Daniela Villani

Predictors of Health-related Quality of Life and Adjustment to Prostate Cancer During Active Surveillance

BACKGROUND Active surveillance (AS) is emerging as an alternative approach to limit the risk of overtreatment and impairment of quality of life (QoL) in patients with low-risk localised prostate cancer. Although most patients report high levels of QoL, some men may be distressed by the idea of living with untreated cancer. OBJECTIVE To identify factors associated with poor QoL during AS. DESIGN, SETTING, AND PARTICIPANTS Between September 2007 and March 2012, 103 patients participated in the Prostate Cancer Research International Active Surveillance (PRIAS) QoL study. Mental health (Symptom Checklist-90), demographic, clinical, and decisional data were assessed at entrance in AS. Health-related QoL (HRQoL) Functional Assessment of Cancer Therapy-Prostate version and Mini-Mental Adjustment to Cancer outcomes were assessed after 10 mo of AS. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Multivariate logistic regression models were used to identify predictors of low (<25th percentile) HRQoL, adjustment to cancer, and a global QoL index at 10 mo after enrollment. RESULTS AND LIMITATIONS The mean age of the study patients was 67 yr (standard deviation: ±7 yr). Lack of partner (odds ratio [OR]: 0.08; p=0.009) and impaired mental health (OR: 1.2, p=0.1) were associated with low HRQoL (p=0.006; area under the curve [AUC]: 0.72). The maladaptive adjustment to cancer (p=0.047; AUC: 0.60) could be predicted by recent diagnosis (OR: 3.3; p=0.072). Poor global QoL (overall p=0.02; AUC: 0.85) was predicted by impaired mental health (OR: 1.16; p=0.070) and time from diagnosis to enrollment in AS <5 mo (OR: 5.52; p=0.009). Influence of different physicians on the choice of AS (OR: 0.17; p=0.044), presence of a partner (OR: 0.22; p=0.065), and diagnostic biopsy with >18 core specimens (OR: 0.89; p=0.029) were predictors of better QoL. Limitations of this study were the small sample size and the lack of a control group. CONCLUSIONS Factors predicting poor QoL were lack of a partner, impaired mental health, recent diagnosis, influence of clinicians and lower number of core samples taken at diagnostic biopsy. Educational support from physicians and emotional/social support should be promoted in some cases to prevent poor QoL.

New Technologies for Relaxation: The Role of Presence

Daniela VillaniCatholic University of Milan and Istituto Auxologico ItalianoFrancesco RivaCatholic University of MilanGiuseppe RivaCatholic University of Milan and Istituto Auxologico ItalianoIn recent years, several publications have appeared on virtual reality (VR)therapyinthetreatmentofanxietydisorders.However,alimitednumberofthesestudies targeted stress management and relaxation. To evaluate the efÞcacy ofVR as a support tool in the relaxation process, this study compared its efÞcacywith two other media (DVD and audiotape). The goals of the experiment were totest the efÞcacy of each condition in increasing relaxation and reducing anxiety,and whether the sense of presenceNthe feeling of being inside the mediacontentNcorrelated with the efÞcacy of the treatment. Results suggested theimportance of the sense of presence as a mediating variable between the mediaexperience and the efÞcacy of the protocol.

Personality of people using chat: An on-line research

Conflicting claims have been presented in the literature about on-line management of personal relationships. The current research, carried out in a substantially descriptive design, aimed to consider psychological and social features of a particular electronic environment, the Chat room. One hundred fifty-eight participants filled out an on-line questionnaire set, designed to investigate the personality traits and the prevailing interpersonal values of those participants who set up interpersonal relationships on-line. The Web research showed that, if sampling control and validity assessment were provided, it could be a valid alternative to a more traditional paper-based procedure. The results highlighted that Chat users were not an homogenous group, but were composed of different personality types. Basically, however, this specific virtual environment proved to be crowded with rather close individuals, who were looking for independence but who needed also to be supported and encouraged. They created deep on-line relationships, but these remained limited to the virtual world.

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.

Self-Help Stress Management Training Through Mobile Phones: An Experience With Oncology Nurses

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

Toward a validation of cyber-interventions for stress disorders based on stress inoculation training: a systematic review

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.

Does a meditation protocol supported by a mobile application help people reduce stress? Suggestions from a controlled pragmatic trial.

The aim of this study was to examine the efficacy of a 3 week mindfulness inspired protocol, delivered by an Android application for smartphones, in reducing stress in the adult population. By using a controlled pragmatic trial, a self-help intervention group of meditators was compared with a typical control group listening to relaxing music and a waiting list group. The final sample included 56 Italian workers as participants, block randomized to the three conditions. The self-reported level of perceived stress was assessed at the beginning and at the end of the protocol. Participants were also instructed to track their heart rate before and after each session. The results did not show any significant differences between groups, but both self-help intervention groups demonstrated an improvement in coping with stress. Nevertheless, meditators and music listeners reported a significant decrease in average heartbeats per minute after each session. Furthermore, both groups perceived a moderate but significant change in stress reduction perceptions, even if with some peculiarities. Limitations and opportunities related to the meditation protocol supported by the mobile application to reduce stress are discussed.

Does Interactive Media Enhance the Management of Stress? Suggestions from a Controlled Study

The relationship between interactive media and stress has gained wide interest in the mental health area. In our research, we found that interactive experiences helped people manage their stress. By combining different techniques, which may produce more significant outcomes than single-strategy programs, we developed a stress management protocol to increase self-awareness, to control and relax oneself, induce positive emotions, and substitute negative emotions. Our stress management protocol was tested in a controlled study comparing three interactive experiences (virtual reality [VR], video, and audio). Results showed the efficacy of all three interactive experiences in inducing positive emotions and integrating different approaches to manage stress. In particular, VR showed better improvements related to the psycho-physiological changes. Implications of the results for worldwide healthcare services will be discussed.

The effects of a mobile stress management protocol on nurses working with cancer patients: a preliminary controlled study

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

Presence-Inducing Media for Mental Health Applications

Presence inducing media have recently emerged as a potentially effective way to provide general and specialty mental health services, and they appear poised to enter mainstream clinical delivery. However, to ensure appropriate development and use of these technologies, clinicians must have a clear understanding of the opportunities and challenges they will provide to professional practice.