Attempts to integrate diverse approaches to psychotherapy and counseling started in 1980s, after a longstanding rivalry among theoretical orientations. After the so-called ideological cold war, psychotherapists acknowledgement of inadequacies of single school approach and the intensive research appraisal of the effectiveness of each approach stirred the psychotherapy integration movement. In 1979, SEPI (Society for Exploration of Psychotherapy Integration) was established in the United States, and international debates and open inquiry were activated to increase therapeutic efficiency, efficacy and applicability of the theories and techniques. There are four routs to psychotherapy integration : technical eclecticism, theoretical integration, common factors approach and assimilative integration. Since late 1990, respect for diversity and pluralism of theories as well as human beings based on the social constructionist epistemology (postmodernism) has accelerated the coexistence of diverse theories and approaches. Now the collaboration of “therapist as a specialist on counseling” and “client as a specialist on oneself” is essential for the psychological support. Attempts to integrate psychotherapy integration and development of collaborative and pluralistic approach were discussed.

  The pandemic of the new coronavirus infection has dramatically changed our daily lives. Even in the practice of biofeedback, infection prevention activities such as wearing a mask and keeping hands clean are required more than ever in the case of face-to-face contact. Under such circumstances, biofeedback utilizing the recent technologies like artificial intelligence (AI), information and communication technology (ICT), and virtual reality (VR) has been drawing attention. For example, because of the increasing tendency to work and stay at home, some persons have mental health problems such as fear of going out and thus difficulty in going to school or work. In this case, social training using VR may be beneficial while staying at home, and remote medical care without visiting the clinic will decrease the psychological burden of going out. On June 20, 2021, the second day of the 48th Annual Conference of the Japanese Society of Biofeedback, a symposium entitled “Trial of Online Biofeedback by Virtual Reality” was planned by the Planning and Public Relations Committee. The members had a free and open discussion on the current status and future vision of online biofeedback by virtual reality, and this review article summarized the contents of the planning symposium.

  Telemedicine has been implemented to maintain social distancing to prevent COVID-19 and remote access to healthcare services may increase participation for those who need medically and psychologically treatment. Remote access can also help preserve the patient-provider relationship at times when an in-person visit is not practical. However, these remote health care services usually do not make use of real-time data from physiological monitoring. This can be remedied by integrating three biofeedback approaches with telemedicine. First, heart rate variability biofeedback using pulse oximeters can be used to monitor O₂ saturation and re-establish sympathetic-parasympathetic balanced to support the immune system and reduce the stress caused by the pandemic. It can also be used to prevent the progression of symptoms by the early detection of “asymptomatic hypoxia” in COVID-19 patients. Second, electroencephalographic biofeedback (neurofeedback) is recommended by the American Academy of Pediatrics as a level 1 evidence-based practice for ADHD and the training with remote neurofeedback can be done at home. Third, skin conductance measurements can be integrated with virtual reality (VR) therapy. The skin conductance that indicates sympathetic arousal is used to adjust the VR exposure intensity to avoid excessive arousal and is combined with psychotherapy such as cognitive-behavioral therapy. Telemedicine with biofeedback and VR may be useful in remote healthcare during and even beyond COVID-19 pandemic.