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Anxiety in situations where one's overall appearance (including body shape) may be negatively evaluated is hypothesized to play a central role in Eating Disorders (EDs) and in their co-occurrence with Social Anxiety Disorder (SAD). Three studies were conducted among community (N = 1995) and clinical (N = 703) ED samples of 11- to 18-year-old Italian girls and boys to (a) evaluate the psychometric qualities and measurement equivalence/invariance (ME/I) of the Social Appearance Anxiety (SAA) Scale (SAAS) and (b) determine to what extent SAA or other situational domains of social anxiety related to EDs distinguish adolescents with an ED only from those with SAD. Results upheld the one-factor structure and ME/I of the SAAS across samples, gender, age categories, and diagnostic status (i.e., ED participants with and without comorbid SAD). The SAAS demonstrated high internal consistency and 3-week test-retest reliability. The strength of the inter-relationships between SAAS and measures of body image, teasing about appearance, ED symptoms, depression, social anxiety, avoidance, and distress, as well as the ability of SAAS to discriminate community adolescents with high and low levels of ED symptoms and community participants from ED participants provided construct validity evidence. Only SAA strongly differentiated adolescents with any ED from those with comorbid SAD (23.2 %). Latent mean comparisons across all study groups were performed and discussed.

Binge eating is one of the key behaviors in relation to the etiology and severity of obesity. Cue exposure with response prevention consists of exposing patients to binge foods while actual eating is not allowed. Augmented reality (AR) has the potential to change the way cue exposure is administered, but very few prior studies have been conducted so far. Starting from these premises, this study was aimed to (a) investigate whether AR foods elicit emotional responses comparable to those produced by the real stimuli, (b) study differences between obese and control participants in terms of emotional responses to food, and (c) compare emotional responses to different categories of foods. To reach these goals, we assess in 15 obese (age, 44.6 ± 13 years; body mass index [BMI], 44.2 ± 8.1) and 15 control participants (age, 43.7 ± 12.8 years; BMI, 21.2 ± 1.4) the emotional responses to high-calorie (savory and sweet) and low-calorie food stimuli, presented through different exposure conditions (real, photographic, and AR). The State-Trait Anxiety Inventory was used for the assessment of state anxiety, and it was administered at the beginning and after the exposure to foods, along with the Visual Analog Scale (VAS) for Hunger and Happiness. To assess the perceived pleasantness, the VAS for Palatability was administered after the exposure to food stimuli. Heart rate, skin conductance response, and facial corrugator supercilii muscle activation were recorded. Although preliminary, the results showed that (a) AR food stimuli were perceived to be as palatable as real stimuli, and they also triggered a similar arousal response; (b) obese individuals showed lower happiness after the exposure to food compared to control participants, with regard to both psychological and physiological responses; and (c) high-calorie savory (vs. low-calorie) food stimuli were perceived by all the participants to be more palatable, and they triggered a greater arousal response.

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.

A distorted body representation is a core symptom in eating disorders (EDs), though its mechanism is unclear. Allocentric lock theory, emphasising the role of reference frame processing in body image, suggests that ED patients may be (b)locked to an (allocentric) representation of their own body stored in long-term memory (e.g., my body is fat) that is not updated (modified) by the (real-time egocentric) perception-driven experience of the physical body. Employing a well-validated virtual reality-based procedure, relative to healthy controls, ED patients showed deficits in the ability to refer to and update a long-term stored (allocentric) representation with (egocentric) perceptual-driven inputs., (Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.)

In case of fire in a building, how will people behave in the crowd? The behavior of each individual affects the behavior of others and, conversely, each one behaves considering the crowd as a whole and the individual others. In this article, I propose a three-step method to explore a brand new way to study behavior dynamics. The first step relies on the creation of specific situations with standard techniques (such as mental imagery, text, video, and audio) and an advanced technique [Virtual Reality (VR)] to manipulate experimental settings. The second step concerns the measurement of behavior in one, two, or many individuals focusing on parameters extractions to provide information about the behavior dynamics. Finally, the third step, which uses the parameters collected and measured in the previous two steps in order to simulate possible scenarios to forecast through computational models, understand, and explain behavior dynamics at the social level. An experimental study was also included to demonstrate the three-step method and a possible scenario.

Art exploration is a complex process conditioned by factors at different levels and includes both basic visual principles and complex cognitive factors. The human figure is considered a critical factor attracting the attention in art painting. Using an eye-tracking methodology, the goal of this study was to explore different elements of the human figure performing an action (face and body parts in action) in complex social scenes characterized by different levels of social interaction between agents depicted in scenes (individual vs. social). The sample included 44 laypersons, and the stimuli consisted of 10 fine art paintings representing the figurative style of classical art. The results revealed different scanning patterns of the human figure elements related to the level of social interaction of agents depicted in the scene. The agents' face attracted eye movements in social interaction scenes while the agents' body parts attracted eye movements only when the agents were involved in individual actions. These processes were confirmed specifically in participants with high empathic abilities who became immediately fixated on faces to develop a mimetic engagement with other agents. Future studies integrating other measures would help confirm the results obtained and strengthen their implication for embodiment processes.

Cognitive neuroscience, traditionally focused on individual brains, is just beginning to investigate social cognition through realistic interpersonal interaction. However, quantitative investigation of the dynamical sensorimotor communication among interacting individuals in goal-directed ecological tasks is particularly challenging. Here, we recorded upper-body motion capture of 23 dyads, alternating their leader/follower role, in a tower-building task. Either a strategy of joining efforts or a strategy of independent action could in principle be used. We found that arm reach velocity profiles of participants tended to converge across trials. Automatic imitation of low-level motor control parameters demonstrates that the task is achieved through continuous action coordination as opposed to independent action planning. Moreover, the leader produced more consistent and predictable velocity profiles, suggesting an implicit strategy of signaling to the follower. This study serves as a validation of our joint goal-directed non-verbal task for future applications. In fact, the quantification of human-to-human continuous sensorimotor interaction, in a way that can be predicted and controlled, is probably one of the greatest challenges for the future of human-robot interaction.

After experiencing a stroke in the right hemisphere, almost 50% of patients showed Unilateral Spatial Neglect (USN). In recent decades, Virtual Reality (VR) has been used as an effective tool both for the assessment and rehabilitation of USN. Indeed, this advanced technology allows post-stroke patients to interact with ecological and engaging environments similar to real ones, but in a safe and controlled way. To provide an overview of the most recent VR applications for the assessment and rehabilitation of USN, a systematic review has been carried out. Since 2010, 13 studies have proposed and tested innovative VR tools for USN. After a wide description of the selected studies, we discuss the main features of these VR tools in order to provide crucial indications for future studies, neurorehabilitation interventions, and clinical practice.

Much is known about how different spatial reference frames continually interact to support spatial navigation, but less explored is whether it is more crucial to process object-to-object information or egocentric heading information for effective orientation in a cluttered environment. To address this question, we evaluated the possible influence on spatial performance of an interactive aerial view of different scale (small vs. large) comprising an arrow indicating participants' egocentric heading. Results revealed that the presence of a small interactive aerial view including a visualized larger arrow facilitated the retrieval of stored spatial layout. These data are consistent with recent studies revealing the role of retrosplenial cortex in translating between different spatial reference frames, and may contribute to elucidate the continuous synchronization between the inter-object direction information in the environment with respect to egocentric current heading., (Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.)

It is not unusual to experience a sense of total absorption, concentration, action-awareness, distortion of time and intrinsic enjoyment during an activity that involves music. Indeed, it is noted that there is a special relationship between these two aspects (i.e., music and flow experience). In order to deeply explore flow in the musical domain, it is crucial to consider the complexity of the flow experience-both as a "state" and as a "trait." Secondly, since music is a multifaceted domain, it is necessary to concentrate on specific music settings, such as (i) musical composition; (ii) listening; and (iii) musical performance. To address these issues, the current review aims to outline flow experience as a "trait" and as a "state" in the three above-mentioned musical domains. Clear and useful guidelines to distinguish between flow as a "state" and as a "trait" are provided by literature concerning flow assessment. For this purpose, three aspects of the selected studies are discussed and analyzed: (i) the characteristics of the flow assessments used; (ii) the experimental design; (iii) the results; and (iv) the interrelations between the three domains. Results showed that the dispositional approach is predominant in the above-mentioned settings, mainly regarding music performance. Several aspects concerning musical contexts still need to be deeply analyzed. Future challenges could include the role of a group level of analysis, overcoming a frequency approach toward dispositional flow, and integrating both state and dispositional flow perspectives in order to deepen comprehension of how flow takes place in musical contexts. Finally, to explain the complex relationship between these two phenomena, we suggest that music and flow could be seen as an emergent embodied system.

In the last decade, many results have been reported supporting the hypothesis that language has an embodied nature. According to this theory, the sensorimotor system is involved in linguistic processes such as semantic comprehension. One of the cognitive processes emerging from the interplay between action and language is motor simulation. The aim of the present study is to deepen the knowledge about the simulation of action verbs during comprehension in a virtual reality setting. We compared two experimental conditions with different motor tasks: one in which the participants ran in a virtual world by moving the joypad knob with their left hand (virtual action performed with their feet plus real action performed with the hand) and one in which they only watched a video of runners and executed an attentional task by moving the joypad knob with their left hand (no virtual action plus real action performed with the hand). In both conditions, participants had to perform a concomitant go/no-go semantic task, in which they were asked to press a button (with their right hand) when presented with a sentence containing a concrete verb, and to refrain from providing a response when the verb was abstract. Action verbs described actions performed with hand, foot, or mouth. We recorded electromyography (EMG) latencies to measure reaction times of the linguistic task. We wanted to test if the simulation occurs, whether it is triggered by the virtual or the real action, and which effect it produces (facilitation or interference). Results underlined that those who virtually ran in the environment were faster in understanding foot-action verbs; no simulation effect was found for the real action. The present findings are discussed in the light of the embodied language framework, and a hypothesis is provided that integrates our results with those in literature.

Background: Unilateral Spatial Neglect, or neglect, is a common behavioral syndrome in patients following unilateral brain damage, such as stroke. In recent years, new technologies, such as computer-based tools and virtual reality have been used in order to solve some limitations of the traditional neglect evaluation. Within this perspective, also mobile devices such as tablets seems to be promising tools, being able to support interactive virtual environments and, at the same time, allowing to easily reproduce traditional paper-and-pencil test., Objective: In this context, the aim of our study was to investigate the potentiality of a new mobile application (Neglect App) designed and developed for tablet (iPad) for screening neglect symptoms., Methods: To address this objective, we divided a sample of 16 right-damaged patients according to the presence or absence of neglect and we administered assessment test in their traditional and Neglect App version., Results: Results showed that the cancellation tests developed within Neglect App were equally effective to traditional paper-and-pencil tests (Line cancellation test and Star Cancellation test) in detecting neglect symptoms. Secondly, according to our results, the Neglect App Card Dealing task was more sensitive in detecting neglect symptoms than traditional functional task., Conclusions: Globally, results gives preliminary evidences supporting the feasibility of Neglect App for the screening of USN symptoms.

The general aim of the present study was to investigate the effect of an interactive aerial view of the experienced environment during the encoding and retrieving of spatial information on the feeling of presence. Our findings showed that this real-time interactive aerial view (both small and large) during the encoding and retrieval of spatial information seems to led to a greater sense of presence. It is argued that the use of this aerial view, which provides a real-time allocentric viewpoint-dependent spatial representation, would ease the translation of a stored allocentric representation into an egocentric one, and this process, consequently, would help individuals to feel present in space.

There is a long last tradition in Artificial Intelligence as use of Robots endowing human peculiarities, from a cognitive and emotional point of view, and not only in shape. Today Artificial Intelligence is more oriented to several form of collective intelligence, also building robot simulators (hardware or software) to deeply understand collective behaviors in human beings and society as a whole. Modeling has also been crucial in the social sciences, to understand how complex systems can arise from simple rules. However, while engineers' simulations can be performed in the physical world using robots, for social scientist this is impossible. For decades, researchers tried to improve simulations by endowing artificial agents with simple and complex rules that emulated human behavior also by using artificial intelligence (AI). To include human beings and their real intelligence within artificial societies is now the big challenge. We present an hybrid (human-artificial) platform where experiments can be performed by simulated artificial worlds in the following manner: 1) agents' behaviors are regulated by the behaviors shown in Virtual Reality involving real human beings exposed to specific situations to simulate, and 2) technology transfers these rules into the artificial world. These form a closed-loop of real behaviors inserted into artificial agents, which can be used to study real society.

Recent investigations emphasized the role of communication features on behavioral trust and reciprocity in economic decision making but no studies have been focused on the effect of communication on affective states in such a context. Thanks to advanced methods of computational psychometrics, in this study, affective states were deeply examined using simultaneous and synchronized recordings of gazes and psychophysiological signals in 28 female students during an investment game. Results showed that participants experienced different affective states according to the type of communication (personal versus impersonal). In particular, participants involved in personal communication felt more relaxed than participants involved in impersonal communication. Moreover, personal communication influenced reciprocity and participants' perceptions about trust and reciprocity. Findings were interpreted in the light of the Arousal/Valence Model and self-disclosure process.

Introduction: Several recent studies have pointed out that early impairment of executive functions (EFs) in Parkinson's Disease (PD) may be a crucial marker to detect patients at risk for developing dementia. The main objective of this study was to compare the performances of PD patients with mild cognitive impairment (PD-MCI) with PD patients with normal cognition (PD-NC) and a control group (CG) using a traditional assessment of EFs and the Virtual Multiple Errands Test (VMET), a virtual reality (VR)-based tool. In order to understand which subcomponents of EFs are early impaired, this experimental study aimed to investigate specifically which instrument best discriminates among these three groups., Materials and Methods: The study included three groups of 15 individuals each (for a total of 45 participants): 15 PD-NC; 15 PD-MCI, and 15 cognitively healthy individuals (CG). To assess the global neuropsychological functioning and the EFs, several tests (including the Mini Mental State Examination (MMSE), Clock Drawing Test, and Tower of London test) were administered to the participants. The VMET was used for a more ecologically valid neuropsychological evaluation of EFs., Results: Findings revealed significant differences in the VMET scores between the PD-NC patients vs. the controls. In particular, patients made more errors in the tasks of the VMET, and showed a poorer ability to use effective strategies to complete the tasks. This VMET result seems to be more sensitive in the early detection of executive deficits because these two groups did not differ in the traditional assessment of EFs (neuropsychological battery)., Conclusion: This study offers initial evidence that a more ecologically valid evaluation of EFs is more likely to lead to detection of subtle executive deficits.

Background: Group reminiscence therapy is a brief and structured intervention in which participants share personal past events with peers. This approach has been shown to be promising for improving wellbeing and reducing depressive symptoms among institutionalized older adults. However, despite the considerable interest in reminiscence group therapy, controlled studies to determine its specific benefits as compared to generic social interactions with peers (group conversations about everyday subjects) are still lacking., Methods/design: We have designed a randomized controlled trial aimed at comparing the effects of group reminiscence therapy with those of group recreational activity on the psychological wellbeing of an institutionalized sample of older adults. The study includes two groups of 20 hospitalized elderly participants: the experimental group and the control group. Participants included in the experimental group will receive six sessions of group reminiscence therapy, while the control group will participate in a recreational group discussion. A repeated-measures design will be used post-intervention and three months post-intervention to evaluate changes in self-reported outcome measures of depressive symptoms, self-esteem, life satisfaction, and quality of life from baseline., Discussion: The protocol of a study aimed at examining the specific effects of group reminiscence therapy on psychological wellbeing, depression, and quality of life among institutionalized elderly people is described. It is expected that the outcomes of this trial will contribute to our knowledge about the process of group reminiscence, evaluate its effectiveness in improving psychological wellbeing of institutionalized individuals, and identify the best conditions for optimizing this approach., Trial Registration: This trial was registered with ClinicalTrials.gov (registration number: NCT02077153) on 31 January 2014.

A great effort has been made to identify crucial cognitive markers that can be used to characterize the cognitive profile of Alzheimer's disease (AD). Because topographical disorientation is one of the earliest clinical manifestation of AD, an increasing number of studies have investigated the spatial deficits in this clinical population. In this systematic review, we specifically focused on experimental studies investigating allocentric and egocentric deficits to understand which spatial cognitive processes are differentially impaired in the different stages of the disease. First, our results highlighted that spatial deficits appear in the earliest stages of the disease. Second, a need for a more ecological assessment of spatial functions will be presented. Third, our analysis suggested that a prevalence of allocentric impairment exists. Specifically, two selected studies underlined that a more specific impairment is found in the translation between the egocentric and allocentric representations. In this perspective, the implications for future research and neurorehabilitative interventions will be discussed., (Copyright © 2014 Elsevier B.V. All rights reserved.)

We describe the main features and preliminary evaluation of Positive Technology, a free mobile platform for the self-management of psychological stress (http://positiveapp.info/). The mobile platform features three main components: (i) guided relaxation, which provides the user with the opportunity of browsing a gallery of relaxation music and video-narrative resources for reducing stress; (ii) 3D biofeedback, which helps the user learning to control his/her responses, by visualizing variations of heart rate in an engaging 3D environment; (iii) stress tracking, by the recording of heart rate and self-reports. We evaluated the Positive Technology app in an online trial involving 32 participants, out of which 7 used the application in combination with the wrist sensor. Overall, feedback from users was satisfactory and the analysis of data collected online indicated the capability of the app for reducing perceived stress levels. A future goal is to improve the usability of the application and include more advanced stress monitoring features, based on the analysis of heart rate variability indexes.

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.

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.

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.

Virtual Reality (VR) is increasingly being used in combination with psycho-physiological measures to improve assessment of distress in mental health research and therapy. However, the analysis and interpretation of multiple physiological measures is time consuming and requires specific skills, which are not available to most clinicians. To address this issue, we designed and developed a Decision Support System (DSS) for automatic classification of stress levels during exposure to VR environments. The DSS integrates different biosensor data (ECG, breathing rate, EEG) and behavioral data (body gestures correlated with stress), following a training process in which self-rated and clinical-rated stress levels are used as ground truth. Detected stress events for each VR session are reported to the therapist as an aggregated value (ranging from 0 to 1) and graphically displayed on a diagram accessible by the therapist through a web-based interface.

Research in obsessive-compulsive disorder (OCD) produced inconsistent results in demonstrating an association between patients' symptom severity and their cognitive impairments. The process involved in volition aspects of behavioral syndromes can be extensively analyzed using specific tests developed in virtual environments, more suitable to manipulate rules and possible breaks of the normal task execution with different, confusing or stopping instructions. The study involved thirty participants (15 OCD patients and 15 controls) during task execution and the relative interferences. At this purpose, the virtual version of Multiple Errands Test was used. Virtual reality setting, with a higher ecological validity respect to a classic neuropsychological battery, allowed us to take into account deficits of volition and the relative dysexecutive functions associated with OCD patients. The proposed paradigm also allows the development of innovative prototypes of coevolving technologies based on new theories and models and deeper understanding of human behavior.

Although all professions are susceptible to work-related stress, the nursing profession has been identified as particularly stressful; indeed, oncology nursing is often described as being among the most stressful specialty areas. The current study tested the short-term effects of an innovative self-help stress management training for oncology nurses supported by mobile tools. The sample included 30 female oncology nurses with permanent status employed in six oncology hospitals in Milan, Italy. The stress inoculation training (SIT) methodology served as the basis of the training, with the innovative challenge being the use of mobile phones to support the stress management experience. To test the efficacy of the protocol, the study used a between-subjects design, comparing the experimental condition (SIT through mobile phones) with a control group (neutral video through mobile phones). The findings indicated psychological improvement of the experimental group in terms of anxiety state, anxiety trait reduction, and coping skills acquisition. This paper discusses implications for the implementation of this protocol in several contexts., (PsycINFO Database Record (c) 2013 APA, all rights reserved.)

Background: Psychological stress occurs when an individual perceives that environmental demands tax or exceed his or her adaptive capacity. Its association with severe health and emotional diseases, points out the necessity to find new efficient strategies to treat it. Moreover, psychological stress is a very personal problem and requires training focused on the specific needs of individuals. To overcome the above limitations, the INTERSTRESS project suggests the adoption of a new paradigm for e-health--Interreality--that integrates contextualized assessment and treatment within a hybrid environment, bridging the physical and the virtual worlds. According to this premise, the aim of this study is to investigate the advantages of using advanced technologies, in combination with cognitive behavioral therapy (CBT), based on a protocol for reducing psychological stress., Methods/design: The study is designed as a randomized controlled trial. It includes three groups of approximately 50 subjects each who suffer from psychological stress: (1) the experimental group, (2) the control group, (3) the waiting list group. Participants included in the experimental group will receive a treatment based on cognitive behavioral techniques combined with virtual reality, biofeedback and mobile phone, while the control group will receive traditional stress management CBT-based training, without the use of new technologies. The wait-list group will be reassessed and compared with the two other groups five weeks after the initial evaluation. After the reassessment, the wait-list patients will randomly receive one of the two other treatments. Psychometric and physiological outcomes will serve as quantitative dependent variables, while subjective reports of participants will be used as the qualitative dependent variable., Discussion: What we would like to show with the present trial is that bridging virtual experiences, used to learn coping skills and emotional regulation, with real experiences using advanced technologies (virtual reality, advanced sensors and smartphones) is a feasible way to address actual limitations of existing protocols for psychological stress., Trial Registration: http://clinicaltrials.gov/ct2/show/NCT01683617.

Background: Several research studies investigating the effectiveness of the different treatments have demonstrated that exposure-based therapies are more suitable and effective than others for the treatment of anxiety disorders. Traditionally, exposure may be achieved in two manners: in vivo, with direct contact to the stimulus, or by imagery, in the person's imagination. However, despite its effectiveness, both types of exposure present some limitations that supported the use of Virtual Reality (VR). But is VR always an effective stressor? Are the technological breakdowns that may appear during such an experience a possible risk for its effectiveness?, Methods: To answer these questions we compared changes following the exposure to an academic examination, one of the most universal examples of real-life stressors, in a sample of 39 undergraduate students. The same experience was offered using text (TX), audio (AU), video (VD), and VR. However, in the virtual environment we manipulated the experience introducing technological breakdowns. The Post Media Questionnaire (PMQ) and the Slater-Usoh-Steed Presence Questionnaire (SUS) were administered to each participant in order to evaluated self-report measures of anxiety and relaxation and the level of presence experience during media exposure. Electrocardiogram (ECG), Thoracic Respiration Signal (RSP) and Facial corrugator supercilii muscle Electromyography (EMG) were recorded in order to obtain objective measures of subjects' emotional state., Results: Analyses conducted on PMQ showed a significant increase in anxiety scores and a mirror decrease in relax scores after all our emotional procedures, showing that all the condition were effective in inducing a negative emotional response. Psychometric scores and psychophysiological indexes showed that VR was less effective than other procedures in eliciting stress responses. Moreover, we did not observe significative difference in SUS scores: VR induced a sense of presence similar to that experienced during the exposition to other media., Conclusions: Technological breakdowns significantly reduce the possibility of VR eliciting emotions related to complex real-life stressors. Without a high sense of presence, the significant advantages offered by VR disappear and its emotional induction abilities are even lower than the ones provided by much cheaper media., Trial Registration Number: NCT01683617.

The use of biosensors in human experimental research has become one of the most reliable methods to objectively quantify participants' behavioral, psychological and physiological measures. Modern bio-behavioral technologies can be integrated in Virtual Reality platforms, for a contactless assessment of affective states. This manuscript proposes a paradigm to deeper reach accuracy in assessment and diagnostics of rehabilitation processes.

Flow is an optimal experience characterized by the perception of high challenges and high skills, positive affect, complete absorption in the activity carried out and intrinsic motivation. Although much research has examined the psychological features of flow, little is known about its biological underpinnings. The present study aimed at contributing to this gap by investigating the psychophysiological correlates of flow experience during daily routines. To this end, 15 university students took part in an experience sampling study, in which they provided real-time information on daily activities and associated experience while cardiac activity was monitored. After seven days of observation, 32 flow events were identified among 10 participants. A multilevel regression analysis revealed a significant correlation between optimal experience and specific cardiovascular indexes. In particular, the experience of flow was associated with increased heart rate and increased LF/HF ratio, suggesting relative sympathetic enhancement. These findings are in line with those obtained by previous related studies and indicate the feasibility of investigating physiological correlates of subjective experience in ecological contexts.

Is the primary motor cortex (M1) necessary for language comprehension? The present study investigates the role of the primary motor cortex during verbs comprehension, within the framework of the embodied theories of language. We applied rTMS over the right and left hand portion of M1 and tested the effects of the stimulation toward the processing of hand-related action verbs versus abstract verbs. Results underlined a specific inhibition effect following left stimulation, only with hand-related action verbs. These findings seem to corroborate the hypothesis of a functional role of M1 in action verbs comprehension., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

Recently, many studies demonstrated the efficacy of using Virtual Reality (VR) in clinical setting, and in particular for neuropsychological assessment. However reliability and usability of the test developed within virtual reality paradigm are often neglect. In this study we test both reliability and usability using well-known psychometrics methods for the Virtual Multiple Errands Test (VMET). In a first experiment, for the reliability, two independent researchers scored the test through several videos. For the usability assessment we analyzed 21 healthy participants and 3 patients with Parkinson's disease.

The use of augmentative and alternative communication (AAC) tools in patients with amyotrophic lateral sclerosis (ALS), as effective means to compensate for the progressive loss of verbal and gestural communication, has been deeply investigated in the recent literature. The development of advanced AAC systems, such as eye-tracking (ET) and brain-computer interface (BCI) devices, allowed to bypass the important motor difficulties present in ALS patients. In particular, BCIs could be used in moderate to severe stages of the disease, since they do not require preserved ocular-motor ability, which is necessary for ET applications. Furthermore, some studies have proved the reliability of BCIs, regardless of the severity of the disease and the level of physical decline. However, the use of BCI in ALS patients still shows some limitations, related to both technical and neuropsychological issues. In particular, a range of cognitive deficits in most ALS patients have been observed. At the moment, no effective verbal-motor free measures are available for the evaluation of ALS patients' cognitive integrity; BCIs could offer a new possibility to administer cognitive tasks without the need of verbal or motor responses, as highlighted by preliminary studies in this field. In this review, we outline the essential features of BCIs systems, considering advantages and challenges of these tools with regard to ALS patients and the main applications developed in this field. We then outline the main findings with regard to cognitive deficits observed in ALS and some preliminary attempts to evaluate them by means of BCIs. The definition of specific cognitive profiles could help to draw flexible approaches tailored on patients' needs. It could improve BCIs efficacy and reduce patients' efforts. Finally, we handle the open question, represented by the use of BCIs with totally locked in patients, who seem unable to reliably learn to use such tool.

In this work we describe the performance evaluation of a system for stress detection. The analysed data is acquired by following an experimental protocol designed to induce cognitive stress to the subjects. The experimental set-up included the recording of electroencephalography (EEG) and facial (corrugator and zygomatic) electromyography (EMG). In a preliminary analysis we are able to correlate EEG features (alpha asymmetry and alpha/beta ratio using only 3 channels) with the stress level of the subjects statistically (by using averages over subjects) but also on a subject-to-subject basis by using computational intelligence techniques reaching classification rates up to 79% when classifying 3 minutes takes. On a second step, we apply fusion techniques to the overall multi-modal feature set fusing the formerly mentioned EEG features with EMG energy. We show that the results improve significantly providing a more robust stress index every second. Given the achieved performance the system described in this work can be successfully applied for stress therapy when combined with virtual reality.

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.

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.

Awake surgery can be highly stressful for patients. In fact, being awake, patients could perceive that the environmental demands are taxing or exceed their adaptive abilities. We proposed the use of Virtual Reality as a functional and effective tool for a new class of clinical applications aimed at helping patients to cope with these specific stressful situations. Using coping skills that have been learnt during the virtual experience, patients can reduce their psychological stress and improve their collaboration and - in general - the outcome of the intervention.

This study aimed at measuring objectively the experience of using social network sites (SNSs). At this aim, a model of experience has been defined, focusing on three main aspects of time-space continuum of individuals' states: physiological arousal, emotional valence, and attentional resources. At this purpose we developed a new approach to assess such an experience. The main idea is to consider arousal, valence and attention to track the users' experience collecting psychophysiological indexes at predefined period (for example each 10 seconds) to build an empirical model based on these data. Once we got the empirical curve we can fit these data using mathematical models.

Oncology nurses face extraordinary stresses that may lead to emotional exhaustion, a feeling of emotional distance from patients and burnout. The presentation describes the preliminary results of a study to test the effects of an innovative 4-week 8-session self-help stress management training for oncology nurses supported by mobile tools (Nokia N70 smarthphone). The sample included 16 female oncology nurses with permanent status employed in different oncology hospitals in Milan, Italy. The study used a between-subjects design, comparing the experimental condition (mobile phone stress management protocol) with a control group (neutral videos through mobile phones). In addition to a significant reduction in anxiety state at the end of each session, the experimental group demonstrated a significant improvement in affective change in terms of anxiety trait reduction and coping skills acquisition at the end of the protocol.

Prolonged exposure to stressful environments can lead to serious health problems. Therefore, measuring stress in daily life situations through non-invasive procedures has become a significant research challenge. In this paper, we describe a system for the automatic detection of momentary stress from behavioral and physiological measures collected through wearable sensors. The system's architecture consists of two key components: a) a mobile acquisition module; b) an analysis and decision module. The mobile acquisition module is a smartphone application coupled with a newly developed sensor platform (Personal Biomonitoring System, PBS). The PBS acquires behavioral (motion activity, posture) and physiological (hearth rate) variables, performs low-level, real-time signal preprocessing, and wirelessly communicates with the smartphone application, which in turn connects to a remote server for further signal processing and storage. The decision module is realized on a knowledge basis, using neural network and fuzzy logic algorithms able to combine as input the physiological and behavioral features extracted by the PBS and to classify the level of stress, after previous knowledge acquired during a training phase. The training is based on labeling of physiological and behavioral data through self-reports of stress collected via the smartphone application. After training, the smartphone application can be configured to poll the stress analysis report at fixed time steps or at the request of the user. Preliminary testing of the system is ongoing.

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. 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.

This paper introduces activity-related behavioural features that can be automatically extracted from a computer system, with the aim to increase the effectiveness of automatic stress detection. The proposed features are based on processing of appropriate video and accelerometer recordings taken from the monitored subjects. For the purposes of the present study, an experiment was conducted that utilized a stress-induction protocol based on the stroop colour word test. Video, accelerometer and biosignal (Electrocardiogram and Galvanic Skin Response) recordings were collected from nineteen participants. Then, an explorative study was conducted by following a methodology mainly based on spatiotemporal descriptors (Motion History Images) that are extracted from video sequences. A large set of activity-related behavioural features, potentially useful for automatic stress detection, were proposed and examined. Experimental evaluation showed that several of these behavioural features significantly correlate to self-reported stress. Moreover, it was found that the use of the proposed features can significantly enhance the performance of typical automatic stress detection systems, commonly based on biosignal processing.

People are more and more using social networking sites (SNSs) like Facebook and MySpace to engage with others. The use of SNSs can have both positive and negative effect on the individual; however, the increasing use of SNSs might reveal that people look for SNSs because they have a positive experience when they use them. Few studies have tried to identify which particular aspects of the social networking experience make SNSs so successful. In this study we focus on the affective experience evoked by SNSs. In particular, we explore whether the use of SNSs elicits a specific psychophysiological pattern. Specifically, we recorded skin conductance, blood volume pulse, electroencephalogram, electromyography, respiratory activity, and pupil dilation in 30 healthy subjects during a 3-minute exposure to (a) a slide show of natural panoramas (relaxation condition), (b) the subject's personal Facebook account, and (c) a Stroop and mathematical task (stress condition). Statistical analysis of the psychophysiological data and pupil dilation indicates that the Facebook experience was significantly different from stress and relaxation on many linear and spectral indices of somatic activity. Moreover, the biological signals revealed that Facebook use can evoke a psychophysiological state characterized by high positive valence and high arousal (Core Flow State). These findings support the hypothesis that the successful spread of SNSs might be associated with a specific positive affective state experienced by users when they use their SNSs account.

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.

In this paper we introduce a new ubiquitous computing paradigm for behavioral health care: "Interreality". Interreality integrates 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) may improve existing psychological treatment. To illustrate the proposed concept, a clinical scenario is also presented and discussed: Daniela, a 40 years old teacher, with a mother affected by Alzheimer's disease.

We present a preliminary quantitative study aimed at developing an optimal standard protocol for automatic classification of specific affective states as related to human- computer interactions. This goal is mainly achieved by comparing standard psychological test-reports to quantitative measures derived from simultaneous non-invasive acquisition of psychophysiological signals of interest, namely respiration, galvanic skin response, blood volume pulse, electrocardiogram and electroencephalogram. Forty-three healthy students were exposed to computer-mediated stimuli, while wearable non-invasive sensors were applied in order to collect the physiological data. The stimuli were designed to elicit three distinct affective states: relaxation, engagement and stress. In this work we report how our quantitative analysis has helped in redefining important aspects of the protocol, and we show preliminary findings related to the specific psychophysiological patterns correlating with the three target affective states. Results further suggest that some of the quantitative measures might be useful in characterizing specific affective states.