

Departments of Psychology and 26 Departments of

Sociology in the United States in 1960, 83

Psychology departments (76.1%) and 25 Sociology

Departments (96.2%) reported to have a computer

installation at their departments. They estimated a

mean of 75.4 hours of machine time within the last 12

month for the psychology departments and 156.0

hours for the sociology departments. In most of the

cases an IBM 650 (n=81; 75.0%) or an IBM 701

(n=25; 23.1%) was used (Fig. 3).

BIOSTEC 2021 - 14th International Joint Conference on Biomedical Engineering Systems and Technologies

According to a summary on computer use at that

time (Newell & Simon, 1963), most of the

procedures, the mainframes were used for were large-

scale statistical and numerical analyses, such as

cluster or factor analyses i.e. determining the factor

analytic structure of the House-Tree-Person-Test

(Digiammo 1962) where an IBM 650 was used to

perform a complete centroid method for the

extraction of factors.

2.4 Microcomputers in Psychology:

Clinical and Experimental

Applications

With the first emergence of microcomputers in the

1970

the costs for using computational applications

decreased together with an easier handling in their

operation. Thus popularity during the late 1970s and

early 1980s exploded and as a consequence digital

applications also went into the field of clinical

psychology by means of decision support systems,

databases for documentation of patient records

(Hayward, 1981; Reynolds et al., 1985). Even the

idea of performing “online” patient interviews in a

man-machine interaction in a way that an emulated

“friendly doctor [is] asking questions requiring

simple YES or NO answers” was realized at that time

(Bevan et al., 1981) using a conventional BASIC

program.

But also in the field of experimental psychology,

computers were used i.e. for computer-controlled

arithmetic problem solving tasks (Fig. 4) (Aaronson

et al., 1976) or the visual display and eye-movement

recording systems (Loftus et al., 1975).

Figure 4: A pupil solving arithmetic problems in a

computer-aided instruction project displayed in (Aaronson

et al., 1976).

2.5 Internet and Psychology: From

USENET to Online Therapy

At the same time when microcomputers found their

way into psychology, first ideas of connecting

networks shifted more and more into the centre of

interest (Schwartz, 1985). A first guide of

psychological resources was summarized in (Quinn,

1995) ranging from Online-Journals such as

“Psycoloquy”, a peer reviewed open access journal

published online from 1990 to 2002 by the American

Psychological Association (APA) to electronic news-

and discussion-groups like “sci. cognitive”, a

newsgroup for cognitive psychology, or “psyart”, a

discussion group for the psychological study of the

arts.

But also therapeutic electronic networks and data

sharing in the field of mental health using “Bulletin

Board Systems” were topics discussed (Miller, 1991)

very early.

Similarly concepts like virtual reality, in which

the computer serves “as a as mediator or imagination

enhancer” were introduced (Reid, 1994) alongside of

first case reports in the field of clinical psychology,

i.e. in the field of exposure treatment of acrophobia

(Rothbaum et al, 1995) using “a head-mounted

display (VR Flight Helmet) and an electromagnetic

sensor […] to track the head and right hand

(Ascension Technology Flock System)” or in the

construction of a virtual sand box for the diagnosis

and treatment of autistic patients (Kijima et al., 1994).

3 ACTUAL TRENDS

Twenty-five years later, most of the ideas and

concepts presented in the last chapters have been

enhanced and tested by means of clinical studies and

meta analyses.

Immersive virtual reality has become an accepted

treatment i.e. in the treatment of schizophrenia

spectrum diseases, where it has shown “safe,

tolerable, and long-term persistent” effects in the

treatment of “delusions, hallucinations or cognitive

and social skills” (Bisso et al., 2020). But also in other

fields like Parkinson’s disease (Dockx et al., 2016) or

traumatic brain injury rehabilitation (Aida et al.,

2018) reviews have shown its effectiveness.

The same holds for online-therapy. Current

clinical research i.e. found electronically delivered

cognitive behavioural therapy “at least as effective”

as face to face cognitive behavioural therapy in the

field of depressive disorders (Luo et al., 2020). Also

other psychotherapies like mindfulness based

Psychological Perspectives and Challenges towards Information Technology and Digital Health Interventions

interventions have been adopted into online formats

and shown its usefulness in particular in cases of

immobile or hard to reach patients (Jayawardene et

al., 2017).

However apart from optimising already known

concepts, recent trends in psychotherapy include new

forms of digital health interventions i.e. AVATAR

therapy for auditory verbal hallucinations in people

with psychosis (Craig et al., 2018) or the digital

analysis of bodily sensation maps (Volynets et al.,

2020). In the clinical context of the latter, Lyons et al.

(2020) were able to show, that depressive subject

showed distinctly reduced bodily sensation maps for

different emotions than healthy controls.

Another aspect is given by mobile devices like

smartphones, tablets and wearables, which are

currently used in clinical psychological diagnoses.

According to a position paper of Torous et al. (2017),

“new digital technologies […] can now explore new

dimensions of pathology largely inaccessible only a

few years before”.

One example is given by the digital tree drawing

test (dTDT). In this test, patients draw a tree with a

digital pen on a Microsoft Surface Pro 3 digitizer

(Fig. 5).

Figure 5: Examples of digital tree drawings of two healthy

controls and two early AD participants from (Ostermann et

al., 2020).

Statistical models identified the average painting

velocity in combination with the variation in the use

of colours and line widths as significant predictors for

early Alzheimer’s disease (Robens et al., 2019).

However, new technologies are not useful for

diagnosis but also for monitoring tasks. A recent

systematic review on the application of wearable

devices for Parkinson’s disease found that wearbales

were efficient in the analysis of body motion, motor

fluctuations and home-based long-term monitoring

(Rovini et al., 2017).

Finally, due to demographic changes and aging

society, the use of human like robots to support older

adults in everyday activities is another emerging field

of research. Although recent surveys have

demonstrated, that people across age groups though

of robots as being “useful” and disagreed that robots

were dangerous (Backonja et al., 2018), research on

attitudes towards robots is still at the very beginning.

4 CONCLUSIONS

Information technology nowadays has reached

almost every part of patient care. Although this

overview is far away from being exhaustive in terms

of having found all information technology

applications in psychological research and patient

care, it nevertheless was able to show, that

psychology has always been on the cutting edge of

information technology making use of the most

innovative technology available.

However, critical questions on the impact of

digitalization on human identity i.e. in child

development, working environment or the increased

use of wearables and smart applications in leisure

time fostering a need of quantification in life should

also be recognized in this rapidly growing area of

research (Meschner, 2020; Nagy & Koles, 2014).

Thus, a mindful integration and cautious adoption

of further developments in the field of information

technology in psychological research should be

encouraged.

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