A developer of online and mobile role-playing training simulations and games is helping individuals who are not trained in mental health to become more familiar with at-risk behaviors and how to respond to them. Christine Karper and Michelle Stone, members of the American Counseling Association’s Cyber Task Force, view such developments positively, not only because these simulations show potential for raising public awareness of mental health, but also because they indicate another step forward in the integration of technology into behavioral health.

The developer, Kognito Interactive, provides gatekeeper and suicide prevention training simulations for faculty, staff, students and resident assistants in higher education settings, as well as for high school educators, middle school educators and high school students. The online training simulations allow participants to enter virtual environments and practice challenging conversations with avatars so they can build real-life skills such as:

• Identifying when a student’s appearance or behavior is a sign of psychological distress
• Discussing these concerns with the student
• Motivating the student to seek help
• Making a referral to mental health support services

Kognito recently released a study examining the effectiveness of its gatekeeper training programs and whether virtual, role-playing games that use avatars can enhance suicide prevention initiatives among the general public. The two-year study involved 1,300 participants from 195 educational institutions in 28 states who had completed one of five training simulations from Kognito Interactive’s At-Risk Training Suite.

The number of students whom educators and staff members approached to discuss mental health concerns after the training increased between 25 to 71 percent, depending on which level of education the faculty member was teaching. Students reported a 70 percent increase in identifying and discussing their concerns with a peer after the training. The number of students whom educators referred to counseling services after the training increased 37 to 53 percent, while students referred their peers to services 53 percent more often. In addition, college students who participated in the training and study reported a “statistically significant increase” in the likelihood that they would seek help from their school’s counseling center if experiencing psychological distress.

Karper and Stone, who co-presented two sessions on social media and virtual worlds at the 2012 ACA Conference in San Francisco, predict virtual role-play interventions will become more integral to counselors and their clients as well.

Using role-playing and avatar technology in mental health settings is becoming more popular for various reasons, says Karper, a licensed professional counselor and associate faculty member for the College of Social Sciences at the University of Phoenix Central Florida Campus. “Some appreciate the ease of access due to mobility restrictions, whether this is due to being homebound, a lack of transportation or other reasons the person is unwilling or unable to travel,” she says. “Some consumers may prefer to engage in counseling from the comfort of their own home. This may also be popular due to a lack of services available in the community, and some prefer the ‘anonymity’ of technology. … The possibilities of using technology in service delivery are endless and considerable.”

Stone, the director of family services at a nonprofit, intends to research computer-mediated human interaction while pursuing a graduate counseling degree. She says that technology “offers previously unavailable or unknown opportunities for training and service delivery. Clinicians are constantly looking for new methods and new approaches to improve outcomes for clients and, in many cases, new technologies fill the bill.”

Stone says technological innovations are also offering increased opportunities for mental health professionals to work with marginalized populations. She cites use of Second Life, an online role-playing game set in a virtual world, by the Department of Defense (DOD) to reach out to military personnel struggling with posttraumatic stress disorder (PTSD).

“The DOD maintains a simulated land environment where [PTSD] sufferers are able to participate in simulations designed to assist with PTSD and where they can also access resources for help and treatment,” she explains. “This provides a nonthreatening mechanism through which sufferers are able to gain information and resources they may be reluctant to seek out otherwise.”

The use of avatars in virtual environments provides clients, gatekeepers and even counselors with realistic practice that is both affordable and accessible, Stone says.

“Various forms of avatar-based training, specifically in virtual worlds, are being used in other industries with success,” she points out. “An example of this is EMT training using Second Life. Opportunities to practice skills, whether in real life or using virtual simulations, can only benefit practitioners.”

Karper is developing a project that uses virtual simulations to desensitize military personnel to combat stresses.

“The digital experience is as valid as a genuine experience, meaning the brain cannot distinguish between a virtual experience over an authentic experience,” she says. “The therapeutic value of the experience is the same.”

Stone has participated in online virtual conferences for counseling professionals and has observed clinicians from around the world using virtual role-playing both for training and counseling purposes. She says she finds the experience to be “immersive and beneficial.”

“One reason is because of the sorts of choices one makes regarding [his or her] avatar, [such as] appearance, clothing and surroundings. This functions as a sort of projective exercise that I believe offers great insight into the individual,” she says. “Though some argue that therapy in a virtual world is impoverished due to the lack of nonverbal cues, I believe it can be enhanced due to the projective nature I previously described. The environment of a virtual world can function as a sort of dynamic Rorschach test.”

Karper recommends that counselors interested in incorporating this kind of technology into their practice seek guidance from other practitioners who have experience in that area. She points out that counselors can also consult with members of the ACA Cyber Task Force on best practices and for networking assistance.

Stone stresses the importance of counselors staying informed about technological developments. “I recommend incorporating journals that address technology in practice into our professional reading schedule,” she says. “Also, becoming aware of how colleagues are incorporating technology into their practices is important. Purposely keeping an open mind while considering new technologies is imperative, while simultaneously critically evaluating all aspects of impact upon practice and the clients the practice serves. Collaboration with colleagues can be very beneficial as well.”

Stone thinks the integration of technology into therapy and other facets of professional life is generally positive. Still, she offers a word of caution to counselors. “It’s imperative that we evaluate what benefit it offers against any vulnerabilities it may present,” she says. “Further, I believe we must take steps to ensure any legal or ethical concerns are satisfactorily mitigated.”

On the other hand, Stone says, “Not being open to the integration of technology in both practice and counselor education means we risk becoming ineffectual by not remaining up to speed with society. In order to remain relevant and of use, we must integrate technology into the field.”

“Technology will become more integral to the practice of counseling and the mental health field as a whole,” Stone predicts. “This integration will simply reflect the integration of technology that we are seeing across the board in many professions.”

Her hope is that counseling professionals will commit themselves to conducting research that will inform the development of future technologies that can be used throughout the field of mental health.

“This reciprocal relationship, handled appropriately, may well offer hope for more efficient and effective practice that has the potential to [impact] previously difficult-to-reach or difficult-to-treat populations.”

“It’s imperative to stay informed of advances in practice and in the technologies that facilitate practice,” Stone continues. “Emerging interventions, such as Kognito, demand that we stay abreast of changes so that we can offer the very best to those who depend upon professional counselors. Additionally, it’s important to maintain a critical and discerning stance regarding new technologies so that best practices may be developed and integrated into their use. This is why it is so important to be part of a professional body [such as ACA] that analyzes new advancements in the field.”

For more information, contact Karper at ckarper@email.phoenix.edu and Stone at michelle.d.stone@gmail.com.

Heather Rudow is a staff writer for Counseling Today. Contact her at hrudow@counseling.org.