Andrea Gaggioli received a MSc in Psychology from University of Bologna and a Ph.D. from the Faculty of Medicine of the University of Milan. He is researcher at the Faculty of Psychology of the Catholic University of Milan and consultant at the Applied Technology for Neuro-Psychology Lab of Istituto Auxologico Italiano (Milan, Italy). He is the founder of Positive Technology, a field that studies how new technologies can be used to promote mental and physical wellbeing.
Abstract: New technologies have influenced communication and interaction among people, enabling them to overcome face-to-face limitations and eliminating the need for persons in a communicative relationship to be in the same place at the same time. This project aimed to test the effectiveness of mobile phone usage applied to emotion induction. The authors wanted to check whether or not mobile narratives supported by multimedia mobile phones can enhance relaxation and reduce anxiety in a sample of commuters. The project sample consisted of 120 commuters, college students aged 20 to 25 years. The sample was randomly assigned into four conditions: the Vidnar group experienced the mobile narrative on a mobile phone during their daily train trip; the Nonar group experienced only video content proposed on a mobile phone; the MP3 group experienced only the audio content proposed on an MP3 player; and the Control group provided a no-intervention condition. The study measured participants' emotional state (State-Trait Anxiety Inventory [STAI] State questionnaire), trait (STAI Trait questionnaire, Generalized Self-Efficacy Scale), and sense of presence (Slater-Usoh-Steed Questionnaire [UCL-SUS] and the International Test Commission-Sense of Presence Inventory [ITC-SOPI]) before and after the experience. The main results showed a significant decrease in anxiety level (p < 0.05, assessed by STAI State questionnaire) and an increase in relaxation level (p < 0.001) assessed by the Visual Analog Scale (VAS). No significant differences were found in other conditions.
Abstract: The aim of the present paper is to describe the role played by three-dimensional (3-D) virtual worlds in eHealth applications, addressing some potential advantages and issues related to the use of this emerging medium in clinical practice. Due to the enormous diffusion of the World Wide Web (WWW), telepsychology, and telehealth in general, have become accepted and validated methods for the treatment of many different health care concerns. The introduction of the Web 2.0 has facilitated the development of new forms of collaborative interaction between multiple users based on 3-D virtual worlds. This paper describes the development and implementation of a form of tailored immersive e-therapy called p-health whose key factor is interreality, that is, the creation of a hybrid augmented experience merging physical and virtual worlds. We suggest that compared with conventional telehealth applications such as emails, chat, and videoconferences, the interaction between real and 3-D virtual worlds may convey greater feelings of presence, facilitate the clinical communication process, positively influence group processes and cohesiveness in group-based therapies, and foster higher levels of interpersonal trust between therapists and patients. However, challenges related to the potentially addictive nature of such virtual worlds and questions related to privacy and personal safety will also be discussed.
Abstract: The aim of this study is to assess the efficacy of a specific stress management protocol, based on immersive Virtual Reality (VR), to be used as part of a multidisciplinary inpatient program for the treatment of obesity. The stress management protocol included imagery, relaxation and different cognitive behavioral approaches -- emotion focused coping, self-monitoring and record keeping. Forty (40) participants, all female, were recruited for the study at the San Giuseppe Hospital, Istituto Auxologico Italiano, Piancavallo (VB), Italy. Participants were chosen among the obese patients without a specific Binge Eating diagnosis but with high level of anxiety and a history of emotional eating. The sample was randomly distributed in three conditions as follows: (a) VR stress Management Protocol; (b) DVD based stress management protocol; (c) no treatment (control condition). Data show that the VR condition produced a significantly higher reduction in anxiety, as compared both to DVD and control groups. More, we found a significant correlation between changes in the emotional state and the level of presence: the more present the users felt, the higher the reduction in anxiety. This datum suggests the possible role of presence in mediating the effects of a stress management protocol.
Abstract: Even if the most sophisticated robot now available is unable to learn and move in the same way as humans, two decades of research in artificial intelligence and cognitive systems introduced the concept of embodiment: the mind has to be understood in the context of its relationship to a physical body that interacts with the world. One of the main outcomes of this vision is the dynamic sensorimotor account of conscious experience. Following this vision, the key feature of a cognitive robot should be the possession and exercise of sensorimotor knowledge. The main criticism against this argument is that such a robot will still lack self-awareness. In this paper, we suggest that a psychology of "presence" can offer new insights to overcome this point. In particular, we argue that in humans the evolutive role of presence is the control of agency through the unconscious separation of "internal" and "external" and the transformation (enaction) and/or recognition (reenaction) of intentions in action. How can we develop presence in robots? If we follow the development of presence in humans, we must use an evolutive process. First, the robot must learn to differentiate itself from the external world by correctly coupling perceptions and movements. Then the robot must learn to clearly separate perception and action planning, even if both share the same language: motor code. Finally, it is through social and cooperative activities that the robot may improve its intentional action and interaction.
Abstract: Many studies showed the ability of movies and imagery techniques to elicit emotions. Nevertheless, it is less clear how to manipulate the content of interactive media to induce specific emotional responses. In particular, this is true for the emerging medium virtual reality (VR), whose main feature is the ability to induce a feeling of "presence" in the computer-generated world experienced by the user. The main goal of this study was to analyze the possible use of VR as an affective medium. Within this general goal, the study also analyzed the relationship between presence and emotions. The results confirmed the efficacy of VR as affective medium: the interaction with "anxious" and "relaxing" virtual environments produced anxiety and relaxation. The data also showed a circular interaction between presence and emotions: on one side, the feeling of presence was greater in the "emotional" environments; on the other side, the emotional state was influenced by the level of presence. The significance of these results for the assessment of affective interaction is discussed.
Abstract: Test-taking anxiety or stress is very common among university students. It can be very distressing and sometimes debilitating. Exam anxiety involves physical components and emotional components that may be taken into account for managing and reducing anxiety. An approach to control exam anxiety is to learn how to regulate emotions. To help students in managing exam stress we developed a specific protocol based on mobile narratives--multimedia narratives experienced on UMTS/3G phones. 30 female university students (M=23.48; sd=1.24) who were going to perform an exam within a week were included in the trial. They were randomly divided in five groups according to the type and mobility of the medium used: (1) audio only narrative (CD at home); (2) audio only narrative (portable MP3); (3) audio and video narrative (DVD at home); (4) audio and video narrative (UMTS based); (5) control group. Audio/video narratives induced a reduction in exam anxiety in more than 80% of the sample vs 50% of the MP3 sample and 0% of the CD sample. Further, all the users who experienced mobile narratives on UMTS phones were able to relax before the exam, against 50% of DVD users and 33% of audio-only users. The trial showed a better efficacy of mobile narratives experienced on UMTS phones in reducing the level of exam stress and in helping the student to relax. These results suggest that for the specific sample considered--Italian university students--the media used for providing an anti-stress protocol has a clear impact on its efficacy.
Abstract: In the past decade, the use of virtual reality for clinical and research applications has become more widespread. However, the diffusion of this approach is still limited by three main issues: poor usability, lack of technical expertise among clinical professionals, and high costs. To address these challenges, we introduce NeuroVR (http://www.neurovr.org--http://www.neurotiv.org), a cost-free virtual reality platform based on open-source software, that allows non-expert users to adapt the content of a pre-designed virtual environment to meet the specific needs of the clinical or experimental setting. Using the NeuroVR Editor, the user can choose the appropriate psychological stimuli/stressors from a database of objects (both 2D and 3D) and videos, and easily place them into the virtual environment. The edited scene can then be visualized in the NeuroVR Player using either immersive or non-immersive displays. Currently, the NeuroVR library includes different virtual scenes (apartment, office, square, supermarket, park, classroom, etc.), covering two of the most studied clinical applications of VR: specific phobias and eating disorders. The NeuroVR Editor is based on Blender (http://www.blender.org), the open source, cross-platform suite of tools for 3D creation, and is available as a completely free resource. An interesting feature of the NeuroVR Editor is the possibility to add new objects to the database. This feature allows the therapist to enhance the patient's feeling of familiarity and intimacy with the virtual scene, i.e., by using photos or movies of objects/people that are part of the patient's daily life, thereby improving the efficacy of the exposure. The NeuroVR platform runs on standard personal computers with Microsoft Windows; the only requirement for the hardware is related to the graphics card, which must support OpenGL.
Abstract: BACKGROUND: Topographical disorientation represents one of the main consequences of brain injury. Up to now several methodological approaches have been used in the assessment of the brain injured patient's navigational abilities showing a moderate correlation with the impairments observed in everyday contexts. METHODS: We propose a combination of standardized neuropsychological tests and a more situated virtual reality-based assessment for the evaluation of spatial orientation in brain injured patients. RESULTS: When tested with this virtual reality integrated procedure patients showed performance and execution times congruent with their neuropsychological evaluation. When compared to a control group, patients revealed significantly slower times and greater errors in solving virtual reality based spatial tasks. CONCLUSION: The use of virtual reality, when combined with classical neuropsychological tests, can provide an effective tool for the study of topographical disorientation.
Abstract: OBJECTIVE: To investigate the technical and clinical viability of using computer-facilitated mental practice in the rehabilitation of upper-limb hemiparesis following stroke. DESIGN: A single-case study. SETTING: Academic-affiliated rehabilitation center. PARTICIPANT: A 46-year-old man with stable motor deficit of the upper right limb following subcortical ischemic stroke. INTERVENTION: Three computer-enhanced mental practice sessions per week at the rehabilitation center, in addition to usual physical therapy. A custom-made virtual reality system equipped with arm-tracking sensors was used to guide mental practice. The system was designed to superimpose over the (unseen) paretic arm a virtual reconstruction of the movement registered from the nonparetic arm. The laboratory intervention was followed by a 1-month home-rehabilitation program, making use of a portable display device. MAIN OUTCOME MEASURES: Pretreatment and posttreatment clinical assessment measures were the upper-extremity scale of the Fugl-Meyer Assessment of Sensorimotor Impairment and the Action Research Arm Test. Performance of the affected arm was evaluated using the healthy arm as the control condition. RESULTS: The patient's paretic limb improved after the first phase of intervention, with modest increases after home rehabilitation, as indicated by functional assessment scores and sensors data. CONCLUSION: Results suggest that technology-supported mental training is a feasible and potentially effective approach for improving motor skills after stroke.
Abstract: We surveyed physicians' attitudes to the use of telemedicine. A questionnaire was sent to 2987 Italian physicians and 361 responded (12%). The topics covered by the survey were: current telemedicine technology knowledge/usage level; general attitude towards telemedicine applications; perceived efficacy of telemedicine in enhancing quality of care; and intention to use telemedicine. In all, 83% of respondents had heard about telemedicine. Some doctors considered telemedicine to be of limited interest and many physicians were not convinced that it could improve clinical practice. These beliefs were more common among doctors of higher seniority, probably because they are more reluctant to accept change. To reduce such negative evaluations, better dissemination of information about the state of the art of research and development in telemedicine is needed. A logistic regression model was used to determine which factors influenced the intention to use telemedicine. The final model predicted 80% of the responses correctly.
Abstract: In the last years the rapid development of the Internet and new communication technologies has had a great impact on psychology and psychotherapy. Psychotherapists seem to rely with more and more interest on the new technological tools such as videophone, audio and video chat, e-mail, SMS and the new Instant Messaging Tools (IMs). All these technologies outline a stimulating as well as complex scenario: in order to effectively exploit their potential, it is important to study which is the possible role played by the Internet-based tools inside a psychotherapeutic iter. Could the technology substitute the health care practitioners or are these tools only a resource in addition to the traditional ones in the therapist's hand? The major aim of this chapter is to provide a framework for the integration of old and new tools in mental health care. Different theoretical positions about the possible role played by e-therapy are reported showing the possible changes that psychotherapy will necessarily face in a cyber setting. The VEPSY website, an integration of different Internet-based tools developed within the VEPSY UPDATED Project, is described as an example of clinical application matching between old (and functional) practices with new (and promising) media for the treatment of different mental disorders. A rationale about the possible scenarios for the use of the VEPSY website in the clinical process is provided.
Abstract: Virtual Reality (VR) offers a blend of attractive attributes for rehabilitation. The most exploited is its ability to create a 3D simulation of reality that can be explored by patients under the supervision of a therapist. In fact, VR can be defined as an advanced communication interface based on interactive 3D visualization, able to collect and integrate different inputs and data sets in a single real-like experience.However, "treatment is not just fixing what is broken; it is nurturing what is best" (Seligman & Csikszentmihalyi). For rehabilitators, this statement supports the growing interest in the influence of positive psychological state on objective health care outcomes.This paper introduces a bio-cultural theory of presence linking the state of optimal experience defined as "flow" to a virtual reality experience. This suggests the possibility of using VR for a new breed of rehabilitative applications focused on a strategy defined as transformation of flow. In this view, VR can be used to trigger a broad empowerment process within the flow experience induced by a high sense of presence.The link between its experiential and simulative capabilities may transform VR into the ultimate rehabilitative device. Nevertheless, further research is required to explore more in depth the link between cognitive processes, motor activities, presence and flow.
Abstract: Rapid and far-reaching technological advances are changing the ways in which people relate, communicate, and live. Technologies that were hardly used ten years ago, such as the Internet, e-mail, and video teleconferencing are becoming familiar methods for diagnosis, therapy, education and training. This is producing an emerging field (cybertherapy) whose focus is the use of communication and information technologies to improve the health care processes. To exploit and understand this potential was the aim of the Telemedicine and Portable Virtual Environment in Clinical Psychology, VEPSY UPDATED, an European Community funded research project (IST-2000-25323, http://www.cybertherapy.info). The chapter describes the clinical and technical rationale behind the cybertherapy applications developed by the project. Further, the actual role of virtual reality in the cybertherapy field is discussed, focusing on the advantages provided by its three different faces: technological, experiential and communicative.
Abstract: Converging lines of evidence suggest that motor imagery (the mental simulation of a motor act within working memory) is associated with subliminal activation of the motor system. This observation has led to the hypothesis that cortical activation during motor imagery may affect the acquisition of specific motor skills and help the recovery of motor function. In this paper, we describe a clinical protocol in which we use interactive tools to stimulate motor imagery in hemiplegic stroke patients, thereby helping them to recover lost motor function. The protocol consists of an inpatient and an outpatient phase, combining physical and mental practice. In the inpatient phase, patients are trained in a laboratory setting, using a custom-made interactive workbench (VR Mirror). After discharge, patients use a portable device to guide mental and physical practice in a home setting. The proposed strategy is based on the hypotheses that: (a) combined physical and mental practice can make a cost-effective contribution to the rehabilitation of stroke patients, (b) effective mental practice is not possible without some form of support, from a therapist (as in our inpatient phase) or from technology (as in the outpatient phase), (c) the inclusion of an outpatient phase will allow the patient to practice more often than would otherwise be possible, therefore increasing the speed and/or effectiveness of learning, and (d) the use of interactive technology will reduce the patient's need for skilled support, therefore improving the cost-effectiveness of training.
Abstract: Early applications of virtual reality (VR) technology in psychological assessment, treatment, and research have yielded promising results. In particular, an increasing number of studies analyze the unique features of the experience made by patients during their exposure to virtual environments. However, the majority of these studies explore how patients navigate in the virtual spaces and interact with virtual objects. Only a few of them investigate the features of inhabited virtual environments, where real people and autonomous virtual humans are able to interact and to cooperate. In particular, there is a lack of discussion of the role that such autonomous virtual humans could have in VR-aided psychotherapy. The main goal of this paper is to identify a framework for future research in this area. Three levels of analysis are identified. The purpose of the first two levels is the identification of the key "physical" features (e.g., appearance, structure) and "internal" characteristics (e.g., behavior, degree of autonomy, perceptual capabilities) needed by an effective simulation. The third level is concerned with the evaluation of the interaction characteristics required for a successful relationship between the patient and the virtual human.
Abstract: Technology is starting to influence psychological fields. In particular, computer-mediated communication (CMC) is providing new tools that can be fruitfully applied in psychotherapy. These new technologies do not substitute for traditional techniques and approaches but they could be used as integration in the clinical process, enhancing or making easier particular steps of it. This paper focuses on the concept of e-therapy as a new modality of helping people resolve life and relationship issues. It utilizes the power and convenience of the Internet to allow synchronous and asynchronous communication between patient and therapist. It is important to underline that e-therapy is not an alternative treatment, but a resource that can be added to traditional psychotherapy. The paper also discusses how different forms of CMC can be fruitfully applied in psychology and psychotherapy, by evaluating the effectiveness of them in the clinical practice. To enhance the diffusion of e-therapy, further research is needed to evaluate all the pros and cons.
Abstract: Emerging changes in health-care delivery are having a significant impact on the structure of health-care professionals' education. Today it is recognized that medical knowledge doubles every 6-8 years, with new medical procedures emerging everyday. While the half-life of medical information is so short, the average physician practices 30 years and the average nurse 40 years. Continuing education thus represents an important challenge to face. Recent advances in educational technology are offering an increasing number of innovative learning tools. Among these, Virtual Reality represents a promising area with high potential of enhancing the training of health-care professionals. Virtual Reality Training can provide a rich, interactive, engaging educational context, thus supporting experiential learning-by-doing; it can, in fact, contribute to raise interest and motivation in trainees and to effectively support skills acquisition and transfer, since the learning process can be settled within an experiential framework. Current virtual training applications for health-care differ a lot as to both their technological/multimedia sophistication and to the types of skills trained, varying for example from telesurgical applications to interactive simulations of human body and brain, to virtual worlds for emergency training. Other interesting applications include the development of immersive 3D environments for training psychiatrists and psychologists in the treatment of mental disorders. This paper has the main aim of discussing the rationale and main benefits for the use of virtual reality in health-care education and training. Significant research and projects carried out in this field will also be presented, followed by discussion on key issues concerning current limitations and future development directions.
Abstract: The human brain can simulate motor actions without physically executing them, and there is a neuro-psychological relationship between imaging and performing a movement. These are shared opinions. In fact there is scientific evidence showing that the mental simulation of an action is correlated to a subliminal activation of the motor system. There is also evidence that virtual stimulation can enhance the acquisition of simple motor sequences. In some situations, virtual training was found to be as beneficial as real training and more beneficial than workbook and no training in teaching complex motor skills to people with learning disabilities. Moreover, studies of brain-injured hemiplegics patients suggest that these patients retain the ability to generate accurate motor images even of actions that they cannot perform. Combined with evidence indicating that motor imagery and motor planning share common neural mechanisms, these observations suggest that supporting mental imagery through non-immersive, low-cost virtual reality (VR) applications may be a potentially effective intervention in the rehabilitation of brain-injured patients. Starting from this background, our goal is to design and develop a new technique for the acquisition of new motor abilities- "imagery enhanced learning" (or I-learning)-to be used in neuro-psychological rehabilitation. A key feature of I-learning is the use of potentially low-cost, Virtual Reality enhanced technology to facilitate motor imagery creating a compelling sense of presence. This paper will discuss the rationale and a preliminary rehabilitation protocol for investigating mental imagery as a means of promoting motor recovery in patients with a neurological disorder. The treatment strategy aims at evoking powerful imaginative responses using an innovative technique which makes no attempt to simulate the real-world motor behavior, but draws the patient's attention to its underlying dynamic structure. This is done by displaying highly stylized sketches of the motor behavior on a computer screen and gradually increasing the perceptual realism of the visualization. This strategy assumes that optimal learning will be achieved when the patient is allowed to elaborate his own schema and sequences of movements, thereby constructing his own personal image of the motor behavior to be trained.
Abstract: More than 10 years ago, Tart (1990) described virtual reality (VR) as a technological model of consciousness offering intriguing possibilities for developing diagnostic, inductive, psychotherapeutic, and training techniques that can extend and supplement current ones. To exploit and understand this potential is the overall goal of the "Telemedicine and Portable Virtual Environment in Clinical Psychology"--VEPSY UPDATED--a European Community-funded research project (IST-2000-25323, www.cybertherapy.info). Particularly, its specific goal is the development of different PC-based virtual reality modules to be used in clinical assessment and treatment of social phobia, panic disorders, male sexual disorders, obesity, and eating disorders. The paper describes the clinical and technical rationale behind the clinical applications developed by the project. Moreover, the paper focuses its analysis on the possible role of VR in clinical psychology and how it can be used for therapeutic change.
Abstract: The emergence of new shared media, such as the Internet and virtual reality are changing the ways in which people relate, communicate, and live. Health care, and in particular clinical psychology, is one of the areas that could be most dramatically reshaped by these new technologies. To exploit and understand this potential is the overall goal of the "Telemedicine and Portable Virtual Environment in Clinical Psychology"--VEPSY UPDATED--an European Community funded research project (IST-2000-25323, http://www.vepsy.com) whose specific goal is the development of different PC based virtual reality modules to be used in clinical assessment and treatment. In particular the developed modules have been using to address the following pathologies: anxiety disorders; male impotence and premature ejaculation; obesity, bulimia and binge-eating disorders. The chapter details the general technical and clinical characteristics of the developed modules.
Abstract: Many of us grew up with the naive assumption that couches are the best used therapeutic tools in psychotherapy. But tools for psychotherapy are evolving in a much more complex environment than a designer's chaise lounge. In particular, virtual reality (VR) devices have the potential for appearing soon in many consulting rooms. The use of VR in medicine is not a novelty. Applications of virtual environments for health care have been developed in the following areas: surgical procedures (remote surgery or telepresence, augmented or enhanced surgery, and planning and simulation of procedures before surgery); preventive medicine and patient education; medical education and training; visualization of massive medical databases; and architectural design for health care facilities. However, there is a growing recognition that VR can play an important role in clinical psychology, too. To exploit and understand this potential is the main goal of the Telemedicine and Portable Virtual Environment in Clinical Psychology--VEPSY Updated--a European Community-funded research project (IST-2000-25323, http://www.vepsy.com). The project will provide innovative tools-telemedicine and portable-for the treatment of patients, clinical trials to verify their viability, and action plans for dissemination of its results to an extended audience-potential users and influential groups. The project will also develop different personal computer (PC)-based virtual reality modules to be used in clinical assessment and treatment. In particular, the developed modules will address the following pathologies: anxiety disorders; male impotence and premature ejaculation; and obesity, bulimia, and binge-eating disorders.
