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An app, developed for the national Italian project "Design for all", is evaluated here. This app supports the user in most of his/her cooking activities. The evaluation process integrates different technologies, such as expert interview, cognitive walkthrough and focus group, to consider different aspects that include, but are not limited to, usability and accessibility.

Unilateral Spatial Neglect (USN) is normally assessed with paper-and-pencil tests. Virtual reality can be an effective neuropsychological tool for a more ecological and functional assessment and rehabilitation of neglect. We developed a 3D Virtual Reality platform - NeuroVirtual 3D - for the assessment and rehabilitation of cognitive deficits, in particular for USN. Within the virtual environments it is possible to interact with virtual objects and execute specific exercises using a Microsoft Kinect. Through the analysis of different grasping tasks it is possible to evaluate in an ecological way the patients' ability to find and handle objects in both sides of the virtual space.

Creating a significant negative impact on both their quality of life and the quality of patient care with an evident economical burden for the healthcare system, there is a growing concern over physician burnout. The range of interventions and treatments that have been used to address this problem, however, appear quite fragmented and lack compelling efficacy. We describe the main factors known to contribute to the development of physician burnout as well as currently available treatments. Studies seem to indicate that both specialisation area as well as personality traits may contribute to the manifestation. The highest risk specialties appear to be critical care physicians, emergency physicians, oncologists and internal medicine physicians, while the highest risk personality attributes are high neuroticism, low agreeableness, introversion, and negative affectivity. In addition, being exceedingly enthusiastic about one's work and having high aspirations at work, with an idealistic approach, also serve as factors which contribute to increased risk of burnout, and in particular for those who are new to the occupation.

Due to advances in treatment and people's living longer, chronic diseases are becoming more common among our population. This is a leading contributor to the increasing burden on our current healthcare system. To reduce this burden and sufficiently meet the needs of this growing segment of the population, healthcare organizations must encourage the elderly to take a more active role in caring for their own health and well-being. Technology may offer a solution to this shortcoming. "Positive Technology" focuses on the use of technology for improving the quality of our personal experience, and it suggests specific strategies for modifying/improving each of the different dimensions involved - Emotional Quality (affect regulation); Engagement/Actualization (presence and flow); Connectdness (collective intentions and networked flow) - and for generating motivation and engagement in the process. "Transformative Technology" are technologically-mediated experiences that support positive, enduring transformation of the self-world. The transformative content is delivered through a set of experiential affordances, which are stimuli designed to elicit emotional and cognitive involvement in the designed experience: (i) emotional affordances; (ii) epistemic affordances. The paper discusses discuss the possible role of positive and transormative technologies for healthy living and active ageing by presenting different practical applications of this approach recently developed by our team.

Information and communication technologies are widely and rapidly spreading in people's daily lives. But what is the possible role of the mass proliferation of digital devices in supporting healthy living and active ageing? Are they useful in fostering personal growth and individual integration of the elderly, by promoting satisfaction, opportunities for action, and self-expression? Rather, do they enhance automation, impose constraints on personal initiative, and result in compulsive consumption of information? In this chapter, we suggest that possible answers to these questions will be offered by the "Positive Technology" approach, i.e., the scientific and applied approach to using technology so that it improves the quality of our personal experiences through its structuring, augmentation, and/or replacement. First, we suggest that it is possible to use technology to manipulate the quality of experience with the goal of increasing wellness and generating strengths and resilience in individuals, organizations, and society. Then, we classify positive technologies according to their effects on these three features of personal experience - Hedonic: technologies used to induce positive and pleasant experiences; Eudaimonic: technologies used to support individuals in reaching engaging and self-actualizing experiences; Social/Interpersonal: technologies used to support and improve the connectedness between individuals, groups, and organizations. Finally, we discuss the possible role of positive technologies for healthy living and active ageing by presenting different practical applications of this approach.

The INTERSTRESS project developed a completely new concept in the treatment of psychological stress: Interreality, a concept that combines cognitive behavioral therapy with a hybrid, closed-loop empowering experience bridging real and virtual worlds. This model provides the opportunity for individual citizens to become active participants in their own health and well-being. This article contains the results of the Marketing Trial and analysis of the opinions of individual consumers/end users of the INTERSTRESS product. The specific objective of this study was to evaluate the feasibility, efficacy and user acceptance of a novel mobile-based relaxation training tool in combination with biofeedback exercises and wearable biosensors. Relaxation was aided through immersion in a mobile virtual scenario (a virtual island) featuring pre-recorded audio narratives guiding a series of relaxation exercises. During biofeedback exercises, a wearable biosensor system provided data which directly modified the virtual reality experience in real-time. Thirty-six participants evaluated the product and overall feedback from users was positive, with some variation seen based on participant gender. A larger market study is now underway to understand if there are cultural variations in acceptability of the device.

Decline in spatial memory in the elderly is often underestimated, and it is crucial to fully investigate the cognitive underpinnings of early spatial impairment. A virtual reality-based procedure was developed to assess deficit in the "mental frame syncing", namely the cognitive ability that allows an effective orientation by synchronizing the allocentric view-point independent representation with the allocentric view-point dependent representation. A pilot study was carried out to evaluate abilities in the mental frame syncing in a sample of 16 elderly participants. Preliminary results indicated that the general cognitive functioning was associated with the ability in the synchronization between these two allocentric references frames.

Laparoscopic Adjustable Gastric Banding (LAGB) is a common surgery method used to help obese patients to lose weight. However, even if LAGB is able to produce a durable and relevant weight loss, it is less effective in improving body image: as demonstrated by a recent study, obese patients with a body image disorder in the pre-operative stage continue to show this even 13 months after the operation. In this presentation we will discuss the possible role of virtual reality (VR) in addressing this problem within an integrated cognitive behavioral approach. To test this approach, a case series of three LAGB patient who experienced body dissatisfaction even after agt;30/40% excess body weight loss, is presented and discussed. At the end of the 6-week protocol the patients experienced a 15%-20% further reduction of their weight. This reduction was also matched by a general improvement of the psychological state. Both the weight loss and the level of well-being were further improved after a three-month follow-up.

The combination of smart phones, wearable sensor devices and social media offer new ways of monitoring and promoting mental and physical wellbeing. In this contribution, we describe recent developments in the field of mobile healthcare (or mHealth), by focusing in particular on mobile mental health applications. First, we examine the potential benefits associated with this approach, providing examples from existing projects. Next, we identify and explain possible differences in focus between mobile mental health and mobile wellbeing applications. Finally, we discuss some open challenges associated with the implementation of this vision, ranging from the lack of evidence-based validation to privacy, security and ethical concerns.

"Psychological stress" occurs when an individual perceives that environmental demands tax or exceed his or her adaptive capacity. According to the Cochrane Database of Systematic Reviews, the best validated approach covering both stress management and stress treatment is the Cognitive Behavioral (CBT) approach. CBT has undergone a very large number of trials in research contexts. However, it has been less efficacious in clinical contexts and it has become obvious that CBT has some failings when applied in general practice. INTERSTRESS is a EU-funded project that aims to design, develop and test an advanced ICT-based solution for the assessment and treatment of psychological stress that is able to address three critical limitations of CBT: a) the therapist is less relevant than the specific protocol used. b) the protocol is not customized to the specific characteristics of the patient; c) the focus of the therapy is more on the top-down model of change (from cognitions to emotions) than on the bottom-up (from emotions to cognitions). To reach this goal the INTERSTRESS project applies an innovative paradigm for e-health - Interreality - that integrates assessment and treatment within a hybrid environment, bridging physical and virtual worlds. On one side, the patient is continuously assessed in the virtual and real worlds by tracking the behavioral and emotional status in the context of challenging tasks (customization of the therapy according to the characteristics of the patient). On the other side, feedback is continuously provided to improve both the appraisal and the coping skills of the patient through a conditioned association between effective performance state and task execution behaviors (improvement of self efficacy). Within this conceptual framework, it is possible to set up and test psychological treatments that could be extended also beyond the traditional research and clinical setting by using more and more emerging mobile technology to deliver real-time interventions during daily activities and ecological contexts.

We have developed a system, allowing real-time monitoring of human gestures, which can be used for the automatic recognition of behavioural correlates of psychological stress. The system is based on a low-cost camera (Microsoft Kinect), which provides video recordings capturing the subject's upper body activity. Motion History Images (MHIs) are calculated in real-time from these recordings. Appropriate algorithms are thereafter applied over the MHIs, enabling the real-time calculation of activity-related behavioural parameters. The system's efficiency in real-time calculation of behavioural parameters has been tested in a pilot trial, involving monitoring of behavioural parameters during the induction of mental stress. Results showed that our prototype is capable to effectively calculate simultaneously eight different behavioural parameters in real-time. Statistical analysis indicated significant correlations between five of these parameters and self-reported stress. The preliminary findings suggest that our approach could potentially prove useful within systems targeting automatic stress detection, through unobtrusive monitoring of subjects.

Human computer confluence (HCC) is an ambitious research program studying how the emerging symbiotic relation between humans and computing devices can enable radically new forms of sensing, perception, interaction, and understanding. It is an interdisciplinary field, bringing together researches from horizons as various as pervasive computing, bio-signals processing, neuroscience, electronics, robotics, virtualamp; augmented reality, and provides an amazing potential for applications in medicine and rehabilitation.

Self tracking is a recent trend in e-health that refers to the collection, elaboration and visualization of personal health data through ubiquitous computing tools such as mobile devices and wearable sensors. Here, we describe the design of a mobile self-tracking platform that has been specifically designed for clinical and research applications in the field of mental health. The smartphone-based application allows collecting a) self-reported feelings and activities from pre-programmed questionnaires; b) electrocardiographic (ECG) data from a wireless sensor platform worn by the user; c) movement activity information obtained from a tri-axis accelerometer embedded in the wearable platform. Physiological signals are further processed by the application and stored on the smartphone's memory. The mobile data collection platform is free and released under an open source licence to allow wider adoption by the research community (download at: http://sourceforge.net/projects/psychlog/).

In this study we consider neurophysiological aspects for the assessment of stress-related disorders. EEG Alpha Asymmetry could represent an effective method to be used in the virtual environment. Nonetheless, new protocols need to be defined. In this study herein, we present two methods and a case study.

Psychological Stress occurs when an individual perceives that environmental demands tax or exceed his or her adaptive capacity. Following this view, that underlines the role of the situated experience of the patient in experiencing a stressor, the European Union funded Interstress project (http://www.interstress.eu) is exploring the possible use of the virtual simulation technology offered by SecondLife (http://www.secondlife.com) to administer a stress management experiential training. The structure of the environment and the contents of the course are described and discussed.

A Stress Inoculation Training-based protocol tested if multimedia audio-video content induced emotional changes and reduced exam anxiety in university students. Seventy-five participants took part in six experimental sessions consisting of viewing multimedia content and performing relaxation exercises. Participants were randomly assigned to five experimental groups: 1) audio and video narrative on mobile phone (UMTS); 2) audio and video narrative on DVD (DVD), 3) audio narrative on MP3 player (M3), 4) audio narrative on CD (CD), 5) control group (CTRL). Results showed that audio/video content induced a significant reduction in exam anxiety and an increase of relaxation in students, compared to the audio-only contents.

Since the European funded project VREPAR--Virtual Reality in Neuro-Psycho-Physiology (1995)--different European research activities have been using virtual reality and advanced information and communication technologies to improve the quality of care in the treatment of many different mental health disorders including anxiety disorders, eating disorders and obesity. Now the European Commission funding is shifting from the traditional hospital-centred and reactive healthcare delivery model toward a person-centred and preventive one. The main outcome of this shift is the "Personal Health Systems" (PHS) paradigm that aims at offering continuous, quality controlled, and personalized health services to empowered individuals regardless of location. The paper introduces four recently funded projects--Interstress, Monarca, Optimi and Psyche--that aim at using PHS based on virtual reality, biosensors and/or mobile technologies to improve the treatment of bipolar disorders, depression and psychological stress.

In the early-middle stages of Parkinson's disease (PD), polysomnographic studies show early alterations of the structure of the sleep, which may explain frequent symptoms reported by patients, such as daytime drowsiness, loss of attention and concentration, feeling of tiredness. The aim of this study was to verify if there is a correlation between the sleep dysfunction and decision making ability. We used a Virtual Reality version of the Multiple Errand Test (VMET), developed using the NeuroVR free software (http://www.neurovr2.org), to evaluate decision-making ability in 12 PD not-demented patients and 14 controls. Five of our not-demented 12 PD patients showed abnormalities in the polysomnographic recordings associated to significant differences in the VMET performance.

At MMVR 2007 we presented NeuroVR (http://www.neurovr.org) a free virtual reality platform based on open-source software. The software allows non-expert users to adapt the content of 14 pre-designed virtual environments to the specific needs of the clinical or experimental setting. Following the feedbacks of the 2000 users who downloaded the first versions (1 and 1.5), we developed a new version--NeuroVR 2 (http://www.neurovr2.org)--that improves the possibility for the therapist to enhance the patient's feeling of familiarity and intimacy with the virtual scene, by using external sounds, photos or videos. More, when running a simulation, the system offers a set of standard features that contribute to increase the realism of the simulated scene. These include collision detection to control movements in the environment, realistic walk-style motion, advanced lighting techniques for enhanced image quality, and streaming of video textures using alpha channel for transparency.

The term "psychological stress" describes a situation in which a subject perceives that environmental demands tax or exceed his or her adaptive capacity. According to the Cochrane Database of Systematic Reviews, the best validated approach covering both stress management and stress treatment is the Cognitive Behavioral (CBT) approach. We aim to design, develop and test an advanced ICT based solution for the assessment and treatment of psychological stress that is able to improve the actual CBT approach. To reach this goal we will use the "interreality" paradigm integrating assessment and treatment within a hybrid environment, that creates a bridge between the physical and virtual worlds. Our claim is that bridging virtual experiences (fully controlled by the therapist, used to learn coping skills and emotional regulation) with real experiences (allowing both the identification of any critical stressors and the assessment of what has been learned) using advanced technologies (virtual worlds, advanced sensors and PDA/mobile phones) is the best way to address the above limitations. To illustrate the proposed concept, a clinical scenario is also presented and discussed: Paola, a 45 years old nurse, with a mother affected by progressive senile dementia.

At least 90% of individuals of limb amputees experience phantom limb pain (PLP). Recent clinical research suggests that providing patients with the mirror image representation of the amputated limb may alleviate PLP. However, mirror therapy cannot be used with bilateral amputees, as visual feedback is dependent on the movement of the intact limb. To overcome this limitation, we designed a novel myoelectric-controlled virtual reality (VR) system for the treatment of phantom limb pain in trans-radial upper extremity amputees. The proposed system allows the patient to directly control the virtual limb by recognizing stump muscle patterns recorded with EMG sensors. The hypothesis behind this strategy is that the VR image of the amputated limb induces better limb imagery than the reflected image of their intact limb and, therefore, is more effective in reducing PLP. A research protocol to test this hypothesis is described.

Generalized anxiety disorder (GAD) is a common anxiety disorder characterized by 6 months of "excessive anxiety and worry" about a variety of events and situations. Anxiety and worry are often accompanied by additional symptoms like restlessness, being easily fatigued, difficulty concentrating, irritability, muscle tension and disturbed sleep. GAD is usually treated with medications and/or psychotherapy. In particular, the two most promising treatments seem to be cognitive therapy and applied relaxation. In this study we integrated these approaches through the use of a biofeedback enhanced virtual reality (VR) system used both for relaxation and controlled exposure. Moreover, this experience is strengthened by the use of a mobile phone that allows patients to perform the virtual experience even in an outpatient setting. This paper describe the results of a controlled trial (NCT00602212) involving 20 GAD patients randomly assigned to the following groups: (1) the VR and Mobile group (VRMB) including biofeedback; (2) the VR and Mobile group (VRM) without biofeedback; (3) the waiting list (WL) group. The clinical data underlined that (a) VR can be used also in the treatment of GAD; (b) in a VR treatment, patients take advantage of a mobile device that delivers in an outpatient setting guided experiences, similar to the one experienced in VR.

NeuroVR 1.5 is a cost-free virtual reality platform based on open-source components, allowing professionals to easily modify a virtual world, to best suit the needs of the clinical setting. The goal of the present project is to extend the functionalities of this platform by allowing users to interact with the virtual environment by using gestures detected by a webcam. To this end, we used CamSpace Beta 7, a cost-free and user-friendly computer vision technology. We describe how this integrated approach can be used to implement cognitive and motor training programs, involving partial or full-body movements.

At CT 2007, we presented NeuroVR (http://www.neurovr.org), a free virtual reality platform based on open-source software. The software allows non-expert users to adapt the content of 14 pre-designed virtual environments to the specific needs of the clinical or experimental setting. Following the feedbacks of the 700 users who downloaded the first version, we developed a new version - NeuroVR 1.5 - that improves the possibility for the therapist to enhance the patient's feeling of familiarity and intimacy with the virtual scene, by using external sounds, photos or videos. The key characteristics that make NeuroVR suitable for most clinical applications are the high level of control of the interaction with the tool, and the enriched experience provided to the patient. Actually, NeuroVR is used in the assessment and treatment of Obesity, Alcohol Abuse, Anxiety Disorders, Generalized Anxiety Disorders, and Cognitive Rehabilitation.

Rehabilitation is placing increasing emphasis on the construct of empowerment as the final goal of any treatment approach. This reflects a shift in focus from deficits and dependence to assets and independence. According to this approach, rehabilitation should aim to improve the quality of the life of the individual by means of effective support to his/her activity and interaction. Here we suggest that advanced technologies can play a significant role in this process. By enhancing the experienced level of "Presence" - the non-mediated perception of successfully transforming intentions into action - these emerging technologies can foster optimal experiences (Flow) and support the empowerment process. Finally, we describe the "NeuroVR" system (http://www.neurovr.org) as an example of how advanced technologies can be used to support Presence and Flow in the rehabilitation process.

Recently, several robotic solutions for the elderly have been proposed. However, to date, the diffusion of these devices has been limited: available robots are too cumbersome, awkward, and expensive to become widely adopted. Another key issue which reduces the appeal of assistive robots is the lack of socio-emotional interaction: affective interchanges represent key requirements to create sustainable relationships between elderly and robots. In this paper, we propose a new approach to enhance the acceptability of robotic systems, based on the introduction of affective dimensions in human-robot interaction. This strategy is aimed at designing a new generation of relational and cognitive robots fusing information from embodied unobtrusive sensory interfaces. The final objective is to develop embodied interfaces, which are able to learn and adapt their affective responses to the user's behavior. User and robot will engage in natural interactions, involving verbal and non-verbal communication, improving empathic exchange of moods and feelings. Relevant independent living and quality of life related issues will be addressed: on-going monitoring of health parameters, assistance in everyday's activities, social support and cognitive/physical exercises. We expect that the proposed strategy will enhance the user's acceptance and adoption of the assistive robotic system.

Generalized anxiety disorder (GAD) is a psychiatric disorder characterized by a constant and unspecific anxiety that interferes with daily-life activities. Together with the cognitive-behavioural treatments, relaxation represents a useful approach for the treatment of GAD, but it has the limitation that it is hard to be learned. To overcome this limitation we propose the use of biofeedback enhanced virtual reality (VR) to facilitate the relaxation process. The VR relaxation experience will be strengthened by the use of a mobile phone able to track and visualize, in an outpatient setting too, the physiological data of the patients. To test this concept, we planned a randomized controlled trial (NCT00602212), including three groups of 15 patients each (for a total of 75 patients): (1) the VR group, (2) the non-VR group and (3) the waiting list (WL) group. This controlled trial will be able to evaluate the effects of the use of VR in relaxation while preserving the benefits of randomization to reduce bias.

At MMVR 2007 we presented NeuroVR (http://www.neurovr.org) a free virtual reality platform based on open-source software. The software allows non-expert users to adapt the content of 14 pre-designed virtual environments to the specific needs of the clinical or experimental setting. Following the feedbacks of the 700 users who downloaded the first version, we developed a new version - NeuroVR 1.5 - that improves the possibility for the therapist to enhance the patient's feeling of familiarity and intimacy with the virtual scene, by using external sounds, photos or videos. Specifically, the new version now includes full sound support and the ability of triggering external sounds and videos using the keyboard. The outcomes of different trials made using NeuroVR will be presented and discussed.

The aim of this study is to assess the efficacy of a specific stress management protocol, based on immersive Virtual Reality (VR), to be used as part of a multidisciplinary inpatient program for the treatment of obesity. The stress management protocol included imagery, relaxation and different cognitive behavioral approaches -- emotion focused coping, self-monitoring and record keeping. Forty (40) participants, all female, were recruited for the study at the San Giuseppe Hospital, Istituto Auxologico Italiano, Piancavallo (VB), Italy. Participants were chosen among the obese patients without a specific Binge Eating diagnosis but with high level of anxiety and a history of emotional eating. The sample was randomly distributed in three conditions as follows: (a) VR stress Management Protocol; (b) DVD based stress management protocol; (c) no treatment (control condition). Data show that the VR condition produced a significantly higher reduction in anxiety, as compared both to DVD and control groups. More, we found a significant correlation between changes in the emotional state and the level of presence: the more present the users felt, the higher the reduction in anxiety. This datum suggests the possible role of presence in mediating the effects of a stress management protocol.

Test-taking anxiety or stress is very common among university students. It can be very distressing and sometimes debilitating. Exam anxiety involves physical components and emotional components that may be taken into account for managing and reducing anxiety. An approach to control exam anxiety is to learn how to regulate emotions. To help students in managing exam stress we developed a specific protocol based on mobile narratives--multimedia narratives experienced on UMTS/3G phones. 30 female university students (M=23.48; sd=1.24) who were going to perform an exam within a week were included in the trial. They were randomly divided in five groups according to the type and mobility of the medium used: (1) audio only narrative (CD at home); (2) audio only narrative (portable MP3); (3) audio and video narrative (DVD at home); (4) audio and video narrative (UMTS based); (5) control group. Audio/video narratives induced a reduction in exam anxiety in more than 80% of the sample vs 50% of the MP3 sample and 0% of the CD sample. Further, all the users who experienced mobile narratives on UMTS phones were able to relax before the exam, against 50% of DVD users and 33% of audio-only users. The trial showed a better efficacy of mobile narratives experienced on UMTS phones in reducing the level of exam stress and in helping the student to relax. These results suggest that for the specific sample considered--Italian university students--the media used for providing an anti-stress protocol has a clear impact on its efficacy.

In the past decade, the use of virtual reality for clinical and research applications has become more widespread. However, the diffusion of this approach is still limited by three main issues: poor usability, lack of technical expertise among clinical professionals, and high costs. To address these challenges, we introduce NeuroVR (http://www.neurovr.org--http://www.neurotiv.org), a cost-free virtual reality platform based on open-source software, that allows non-expert users to adapt the content of a pre-designed virtual environment to meet the specific needs of the clinical or experimental setting. Using the NeuroVR Editor, the user can choose the appropriate psychological stimuli/stressors from a database of objects (both 2D and 3D) and videos, and easily place them into the virtual environment. The edited scene can then be visualized in the NeuroVR Player using either immersive or non-immersive displays. Currently, the NeuroVR library includes different virtual scenes (apartment, office, square, supermarket, park, classroom, etc.), covering two of the most studied clinical applications of VR: specific phobias and eating disorders. The NeuroVR Editor is based on Blender (http://www.blender.org), the open source, cross-platform suite of tools for 3D creation, and is available as a completely free resource. An interesting feature of the NeuroVR Editor is the possibility to add new objects to the database. This feature allows the therapist to enhance the patient's feeling of familiarity and intimacy with the virtual scene, i.e., by using photos or movies of objects/people that are part of the patient's daily life, thereby improving the efficacy of the exposure. The NeuroVR platform runs on standard personal computers with Microsoft Windows; the only requirement for the hardware is related to the graphics card, which must support OpenGL.

The emergence of new shared media, such as the Internet and virtual reality are changing the ways in which people relate, communicate, and live. Health care, and in particular clinical psychology, is one of the areas that could be most dramatically reshaped by these new technologies. To exploit and understand this potential is the overall goal of the "Telemedicine and Portable Virtual Environment in Clinical Psychology"--VEPSY UPDATED--an European Community funded research project (IST-2000-25323, http://www.vepsy.com) whose specific goal is the development of different PC based virtual reality modules to be used in clinical assessment and treatment. In particular the developed modules have been using to address the following pathologies: anxiety disorders; male impotence and premature ejaculation; obesity, bulimia and binge-eating disorders. The chapter details the general technical and clinical characteristics of the developed modules.

Rapid and far-reaching technological advances are changing the ways in which people relate, communicate, and live. Technologies that were hardly used ten years ago, such as the Internet, e-mail, and video teleconferencing are becoming familiar methods for diagnosis, therapy, education and training. This is producing an emerging field (cybertherapy) whose focus is the use of communication and information technologies to improve the health care processes. To exploit and understand this potential was the aim of the Telemedicine and Portable Virtual Environment in Clinical Psychology, VEPSY UPDATED, an European Community funded research project (IST-2000-25323, http://www.cybertherapy.info). The chapter describes the clinical and technical rationale behind the cybertherapy applications developed by the project. Further, the actual role of virtual reality in the cybertherapy field is discussed, focusing on the advantages provided by its three different faces: technological, experiential and communicative.

In the last years the rapid development of the Internet and new communication technologies has had a great impact on psychology and psychotherapy. Psychotherapists seem to rely with more and more interest on the new technological tools such as videophone, audio and video chat, e-mail, SMS and the new Instant Messaging Tools (IMs). All these technologies outline a stimulating as well as complex scenario: in order to effectively exploit their potential, it is important to study which is the possible role played by the Internet-based tools inside a psychotherapeutic iter. Could the technology substitute the health care practitioners or are these tools only a resource in addition to the traditional ones in the therapist's hand? The major aim of this chapter is to provide a framework for the integration of old and new tools in mental health care. Different theoretical positions about the possible role played by e-therapy are reported showing the possible changes that psychotherapy will necessarily face in a cyber setting. The VEPSY website, an integration of different Internet-based tools developed within the VEPSY UPDATED Project, is described as an example of clinical application matching between old (and functional) practices with new (and promising) media for the treatment of different mental disorders. A rationale about the possible scenarios for the use of the VEPSY website in the clinical process is provided.