Cybertherapy – the provision of healthcare services using advanced technologies – can help improve the lives of many of us, both patients and health professionals, while tackling the challenges to healthcare systems.

Despite the potential of cybertherapy, its benefits and the technical maturity of the applications, the use of cybertherapy services is still limited, and the market remains highly fragmented. Although many countries – including USA, Europe, Korea and Japan – have expressed their commitment to wider deployment of cybertherapy, most cybertherapy initiatives are no more than one-off, small-scale projects that are not integrated into healthcare systems.

It is recognised that integrating these new types of services in healthcare systems is a challenging task. The aim of this book is to support and encourage all the interested countries in this endeavour, by identifying and helping to address the main barriers hindering the wider use of cybertherapy and by providing evidence to build trust and acceptance.

Healthcare systems focus on meeting the needs of patients. Achieving cybertherapy's potential, therefore, depends on patients being convinced of its ability to satisfy their healthcare needs. Acceptance by patients depends crucially on acceptance by the health professionals treating them, given the high degree of trust the former place in the latter.

An important factor for ensuring the confidence and acceptance of health professionals is enhanced dissemination of the evidence base regarding the effectiveness of cybertherapy services, their safety features and user-friendliness.

For the complexity of this goal, we have put a great deal of effort in the definition of the structure of the book and in the sequence of the contributions, so that those in search of a specific reading path will be rewarded. To this end we have divided the different chapters in four main Sections:

1. Critical Reviews: They summarize and evaluate emerging cybertherapy topics, including Interreality, CyberAddiction and Telemedicine;

2. Evaluation Studies: They are generally undertaken to solve some specific practical problems and yield decisions about the value of cybertherapy interventions;

3. Original Research: They presents research studies addressing new cybertherapy methods or approaches;

4. Clinical Observations: They include case studies or research protocols with a long-term potential.

Each chapter begins with a brief abstract, helping the readers in identifying the relationships among its sections.

For both health professionals and patients, the selected contents will play an important role in ensuring that the necessary skills and familiarity with the tools are present, as well as a fair understanding of the context of interaction in which they are operated.

Although some cybertherapy services have existed for a long time and most of the ICT has been in place for a while, the chapters underline different areas where technical and social and ethical issues need to be addressed.

Broadband access and the ability of providers to enable full connectivity is a prerequisite for the deployment of many cybertherapy and telemedicine applications.

Interoperability and standardisation are crucial to allow widespread use of the technologies, to enable them to benefit from the single market and to contribute to its completion. Use of existing standards and adoption of new standards and standardised approaches to achieve interoperability should be supported by standards development organisations, with the active participation of industry.

Trust and confidence in new and innovative technologies and ICT-based services within the health sector need to be built through rigorous testing, agreed standards and a widely accepted certification process. Unfortunately, this is a difficult process that requires time and money. In particular, as underlined by the fourth Section of the book, there are many good ideas and protocols that still need further tuning and research. Promising research areas consist of treatment of addictions, depression, attention deficit disorder, stress management, and social skills training.

In conclusion, this book underlines how cybertherapy has made initial progress in treating a variety of mental health disorders, but there is more work to be done in a number of areas including the development of easy to use and more affordable hardware and software, the development of objective measurement tools, the issue of side effects for some patients, and more controlled studies to evaluate the strength of cybertherapy in comparison to traditional therapies.

Wider dissemination of the technology will encourage the industry to develop tools in response to user needs. Web-based resources for cybertherapy practitioners are currently available and are in continuous development. Input on such topics as clinical protocols, equipment updates and purchases, ethical issues, and the newest research findings will be soon easily accessed using the Internet.

We are also grateful to Alessandra Gorini, Daniel Stevens, Federica Pallavicini and Tatiana Hulko for their work in collecting and coordinating chapters for this volume.

We sincerely hope that you will find this year's volume to be a fascinating and intellectually stimulating read. We continue to believe that together we can change the face of healthcare.

Brenda K. Wiederhold

Giuseppe Riva