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The popularity of Second Life peer support communities, and additional health-related activities (e.g., health promotion and education), may result from users’ ability to collaborate, interact, and consult with other avatars in real time while maintaining their anonymity ( 6). Many peer communities focused on sensitive topics (e.g., sexual health, addictions) or were organized for and by groups of people who are vulnerable to marginalization and discrimination in “real life” (e.g., people with disabilities). In 2008, there were 68 health-related activities on Second Life, 20% of which were intended primarily for peer support ( 6).
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Most attention has focused on the program Second Life, where users can create realistic-looking human avatars that they can use to manipulate stimuli within the virtual environment and remotely interact with other users – also represented as avatars – via text and/or audio. The potential to foster cohesive social networks is cited as a strength of virtual worlds in which users can interact with each other by adopting personalized avatars ( 1). Applications of Avatars in e-Mental Health: An Overview Online Peer Support Communities We additionally synthesize the functions that avatars can serve in such applications and consider the advantages and challenges of implementing this novel technology within e-mental health interventions. In this narrative review, we consider the psychotherapeutic applications of computer-based and online avatar technology specifically, the ways in which avatars have been used to replace or augment traditional models of client–therapist interaction and communication. Indeed, immersive virtual reality technology has previously been reviewed for its significant potential in psychiatric applications ( 4, 5). For instance, head-mounted virtual reality devices that immerse clients into computer-generated interactions with avatars are increasingly being utilized to treat anxiety disorders ( 2) and persecutory delusions ( 3). Studies since 2008 have proposed several further applications of avatars in the delivery of e-mental health interventions.
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These included (1) an alternative form of technology (i.e., other than head-mounted virtual reality devices) to deliver exposure-based therapy for anxiety disorders and substance-abuse problems and (2) facilitation of online peer support communities. ( 1) proposed two key applications of avatars in multiuser, computer-based, three-dimensional virtual worlds, such as Second Life, which could potentially transform the delivery of online interventions for mental health problems (i.e., e-mental health interventions). In their seminal 2008 paper, Gorini et al. In online virtual environments, multiple remotely located users can synchronously communicate and interact with each other via an avatar – a digital character that the user can customize to represent his/her identity. Further research into the feasibility and ethical implementation of avatar-based psychotherapies is required. Across these applications, avatars appeared to serve several functions conducive to treatment engagement by (1) facilitating the development of a virtual therapeutic alliance (2) reducing communication barriers (3) promoting treatment-seeking through anonymity (4) promoting expression and exploration of client identity and (5) enabling therapists to control and manipulate treatment stimuli. Five key applications were identified (1) in the formation of online peer support communities (2) replicating traditional modes of psychotherapy by using avatars as a vehicle to communicate within a wholly virtual environment (3) using avatar technology to facilitate or augment face-to-face treatment (4) as part of serious games and (5) communication with an autonomous virtual therapist. In this narrative review, we examine the psychotherapeutic applications of avatars that have been investigated and trialed to date. Avatars are digital self-representations, which enable individuals to interact with each other in computer-based virtual environments. In the burgeoning field of e-mental health interventions, avatars are increasingly being utilized to facilitate online communication between clients and therapists, and among peers. 3Monash Alfred Psychiatry Research Centre, Monash University Central Clinical School and The Alfred, Melbourne, VIC, Australia.2Research School of Psychology, College of Medicine, Biology and Environment, Australian National University, Canberra, ACT, Australia.1National eTherapy Centre, Centre for Mental Health, Swinburne University of Technology, Melbourne, VIC, Australia.Abbott 1 Michael Kyrios 2 Neil Thomas 1,3* Rehm 1 Emily Foenander 1 Klaire Wallace 1 Jo-Anne M.