Emotions, Technology, and Health

Emotions, Technology, and Health

First Edition

Sharon Y. Tettegah

Professor, University of Nevada, Las Vegas, College of Education, Las Vegas, NV, USA

Beckman Institute for Advanced Science and Technology, National Center for Supercomputing Applications, affiliate, University of Illinois, Urbana, IL, USA

Yolanda Evie Garcia

Associate Professor, Educational Psychology, Northern Arizona University, Flagstaff, AZ, USA

Table of Contents

Cover image

Title page

Copyright

Contributors

Foreword

Acknowledgments

Preface

The Intersection Between Emotions, Technology, and Health

Telehealthcare Systems and Patient Interactions

Use of Technology to Promote Emotional Health

Technology in Clinical Treatment

Section I: Telehealthcare Systems and Patient Interactions

Chapter 1: Using Technology for Evaluation and Support of Patients’ Emotional States in Healthcare

Abstract

Doctor-Patient Communication

Types of Emotion

Using Technology to Support Healthcare Assessments

Physiological Responses and Detection

Artificial Intelligence

Computer Games and Simulations

Discussion

Conclusion

Chapter 2: Patient Emotions and Patient Education Technology

Abstract

Overview

Meanings

Emotions

Patient Education Technology

Pedagogy

Discussion and applications

Summary

Chapter 3: Digitized Emotions in the Pocket: Social Computing and Mobile Mental Health (mMH) Applications

Abstract

Introduction

Current Scientific Knowledge in Smartphone Health Applications Research

Future Research Directions

Chapter 4: Electronic Record Keeping and Psychotherapy Alliance: The Role of Concurrent Collaborative Documentation

Abstract

Introduction

EHRs: Changing the Landscape

The Emergence of Collaborative Documentation

The Alliance in Psychotherapy

Treatment Notes, Clients, and Technology

Involving Clients Through Collaboration and Transparency

Conclusion

Section II: Uses of Technology to Promote Emotional Health

Chapter 5: What Is Emotional About Emotional Robotics?

Abstract

Acknowledgment

Emotional Robots in an Aging Society

Affective States in Different Types of Interactions

Acceptance of Paro and First Clinical Evaluations

Ethical, Political, and Social Psychological Considerations on the Use of Emotional Robots

Summary, Conclusions, and Future Research

Chapter 6: Memory, Media, Nostalgia, and Grief

Abstract

Introduction

Memory, Representation, Language, and the Lacanian Gaze

Memory, Mediation, and Film

Memory, Mediation, and Online Art Communities

Conclusion

Chapter 7: The Stories We Tell Each Other: Using Technology for Resistance and Resilience Through Online Narrative Communities

Abstract

Theoretical Grounding

Methods

Literature Review

Analysis

Discussion

Conclusion

Appendix

Section III: Technology in Clinical Treatment

Chapter 8: Technology Enhances Social-Emotional Intelligence in Individuals with Autism Spectrum Disorders

Abstract

Introduction

Framework

Construct Overview

Social-Emotional Intelligence

Self-Awareness

Social and Emotional Technology Curricula

Science of Me Curriculum

Utilizing Technology to Support SEI Instruction

SymTrend: A Health Diary Journal

HeartMath EmWave Desktop Software and Inner Balance App: Stress Management Tools

The Trifecta: Self-Awareness, Stress-Management, and Social Competency through the Science of Me Curriculum and Technology

Outcomes

Future Exploration and Questions

Appendix A SEI and Stress Management Technology for Individuals with ASD

Appendix B SEI and Healthy Living Technology for the General Population

Chapter 9: Our Songs, Our Selves: Building Elder Community Through Teleconference Technology

Abstract

Session 1: Meet the Participants

Session 2: Our First Listening

Session 3: Opera Enthusiasts Unite

Session 4: Alone Together

Session 5: Grateful

Conclusion: Our Teleconference Community

Chapter 10: Interpersonal Media Used by Couples in Non-Proximal Romantic Relationships: Implications for Psychological Practice

Abstract

Nature and Scope of Non-Proximal Romantic Relationships

Telemental Health Interventions

Conclusion and Future Research Directions

Index

Copyright

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Contributors

Stefanie Baisch     Developmental Psychology Lab, Department of Psychology, Johann Wolfgang Goethe-University, Frankfurt am Main, Germany

Sherry Craft     Washington State University, Pullman, WA, USA

Robert DiCarlo     Department of Education Psychology, Northern Arizona University, Flagstaff, AZ, USA

Katrina M. Dixon     ACME Films LLC, Lexington, KY, USA

Marisa C. Garcia Rodriguez     School of Communication, Northern Arizona University, Flagstaff, AZ, USA

Yolanda Evie Garcia     Department of Education Psychology, Northern Arizona University, Flagstaff, AZ, USA

Ziyon Kim     Developmental Psychology Lab, Department of Psychology, Johann Wolfgang Goethe-University, Frankfurt am Main, Germany

Barbara Klein     R&D-Group Assistive Technologies, Frankfurt University of Applied Sciences, Frankfurt am Main, Germany

Monika Knopf     Developmental Psychology Lab, Department of Psychology, Johann Wolfgang Goethe-University, Frankfurt am Main, Germany

Thorsten Kolling     Developmental Psychology Lab, Department of Psychology, Johann Wolfgang Goethe-University, Frankfurt am Main, Germany

Jan Krasniewicz     School of Computing and Digital Technology, Faculty of Computing, Engineering and the Built Environment, Birmingham City University, Birmingham, UK

Amanda Lacy     Centre for Research on Computer Supported Learning and Cognition, University of Sydney, Sydney, NSW, Australia

Dorothy Lucci     Lurie Center for Autism, Massachusetts General Hospital for Children, Lexington, MA, USA

Frank Oswald     Interdisciplinary Ageing Research, Johann Wolfgang Goethe-Goethe University, Frankfurt am Main, Germany

Johannes Pantel     Geriatric Medicine, Institute of General Practice, Johann Wolfgang Goethe-University, Frankfurt, Germany

Julie Prescott     School of Education and Psychology, The University of Bolton, Bolton, UK

Ned Prutzer     Institute of Communications Research, University of Illinois at Urbana-Champaign, Urbana-Champaign, IL, USA

Saskia Rühl     Interdisciplinary Ageing Research, Johann Wolfgang Goethe-Goethe University, Frankfurt am Main, Germany

Holger Rossberg     R&D-Group Assistive Technologies, Frankfurt University of Applied Sciences, Frankfurt am Main, Germany

Arthur Schall     Geriatric Medicine, Institute of General Practice, Johann Wolfgang Goethe-University, Frankfurt, Germany

Gül Seçkin     Department of Sociology, University of North Texas, College of Arts and Sciences, Denton, TX, USA

Stefanie Selic     R&D-Group Assistive Technologies, Frankfurt University of Applied Sciences, Frankfurt am Main, Germany

Andrew Sean Wilson     School of Computing and Digital Technology, Faculty of Computing, Engineering and the Built Environment, Birmingham City University, Birmingham, UK

Foreword

With respect to technology, it is important to place terms and tools within a historical context, given that in today's society when speaking to a person who is a Millennial (individuals who are born in the early 1980s to 2000), s(he) may tell you that technology is the Internet and Smart Phones. For the Millennial, then, technology may only mean digital or biotechnologies. If we were to speak broadly to some individuals from The Silent Generation, Boomers, Millennials, and Generation Y, technology may also mean automobiles, airlines, overhead projectors, flashlights, microwaves, ATMs, etc. Hence, technology in the twenty-first century can mean many things. For example, technology could mean software applications, hardware, social media platforms, functional magnetic resonance imaging, mobile technology, learning and content management systems, just to name a few.

Humans and other animals have used tools for centuries; however, the most important aspect of any tool is how we use and interact with it and the emotional responses we experience, while we interact with it either physically or psychologically. The focus of this book series is to provide a variety of conceptual, theoretical, and practical perspectives on the role of emotions and technology. Various psychological and social-emotional aspects of communicating through and with many types of technology are engaged in ways that extend our understanding of technology and its consequences on our lives.

A specific goal and purpose of this book series focuses on emotions and affective interactions with and through technology. In some cases, these interactions are user-to-user, supported by the technology. In other instances, these interactions are between the user and the technology itself. Let us take, for example, researchers who have used animated social simulation technology to measure emotions of educators (Tettegah, 2007) and others who use biotechnology to measure decision-making and emotional responses of users of technology (Baron-Cohen, 2011; Decety & Ickes, 2009). In a recent article, Solomon (2008) points out, One of the most critical questions about human nature is the extent to which we can transcend our own biology (p. 13). I would argue that through our use of technology we, in fact, are attempting to extend and transcend our emotions by way of robots and other intelligent technological agents. As such, we should then ask ourselves: why are discussions of emotions and technology so important?

Inquiry regarding the nature of emotions is not new. In fact, examples of such forms of inquiry have been documented since the dialogs of Socrates and Plato. Researchers and practitioners in psychology, sociology, education, and philosophy understand the complicated nature of emotions, as well as [the importance of] defining emotions and social interactions. The study of emotions is so complicated that we still continue to debate within the fields of philosophy, education, and the psychology the nature of emotions and the roles of affective and cognitive processes involving human learning and behavior. The volumes in this series, therefore, seek to present important discussions, debates, and perspectives involving the interactions of emotions and various technologies. Specifically, through this book series on Emotions and Technology, we present chapters on emotional interactions with, from, and through technology.

The diversity of emotions played out by humans with and through technology run the gamut of emotions, including joy, anger, love, lust, empathy, compassion, jealousy, motivation, frustration, and hatred. These emotional interactions can occur through interactions with very human looking technologies (e.g., avatars, robots) or through everyday commonplace technologies (e.g., getting angry at an ATM machine when the user fails to follow directions). Hence, understanding the ways in which technology affords the mediation of emotions is extremely important toward enhancing our critical understanding of the ways in which student minds, through technology, are profoundly involved in learning, teaching, communicating, and developing social relationships in the twenty-first century.

The majority of the chapters presented in books included in the series will no doubt draw on some of the recent, pervasive, and ubiquitous technologies. Readers can expect to encounter chapters that present discussions involving emotions and mobile phones, iPads, digital games, simulations, MOOCs, social media, virtual reality therapies, and Web 2.0/3.0 technologies. However, the primary focus of this book series engages the readers in psychological, information communication, human computer interaction, and educational theories and concepts. In other words, technologies will showcase the interactions, however, the concepts discussed promise to be relevant and consistent constructs, whether engaging current technologies or contemplating future tools.

The book series began with a call for a single volume. However, there was such a huge response, that one volume turned into eight volumes. It was very exciting to see such an interest in literature that lies at the intersection of emotions and technology. What is very clear here is that human beings are becoming more and more attached to digital technologies, in one form or another. In many ways, we could possibly posit the statement that many individuals in the world are inching their way toward becoming cyborgs. It is apparent that digital technologies are in fact more and more second nature to our everyday life. Actually, digital technologies are changing faster than we are aging.

The life of a new technology can be 6 months to 1 year, while human lifespan ranges from 0 to 80 years. With the aforementioned in mind, humans have to consider how their emotions will interact and interface with the many different technologies they will encounter over the course of a lifetime. It seems as if it were only yesterday when the personal computer was invented and now we have supercomputing on a desktop, billions of data at our fingertips on our smartphone computers, and nanotechnology assisting us with physiological functions of living human animals. Regardless of the technology we use and encounter, emotions will play a major role in personal and social activities.

The major role that technology plays can be observed through the many observations of how humans become excited, frustrated, or relieved when interacting with new technologies that assist us within our daily activities.

Our hope is that scholars and practitioners from diverse disciplines, such as Informatics, Psychology, Education, Computer Science, Sociology, Engineering and other Social Sciences and Science, Technology, Media Studies, and Humanities fields of study will find this series significant and informative to their conceptual, research, and educational practices. Each volume provides unique contributions about how we interact emotionally with, through, and from various digital technologies. Chapters in this series range from how intelligent agents evoke emotions, how humans interact emotionally with virtual weapons, how we learn or do not learn with technology, how organizations are using technology to understand health related events, to how social media helps to display or shape our emotions and desires.

This series on Emotions and Technology includes the following volumes: (1) Emotions, Technology and Games, (2) Emotions, Technology, Design and Learning, (3) Emotions, Technology, and Behaviors, (4) Emotions, Technology and Learning, (5) Emotions, Technology and Health, (6) Emotions, Technology and Design, (7) Emotions, Technology and Social Media, and (8) Emotions and Mobile Technology.

Sharon Tettegah, University of Nevada, Las Vegas, USA University of Nevada Las Vegas USA

Acknowledgments

I would like to give a special thank you to Martin Gartmeier, Dorothy Espelage, Richard Ferdig, WenHao David Huang, Grant Kien, Angela Benson, Michael McCreery, Safiya Umoja Noble, Y. Evie Garcia, and Antonia Darder and all of the authors for their reviews and contributions to this work.

References

Baron-Cohen S. The science of evil. New York: Basic Books; 2011.

Decety J., Ickes W., eds. The social neuroscience of empathy. Cambridge: The MIT Press; 2009.

Solomon R.C. The philosophy of emotions. In: Lewis M., Haviland-Jones J.M., Barrett L.F., eds. The handbook of emotions. 3rd ed. London: Guildford Press; 2008:3–16.

Tettegah S. Pre-service teachers, victim empathy, and problem solving using animated narrative vignettes. Technology, Instruction, Cognition and Learning. 2007;5:41–68.

Preface

The Intersection Between Emotions, Technology, and Health

Technology has been the primary vehicle for healthcare innovation for more than 50 years (Rheuban, 2012). The advent of computers and subsequent burgeoning of technology has arguably been the driver of change in healthcare service delivery during the twentieth and twenty-first centuries. Inputting the search terms technology and healthcare into any university library's database search engine yields more than 17,000 peer-reviewed journal articles on the intersection between technology and health within the last 10 years alone. References to this intersection use terms such as e-health and health technology, with telehealth being the most broad and consistently used term. Telemedicine, medical technology, telemental health, telepsychology, and similar terms describe profession-specific aspects of telehealth. Traditionally, telehealth has been defined as the use of electronic information and communication in distance healthcare delivery (Health Resources & Service Administration, n.d.; Luxton, 2014). However, telehealth is sufficiently endemic within healthcare that most current articles do not overtly define the concept, opting instead to simply describe healthcare studies using technology-based interventions in hospitals and other treatment settings that do not include distance as a necessary component. Thus, the definition seems to have informally evolved to indicate that distance may be one aspect of telehealth but is no longer central to its definition. Accordingly, for this volume, a more broad definition of telehealth as the intersection of emotions, technology and health delivery is conceptualized and applied.

Technology is integrated into every aspect of the field of health ranging on a continuum from its potential contribution to health problems, such as poor sleep and associated health risks due to being constantly plugged in to media devices (Chahal, Fung, Kuhle, & Veugelers, 2013), addictions to gaming (Kuss, 2013), and repetitive use injuries (Sparks, Coughlin, & Chase, 2011), to ameliorating emotional and physical health problems via electronically mediated assessment and diagnosis, global tracking of health trends and diseases using informatics, electronic record keeping, training and education for professionals, social support and self-help for specific health problems, treatment compliance, robotic prosthetics, and possibly most impactful, treatment delivery via electronic systems such as video conferencing, artificial intelligence built into software, and web-based information available for every aspect of health and treatment. Yet, practitioners in many healthcare arenas find themselves working in uncharted territory when it comes to structural capacity of current healthcare delivery systems and processes to accommodate rapidly increasing and changing technology (Hufstader Gabriel, Jones, Samy, & King, 2014), evolving ethics and boundary issues related to the use of technology (Drum & Littleton, 2014; McCoy, Hjelmstad, & Stinson, 2013), and changes to practitioner-consumer interactions (Phillips, 2015).

Emotion, technology, and health are intimately connected. The field of health psychology is rooted in the intersection of emotion and health and is defined by scientific study and treatment of the complicated relationship between biology, environment, behavior, affect/emotion, and health, a relationship which has been well documented in the literature (Denson, Spanovic, & Miller, 2009).

Within the relationship between emotion and health, technology may be implicated as a contributing factor to health problems or employed as part of treatment. This somewhat paradoxical relationship between emotion and technology is illustrated in studies on the deleterious effects of emotional over-involvement with technology (Harwood, Dooley, Scott, & Joiner, 2014) and, conversely, the use of technology to relieve the emotional effects of stress (Villani et al., 2013).

Four overarching observations emerge from a review of health technology, and emotion literature.

(1) There are a relatively small number of studies grounded in theories of emotion compared with an enormous number of studies generated in response to practical considerations, mainly cost-effective healthcare access and quality assurance.

(2) The status of the field seems to be at a stage of implementation feasibility with the majority of studies focused on demonstrating how technology may be successfully implemented with positive emotional impact.

(3) Electronic delivery of healthcare treatment is focused on emotional outcomes as ancillary to treatment effectiveness and implementation feasibility.

(4) From the crux of emotion, technology, and healthcare springs a variety of situations that seem to fall outside of the provisions of legal statutes (e.g., distance healthcare delivery that crosses state jurisdictions) and professional ethical standards (e.g., evolving professional guidelines for telehealth care).

Overall, telehealth appears to be incrementally moving beyond the place where it was, at its peak, considered a panacea for two of the biggest barriers to healthcare: (1) access, especially for underserved populations who may live in rural areas with minimal services, lack transportation, or do not usually seek care and (2) the high cost of providing healthcare. Some researchers, however, are beginning to question whether telehealth is truly feasible, cost effective, or even as accessible as once anticipated, compared to traditional approaches, given the need for system modification, training, barriers to consumer access to technology, and other limiting factors. Additional questions remain regarding the role of technology as mediator between healthcare providers and consumers and the emotional relationship between technology and those who use it. For example, Harwood et al. (2014) found that the level of emotional involvement with one's smart phone was a better predictor of technology-related distress than actual extent of smart phone use.

The chapters in this volume largely reflect the breadth and richness of investigation and innovative thought about emotion, technology, and health. Chapter authors include scientists, philosophers, communicators, psychologists, and counselors who view the intersection through different lenses to focus on aspects of emotion, technology, and health that urge readers to step beyond their comfort zones to examine the intersection from a variety of perspectives, and to come away with a deeper and more nuanced understanding of the interaction between emotion, technology, and health.

The volume is divided into three sections: (1) Telehealthcare Systems and Patient Interactions, (2) Use of Technology to Promote Emotional Health, and (3) Technology in Clinical Treatment. Each section is introduced below.

Telehealthcare Systems and Patient Interactions

This section of the volume addresses the role of emotion when technology mediates the relationship between healthcare systems and those they serve. Hospitals and clinics are increasingly employing electronic systems to manage patient records and improve interactions between healthcare providers and patients to maximize treatment outcomes while managing cost. For example, access to healthcare information on the Internet adds significantly to medical decision-making processes for many consumers and has fundamentally changed interactions between healthcare providers and those they serve. Advances in web-based software, smartphone, and tablet applications, and other portable electronic devices contribute to increasing use of electronic devices to prevent, monitor, and treat patients while evaluating the emotional impacts of interventions.

This section begins with Andrew Wilson, Julie Prescott, and Jan Krasniewicz' comprehensive overview of electronic methods that assist physicians in more accurately identifying patient emotions, such as depression and anxiety, via technology such as biofeedback, electroencephalograms, and facial recognition programs that can also be built into games that improve ability to evaluate patients' emotions and improve patient care and satisfaction.

In the second chapter, Amanda Lacy explores the impact of emotion on patient learning and patient education technology. She uses a theoretical approach to develop criteria regarding patient emotion and its role in motivating patients to engage more actively in learning about their health conditions and engaging in decision-making processes related to healthcare.

Gül Seçkin's chapter on social computing and mobile mental health applications provides a thorough overview and incisive critique of current applications for delivery of mental health information and interventions available via smartphone. The chapter addresses how smartphones are altering the face of clinical and behavioral research, social support provision, patient care, and service delivery.

In the final chapter for this section, Robert DiCarlo discusses the role of collaborative electronic documentation in community mental health care settings and the potential impact on the emotional climate and collaborative approach that comprise the therapeutic alliance between patients and psychotherapists. He draws attention to the need for empirical outcome studies that are grounded in strong theoretical frameworks.

Use of Technology to Promote Emotional Health

The use of technology plays a role in mediating emotions within and between individuals, groups, and organizations. The specific ways that devices and programs mediate emotions, both internally and interpersonally, have implications for the design and use of devices that gather health data and contribute to healthcare interventions. Likewise, unconventional uses of electronic media to provide understanding of complex interactions between emotions and health can provide insight for development of innovative, multidisciplinary healthcare approaches and policies.

In the first chapter of this section, Thorsten Kolling and his colleagues provide an indepth description of the use of social robots to augment the emotional aspects of patient care. The role of emotion in the use of social robots and specific interactions that trigger emotion in people using robotic devices are examined, along with ethical considerations.

Ned Prutzer examines memory and emotion tied to the use of photographs that are portrayed in two films. He employs perspectives from neuroscience, psychoanalysis, and critical theory to argue that memory is continuously recontextualized and influenced by emotion.

In the third chapter of this section, Marisa Garcia Rodriguez analyzes blog posts from men in support of women regarding issues of misogyny. Narrative posts demonstrate the healing effects of online communities in generating tangible, measurable emotional support of women who had suffered the detrimental emotional effects of aggression, harassment, sexism, and assault.

Technology in Clinical Treatment

Use of devices in health and mental health prevention and intervention services has become increasingly widespread since relatively low-cost, high-value methods for monitoring health status and behaviors have become available. This section examines three different situations in which technology is a key component of the intervention.

This section begins with Dorothy Lucci's description of curriculum for teenaged students with Autism Spectrum Disorder that uses science-based education to promote self-understanding, including individual strengths that can be used to counter ASD-related difficulties. Face-to-face curriculum and learning activities were combined with web-based applications that gathered data on daily functioning and assisted with acquisition of new skills. Results indicated improvements in self-awareness, self-regulation, and stress management with teens who had IQs that were average or higher.

Katrina Dixon's chapter on mood intervention for older adults provides an innovative approach using the established and familiar technologies of teleconference and web-based music to address mood and relieve isolation of older adults for whom transportation was a barrier to interpersonal interaction.

In the final chapter, Sherry Craft and Evie Garcia explore the dynamics of couples in nonproximal romantic relationships who are living separately but maintaining their relationship across distance and other barriers via the use of various computer-mediated communication media, including email, video chat, mobile phone texting, and instant messaging is explored. Implications for telepsychology treatment are discussed.

The use of electronic media to provide emotional support and connection, and improve healthcare outcomes is becoming the norm, rather than the exception. This collection of chapters highlights the variety of ways that technology, emotion, and health are intertwined. The chapters provide insight into ways technology is or can be used to provide support within the field of healthcare. Novel perspectives are presented; we