Fabrizia Mantovani

Virtual reality training for health-care professionals

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.

Is severe obesity a form of addiction?: Rationale, clinical approach, and controlled clinical trial

For many, obesity is just a problem of energy input and expenditure: more energy input than expenditure. However, the clinical practice and epidemiological data clearly show that weight control is more complex than expected by this simple equation. This is particularly true in morbid obesity, a form of severe obesity in which a persons Body Mass Index (BMI, kg/m(2)) is over 40. If we compare the definitions and diagnostic criteria for dependence and addiction with the situation of many severe obese subjects, it is apparent that they match very well. Further, different neurological studies confirm this similarity: both addiction and obesity patients have a deficiency of dopamine receptors. Nevertheless, when we compare many of the actual obesity treatments with the ones used in the area of addictions it is possible to find relevant differences: obesity treatments neither consider different levels of type and intensity of care, nor a multidimensional approach. To overcome these limitations, in this paper we propose a bio-psychosocial approach in which the genetic influence (lack of dopamine receptors) is matched by psychosocial issues (pressure for thinness and diet as main body image dissatisfaction treatment). Further, the paper outlines how this approach may influence the treatment options, by focusing both on the lessons coming from actual addiction treatment and the opportunities offered by virtual reality. Finally, the paper presents and discusses the outcome of a controlled trial, based on the proposed approach, including a 6-month follow-up (211 morbid obese females with a BMI of >40 and a documented history of failures.

The VEPSY UPDATED Project: Clinical Rationale and Technical Approach

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.

Being There: Understanding the Feeling of Presence in a Synthetic Environment and its Potential for Clinical Change

© 2012 Riva and Mantovani, licensee InTech. This is an open access chapter distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Being There: Understanding the Feeling of Presence in a Synthetic Environment and Its Potential for Clinical Change

New tools in cybertherapy: the VEPSY Web Site

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 therapists 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.

New Technologies for Improving the Psychological Treatment of Obesity

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