Stefano Triberti

eHealth for patient engagement: A Systematic Review

eHealth interventions are recognized to have a tremendous potential to promote patient engagement. To date, the majority of studies examine the efficacy of eHealth in enhancing clinical outcomes without focusing on patient engagement in its specificity. This paper aimed at reviewing findings from the literature about the use of eHealth in engaging patients in their own care process. We undertook a comprehensive literature search within the peer-reviewed international literature. Eleven studies met the inclusion criteria. eHealth interventions reviewed were mainly devoted to foster only partial dimensions of patient engagement (i.e., alternatively cognitive, emotional or behavioral domains related to healthcare management), thus failing to consider the complexity of such an experience. This also led to a great heterogeneity of technologies, assessed variables and achieved outcomes. This systematic review underlines the need for a more holistic view of patient needs to actually engage them in eHealth interventions and obtaining positive outcomes. In this sense, patient engagement constitute a new frontiers for healthcare models where eHealth could maximize its potentialities.

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.

Is virtual reality always an effective stressors for exposure treatments? some insights from a controlled trial

BackgroundSeveral research studies investigating the effectiveness of the different treatments have demonstrated that exposure-based therapies are more suitable and effective than others for the treatment of anxiety disorders. Traditionally, exposure may be achieved in two manners: in vivo, with direct contact to the stimulus, or by imagery, in the person’s imagination. However, despite its effectiveness, both types of exposure present some limitations that supported the use of Virtual Reality (VR). But is VR always an effective stressor? Are the technological breakdowns that may appear during such an experience a possible risk for its effectiveness?MethodsTo answer these questions we compared changes following the exposure to an academic examination, one of the most universal examples of real-life stressors, in a sample of 39 undergraduate students. The same experience was offered using text (TX), audio (AU), video (VD), and VR. However, in the virtual environment we manipulated the experience introducing technological breakdowns. The Post Media Questionnaire (PMQ) and the Slater-Usoh-Steed Presence Questionnaire (SUS) were administered to each participant in order to evaluated self-report measures of anxiety and relaxation and the level of presence experience during media exposure. Electrocardiogram (ECG), Thoracic Respiration Signal (RSP) and Facial corrugator supercilii muscle Electromyography (EMG) were recorded in order to obtain objective measures of subjects’ emotional state.ResultsAnalyses conducted on PMQ showed a significant increase in anxiety scores and a mirror decrease in relax scores after all our emotional procedures, showing that all the condition were effective in inducing a negative emotional response. Psychometric scores and psychophysiological indexes showed that VR was less effective than other procedures in eliciting stress responses. Moreover, we did not observe significative difference in SUS scores: VR induced a sense of presence similar to that experienced during the exposition to other media.ConclusionsTechnological breakdowns significantly reduce the possibility of VR eliciting emotions related to complex real-life stressors. Without a high sense of presence, the significant advantages offered by VR disappear and its emotional induction abilities are even lower than the ones provided by much cheaper media.Trial registrationTrial registration number: NCT01683617

Serious Games as Positive Technologies for Individual and Group Flourishing

By fostering continuous learning experiences blended with entertaining affordances, serious games have been able to shape new virtual contexts for human psychological growth and well-being. Thus, they can be considered as Positive Technologies. Positive Technology is an emergent field based on both theoretical and applied research, whose goal is to investigate how Information and Communication Technologies (ICTs) can be used to empower the quality of personal experience. In particular, serious games can influence both individual and interpersonal experiences by nurturing positive emotions, and promoting engagement, as well as enhancing social integration and connectedness. An in-depth analysis of each of these aspects will be presented in the chapter, with the support of concrete examples. Networked flow, a specific state where social well-being is associated with group flourishing and peak creative states, will eventually be considered along with game design practices that can support its emergence.

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.

Being present in action: A theoretical model about the "interlocking" between intentions and environmental affordances

Recent neuropsychological evidence suggest that a key role in linking perceptions and intentions is played by sense of presence. Despite this phenomenon having been studied primarily in the field of virtual reality (conceived as the illusion of being in the virtual space), recent research highlighted that it is a fundamental feature of everyday experience. Specifically, the function of presence as a cognitive process is to locate the Self in a physical space or situation, based on the perceived possibility to act in it; so, the variations in sense of presence allow one to continuously adapt his own action to the external environment. Indeed intentions, as the cognitive antecedents of action, are not static representations of the desired outcomes, but dynamic processes able to adjust their own representational content according to the opportunities/restrictions emerging in the environment. Focusing on the peculiar context of action mediated by interactive technologies, we here propose a theoretical model showing how each level of an intentional hierarchy (future-directed; present directed; and motor intentions) can “interlock” with environmental affordances in order to promote a continuous stream of action and activity.

Towards Adaptive Ambient In-Vehicle Displays and Interactions: Insights and Design Guidelines from the 2015 AutomotiveUI Dedicated Workshop

Informing a driver of a vehicle’s changing state and environment is a major challenge that grows with the introduction of in-vehicle assistant and infotainment systems. Even in the age of automation, the human will need to be in the loop for monitoring, taking over control, or making decisions. In these cases, poorly designed systems could lead to needless attentional demands imparted on the driver, taking it away from the primary driving task. Existing systems are offering simple and often unspecific alerts, leaving the human with the demanding task of identifying, localizing, and understanding the problem. Ideally, such systems should communicate information in a way that conveys its relevance and urgency. Specifically, information useful to promote driver safety should be conveyed as effective calls for action, while information not pertaining to safety (therefore less important) should be conveyed in ways that do not jeopardize driver attention. Adaptive ambient displays and peripheral interactions have the potential to provide superior solutions and could serve to unobtrusively present information, to shift the driver’s attention according to changing task demands, or enable a driver to react without losing the focus on the primary task. In order to build a common understanding across researchers and practitioners from different fields, we held a “Workshop on Adaptive Ambient In-Vehicle Displays and Interactions” at the AutomotiveUI‘15 conference. In this chapter, we discuss the outcomes of this workshop, provide examples of possible applications now or in the future and conclude with challenges in developing or using adaptive ambient interactions.

Exploration of virtual body-representation in adolescence: the role of age and sex in avatar customization

The malleable nature of the self led researchers to investigate the meaning of virtual identity by exploring virtual self-representation through avatars and its association with users’ identity. The present study aims to investigate the changes in virtual body-representation in adolescence related to age levels and sex and the association with adolescents’ self-esteem and body esteem. Anthropometric features, body esteem and self-esteem were used to assess adolescents’ body image and identity. The scoring code of the “Drawing Me” graphical test was used to evaluate the avatars. The sample is composed of 63 adolescents of different ages—early, middle and late adolescence—balanced by sex. Results show that the creation of a digital avatar changes with age and is partially associated with adolescents’ perceptions in terms of body esteem and self-esteem. Moreover, the creation of avatars occurs differently for boys, who enrich their avatars with many sexual features, than for girls, who prefer to detail their avatars’ clothing to enrich them. Critical reflections and implications for psychological interventions that may use avatars to investigate adolescents’ identity in integration with other tools will be discussed.

Assessing the Emotional State of Job Applicants Through a Virtual Reality Simulation: A Psycho-Physiological Study

Job interview is one of the most frequently used methods to assess candidates for employment and it often evokes feelings of anxiety and distress. The principal aim of this study is to use a VR simulation experience to assess the emotional state, and specifically anxiety, of job applicants. Two VR job simulations are proposed to twenty-five participants, before and after a five weeks training aimed to enhance their emotional skills. Results show differences in anxiety experienced by participants exposed to VR-simulated job interviews before and after the trainings and suggest adequacy of VR as an assessment tool sensitive to the changes in internal states of candidates.

New Technologies as Opportunities for Flow Experience: A Framework for the Analysis

New technologies present remarkable opportunities for flow experience. We provide an integrated theoretical framework for the study of flow in Human-Technologies Interaction referring to two specific cognitive processes – presence and social presence – whose goals are the control of the activity of the Self (presence) and the understanding of the activity of the Other (social presence). On the individual level, the chance for a technology user to enter a state of flow depends on how much the technology addresses the user’s hierarchy of intentions (presence): I am present in a real or virtual space if I manage to put my intentions into action (enacting them). On this basis, we elaborate on a new model aimed to describe how a “Perfect Interaction” (P.I.M.) takes place. On the collective level, research shows that a peculiar type of flow state could be reached by creative groups. Central to the presented model is the definition of a shared intersubjective space, which we identify with (highest level of) social presence. When this is achieved, participants can experience networked flow, an optimal state that maximizes the creative potential of the group.