Giuseppe Riva

Virtual Reality in Psychotherapy: Review

Virtual reality (VR) has recently emerged as a potentially effective way to provide general and specialty health care services, and appears poised to enter mainstream psychotherapy delivery. Because VR could be part of the future of clinical psychology, it is critical to all psychotherapists that it be defined broadly. To ensure appropriate development of VR applications, clinicians must have a clear understanding of the opportunities and challenges it will provide in professional practice. This review outlines the current state of clinical research relevant to the development of virtual environments for use in psychotherapy. In particular, the paper focuses its analysis on both actual applications of VR in clinical psychology and how different clinical perspectives can use this approach to improve the process of therapeutic change.

The use of the internet in psychological research: comparison of online and offline questionnaires.

The Internet can be an effective medium for the posting, exchange, and collection of information in psychology-related research and data. The relative ease and inexpensiveness of creating and maintaining Web-based applications, associated with the simplicity of use via the graphic-user interface format of form-based surveys, can establish a new research frontier for the social and behavioral sciences. To explore the possible use of Internet tools in psychological research, this study compared Web-based assessment techniques with traditional paper-based methods of different measures of Internet attitudes and behaviors in an Italian sample. The collected data were analyzed to identify both differences between the two samples and in the psychometric characteristics of the questionnaires. Even if we found significant differences between the two samples in the Internet attitudes and behaviors, no relevant differences were found in the psychometric properties of the different questionnaires. This result, similar to the ones previously obtained in Web-based assessments of personality constructs, is even more interesting given the lack of control on the characteristics of the online sample. These finding suggests that, if sampling control and validity assessment is provided, Internet-based questionnaires can be a suitable alternative to more traditional paper-based measures.

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.

“Real” Presence: How Different Ontologies Generate Different Criteria for Presence, Telepresence, and Virtual Presence

This article claims that the meaning of presence is closely linked to the concept we have of reality, i.e., to the ontology that we more or less explicitly adopt. Different ontological stances support different criteria for presence, telepresence, and virtual presence. We propose a cultural conception of presence that challenges the current idea that experiencing a real or simulated environment deals essentially with perceiving its objective physical features. We reject commonsense ingenuous realism and its dualism opposing external reality and internal ideas. In our perspective, presence in an environment, real or simulated, means that individuals can perceive themselves, objects, and other people not only as situated in an external space but also as immersed in a sociocultural web connecting objects, people, and their interactions. This cultural webstructured by artifacts both physical (e.g., the physical components of the computer networks) and ideal (e.g., the social norms that shape the organizational use of the computer networks)makes possible communication and cooperation among different social actors by granting them a common reference grid. Environments, real and virtual, are not private recesses but public places for meaningful social interaction mediated by artifacts. Experiencing presence in a social environment such as a shared virtual office requires more than the reproduction of the physical features of external reality; it requires awareness of the cultural web that makes meaningfuland therefore visibleboth people and objects populating the environment.

The Layers of Presence: A Bio-cultural Approach to Understanding Presence in Natural and Mediated Environments

This paper proposes a bio-cultural theory of presence based on four different positions related to the role and structure of presence, as follows. First, presence is a defining feature of self and it is related to the evolution of a key feature of any central nervous system: the embedding of sensory-referred properties into an internal functional space. Without the emergence of the sense of presence it is impossible for the nervous system to experience distal attribution: the referencing of our perception to an external space beyond the limits of the sensory organs themselves. Second, even if the experience of the sense of presence is a unitary feeling, conceptually it can be divided in three different layers, phylogenetically different and strictly related to the three levels of self identified by Damasio. In particular we can make conceptual distinctions between proto presence (self vs. non self), core presence (self vs. present external world), and extended presence (self relative to present external world). Third, given that each layer of presence solves a particular facet of the internal/external world separation, it is characterized by specific properties. Finally, in humans the sense of presence is a direct function of these three layers: the more they are integrated, the more we are present. In the experience of optimal presence, biologically and culturally determined cognitive processes are working in harmony--to focus all levels of the self on a significant situation in the external world, whether this is real or virtual.

Why Is Facebook So Successful? Psychophysiological Measures Describe a Core Flow State While Using Facebook

People are more and more using social networking sites (SNSs) like Facebook and MySpace to engage with others. The use of SNSs can have both positive and negative effect on the individual; however, the increasing use of SNSs might reveal that people look for SNSs because they have a positive experience when they use them. Few studies have tried to identify which particular aspects of the social networking experience make SNSs so successful. In this study we focus on the affective experience evoked by SNSs. In particular, we explore whether the use of SNSs elicits a specific psychophysiological pattern. Specifically, we recorded skin conductance, blood volume pulse, electroencephalogram, electromyography, respiratory activity, and pupil dilation in 30 healthy subjects during a 3-minute exposure to (a) a slide show of natural panoramas (relaxation condition), (b) the subjects personal Facebook account, and (c) a Stroop and mathematical task (stress condition). Statistical analysis of the psychophysiological data and pupil dilation indicates that the Facebook experience was significantly different from stress and relaxation on many linear and spectral indices of somatic activity. Moreover, the biological signals revealed that Facebook use can evoke a psychophysiological state characterized by high positive valence and high arousal (Core Flow State). These findings support the hypothesis that the successful spread of SNSs might be associated with a specific positive affective state experienced by users when they use their SNSs account.

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/).

Virtual reality based experiential cognitive treatment of anorexia nervosa

The treatment of a 22-year old female university student diagnosed with Anorexia Nervosa is described. In the study the Experiential Cognitive Therapy (ECT) was used: a relatively short-term, integrated, patient oriented approach that focuses on individual discovery. Main characteristic of this approach is the use of Virtual Reality, a new technology that allows the user to be immersed in a computer-generated virtual world. At the end of the in-patient treatment, the subject increased her bodily awareness joined to a reduction in her level of body dissatisfaction. Moreover, the patient presented a high degree of motivation to change. The results are discussed with regard to Vitousek, Watson and Wilson (1998, Clinical Psychology Review, 18(4), 391-420) proposal of using the Socratic Method to face denial and resistance of anorectic patients.

Virtual reality and psychotherapy.

Virtual Reality (VR) is a new technology consisting on a graphic environment in which the user, not only has the feeling of being physically present in a virtual world, but he/she can interact with it. The first VR workstations were designed for big companies in order to create environments that simulate certain situations to train professionals. However, at this moment a great expansion of this technology is taking place in several fields, including the area of health. Especially interesting for us is the use of VR as a therapeutic tool in the treatment of psychological disorders. Compared to the traditional treatments, VR has many advantages (e.g., it is a protected environment for the patient, he/she can re-experience many times the feared situation, etc.). There are already data on the effectiveness of this technology in the treatment of different psychological disorders; here anxiety disorders, eating disorders and sexual disorders are reviewed. Finally, this chapter ends with some words about the limitations of VR and future perspectives.

The Key to Unlocking the Virtual Body: Virtual Reality in the Treatment of Obesity and Eating Disorders

Obesity and eating disorders are usually considered unrelated problems with different causes. However, various studies identify unhealthful weight-control behaviors (fasting, vomiting, or laxative abuse), induced by a negative experience of the body, as the common antecedents of both obesity and eating disorders. But how might negative body image—common to most adolescents, not only to medical patients—be behind the development of obesity and eating disorders? In this paper, I review the “allocentric lock theory” of negative body image as the possible antecedent of both obesity and eating disorders. Evidence from psychology and neuroscience indicates that our bodily experience involves the integration of different sensory inputs within two different reference frames: egocentric (first-person experience) and allocentric (third-person experience). Even though functional relations between these two frames are usually limited, they influence each other during the interaction between long- and short-term memory processes in spatial cognition. If this process is impaired either through exogenous (e.g., stress) or endogenous causes, the egocentric sensory inputs are unable to update the contents of the stored allocentric representation of the body. In other words, these patients are locked in an allocentric (observer view) negative image of their body, which their sensory inputs are no longer able to update even after a demanding diet and a significant weight loss. This article discusses the possible role of virtual reality in addressing this problem within an integrated treatment approach based on the allocentric lock theory.