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How we can use technology to improve health.

Does Your Phone Know More About You Than Your Therapist?

We disclose more sensitive topics to computers than in face to face interviews.

The relationship between a therapist and client is a social bond that is designed to allow the client the opportunity to disclose information that they might not disclose to anyone else. Self-disclosure and privacy are so crucial to the therapeutic relationship that therapists can be sued for breaching confidentiality in situations where the disclosure is unauthorized. Social penetration theory describes the process of self-disclosure as a stage-based process in which individuals disclose more personal and unflattering information as the level of trust and intimacy shared by individuals increases. As in any relationship, we are more likely to disclose and view disclosure positively if we believe our therapist is non-judgmental and empathic rather than judgmental or dismissive.

Forty years of research indicates that individuals are more likely to disclose information relating to mental health concerns during computer interviews than face-to-face interviews. When using computer meditated interviews, women report more sexual partners while men report fewer, individuals report more suicidal feelings, alcohol use, high risk sexual behaviors, drug use behaviors, and domestic violence. These are not trivial differences in disclosure either. For example, in one study 16% of individuals reported domestic violence to a computer compared to only 1% during an in-person interview. Last year, Healthline Networks (2012) published findings revealing that health searches on the mobile phone were on more sensitive topics (i.e. mental health and sexually transmitted diseases) than computer-based health searches, suggesting that we may be even more willing to disclose sensitive information to our phones. These findings bring an interesting question to light: why do we tell our devices about more sensitive issues than trained clinicians who are experts in assessment and are bound by confidentiality?

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One logical conclusion is that computer and mobile-mediated interaction is more anonymous – and therefore more secure – than in-person interviews. However, while anonymity is certainly a component in these interactions, studies have found that ensuring anonymity compared to confidentiality does not significantly increase honest responses in web-based interactions. Moreover phones and computers contain identifiable IP addresses that can be collected and stored by third parties. Thus, a more important mechanism may be the real and perceived distancing that occurs in computer and mobile-mediated interactions. That is, we feel less vulnerable to judgment when we disclose sensitive information via computer or mobile phone.

Just as we are less likely to disclose information to a dismissive therapist, many individuals fear disclosing information because of the possibility that the other individual’s feedback will be judgmental. For example, socially anxious individuals, for whom fear of negative evaluation is a hallmark, are more likely to prefer online and text communications to voice and face-to-face communications than those who are socially at ease. Other studies suggest that shy individuals are more likely to disclose personal information online because the impersonal setting reduces negative or inhibitory feedback cues from others. Essentially, computer-mediated assessment allows us to feel safe when discussing sensitive topics such as mental health concerns, which continue to be socially stigmatized. Using a computer or phone, we rapidly pass through the stages of disclosure by virtue of the fact that we are not being judged or dismissed by another individual. My assumption is that if your phone were to raise its eyebrow when you searched "sexual addiction,” you probably wouldn’t disclose such sensitive information to it in the future.

So, does the fact that we disclose more to our phones than we do in face-to-face interactions prove that we trust our phones more than our therapists? Not exactly. Face-to-face interactions are more likely to foster trust than distal interactions. Moreover, disclosure continues to be intimately linked with the expectation of feedback. While computers are adept at providing tailored feedback, we are not yet at the point where they can process the emotions one feels when revealing these sensitive topics. Thus, the goal is not to replace the human connection with a virtual connection, but rather to leverage the safety we feel with our devices when disclosing sensitive information, then use it to enhance the therapeutic experience and help us reduce the fear of sharing information with a person with whom we should feel safe.

The mechanisms discussed in this post are only a few of the numerous that are at play in why we disclose sensitive information to our phones. For those of you attending South by Southwest, I have the pleasure of being on a discussion panel on this topic entitled, Mobiles Unmentionables, moderated by Jeremy Vanderlan. We are going to plunge into all the possible mechanisms of this phenomenon and brainstorm ways to use the safety we feel searching sensitive topics on our phones to develop effective interventions. For those of you not attending, I will be sure to summarize the discussion and findings in a future post.

Frederick Muench, Ph.D., is a Senior Research Associate at the National Center on Addiction and Substance Abuse at Columbia University.

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