The standard of living of the Dutch population is amongst the highest in the world. Indeed, the Netherlands’ human development index (a measure of three basic dimensions of human development: education, health and income) is considered to be very high and the country is ranked third out of 187 countries with comparable data. It is also interesting to note that Dutch people are not only known for their prosperity and well-being, but also for their satisfaction with life. In fact, according to surveys, the Dutch population is one of the happiest in the world, with almost 90% of people reporting themselves satisfied in their everyday life.
Furthermore, the Netherlands are distinct for their people’s progressive ideas about various social issues. For example, legislation and regulation about controversial subjects such as prostitution, use of marijuana and euthanasia are definitely avantgarde.
Mental Health in the Netherlands
Many epidemiology studies have been conducted in the Netherlands in the past decades and they have greatly contributed to our understanding of psychopathology. Thus, the portrait of the mental health situation in the Dutch population is becoming well defined and government’s health and social policies seem to be improving accordingly.
According to the Netherlands Mental Health Survey and Incidence Study-2 (NEMESIS-2), 18% of adults aged 18-64 in the general population had suffered from a mental health condition in the past year. This percentage rises to 43% for the presence of a mental disorder at some point in their lifetime. More specifically, according to the Netherlands Study of Depression and Anxiety (NESDA), approximately one out of three individuals in the Netherlands will be affected by depression or anxiety disorders at some time during their lives. Amongst all mental health disorders, depression contributes to the highest strain on health services. Similarly, sufferers of depression are also most likely to require and use medication.
Statistics also show that Dutch inhabitants with a lower level of education, lower income and those without paid employment have greater chances of developing a mental health disorder. Fortunately, since 2008, the mental healthcare services developed a program in which people can benefit from a whole year of free services. More precisely, the first year of mental health services is entirely covered by the general healthcare insurance policy.
Moreover, Internet-based psychotherapy is now recognized by Dutch regulatory health bodies as a valid alternative to regular therapy and is even reimbursed through public health insurance. Such social policies reveal the government’s genuine interest regarding mental health is sues and testify to their sincere will of offering cutting edge services to their population.
Research Facilities in Netherlands
Alongside countries like Italy, Spain and Germany, the Netherlands are at the forefront in Europe for implementing new technologies in order to refine our comprehension of different mental illnesses and to improve the quality of various treatments. Since the Netherlands is a wealthy region, investment in the academic field is generally sufficient and promotes the development of high-standard research facilities. For instance, two important research teams – University of Amsterdam and Delft University of Technology – use head-mounted displays in their projects related to the field of cyberpsychology. Research Areas and Topics Exergaming (a combination of active video gaming and exercise), Virtual Reality (VR) exposure therapy for anxiety disorders, level of presence and therapy outcome, interapy (Internet-based psychotherapy), and virtual environments to study paranoia and psychosis are important fields of research that are highlighted by Dutch researchers. The improvements in the field of cyberpsychology are hastening developments in these topics of interest.
Dutch Projects in the Spotlight
Recently, two important research projects have been completed at the University of Amsterdam under the supervision of professor Paul M. G. Emmelkamp, clinical psychologist. The aim of the first controlled trial study was to compare VR exposure therapy (VRET) with in vivo exposure in the treatment of panic disorder with agoraphobia (PDA). Results have shown similar effects for the two treatment modalities. Dr. Emmelkamp says, “Such work is of great interest because there is a clear need for controlled clinical studies regarding the treatment of more complex and prevalent anxiety disorders like PDA, social anxiety, posttraumatic stress or obsessive-compulsive disorder.”
The second research project’s goal was to measure the effect of Internet-based psychotherapy (INTERAPY) on subjects affected by Posttraumatic Stress Disorder, burnout, depression, eating disorders and panic disorder.
The results gathered from nine controlled trials showed that patients’ improvements in the Internet-based psychotherapy condition were comparable to those of the subjects who received classical (face-to-face) cognitive behavioral therapy. In a subsequent series of 1,500 regular patients, Internetbased CBT was found to be equally effective as the treatments in the randomized controlled trials.
Moreover, according to Dr. Emmelkamp, “Patients’ reaction to the online psychotherapy was positive and they seemed to be highly satisfied at the end of the treatment.” In summary, a decade of online therapy research has provided compelling support for the efficacy and effectiveness of Internet-based cognitive behavioral treatment. In the Netherlands, the implementation and dissemination of such technology has begun and is supported by reputable healthcare professionals.
Another interesting project in ICT research will soon take place at the University of Amsterdam. This innovative study will combine Internet-based psychotherapy with VRET, two methods that have shown promising results as mentioned earlier. This new treatment for social phobia will include exposure sessions to avatars that could be completed online. Of course, if effective, “this project is a great demonstration of the potential of information technologies in the treatment of mental disorders,” says Dr. Emmelkamp.
Dr. Willem-Paul Brinkman with the Interactive Intelligence Group at Delft University of Technology has also dedicated his time towards pioneering works implementing VR techniques for mental healthcare. “The group’s research mission is to create synergy between humans and technology by understanding, shaping and using fundamentals of intelligence and interaction,” he explains. “Our research finds applications in multiple contexts, such as healthcare, wellbeing, entertainment, safety and security.”
Drs. Emmelkamp and Brinkman recently partnered to work on a project “Computer support for anxiety disorder treatment at home” (CATCH) project funded by the Netherlands Organisation for Scientific Research (NWO). “We developed a VR exposure therapy system specifically designed to expose patients with social phobia to various social situations,” says Dr. Brinkman. “Patients can engage in free speech dialogue with virtual avatars, which the therapist can control for specific phobic stressors.” The effectiveness of the treatment is currently being evaluated in an extensive RCT.
Looking to the future role of advanced technologies in healthcare, Dr. Brinkman says, “Considering demographic changes in the western world and rising national healthcare costs, patient self-management systems will become more important. In this context, the use of eCoaches seems an important element in patient empowerment and a way to reduce face-to-face consultation with care providers.”
The Future of ICT Research in the Netherlands
Even with promising results in research, the implementation of new technologies in the treatment of mental illnesses in the Netherlands still faces major challenges and obstacles. Indeed, one of the most important difficulties is the transfer of knowledge from the academic community to common clinical practice. The use of new technologies has presented many advantages and is associated with great satisfaction in service users, but some practitioners show resistance to change because it makes them feel somewhat obsolete. In other words, some clinicians may fear being replaced by computers.
Another important issue related to the implementation of new equipment like HMDs is the lack of training on how to use VRET and appropriate technical support. In order to efficiently use such technology, clinicians may need help in case of deficiencies of the equipment or for installation. According to Dr. Emmelkamp, one of the solutions might be to “create central locations where practitioners could use the equipment and demand technical support when needed.”
Finally, since people around the world are becoming more and more familiar with new technologies, another challenge in ICT research will be to keep up with the products offered by the competitive industry. For example, the graphic quality of video games improves continuously so the virtual environments created in the future will have to meet the same expectations or otherwise they will seem outdated.
Nevertheless, the support for these technologies is leading to exciting developments in the treatment of mental health disorders. The Netherlands will undoubtedly use these advancements to continue offering cutting-edge care for its population.
Sources: Personal communication with Paul M.G. Emmelkamp, Ph.D., Willem-Paul Brinkman, Ph.D., World Health Organization, Organisation for Economic Co-operation and Development, Trimbos Institute, and Netherlands Study of Depression and Anxiety
Claudie Loranger Freelance Contributor C&R Magazine www.vrphobia.eu lorc08@uqo.ca
About Brenda Wiederhold
President of Virtual Reality Medical Institute (VRMI) in Brussels, Belgium.
Executive VP Virtual Reality Medical Center (VRMC), based in San Diego and Los Angeles, California.
CEO of Interactive Media Institute a 501c3 non-profit
Clinical Instructor in Department of Psychiatry at UCSD
Founder of CyberPsychology, CyberTherapy, & Social Networking Conference
Visiting Professor at Catholic University Milan.
