title: Therapy in virtual environments--clinical and ethical issues.
abstract: BACKGROUND
  As virtual reality and computer-assisted therapy strategies are increasingly implemented for the treatment of psychological disorders, ethical standards and guidelines must be considered. This study determined a set of ethical and legal guidelines for treatment of post-traumatic stress disorder (PTSD)/traumatic brain injury (TBI) in a virtual environment incorporating the rights of an individual who is represented by an avatar.
  
  
  METHODS
  A comprehensive literature review was undertaken. An example of a case study of therapy in Second Life (a popular online virtual world developed by Linden Labs) was described.
  
  
  RESULTS
  Ethical and legal considerations regarding psychiatric treatment of PTSD/TBI in a virtual environment were examined. The following issues were described and discussed: authentication of providers and patients, informed consent, patient confidentiality, patient well-being, clinician competence (licensing and credentialing), training of providers, insurance for providers, the therapeutic environment, and emergencies. Ethical and legal guidelines relevant to these issues in a virtual environment were proposed.
  
  
  CONCLUSIONS
  Ethical and legal issues in virtual environments are similar to those that occur in the in-person world. Individuals represented by an avatar have the rights equivalent to the individual and should be treated as such.
authors: Department of Psychiatry, University of California, Davis, Sacramento, California 95817, USA. pmyellowlees@ucdavis.edu
authors: Peter M
authors: PM
authors: Yellowlees
authors: Kevin M
authors: KM
authors: Holloway
authors: Michelle Burke
authors: MB
authors: Parish
mesh_terms: D001930:Brain Injuries / Q000628:therapy*; D002983:Clinical Competence; D003219:Confidentiality; D006801:Humans; D007258:Informed Consent; D061214:Patient Safety; D013313:Stress Disorders, Post-Traumatic / Q000628:therapy*; D013813:Therapy, Computer-Assisted / Q000941:ethics* / Q000331:legislation & jurisprudence*; D014584:User-Computer Interface