Andrea Gaggioli

A Second Life for eHealth: Prospects for the Use of 3-D Virtual Worlds in Clinical Psychology

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.

A mobile data collection platform for mental health research

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/).

Therapeutic applications of the mobile phone

ABSTRACT As the availability of new communication technologies increases, mental health professionals have incorporated these innovations into their practice and research. Up to now several studies have presented promising results in using the power and convenience of the Internet for clinical care. While multiple contributions focus on the potential and the advantages of therapies delivered through the Internet, mental health practitioners may take into account new technological opportunities to improve their practice. Mobile phone diffusion is expanding worldwide at breath-taking speed. In fewer than 20 years, mobile phones have gone from being rare and expensive pieces of equipment used primarily by the business elite, to a pervasive low-cost personal item. In many countries, mobile phones now outnumber land-line telephones, with most adults and many children now owning mobile phones. With high levels of mobile telephone penetration, a mobile culture has evolved, where the phone becomes a key social and cultural tool. The purpose of this paper is to explore the potentialities that mobile phones may offer in clinical care. The paper will investigate in which areas of clinical interventions mobile phones have already been successfully applied. Moreover, the paper will discuss these opportunities by presenting the results of two different studies based on the use of the mobile phone for anxiety management.

The Present and Future of Positive Technologies

The goal of this work is to delimit the field of Positive Technology--the scientific and applied approach to the use of technology for improving the quality of our personal experience. This new field combines the objectives of Positive Psychology with enhancements of Information and Communication Technologies (ICTs) by focusing on three key variables--emotional quality, engagement/actualization, and connectedness--that are able to transform our personal experience in a tool for building new and enduring personal resources. In fact, Positive Technologies include those designed to manipulate the quality of experience through its structuring, augmentation and/or replacement, with the goal of increasing wellness, and generating strengths and resilience in individuals, organizations, and society. This work describes existing Positive Technologies, classified according to their objectives: hedonic (mood-altering devices, which use ICTs to induce positive and pleasant experiences); eudaimonic (systems designed to support individuals in reaching engaging and self-actualizing experiences); and social/interpersonal (technologies that seek to improve the connectedness between individuals, groups, and organizations). Finally, possible directions of future developments are suggested.

A Strategy for Computer-Assisted Mental Practice in Stroke Rehabilitation

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.

From Psychotherapy to e-Therapy: The Integration of Traditional Techniques and New Communication Tools in Clinical Settings

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.

Training with Computer-Supported Motor Imagery in Post-Stroke Rehabilitation

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 patients need for skilled support, therefore improving the cost-effectiveness of training.

New and old tools in psychotherapy: the use of technology for the integration of the traditional clinical treatments

The proliferation of computer-mediatedcommunication has led to theexperimentation with these tools inpsychotherapy. This article examinesthe possible integration betweentraditional and new tools inpsychotherapy, showing pros and consof the use of technology. In particular,the article focuses on the concept ofe-therapy and the technology itrequires. An analysis of the mostfunctional tools and software nowavailable is also presented, with aparticular focus on shared hypermedia,new Internet tools in which differentusers who are simultaneously browsingthe Web can communicate and surftogether.

Is your phone so smart to affect your state? An exploratory study based on psychophysiological measures

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.

NeuroVR 2--a free virtual reality platform for the assessment and treatment in behavioral health care.

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