ArticlePDF Available

Inter-Reality in the Evaluation and Treatment of Psychological Stress Disorders: the INTERSTRESS Project.

DOI:10.3233/978-1-61499-121-2-8
Authors:
Pietro Cipresso at Università degli Studi di Torino
Pietro Cipresso
Andrea Gaggioli at Catholic University of the Sacred Heart
Andrea Gaggioli
Silvia Serino at Università degli Studi di Milano-Bicocca
Silvia Serino
Simona Raspelli at I.R.C.C.S. Istituto Auxologico Italiano
Simona Raspelli
Show all 7 authorsHide
Download full-text PDF
Read full-text
Download citation

Abstract and Figures

"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.
Figures - uploaded by Pietro Cipresso
Author content
All figure content in this area was uploaded by Pietro Cipresso
Content may be subject to copyright.
Content uploaded by Pietro Cipresso
Author content
All content in this area was uploaded by Pietro Cipresso on Nov 11, 2018
Content may be subject to copyright.
Inter-reality in the Evaluation and
Treatment of Psychological Stress
Disorders: the INTERSTRESS Project
Pietro CIPRESSO a,
1
, Andrea GAGGIOLI a,
Silvia SERINO a , Simona RASPELLI a, Cinzia VIGNA a, Federica PALLAVICINI a
and Giuseppe RIVA a
a Applied Technology for Neuro-Psychology Lab,
Istituto Auxologico Italiano, Milan, Italy
Abstract. “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.
Keywords. Psychological stress, physiological monitoring, wearable sensors, knowledge models, decision
support system
1. Introduction
According to Cohen and colleagues [1] “Psychological Stress” occurs when an
individual perceives that environmental demands tax or exceed his or her adaptive
capacity. In this view, stressful experiences are conceptualized as person-environment
transactions, whose result is dependent on the impact of the external stimulus.
The Cochrane Database of Systematic Reviews [2, 3] identified in the Cognitive
Behavioral (CBT) approach the best validated approach for stress management and
stress treatment. Even if CBT is the treatment of choice for psychological stress, there
is still room for improvement .
1
Corresponding Author.
Specifically, there are three major issues to solve:
the therapist is less relevant than the specific protocol used;
the protocol is not customized to the specific characteristics of the patient.
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 overcome the above limitations, Riva and coll. [4] recently introduced a new
paradigm for e-health – “Interreality” - that integrates assessment and treatment within
a hybrid environment, bridging physical and virtual world. By creating a bridge
between virtual and real worlds, Interreality allows a full-time closed-loop approach
actually missing in current approaches to the assessment and treatment of
psychological stress: first, the assessment is conducted continuously throughout the
virtual and real experiences: it enables tracking of the individual’s psycho-
physiological status over time in the context of a realistic task challenge; second, the
information is constantly used to improve both the appraisal and the coping skills of the
patient: it creates a conditioned association between effective performance state and
task execution behaviors. The potential advantages offered to stress treatments by this
approach are: (a) an extended sense of presence [5]: Interreality uses advanced
simulations (virtual experiences) to transform health guidelines and provisions in
experience; (b) an extended sense of community: Interreality provides social support in
both real and virtual worlds; (c) a real-time feedback between physical and virtual
worlds: Interreality uses bio and activity sensors and devices (PDAs, smartphones)
both to track in real time the behavior and the health status of the user and to provide
suggestions and guidelines [6, 7].
Fig. 1. A Virtual Reality based stressful situation.
2. Method
From a technological viewpoint Interreality is based on the following devices/platform:
3D Individual and/or shared virtual worlds: They allow controlled exposure
and objective assessment;
Personal digital assistants and/or mobile platforms (from the virtual world to
the real one): It allows an objective assessment, provision of warnings and
motivating feedbacks;
Personal biomonitoring system (from the real world to the virtual one): It
allows a quantitative assessment and decision support for treatment.
These devices are integrated around two subsystems: the Clinical Platform (in patient
treatment, fully controlled by the therapist) and the Personal Mobile Platform (real
world support, available to the patient and connected to the therapist) that allow a)
monitoring of the patient behavior and of his general and psychological status, early
detection of symptoms of critical evolutions and timely activation of feedbacks in a
closed loop approach; b) Monitoring of the response of the patient to the treatment,
management of the treatment and support to the therapists in their therapeutic decisions.
The clinical use of these technologies in the Interreality paradigm is based on a closed-
loop concept that involves the use of technology for assessing, adjusting and/or
modulating the emotional regulation of the patient, his/her coping skills and appraisal
of the environment (both virtual, under the control of a clinician, and real, facing actual
stimuli) based upon a comparison of that patient’s behavioural and physiological
responses with a baseline or performance criterion.
Figure 1. Inter-reality: A link between Virtual and Real world.
3. Results
The release of the main INTERSTRESS technological components was successfully
completed and the integrated service platform is currently in an advanced development
stage. The formative evaluation studies have involved so far over 100 participants in
three EU countries (Italy, Spain, Germany). The full trials are expected to run for nine
months, during which the efficacy and effectiveness of the Interreality approach in
supporting stress management will be compared with conventional cognitive-
behavioral program. The assessment phase features psychological questionnaires, a
clinical interview and a self-monitoring week, where the participants will monitor their
physiological and psychological stress reactions by means of biosensors and a
smartphone (experimental group) or by a diary (control group). In the experimental
training phase, participants in the experimental condition will be exposed to typical of
stressful scenarios in a virtual reality simulator, and then the participants will learn
basic coping strategies.
4. Conclusion
Stress is an increasingly recognized phenomenon that has negative effects on growing
numbers of people. Chronic stress is responsible for premature mortality in Western
countries, and work-related stress accounts for premature cardiovascular mortality rates.
INTERSTRESS aims to improve links and interaction between patients and doctors,
facilitating more active participation of patients in the care process. Also, it envisions a
better quality of life, where personalized, immersive e-therapy allow the ability to
detect and manage stress anytime, anywhere.
Acknowledgments:
This work was supported by the European funded project ‘‘Interstress-Interreality in
the management and treatment of stress-related disorders’’, FP7-247685.
References
[1] Cohen, S., Janicki-Deverts, D., Miller, G.E.: Psychological Stress and Disease. JAMA: The Journal of
the American Medical Association 298, 1685-1687 (2007)
[2] Bisson, J., Andrew, M.: Psychological treatment of post-traumatic stress disorder (Withdrawn Paper.
2007, art. no. CD003388). Cochrane Db Syst Rev (2007)
[3] Thomson, A.B., Page, L.A.: Psychotherapies for hypochondriasis. Cochrane Db Syst Rev (2007)
[4] Riva, G., Raspelli, S., Pallavicini, F., Grassi, A., Algeri, D., Wiederhold, B.K., Gaggioli, A.: Interreality
in the management of psychological stress: a clinical scenario. Studies in health technology and
informatics 154, 20-25 (2010)
[5] Villani, D., Repetto, C., Cipresso, P., Riva, G.: May I experience more presence in doing the same thing
in virtual reality than in reality? An answer from a simulated job interview. Interacting with Computers
(in press)
[6] Cipresso, P., Serino, S., Villani, D., Repetto, C., Sellitti, L., Albani, G., Mauro, A., Gaggioli, A., Riva,
G.: Is your phone so smart to affect your states?: An exploratory study based on psychophysiological
measures. Neurocomputing 84, 23-30 (2012)
[7] Gaggioli, A., Pioggia, G., Tartarisco, G., Baldus, G., Corda, D., Cipresso, P., Riva, G.: A mobile data
collection platform for mental health research. Personal and Ubiquitous Computing 1-11 (2011)
... Whilst the COVID-19 pandemic posed an immediate risk to university students' short and long-term physical health [16], there is also evidence that it aggravated students' stress levels. Negative stress can occur when environmental demands overwhelm or surpass individuals' coping capacities [17]. Poor mental health can be linked to rapid social change, stressful work requirements, social exclusion, unhealthy routines and physical illness [18]. ...
“University students’ economic situation during the COVID-19 pandemic: A cross-sectional study in Germany”
Article
Full-text available
The COVID-19 pandemic caused a major economic downturn that disproportionally affected university students. This empirical research investigated effects and risk factors of the pandemic on students’ economic situation with focus on financial distress and financial limitations. Data was collected using an online survey in May and June 2020 from students (n = 917) enrolled at universities in Germany. 80.6% were enrolled in bachelor programs (n = 738), the mean semester was 3.8 (standard deviation (SD = 2.0) and students’ mean age was 23.1 years (SD = 4.1). 51.8% (n = 472) were female and 47.4% (n = 432) male. 56.7% (n = 506) of students worked before the pandemic. More than one third reported a decrease in income (36.5%; n = 334) and an increase in financial constraints (38.7%; n = 354). A multivariate logistic regression analysis showed that students with regular income were less likely to experience financial distress compared to those without (odds ratio (OR) = 0.456; p = 0.014). Furthermore, working part-time as associated with a higher financial distress compared to those without part-time employment (OR = 1.811; p = 0.003). Students who worked part-time before the pandemic also had a higher probability of increased financial restriction (or constraint) compared to those who did not work part-time (OR = 2.094; p < 0.001). University students were disproportionally affected by the economic consequences of the COVID-19 pandemic, which increased students’ economic uncertainty. To offset such problems, financial aid schemes for students need to be made available to alleviate distress and to allow students to focus on their studies but should not compound problems by leading to financial hardship at a later point in time.
View
... In contrast to mental health, mental or psychological distress is defined as a state of emotional distress or suffering characterized by symptoms of depression [11]. Psychological stress can arise when individuals' environmental demands strain or exceed their adaptive capacity [12]. Poor mental health can be linked with fast social change, social exclusion, unhealthy lifestyle and physical illness [10]. ...
“Effects of the COVID-19 pandemic on university students’ physical health, mental health and learning, a cross-sectional study including 917 students from eight universities in Germany”
Article
Full-text available
The COVID-19 pandemic has severely affected physical and mental health. Since its commencement in 2020, social distancing has become the “new normal”. Temporary lockdowns and distance learning have disproportionately affected young adults, including university students. To identify effects of the pandemic on university students’ physical and mental health and learning, this empirical study included eight universities in Heidelberg, Mannheim and Ludwigshafen. Data was collected in May and June 2020. The self-administered survey was filled by 1,246 university students. 917 students completed the survey in full. 80.6% were bachelor students (n = 738), the mean semester was 3.8 and mean age was 23.1 years. 51.8% (n = 472) were female students and 47.4% (n = 432) male students. 38.5% (n = 352) stated a deterioration in physical health and 53.1% (n = 485) in mental health. From 0 to 10, students rated mean levels of stress highest due to social distancing (5.6), spending most time at home (5.0) and e-learning (4.5). Compared to male students, female students’ mental health worsened significantly (58.7% vs. 46.8%). A logistic regression analysis identified gender having a significant effect on university students’ stress levels: males seemed to have a lower risk of moderate to high levels of stress compared to females (odds ratio = 0.698; 95% CI = 0.515 to 0.945). Age, city of university and semester did not show a significant effect. The results are important to both regional and international audiences as university students face similar physical and mental health challenges due to the pandemic and its public health measures. Low-threshold initiatives are needed to mitigate the effects of the pandemic. These may include measures to reinforce students’ locus of control, sense of belonging, relaxation and mindfulness as well as (online) counselling services. Gender-specific differences must be taken into account.
View
... ESM has been applied to study a wide range of behaviours and experiences, including daily stress [23], [24]. However, this procedure has high costs and places a significant burden on the participant, thus limiting its practical applicability as a stress monitoring technique [10], [25]. ...
Continuous measurement of stress levels in naturalistic settings using heart rate variability: An experience-sampling study driving a machine learning approach
Article
Full-text available
  • Dec 2021
p class="Abstract"> Developing automatic methods to measure psychological stress in everyday life has become an important research challenge. Here, we describe the design and implementation of a personalized mobile system for the detection of psychological stress episodes based on Heart-Rate Variability (HRV) indices. The system’s architecture consists of three main modules: a mobile acquisition module; an analysis-decision module; and a visualization-reporting module. Once the stress level is calculated by the mobile system, the visualization-reporting module of the mobile application displays the current stress level of the user. We carried out an experience-sampling study, involving 15 participants, monitored longitudinally, for a total of 561 ECG analyzed, to select the HRV features which best correlate with self-reported stress levels. Drawing on these results, a personalized classification system is able to automatically detect stress events from those HRV features, after a training phase in which the system learns from the subjective responses given by the user. Finally, the performance of the classification task was evaluated on the empirical dataset using the leave one out cross-validation process. Preliminary findings suggest that incorporating self-reported psychological data in the system’s knowledge base allows for a more accurate and personalized definition of the stress response measured by HRV indices. </p
View
... Stress can affect individuals with long term adverse effects, and in some cases, develop in other mental disorders, such as depression or anxiety [71]. IoT related technologies, such as smartphones, wearables, or ambient sensing devices, provide with new possibilities for addressing and treating stress-related disorders [72]. Physiological characteristics such as voice features can be used to determine levels of stress in individuals. ...
Internet of Things for Mental Health: Open Issues in Data Acquisition, Self-Organization, Service Level Agreement, and Identity Management
Preprint
Full-text available
The increase of mental illness cases around the world can be described as an urgent and serious global health threat. Around 500 million people suffer from mental disorders, among which depression, schizophrenia, and dementia are the most prevalent. Revolutionary technological paradigms such as the Internet of Things (IoT) provide us with new capabilities to detect, assess, and care for patients early. This paper comprehensively survey works done at the intersection between IoT and mental health disorders. We evaluate multiple computational platforms, methods and devices, as well as study results and potential open issues for the effective use of IoT systems in mental health. We particularly elaborate on relevant open challenges in the use of existing IoT solutions for mental health care, which can be relevant given the potential impairments in some mental health patients such as data acquisition issues, lack of self-organization of devices and service level agreement, and security, privacy and consent issues, among others. We aim at opening the conversation for future research in this rather emerging area by outlining possible new paths based on the results and conclusions of this work.
View
... Furthermore, the authors of a quasi-experimental study state that their multi-biosensor platform is appropriate for decreasing sympathetic arousal, increasing parasympathetic activity and enhancing overall capability of ANS modulation, although the quantitative results of the ambulatory part of the intervention remained unclear (Wu et al., 2012). At last, two pilot-studies investigating a mobile biofeedback application were found, both part of the INTERSTRESS project (Wiederhold and Riva, 2012). In one study, 196 sessions (out of which 63 sessions with biofeedback, not separately analyzed) from 38 participants were used for analysis . ...
Biocueing and ambulatory biofeedback to enhance emotion regulation: A review of studies investigating non-psychiatric and psychiatric populations
Article
Full-text available
Over the last years, biofeedback applications are increasingly used to enhance interoceptive awareness and self-regulation, in psychiatry and beyond. These applications are used to strengthen emotion regulation skills by home training (ambulatory biofeedback) and real-time support in everyday life stressful situations (biocueing). Unfortunately, knowledge about the feasibility and effectivity of these applications is still scarce. Therefore, a systematic literature search was performed. In total, 30 studies (4 biocueing, 26 ambulatory biofeedback) were reviewed; 21 of these studies were conducted in non-psychiatric samples and 9 studies in psychiatric samples. Study characteristics, biofeedback characteristics, effectivity and feasibility outcomes were extracted. Despite the rapid advances in wearable technology, only a few biocueing studies were found. In the majority of the studies significant positive effects were found on self-reported (stress-related) psychological measures. Significant improvements on physiological measures were also reported, though these measures were used less frequently. Feasibility of the applications was often reported as sufficient, though not adequately assessed in most studies. Taken into account the small sample sizes and the limited quality of the majority of the studies in this recently emerging field, biocueing and ambulatory biofeedback interventions showed promising results. Future research is expected to be focusing on biocueing as a just-in-time adaptive intervention. To establish this research field, closer cooperation between research groups, use of more rigorous as well as individually tailored research designs and more valid feasibility and effectivity assessment are recommended.
View
... The feeling of presence and the immersive visual cue provided by virtual reality (VR) are known to facilitate relaxation, reduce stress, and improve positive emotional states Villani, Lucchetta, Preziosa, & Riva, 2006;Villani, Riva, & Riva, 2007). When aimed at relaxation, VR lends is also associated with biofeedback training (Cipresso et al., 2012;Riva, 2009). Biofeedback is a coaching and training technique that helps people learn how to change their physiological response patterns in order to improve their mental and emotional functioning (Repetto et al., 2009). ...
Positive Technology: From Communication to Positive Experience
Chapter
Full-text available
  • Aug 2018
Positive Technology is an emergent topic within human-computer interaction that seeks to understand how interactive technologies can be used in evidence-based well-being interventions. It’s focus of analysis is two-fold: at the theoretical level, Positive Technology aims to develop conceptual frameworks and models for understanding how computers can be effectively used to help individuals achieve greater well-being. At the methodological and applied level, Positive Technology is concerned with the design, development, and validation of digital experiences that promote positive change through pleasure, flow, meaning, competence, and positive relationships. The chapter will introduce the concept of Positive Technology presenting different practical examples of the concept.
View
... In the following, clinical validation phase, the effectiveness of the proposed approach was tested in a randomized controlled trial, in which the INTERSTRESS treatment (integrating cognitive-behavioral therapy, virtual reality exposure and mobile stress monitoring/support) was compared with cognitivebehavioral therapy and no treatment at all ("waiting list") (Cipresso et al., 2012). Results showed that both treatments were able to significantly reduce perceived stress better than waiting list, but only INTERSTRESS participants reported a significant reduction in chronic "trait" anxiety and a significant increase in emotional coping skills (Gaggioli et al., 2014). ...
User Engagement
Chapter
  • May 2018
As seen throughout this book, eHealth is a promising way to improve health, wellbeing and healthcare. However, for eHealth technologies to have an effect, they need to be accepted and used in the intended way to benefit most from what eHealth technologies have to offer. But this has often proven to be difficult to promote. In this chapter, we will go deeper into this issue by first elaborating on three important concepts regarding the use of technology, namely acceptance, adoption and adherence. Second, we will connect these three concepts to user engagement. User engagement is introduced as a way to increase the use of eHealth technologies. The Perfect Interaction Model will be introduced as a way to support the design eHealth technologies that fit with the intentions of users and thereby increasing user engagement. Part three of the chapter focuses on how to measure user engagement, while part four provides a case study as an example of how to design and evaluate an eHealth technology based on user engagement.
View
... Augmented virtuality was also proved to be effective in the treatment of stress disorders [11]. MR has not been a focus of exposure therapy research yet as it is a relatively new technology. ...
A Mixed Reality Based Social Interactions Testbed: A Game Theory Approach
Chapter
  • Jun 2018
This paper describes a Mixed Reality (MR) based testbed and a framework for studying social interactions using a game theory approach. MR technology enables moving and interacting naturally with the real and virtual world in three dimensions, thereby using affordances for a better sense of presence. That, in turn, provides a unique opportunity to create a realistic but controlled interaction scenario to stimulate the natural response of a subject, making it an efficient platform for studying situated interactions. The users are engaged with digital characters in repetitive social interactions where the behavior of the characters is modeled using game theory. Game theory interaction models stimulate behavioral gestures in subjects that can be studied to explore psycho-pathological traits or other behavioral aspects of subjects. A proof of concept MR application is presented that provides exposure therapy for treatment of individuals with Social Anxiety Disorder. A case study for exposure therapy treatment using the proposed testbed is also presented. The small pilot study demonstrates the feasibility of the developed approach for studying social situations as well as the influence of the facial expressions displayed by 3D avatars on the user’s perception of realism in an MR environment.
View
Positive and Transformative Technologies for Active Ageing
Article
Full-text available
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.
View
Positive Technology: The Use of Technology for Improving and Sustaining Personal Change
Chapter
Full-text available
  • Mar 2016
This chapter describes and discusses the "Positive Technology" approach: the scientific and applied approach for the use of technology in improving the quality of our personal experience through its structuring, augmentation and/or replacement - as a way for improving and sustaining personal change. On one side, we suggest that our cognitive system is naturally shaped to identify and counter the experiential conflicts that are usually the main motives for change. Optimal experiences, also defined as "flow experiences", instead allow the individual to consider long-term personal goals differently and start to experiment with changing them. In other words optimal experiences, when meaningful for the individual, widen the array of thoughts and actions, facilitating generativity and behavioral flexibility. On the other side we claim 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.
View
A Mobile Data Collection Platform for Mental Health Research
Article
Full-text available
Ubiquitous computing technologies offer exciting new possibilities for monitoring and analyzing user’s experience in real time. In this paper, we describe the design and development of Psychlog, a mobile phone platform designed to collect users’ psychological, physiological, and activity information for mental health research. The tool allows administering self-report questionnaires at specific times or randomly within a day. The system also permits to collect heart rate and activity information from a wireless electrocardiogram equipped with a three-axial accelerometer. By combining self-reports with heart rate and activity data, the application makes it possible to investigate the relationship between psychological, physiological, and behavioral variables, as well as to monitor their fluctuations over time. The software runs on Windows mobile operative system and is available as open source (http://sourceforge.net/projects/psychlog/).
View
May I experience more presence in doing the same thing in virtual reality than in reality? An answer from a simulated job interview
Article
Full-text available
  • Jul 2012
Is it possible to experience more presence in doing the same thing in virtual reality than in reality? According to the well known definition of presence as “disappearance of mediation”, the answer is no: technology is a barrier, a mediating tool that can only reduce the level of presence experienced in an interaction. However, the increasing diffusion of a technology like augmented reality that adds a technological layer of information to the real world suggests the opposite: the experience of “being there” may be influenced by the ability of “making sense there”. To explore this issue we used a sample of 20 university students to evaluate the level of presence experienced in two different settings: an immersive virtual reality job simulation and a real world simulation that was identical to its VR counterpart (same interviewer, same questions) but without technological mediation and without any social and cultural cues in the environment that may give a better meaning to both the task and its social context. Self-report data, and in particular the scores in the Spatial Presence and the Ecological Validity ITC-SOPI scales, suggest that experienced presence was higher during the virtual interview than in the real world simulation. This interpretation was confirmed by subjective (higher in VR) but not by objective (Skin Conductance) anxiety scores. These data suggest a vision of presence as a social construction, in which reality is co-constructed in the relationship between actors and their environments through the mediation of physical and cultural artifacts.
View
Is your phone so smart to affect your state? An exploratory study based on psychophysiological measures
Article
Full-text available
a b s t r a c t 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. & 2012 Elsevier B.V. All rights reserved.
View
Interreality in the management of psychological stress: A clinical scenario
Article
Full-text available
The term "psychological stress" describes a situation in which a subject perceives that environmental demands tax or exceed his or her adaptive capacity. According to the Cochrane Database of Systematic Reviews, the best validated approach covering both stress management and stress treatment is the Cognitive Behavioral (CBT) approach. We aim to design, develop and test an advanced ICT based solution for the assessment and treatment of psychological stress that is able to improve the actual CBT approach. To reach this goal we will use the "interreality" paradigm integrating assessment and treatment within a hybrid environment, that creates a bridge between the physical and virtual worlds. Our claim is that bridging virtual experiences (fully controlled by the therapist, used to learn coping skills and emotional regulation) with real experiences (allowing both the identification of any critical stressors and the assessment of what has been learned) using advanced technologies (virtual worlds, advanced sensors and PDA/mobile phones) is the best way to address the above limitations. To illustrate the proposed concept, a clinical scenario is also presented and discussed: Paola, a 45 years old nurse, with a mother affected by progressive senile dementia.
View
Psychological stress and disease. JAMA, 298, 1685-1687
Article
Full-text available
Despite widespread public belief that psychological stress leads to disease, the biomedical community remains skeptical of this conclusion. In this Commentary, we discuss the plausibility of the belief that stress contributes to a variety of disease processes and summarize the role of stress in 4 major diseases: clinical depression, cardiovascular disease (CVD), human immunodeficiency virus (HIV)/AIDS, and cancer.Corresponding Author: Sheldon Cohen, PhD, Department of Psychology, Carnegie Mellon University, 5000 Forbes Ave, Pittsburgh, PA 15213 (scohen@cmu.edu).Financial Disclosures: Dr Cohen reported consulting for Johnson & Johnson Consumer Companies Inc on issues of stress measurement. None of the other authors reported any financial disclosures.Role of the Sponsor: This article is based on a paper commissioned by the Institute of Medicine Committee on Psychosocial Services to Cancer Patients and Families in Community Settings. The Institute of Medicine suggested the topic but played no role in structuring the paper; in the collection, management, and interpretation of the data; or the preparation, review, or approval of the manuscript.Additional Contributions: We thank David Krantz, PhD (Uniformed Services University of the Health Sciences), Margaret Kemeny, PhD (School of Medicine, University of California at San Francisco), Stephen Manuck, PhD, and Karen Matthews, PhD (University of Pittsburgh), and Scott Monroe, PhD (Notre Dame University), for their comments on an earlier draft; the John D. and Catherine T. MacArthur Foundation Network on Socioeconomic Status and Health and members of the Pittsburgh Mind-Body Center (HL65111, HL65112) for their intellectual support; and Ellen Conser, MA, Ashleigh Molz, and Wesley Barnhart, BS (Carnegie Mellon University), for assistance in preparing the manuscript. None of these individuals received any extra compensation for their contributions.
View
Psychological treatment of post-traumatic stress disorder (PTSD) - art. no. CD003388.pub2
Article
  • Feb 2007
Psychological treatments can reduce symptoms of post traumatic stress disorder (PTSD). Trauma focused treatments are more effective than non-trauma focused treatments. This review concerns the efficacy of psychological treatment (excluding eye movement desensitisation and reprocessing) in the treatment of PTSD. There is evidence that individual trauma focused cognitive-behavioural therapy (TFCBT), stress management and group TFCBT are effective in the treatment of PTSD. Other non-trauma focused psychological treatments did not reduce PTSD symptoms as significantly. There is some evidence that individual TFCBT is superior to stress management in the treatment of PTSD at between 2 and 5 months following treatment, and also that TFCBT was also more effective than other therapies. There is insufficient evidence to show whether or not psychological treatment is harmful. Trauma focused cognitive behavioural therapy should be considered in individuals with PTSD.
View
Psychotherapies for hypochondriasis
Article
  • Feb 2007
Background: Hypochondriasis is associated with significant medical morbidity and high health resource use. Recent studies have examined the treatment of hypochondriasis using various forms of psychotherapy. Objectives: To examine the effectiveness and comparative effectiveness of any form of psychotherapy for the treatment of hypochondriasis. Search strategy: 1. CCDANCTR-Studies and CCDANCTR-References were searched on 7/8/2007, CENTRAL, Medline, PsycINFO, EMBASE, Cinahl, ISI Web of Knowledge, AMED and WorldCat Dissertations; Current Controlled Trials meta-register (mRCT), CenterWatch, NHS National Research Register and clinicaltrials.gov; 2. Communication with authors of relevant studies and other clinicians in the field; 3. Handsearching reference lists of included studies and relevant review articles, and electronic citation search in ISI Web of Knowledge for all included studies. Selection criteria: All randomised controlled studies, both published and unpublished, in any language, in which adults with hypochondriasis were treated with a psychological intervention. Data collection and analysis: Data were extracted independently by two authors using a standardised extraction sheet. Study quality was assessed independently by the two authors qualitatively and using a standardised scale. Meta-analyses were performed using RevMan software. Standardised or weighted mean differences were used to pool data for continuous outcomes and odds ratios were used to pool data for dichotomous outcomes, together with 95% confidence intervals. Main results: Six studies were included, with a total of 440 participants. The interventions examined were cognitive therapy (CT), behavioural therapy (BT), cognitive behavioural therapy (CBT), behavioural stress management (BSM) and psychoeducation. All forms of psychotherapy except psychoeducation showed a significant improvement in hypochondriacal symptoms compared to waiting list control (SMD (random) [95% CI] = -0.86 [-1.25 to -0.46]). For some therapies, significant improvements were found in the secondary outcomes of general functioning (CBT), resource use (psychoeducation), anxiety (CT, BSM), depression (CT, BSM) and physical symptoms (CBT). These secondary outcome findings were based on smaller numbers of participants and there was significant heterogeneity between studies. Authors' conclusions: Cognitive therapy, behavioural therapy, cognitive behavioural therapy and behavioural stress management are effective in reducing symptoms of hypochondriasis. However, studies included in the review used small numbers of participants and do not allow estimation of effect size, comparison between different types of psychotherapy or whether people are "cured". Most long-term outcome data were uncontrolled. Further studies should make use of validated rating scales, assess treatment acceptability and effect on resource use, and determine the active ingredients and nonspecific factors that are important in psychotherapy for hypochondriasis.
View