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A recently published study of clinicians’ mass exposure to telehealth during the COVID pandemic was published in the Journal of Technology in Behavioral Science. In reviewing the literature on working from home and COVID’s impact on behavioral health practices, the research team used “clinician technophobia” as a “provocative term that invites clinicians to engage in honest self-reflection.” They then asked, “Are you avoiding technology based on your evaluation of the empirical research or your own worries about using it?” Led by Andrew Sherril, the research team reviewed the available literature and proposed a salient model to address clinical technophobia using exposure therapy.
Context of Pre-COVID Clinical Technophobia
The researchers cite research describing clinicians’ negative attitudes and worries as one of the most significant barriers to telehealth adoption and implementation. The concept of the inevitability of healthcare’s urgent need to adapt to the Fourth Industrial Revolution (Schwab, 2016) provides a backdrop for introducing a detailed approach to increasing clinician comfort with using technology. They explain how clinicians can use an exposure therapy model to change their beliefs about technology adoption,
Clinicians are encouraged to consider that before COVID, technology had already been changing mental health services profoundly (Reger, 2020). They are reminded that COVID did not introduce new technologies but rather introduced new reasons for using the technology already available in the marketplace (Drude, 2021). After offering a detailed literature review, the researchers then present their perspective of the inevitability that the future of clinical work rests with increased comfort with using technology in clinical settings.
They posited that the mass transition to telehealth at the beginning of COVID “functioned as an exposure exercise that changed many clinicians’ cognitive and emotional reactions to the use of telehealth technologies.” They then suggested ways clinicians might persist with increasing their exposure to learning more about using safe technologies to benefit all stakeholders.
Using Exposure Techniques to Overcome Practitioner Reluctance
The researchers next encourage behavioral professionals to use other exposure strategies to provide proactive steps toward technological innovation as future technologies become available. Such measures can be taken by individual practitioners and organizations faced with reluctant staff members who refuse to use technology despite its proven value to the organization.
Extracting from an evidence-based theoretical model of exposure therapy called inhibitory learning (Craske et al., 2014), the research team suggests that the clinical guidelines informed by this model (e.g., Maples-Keller et al., 2022) be adapted to help clinicians address their discomfort and anxiety about using technology. The researchers explain three steps to dealing with technophobia:
- Validating hesitancy, understanding, and acknowledging one’s reactions before the change is attempted.
- Generate a list of behavioral exercises (i.e., “exposures”) to reduce unhelpful emotional responses to technology and replace them with helpful perspectives as behavioral flexibility increases.
- Engage in each listed item, starting with more manageable tasks and gradually progressing to more challenging tasks.
The research team offered these tips for each technology exposure:
- Look for modeling and guidance from an experienced professional
- Start slowly and deliberately
- Focus on learning one new task at a time
- Give yourself time to learn at a pace that allows for observing that discomfort reduces over time and disproves previously negative thoughts about the task
- Repeat the exposure until further adaptive information is learned.
- The researchers also offer a useful table of evidence-based exposure guidelines for clinicians to overcome technophobia. The first two guidelines offered in the aforementioned Table 1 are the following:
|Expectancy violation||Prior to engaging in exposures, describe your expectations of your reactions to the technology and your performance. Design exposures that can test each of these expectancies. For example, one might expect that telehealth will result in diminished rapport. This expectancy can be tested after completing several sessions with a patient in which usual rapport-building strategies are used|
|Deepened extinction||Before using the entirety of a new technology, you can first break apart the task into smaller components and then use them all together. For example, one can use telehealth technologies with colleagues prior to using it with a patient. The clinician can start with basic tasks (e.g., maintaining a conversation) and then engage in more complex tasks (e.g., screen sharing). After the clinician is comfortable using the equipment with a nonpatient, an exposure with patients may seem more manageable|
Conclusions: How to Overcome Clinician Technophobia
Clinician technophobia is real. This timely article provides needed guidance for clinicians and employers who face clinician technophobia using skills that most clinicians already have in their clinical toolkits. Perhaps the time has come for our industry to look to its own ranks to see where behavior change is needed. The need is particularly salient, given that the largest US insurer, Medicare, has made telephone and audio behavioral telehealth reimbursement permanent. Also, addiction professionals, counselors, and marriage and family therapists will be reimbursed by Medicare for telehealth and other services starting in January 2024.
The world has steadily grown dependent on technology for even the most basic functions, such as buying groceries and pumping gas. Consumers and clinicians alike have trusted their smartphones to make transfers to and from their bank accounts, manage security systems for their homes and access their medical records.
Andrew Sherril and his research team not only posit that post-COVID healthcare practitioners face a global transition to telehealth but also provide a well-detailed approach to how clinicians can start addressing clinician technophobia in themselves and their colleagues. The researchers conclude, “In this paper, we share the perspective that the future of clinical work will increasingly require mental health clinicians to overcome technophobia, which we broadly define as any level of hesitancy, reluctance, skepticism, worry, anxiety, or fear of implementing technology in one’s clinical practice (Khasawneh, 2018).”
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