IEEE Technology and Society Magazine - March 2021 - 83

afford frequent therapy though having an access to
help. Cost-based availability is closely connected
to the wider cost problem, as discussed before.

Stigma
Self-stigma, the prejudice which people with mental illness turn against themselves, and public stigma,
the reaction that the general population has to people with mental illness, are prevailing issues in the
battle for mental health [38]. The problem is twofold:
public stigma makes individuals fear about what the
society will think of them if they seek treatment,
whereas self-stigma makes them fear about interacting with a professional as well as doubt themselves
in terms of having problems worth seeking treatment
for. Thus, both lead to individuals with mental health
issues deciding not to seek treatment from mental
health professionals. Up to 96% of people with SAD
do not seek treatment [39]. Research on PT for mental health, especially on ICAs for treating SAD, has
shown that people are more comfortable disclosing
their feelings and personal information to a computerized or mobile system than to a person [30]. This is
because they do not fear of being judged as well as
having a more private channel (at least, as perceived
by them) for disclosing their feelings, thoughts, and
issues, in general. People also show lower valuation
fears and impression management and increase
their expression of sadness and objectively rated disclosure when communicating with artificial systems.
This means that the number of people not seeking
treatment can be reduced by introducing therapeutic options that they perceive to be safer and free of
stigma for them.
However, there are potential risks, that such technologies bring, that have to be noted and solemnly
addressed for PT to reach the potential it has in
mental health care.

Group exclusion
Some groups of people can be excluded from
technology-oriented mental health care. The groups
discussed are: the elderly, the lowest socioeconomic
class, and culturally specific groups. The group most
affected by the introduction of technology seems to
be the elderly [40]. Their thwarted ability to incorporate technology into their lives can cause further
ageist divides between them and other generational
groups. PT should, therefore, strive to be persuasive
for everyone, which many times means focusing on

March 2021

research that targets only the elderly as participants
(one of the big problems of psychological research
is that the majority of the samples are students).
Another group of people that may be excluded
from the benefits of PT for mental health are people
from the lowest socioeconomic class, where even
PT might not be available to them [41]. Creating an
even bigger divide for them would result in increasingly catastrophic socioeconomic living conditions.
Groups that are affected in technological adoption
due to the cultural differences are also crucially
important when considering how to advance equality. Research shows that cultures with less contemporary sociopolitical leanings show less adoption of
technology [42]. Luckily, the research on PT seems
to be fledging in certain low-income countries [43].

Researcher bias
Due to lack of evaluation standardization of PT
for mental health, the research field is prone to the
introduction of researcher bias. The potential problems are many: 1) PT systems that are claimed to
be successful are not always studied in empirical
experiments (e.g., randomized controlled trials), but
in quasi-experiments [27] or no experiments at all;
2) the metric on which to evaluate such systems is
unclear (usually comes indirectly from their effectiveness in an experiment where the goal is SAD
symptoms relief [16]); and 3) no consensus on what
data is needed to understand a user in a way to offer
effective help, as there are always some presuppositions on which data to collect and how to use it for
strategy selection.
Using PT for mental health, as a fairly young
endeavor, also has wider problems not pertaining
to seeking equality only which are connected to
the technological integration in our society as a
whole. Our limited perspective, therefore, falls into
a broader range of various issues, including: 1) the
problem of personal information privacy [44]; 2)
the problem of the lack of longitudinal research on
behavior change with PT [45]; 3) the ethics of using
personal information for persuasion [46]; 4) the
potential risks of digital dependence [47], [48]; 5)
the problem of creating AI that does not align with
our values [49]; and 6) the potential problem of
automation and job loss of mental health care professionals. PT is prone to the listed issues (and others
not listed), as any other technology.

IEEE Technology and Society Magazine - March 2021

Table of Contents for the Digital Edition of IEEE Technology and Society Magazine - March 2021