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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.

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.

It is not unusual to experience a sense of total absorption, concentration, actionawareness, 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 abovementioned 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.

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.

Social network sites have been studied extensively with an aim to understand users' experience during their use. Facebook is the most frequently used social network site, with more than one billion active users. However, despite 819 million of active Facebook users currently accessing it using their mobile device, only a limited number of studies have investigated their experiences with Facebook. Our goal was to objectively verify in an experimental setting the subjective experience of users accessing Facebook through a PC and through a smart phone, which has a higher pervasiveness. Psychophysiological correlates of 28 subjects were measured using wearable biosensors, which record signals through an electrocardiogram; a 14-channel Electroencephalogram; facial Electromyography; an Electrooculogram, and a chest Respiration strip. An accurate signal processing permitted to compute twenty psychophysiological measures for the statistical analysis. The results showed significant patterns in arousal, valence, attention, and anxiety, indicating a subjects' engagement during Facebook navigation, which was also more evident during the mobile session, suggesting an optimal experience during the pervasive use of Facebook. Some hypotheses and the directions for future studies are presented, in particular, the suggestion to make further studies with higher ecological validity, outside the lab, to assess the ubiquitous use of Facebook.

Unilateral Spatial Neglect is one of the most common neuropsychological disorders that can occur after vascular brain accidents. Virtual reality is a new paradigm that showed its effectiveness in clinical setting, enhancing the traditional methods of assessment and rehabilitation. However, usability of a virtual reality system is often undervalued. In this study we present and test the usability of a new mobile virtual reality platform: Neglect App. For the usability evaluation we interviewed four neuropsychologists. The expert showed problems only in five of the fourteen tasks. Only two tasks presented an high (negative) impact on the usability of the application .The results of the SUS showed high levels of usability of our application, both for the assessment and the rehabilitation parts.

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.

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.

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.

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.

Virtual Reality (VR) is a computer-based simulation designed to expose users to environments in order to replicate real world objects and events. In this framework, video games are one of the most popular forms of VR media all over the worlds. Their popularity has been fuelled by advancements in gaming technology and interactive devices at a low cost in home gaming market but also in clinical and research settings. In clinical and research virtual rehabilitation, the user should be able to interact (directly or indirectly) with the environment via a wide array of input technologies. These include activation of computer keyboard keys, a mouse or a joypad (indirect) and even by using special sensors or visual tracking (direct). For example, Microsoft Kinect provides low-cost motion tracking sensors, allowing to clinicians to interact with rehabilitation applications in the most natural and flexible way. This flexibility can be employed to tailor the user interaction to the specific rehabilitation user aims. According to this perspective, the paper aims to present a potential new platform, NeuroVirtual3D, which intends to develop a software interface for supporting assessment and rehabilitation of cognition function through several input/output devices, such as data gloves, joypad and Microsoft Kinect.

Stress reduces quality of life and causes many diseases. Nevertheless, it is not completely clear whether stress transmission may involve acquaintances and other people in addition to lovers, friends, and relatives. More generally, it is not clear how stress spreads among the population and how its diffusion in a society can be estimated. This chapter presents a set of mathematical and computational models that can be used to approach the modeling of psychological stress diffusion.

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.

Several studies have reported the efficacy of group reminiscence in improving wellbeing in older adults. Still, the potential of intergenerational reminiscence, involving groups of seniors and children, has not been thoroughly investigated. We explored the potential benefits of this approach in a feasibility study, which involved 32 older adults and 114 students participating in a within-subject, repeated measures design. Participants were assigned to 16 groups, each including two seniors and six to eight pupils. The intervention consisted of three weekly meetings, totaling to about six hours of reminiscing activities. Pretest and posttest measures included seniors' perceived levels of Loneliness, Self-esteem, and Quality of life. In addition, the effects of intergenerational contact on children's perception of the elderly were investigated by using an ad hoc semantic differential scale. Analyses of pre- and postintervention measures revealed that the elderly participants reported significantly lower values of loneliness and an increase in perceived Quality of life. Further, results indicated that following their participation in the program the children's attitude towards the elderly positively changed in a positive way. Intergenerational group reminiscence is a potentially effective activity to improve psychosocial wellbeing and Quality of life in healthy older adults and to improve the way younger generations perceive the elderly.

Everyone is interested in the pursuit of happiness, but the real problem for the researchers is how to measure it. Our aim was to deeply investigate happiness measurement through biomedical signals, using psychophysiological methods to objectify the happiness experiences measurements. The classic valence-arousal model of affective states to study happiness has been extensively used in psychophysiology. However, really few studies considered a real combination of these two dimensions and no study further investigated multidimensional models. More, most studies focused mainly on self-report to measure happiness and a deeper psychophysiological investigation on the dimensions of such an experience is still missing. A multidimensional model of happiness is presented and both the dimensions and the measures extracted within each dimension are comprehensively explained. This multidimensional model aims at being a milestone for future systematic study on psychophysiology of happiness and affective states.

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.

New advanced technologies have recently emerged as a potentially effective way for delivering stress management techniques. Specifically, the stress inoculation training (SIT) represents a validated approach to manage stress in several settings, and research is growing related to this clinical protocol combined with advanced technologies. This review aims to outline the state of the art of cyber-interventions based on SIT methodology (cyber-SIT). In the current review, we deeply analyzed and discussed three aspects of the selected studies: (1) the type of technological devices used for delivering cyber-SIT; (2) the sampling strategies; (3) and the stress-related measures for assessing the effectiveness of cyber-SIT. The results of this systematic review suggest the potential efficacy of cyber-SIT for managing psychological stress in several settings. Considering cyber-SIT for psychological stress, controlled trials testing a greater number of participants are needed. Other future challenges include adopting better inclusion/exclusion criteria, standardized outcome measures, and different conditions for comparing the effect and/or the integration of different technological devices. In conclusion, as the cyber-SIT may play an important role in the future clinical psychology, it is crucial to enhance the validation of this approach from a methodological point of view.

One of the most amazing capacities of the human mind is its ability to go beyond its boundaries. The well-known example of the "blind man" by Gregory Bateson helps us understand how our mind is able to expand its potentiality thanks to the use of a tool. This famous example demonstrates two specific features that characterize the relationship between the human mind and the use of tool. From a neuropsychological point of view, the tool is integrated in near space, extending it to the end point of the instrument. From a phenomenological point of view, we are present in the tool because we can use it in an intuitive way to realize our intentions.

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.

In the last decade the use of Virtual Reality platforms in psychology and neurorehabilitation increased thanks to a higher availability of low-cost technology and a wider acceptance from the clinical world. Nonetheless multiplatform taking into consideration the combined use of innovative low-cost technologies are still missing. This chapter will extensively discuss the opportunities offered by the NeuroVirtual 3D platform in term of technologies innovations for the clinicians. After an overview of the state of the art in the field, a comprehensive discussion will focus above all on the low-cost stereo cameras and the Eye-Trackers, both more and more used in the assessment and neurorehabilitation of motor and cognitive abilities.

In recent years, Virtual Reality technologies have emerged as assessment and treatment tools in neuropsychology. In this chapter, we will explore the possibility of using Virtual Reality to improve the traditional neuropsychological assessment of executive functions. First, we will discuss the advantages offered by Virtual Reality to more traditional approaches. Then, the chapter details the characteristics of the Virtual Multiple Errands Test (VMET), a virtual reality tool developed using NeuroVR (http://www.neurovr.org)-a free virtual reality platform useful for the assessment and neurorehabilitation. Specifically, the VMET is an assessment protocol of executive functions, where participants are invited to navigate a virtual supermarket, completing tasks that require certain rules. In the chapter, we will present the detailed description of its clinical rationale and its different phases. Furthermore, a systematic analysis of the results obtained in different studies using the VMET will be outlined. Finally, we will discuss the potentiality of the VMET for integrating the traditional neuropsychological evaluation of patients with Parkinson's disease. Detection of early executive deficits in Parkinson's disease could facilitate the identification of patients at risk to develop dementia, and could give the chance to develop early neurorehabilitation interventions.

In recent years, there is growing interest in the use of advanced technologies for supporting well-being. The aim of this study was to test the efficacy of Positive Technology, the first application for smartphone and tablet that exploits the potential of new technologies and wearable biosensors for the self-management of psychological stress. 68 users who performed guided relaxation or biofeedback exercises for at least 120 seconds were included in the sample. The stress management exercises performed with the application were effective in reducing users' psychological stress level. It is possible to note a significant decrease in the arousal, associated with a concomitant increase in the hedonic valence after the stress management exercises. A decrease in heart rate values was observed, although it was not statistically significant. Although preliminary, overall these data suggest that even a brief stress management exercise carried out on a mobile application might be useful to reduce psychological discomfort.

The recent convergence between technology and medicine is offering innovative methods and tools for behavioral health care. Among these, an emerging approach is the use of virtual reality (VR) within exposure-based protocols for anxiety disorders, and in particular posttraumatic stress disorder. However, no systematically tested VR protocols are available for the management of psychological stress. Objective: Our goal was to evaluate the efficacy of a new technological paradigm, Interreality, for the management and prevention of psychological stress. The main feature of Interreality is a twofold link between the virtual and the real world achieved through experiential virtual scenarios (fully controlled by the therapist, used to learn coping skills and improve self-efficacy) with real-time monitoring and support (identifying critical situations and assessing clinical change) using advanced technologies (virtual worlds, wearable biosensors, and smartphones). Methods: The study was designed as a block randomized controlled trial involving 121 participants recruited from two different worker populations-teachers and nurses-that are highly exposed to psychological stress. Participants were a sample of teachers recruited in Milan (Block 1: n=61) and a sample of nurses recruited in Messina, Italy (Block 2: n=60). Participants within each block were randomly assigned to the (1) Experimental Group (EG): n=40; B1=20, B2=20, which received a 5-week treatment based on the Interreality paradigm; (2) Control Group (CG): n=42; B1=22, B2=20, which received a 5-week traditional stress management training based on cognitive behavioral therapy (CBT); and (3) the Wait-List group (WL): n=39, B1=19, B2=20, which was reassessed and compared with the two other groups 5 weeks after the initial evaluation. Results: Although both treatments were able to significantly reduce perceived stress better than WL, only EG participants reported a significant reduction (EG=12% vs CG=0.5%) in chronic t

Mobile phones are gaining particular importance in health care services. In fact, the incredible diffusion of mobile electronic devices has opened new scenarios for the assessment of stress-related events. We presented an Android Smartphone based experience sampling method and a real life data set containing stress related events. Data consisted of 12 weeks of 9 trial participants provided with Android Smartphone equipped with a specific experience sampling application.

The assessment of cognitive deficits, such as executive functions, can be critical in neuropsychology because is not easy to catch all the important cues of real-life behavior using the classic paper and pensil tests or even sophisticated laboratory tasks. On the other hand, using virtual simulations of prototypical daily situations, by the means of 3D virtual environments, it is possible to create situations which could help the therapeutic assessment, within the safe context of the therapist's laboratory. In this study, we described how we assessing executive functions using a Virtual Reality Test.

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.

Positive Technology is an emerging field that could be defined as the scientific and applied approach to the use of advanced technology for improving the quality of our personal experience. This discipline effectively combines the purposes of Positive Psychology with the enhancements of Information and Communication Technologies to promote individual and social well-being. Here, we suggest that a further advancement for Positive Technology might be offered by a new technological paradigm, namely Interreality. The value of Interreality Paradigm lies in bridging the gap between virtual and real world by integrating different pervasive sensors and computing technologies to create a hybrid, closedloop empowering experience for the assessment and treatment actually missing in the traditional research and clinical approach of psychological disorders. Interreality Paradigm uses biosensors, activity sensors and mobile devices (PDAs, mobile phones, etc.) to conduct the continuous assessment throughout the virtual and real experiences. It enables tracking of the individuals’ general and psychological status over time in several settings. The information collected during the assessment phase is constantly used to monitor individuals’ progress and to precisely calibrate their treatment sessions thanks to a decision support system. Finally, Interreality Paradigm uses advanced simulations (virtual experiences) to transform health guidelines and provision in meaningful and engaging experiences. A recently funded European project “INTERSTRESS – Interreality in the management and treatment of stress-related disorders” will offer the right context to test and tune these ideas.

This stusdy aim at testing the psychometric reliability of the NeuroVR-based virtual version of the Multiple Errands Test (VMET). In a first experiment two independent researchers scored 11 videos, each one of a subject running the VMET. In a second experiment 7 researcher scored two videos, each one of a subject running the VMET. Results showed the extent to which a disagreement become critical in VMET.

The incredible advancement in the ICT sector has challenged technology developers, designers, and psychologists to reflect on how to develop technologies to promote mental health. Computerized experience-sampling method appears to be a promising assessment approach to investigate the real-time fluctuation of experience in daily life in order to detect stressful events. At this purpose, we developed PsychLog (http://psychlog.com) a free open-source mobile experience sampling platform that allows psychophysiological data to be collected, aggregated, visualized and collated into reports. Results showed a good classification of relaxing and stressful events, defining the two groups with psychological analysis and verifying the discrimination with physiological measures. Within the paradigm of Positive Technology, our innovative approach offers for researchers and clinicians new effective opportunities for the assessment and treatment of the psychological stress in daily situations.

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.

Most clinicians and patients consider obesity just as a problem of energy balance: more energy input than expenditure. However, the epidemiological data and the clinical practice clearly show that obesity is more complex than described by this simple equation. In particular, the chapter underlined the possible role of negative body image in the etiology of this disturbance. Specifically, we suggested that unhealthful weight-control behaviors, that induce significant weight gain over time, may be driven by an allocentric negative body image that is no more updated by contrasting egocentric representations driven by perception (allocentric lock). In other words, subjects are locked to an allocentric negative representation of their body that their sensory inputs are no more able to update even after the dramatic body changes following a successful diet or bariatric surgery. In the chapter, we also discussed the possible role of virtual reality (VR) in addressing this problem within an integrated treatment approach. Specifically, we suggested that adding a 10-session experiential protocol based on the free NeuroVR (http://www.neurovr.org) virtual reality software to the classical treatment of obesity may improve its long-term outcome. The characteristics of the protocol and the outcome of two controlled clinical trials used to test it (VEPSY UPDATED - ISRCTN59019572, and AVATOB-NCT01394393) are detailed and discussed

Several studies have demonstrated that exposure therapy - in which the patient is exposed to specific feared situations or objects that trigger anxiety - is an effective way to treat anxiety disorders. However, to overcome a number of limitations inherent in this approach - lack of full control of the situation, costs and time required, etc. - some therapists have started to add virtual reality (VR) to the in vivo exposure-based therapy, providing in-office, controlled exposure therapy. Compared to the in vivo exposure, VR Exposure Therapy (VRET) is completely controlled: the quality, the intensity and the frequency of the exposure are decided by the therapist, and the therapy can be stopped at any time if the patient does not tolerate it. Moreover, the flexibility of a virtual experience allows the patient to experience situations that are often much worse and more exaggerated than those that are likely to be encountered in real life. However, a critical issue underlying the use of VRET in the treatment of anxiety-related disorders is the lack of a virtual reality system in the patient's real-life context. In this paper, we present a clinical protocol for the treatment of Generalized Anxiety Disorders (GAD) based on the ubiquitous use of a biofeedback-enhanced VR system. The protocol includes the use of a mobile exposure system allowing patients to perform the virtual experience in an outpatient setting. A between-subjects study, involving 25 GAD patients, was carried out to verify the efficacy of the proposed approach. The clinical data in this pilot study seemed to support the efficacy of the ubiquitous approach. © 2011 Springer-Verlag London Limited.

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 experien

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 sim

Lo studio esplora la modificazione dell’attività corticale alfa in risposta a stimoli emotivi positivi vs. negativi in contesti “reali” o “virtuali”

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.

Research has proven that stress reduces quality of life and causes many diseases. It is not clear how stress spreads among the population and how its diffusion in a society can be estimated. From a complex system perspective, this paper defines the rules of stress transmission, including input and output factors. Stress transmission flow is defined to describe an entropy-derived measure of stress between two interconnected individuals, and the analysis is extended to networked individuals to analyze stress diffusion in a theoretical setting that includes the modeling of complex networks and the use of agent-based models in a simulated framework. These approaches endow artificial, interacting agents with behavioral rules, allowing the authors to determine the important components that must be considered as the nature of the equilibrium that exists between two distinctly different classifications of individuals. The first classification is “isolated individuals” who experience self-induced stress. The second classification consists of “too connected individuals” who have a high perception of social pressure, have a higher probability of being stressed, and who are surrounded by a higher number of stressed people.

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.

Traditional stress management techniques require significant professional training and expertise to administer as well as people, time, and resources, which can be difficult to achieve. Thanks to the recent progress and diffusion of mobile electronic devices, it is possible today to set up and test an effective self-help stress management program outside a clinical setting. Although the efficacy of mobile self-help approaches have been tested through several studies, and promising applications can be developed, as yet no study has tested the feasibility of mobile platforms to actually elicit core affective states. In this study we used an advanced approach to assess the efficacy of these mobile platforms by recording and processing many psychophysiological measures, which extend the capabilities of the standard self-report questionnaires, objectifying the subjective. Our results seem to show the efficacy of inducing positive and negative affective states, using smart phones.

Emerging studies suggest that sedentary work style is often associated with deleterious physiological implications, including diabetes, high blood pressure and obesity. However, only few studies linked prolonged periods of sitting with psychological responses thus the implications of sedentary behavior on mental health still remain highly unexplored. In this study, we investigated the relation between sedentary time and Heart Rate Variability (HRV) parameters, which are considered important biological markers of psychological processes including cognitive and emotional aspects. In this manner, we aim to explore factors that may indicate that sedentary behavior causes responses at psychological level. Recent progress in the sophistication and usability of wearable sensors offers the opportunity to continuously record ECG parameters and accelerometer data in daily-life settings, such as at workplace.

Computerized experience-sampling method comprising a mobile-based system that collects psychophysiological data appears to be a very promising assessment approach to investigate the real-time fluctuation of experience in daily life in order to detect stressful events. At this purpose, we developed PsychLog (http://sourceforge.net/projects/psychlog/) a free open-source mobile experience sampling platform that allows psychophysiological data to be collected, aggregated, visualized and collated into reports. Results showed a good classification of relaxing and stressful events, defining the two groups with psychological analysis and verifying the discrimination with physiological measures. Our innovative approach offers to researchers and clinicians new effective opportunities to assess and treat psychological stress in daily-life environments.

"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 in

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.© 2012 The authors and IOS Press. All rights reserved.

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. © 2012 The authors and IOS Press. All rights reserved.