Internet-Based Telehealth System for the Treatment of Agoraphobia MARIANO ALCAÑIZ, Ph.D., 1 CRISTINA BOTELLA, Ph.D., 2 ROSA BAN ˜ OS, Ph.D., 3 CONCEPCIÓN PERPIÑÁ, Ph.D., 3 BEATRIZ REY, M.Sc., 1 JOSÉ ANTONIO LOZANO, 1 VERÓNICA GUILLÉN, M.Sc., 2 FRANCISCO BARRERA, M.Sc., 1 and JOSÉ ANTONIO GIL 1 ABSTRACT In this work that is being validated within the VEPSY project, we present a system that al- lows the patient to continue a psychological virtual reality treatment from his or her home PC as complementary therapy. In the consulting room, we have been using virtual therapy for panic disorder and agoraphobia treatment to expose the patient to several situations. For the complementary therapy, a structured treatment via the Internet has been prepared, which consists of several parts: an assessment protocol; a structured treatment protocol organized in several blocks (such as psychoeducation and exposure); and an outcome protocol. The same situations as in the consulting room have been selected for the exposure, but each of them has been divided into several virtual environments with specific characteristics that limit its dif- ficulty level. The stimuli that are used at each level are controlled automatically by the sys- tem. The information of the patient is stored in a database, which is placed in a remote server using XML format and used to control which stages of the treatment he or she can access. The psychologist can limit the evolution of the patient. The virtual environments are installed in the patient’s PC, and they are implemented with a mechanism that ensures that they can only be run when the patient connects to the web. The user should not have any special virtual re- ality hardware at home, so head rotations have been simulated with the navigation system. 355 CYBERPSYCHOLOGY &BEHAVIOR Volume 6, Number 4, 2003 © Mary Ann Liebert, Inc. INTRODUCTION O NE OF THE AREAS OF APPLICATION of virtual real- ity in the health field is its use as a tool for the treatment of different psychological problems. Vir- tual reality is capable of recreating a hierarchy of real situations and allowing the patient to experi- ence them in a real way due to the fact that all the senses are involved in the experience. 1 The person arranges of a series of scenarios related to the feared situation, so he or she can expose him or her- self to all possible and impossible situations. As virtual environments are programmable, they allow the therapists to present a great range of con- trolled stimuli to the patient while measuring and monitoring the user’s response. The idea of using VR for the treatment of these problems appeared first in November 1992 in the Human-Computer Interaction Group of Clark At- lanta University. Their effectiveness and clinical utility have been proven. We can mention the first applications designed by Rothbaum and North’s group for the treatment of acrophobia, 2–4 agorapho- bia, 5,6 spider phobia, 7 or flying phobia. 8 Our group has also developed VR software for the treatment of claustrophobia and of flying phobia. 9 VR has also proven to be an effective treatment of more complex disorders, such as eating disorders. 10,11 1 Medical Image Computing Laboratory, Universidad Politécnica de Valencia, Valencia, Spain. 2 Grupo de Investigación en Psicopathología y Psycología Clínica, Universidad Jaume I, Castellón, Spain. 3 Departamento de Personalidad, Universidad de Valencia, Valencia, Spain.