Prior to Proof Stage

The present paper considers the existing research in cybertherapy, which is psychological therapy carried out with the use of a mediated environment, and examines the way in which the users’ sense of presence in the mediated environment can be of relevance for the validation of the intervention. With this purpose, a collection of 41 papers reporting the measurement of presence in the context of a cybertherapy treatment has been identified and examined. The general relevance of presence in cybertherapy, and the measurement techniques adopted in the studies collected here are described and discussed. The way in which presence corresponds to establishing internal validity, convergent or predictive validity and external validity of a treatment is examined. In conclusion, a checklist to apply when planning a validation study is proposed, to improve the way in which presence is used. Keywords--presence, cybertherapy, validation. 1. Validation in Cybertherapy Cybertherapy is a term used in clinical and health psychology to identify psychological therapy carried out with the use of a mediated environment, i.e., an environment supported by an information or communication technology such as computers, mobile phones, specific related devices (e.g., biosensors, headsets, helmet) and even TV. The mediated environment supporting a cybertherapy treatment offers visual and other perceptual synthetic stimuli produced by the technology that (a) facilitate the achievement of a target psychological condition such as distraction, relaxation or proficiency in cognitive tasks and/or (b) supports and motivates performance, as in rehabilitative exercises. Although on-line counseling has been also considered as cybertherapy (e.g., [10] ), we will not consider here those mediated environments that just provide a venue where patient and therapist can talk, such as email or Internet fora. We will only consider those mediated environments that embed some clinical treatment, whether they are specifically designed for the treatment or adaptations to clinical purposes of existing commercial applications, like in [11] where a videogame desert-like scenario was adapted for a snake-phobia treatment. Most commonly, cybertherapy is used to treat psychological conditions related to disorders such as anxiety disorders, eating disorders, autism, and phobias; to treat substance abuse, and addiction; to reduce the pain and discomfort perceived during unpleasant medical treatments; to manage stress; and to administer exercises for cognitive rehabilitation (e.g., memory or attention training for elderly people) [91] [69] . Results of this treatment mode are comparable to those obtained in counseling or therapy protocols that are not supported by a mediated environment (e.g., [51] [59] ), with some additional advantages that may make cybertherapy a preferable option. The most obvious advantage is that the mediated environment allows patients to experience situations, to display stimuli or to provide feedback of the patient’s action that in vivo would be not controllable (e.g., crowd behavior), not feasible (e.g., scenario variation to improve