Experiential virtual scenarios with real-time monitoring (interreality) for the management of psychological stress: a block randomized controlled trial.

BACKGROUND: The recent convergence between technology and medicine is offering innovative methods and tools for behavioral health care. Among these, an emerging approach is the use of virtual reality (VR) within exposure-based protocols for anxiety disorders, and in particular posttraumatic stress disorder. However, no systematically tested VR protocols are available for the management of psychological stress. OBJECTIVE: Our goal was to evaluate the efficacy of a new technological paradigm, Interreality, for the management and prevention of psychological stress. The main feature of Interreality is a twofold link between the virtual and the real world achieved through experiential virtual scenarios (fully controlled by the therapist, used to learn coping skills and improve self-efficacy) with real-time monitoring and support (identifying critical situations and assessing clinical change) using advanced technologies (virtual worlds, wearable biosensors, and smartphones). METHODS: The study was designed as a block randomized controlled trial involving 121 participants recruited from two different worker populations-teachers and nurses-that are highly exposed to psychological stress. Participants were a sample of teachers recruited in Milan (Block 1: n=61) and a sample of nurses recruited in Messina, Italy (Block 2: n=60). Participants within each block were randomly assigned to the (1) Experimental Group (EG): n=40; B1=20, B2=20, which received a 5-week treatment based on the Interreality paradigm; (2) Control Group (CG): n=42; B1=22, B2=20, which received a 5-week traditional stress management training based on cognitive behavioral therapy (CBT); and (3) the Wait-List group (WL): n=39, B1=19, B2=20, which was reassessed and compared with the two other groups 5 weeks after the initial evaluation. RESULTS: Although both treatments were able to significantly reduce perceived stress better than WL, only EG participants reported a significant reduction (EG=12% vs. CG=0.5%) in chronic "trait" anxiety. A similar pattern was found for coping skills: both treatments were able to significantly increase most coping skills, but only EG participants reported a significant increase (EG=14% vs CG=0.3%) in the Emotional Support skill. CONCLUSIONS: Our findings provide initial evidence that the Interreality protocol yields better outcomes than the traditionally accepted gold standard for psychological stress treatment: CBT. Consequently, these findings constitute a sound foundation and rationale for the importance of continuing future research in technology-enhanced protocols for psychological stress management. TRIAL REGISTRATION: ClinicalTrials.gov: NCT01683617; http://clinicaltrials.gov/show/NCT01683617 (Archived by WebCite at http://www.webcitation.org/6QnziHv3h).

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

BACKGROUND: Several 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? METHODS: To 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. RESULTS: Analyses 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. CONCLUSIONS: Technological 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 REGISTRATION NUMBER: NCT01683617.

EEG alpha asymmetry in virtual environments for the assessment of stress-related disorders.

In this study we consider neurophysiological aspects for the assessment of stress-related disorders. EEG Alpha Asymmetry could represent an effective method to be used in the virtual environment. Nonetheless, new protocols need to be defined. In this study herein, we present two methods and a case study.

Learning Island: the development of a virtual reality system for the experiential training of stress management.

Psychological Stress occurs when an individual perceives that environmental demands tax or exceed his or her adaptive capacity. Following this view, that underlines the role of the situated experience of the patient in experiencing a stressor, the European Union funded Interstress project (http://www.interstress.eu) is exploring the possible use of the virtual simulation technology offered by SecondLife (http://www.secondlife.com) to administer a stress management experiential training. The structure of the environment and the contents of the course are described and discussed.

Inter-reality in the evaluation and treatment of psychological stress disorders: the INTERSTRESS project.

"Psychological stress" occurs when an individual perceives that environmental demands tax or exceed his or her adaptive capacity. According to the Cochrane Database of Systematic Reviews, the best validated approach covering both stress management and stress treatment is the Cognitive Behavioral (CBT) approach. CBT has undergone a very large number of trials in research contexts. However, it has been less efficacious in clinical contexts and it has become obvious that CBT has some failings when applied in general practice. INTERSTRESS is a EU-funded project that aims to design, develop and test an advanced ICT-based solution for the assessment and treatment of psychological stress that is able to address three critical limitations of CBT: a) the therapist is less relevant than the specific protocol used. b) the protocol is not customized to the specific characteristics of the patient; c) the focus of the therapy is more on the top-down model of change (from cognitions to emotions) than on the bottom-up (from emotions to cognitions). To reach this goal the INTERSTRESS project applies an innovative paradigm for e-health - Interreality - that integrates assessment and treatment within a hybrid environment, bridging physical and virtual worlds. On one side, the patient is continuously assessed in the virtual and real worlds by tracking the behavioral and emotional status in the context of challenging tasks (customization of the therapy according to the characteristics of the patient). On the other side, feedback is continuously provided to improve both the appraisal and the coping skills of the patient through a conditioned association between effective performance state and task execution behaviors (improvement of self efficacy). Within this conceptual framework, it is possible to set up and test psychological treatments that could be extended also beyond the traditional research and clinical setting by using more and more emerging mobile technology to deliver real-time interventions during daily activities and ecological contexts.

The Effects of Playing Video Games on Stress, Anxiety, Depression, Loneliness, and Gaming Disorder During the Early Stages of the COVID-19 Pandemic: PRISMA Systematic Review.

During the initial phases of the COVID-19 pandemic, playing video games has been much more than just a pastime. Studies suggested that video games for many individuals have helped to cope with such difficult life experience. However, other research indicates that gaming may have had harmful effects. Within this context, this systematic review aimed to describe the literature on the effects of video games during the early stages of the COVID-19 crisis on stress, anxiety, depression, loneliness, and gaming disorder (GD), examining the study characteristics and outcomes. A systematic search of the literature was made following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. It was preregistered in the International Platform of Registered Systematic Review and Meta-Analysis Protocols (INPLASY)-INPLASY202180053. The search databases were PsycINFO, Web of Science, and Medline. The search string was: [("video game*") OR ("computer game*") OR ("gaming")] AND [("COVID-19")]. Twenty-four studies met the inclusion criteria. Four research explored the effects of playing video games during the COVID-19 pandemic on stress, anxiety, and depression. Four studies investigated loneliness, while 18 research investigated game disorder. Video games, especially augmented reality and online multiplayer ones, mitigated stress, anxiety, depression, and loneliness among adolescents and young adults during stay-at-home restrictions. However, in the case of at-risk individuals (i.e., particularly male youths), playing video games had detrimental effects.

Virtual Reality Applications in Medicine During the COVID-19 Pandemic: Systematic Review.

BACKGROUND: Virtual reality can play an important role during the COVID-19 pandemic in the health care sector. This technology has the potential to supplement the traditional in-hospital medical training and treatment, and may increase access to training and therapies in various health care settings. OBJECTIVE: This systematic review aimed to describe the literature on health care-targeted virtual reality applications during the COVID-19 crisis. METHODS: We conducted a systematic search of the literature on the PsycINFO, Web of Science, and MEDLINE databases, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. The search string was as follows: "[(virtual reality)] AND [(COVID-19) OR (coronavirus) OR (SARS-CoV-2) OR (healthcare)]." Papers published in English after December 2019 in peer-reviewed journals were selected and subjected to the inclusion and exclusion criteria. We used the Mixed Methods Appraisal Tool to assess the quality of studies and the risk of bias. RESULTS: Thirty-nine studies met the inclusion criteria. Seventeen studies showed the usefulness of virtual reality during the COVID-19 crisis for reducing stress, anxiety, depression, and pain, and promoting physical activity. Twenty-two studies revealed that virtual reality was a helpful learning and training tool during the COVID-19 crisis in several areas, including emergency medicine, nursing, and pediatrics. This technology was also used as an educational tool for increasing public understanding of the COVID-19 pandemic. Different levels of immersion (ie, immersive and desktop virtual reality), types of head-mounted displays (ie, PC-based, mobile, and standalone), and content (ie, 360° videos and photos, virtual environments, virtual reality video games, and embodied virtual agents) have been successfully used. Virtual reality was helpful in both face-to-face and remote trials. CONCLUSIONS: Virtual reality has been applied frequently in medicine during the COVID-19 pandemic, with positive effects for treating several health conditions and for medical education and training. Some barriers need to be overcome for the broader adoption of virtual reality in the health care panorama. TRIAL REGISTRATION: International Platform of Registered Systematic Review and Meta-analysis Protocols (INPLASY) INPLASY202190108; https://inplasy.com/inplasy-2021-9-0108/.

A virtual reality home-based training for the management of stress and anxiety among healthcare workers during the COVID-19 pandemic: study protocol for a randomized controlled trial.

BACKGROUND: Healthcare workers represent one of the most affected categories by the adverse effects of the COVID-19 pandemic on mental health. Excessive stress and anxiety are critical factors that could compromise work performance. Besides, high levels of stress and anxiety may have long-term physical and psychological consequences. Recent studies investigated virtual reality to reduce stress and anxiety among healthcare workers during the COVID-19 pandemic. However, the proposed virtual reality interventions have important limitations related to their location (i.e., research lab and hospitals) and content (i.e., virtual experiences only for relaxation). Within this context, this randomized controlled trial aims to investigate the efficacy and acceptability of a brief home-based virtual reality training for managing stress and anxiety during the COVID-19 crisis in a sample of Italian healthcare workers. METHODS: The study is a randomized controlled trial. It includes two groups of 30 individuals recruited from healthcare workers: (1) the experimental group and (2) the control group. Participants in the experimental group will receive a training consisting of three home sessions performed in a week. In each session, participants will try through an immersive virtual reality standalone system (i.e., Oculus Quest 2) a virtual psychoeducation experience on stress and anxiety (i.e., MIND-VR). Subsequently, they will try the virtual relaxation content (i.e., The Secret Garden). The control group will receive no training and will be reassessed one week and one month after the initial evaluation. DISCUSSION: If the proposed brief home-based virtual reality training will result helpful and easy to use, it could become an empirically assessed viable option for protecting healthcare workers' mental health both during the COVID-19 pandemic and once it will be over. Furthermore, the intervention might be easily adapted for other categories of people who need support in managing stress and anxiety. TRIAL REGISTRATION: ClinicalTrials.gov NCT04611399 .

Ubiquitous health in practice: the interreality paradigm.

In this paper we introduce a new ubiquitous computing paradigm for behavioral health care: "Interreality". Interreality integrates assessment and treatment within a hybrid environment, that creates a bridge between the physical and virtual worlds. Our claim is that bridging virtual experiences (fully controlled by the therapist, used to learn coping skills and emotional regulation) with real experiences (allowing both the identification of any critical stressors and the assessment of what has been learned) using advanced technologies (virtual worlds, advanced sensors and PDA/mobile phones) may improve existing psychological treatment. To illustrate the proposed concept, a clinical scenario is also presented and discussed: Daniela, a 40 years old teacher, with a mother affected by Alzheimer's disease.

Validation of a Neuro Virtual Reality-based version of the Multiple Errands Test for the assessment of executive functions.

The purpose of this study was to establish ecological validity and initial construct validity of the Virtual Reality (VR) version of the Multiple Errands Test (MET) (Shallice & Burgess, 1991; Fortin et al., 2003) based on the NeuroVR software as an assessment tool for executive functions. In particular, the MET is an assessment of executive functions in daily life, which consists of tasks that abide by certain rules and is performed in a shopping mall-like setting where items need to be bought and information needs to be obtained. The study population included three groups: post-stroke participants (n = 5), healthy, young participants (n = 5), and healthy, older participants (n = 5). Specific objectives were (1) to examine the relationships between the performance of three groups of participants in the Virtual Multiple Errands Test (VMET) and at the traditional neuropsychological tests employed to assess executive functions and (2) to compare the performance of post-stroke participants to those of healthy, young controls and older controls in the VMET and at the traditional neuropsychological tests employed to assess executive functions.

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 patient's 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.

Commercial Off-The-Shelf Video Games for Reducing Stress and Anxiety: Systematic Review.

BACKGROUND: Using commercial off-the-shelf video games rather than custom-made computer games could have several advantages for reducing stress and anxiety, including their low cost, advanced graphics, and the possibility to reach millions of individuals worldwide. However, it is important to emphasize that not all commercial video games are equal, and their effects strongly depend on specific characteristics of the games. OBJECTIVE: The aim of this systematic review was to describe the literature on the use of commercial off-the-shelf video games for diminishing stress and anxiety, examining the research outcomes along with critical variables related to computer game characteristics (ie, genre, platform, time of play). METHODS: A systematic search of the literature was performed following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guidelines. The search databases were PsycINFO, Web of Science, Medline, IEEExplore, and the Cochrane Library. The search string was: [("video game*") OR ("computer game*")] AND [("stress") OR ("anxiety") OR ("relaxation")] AND [("study") OR ("trial") OR ("training")]. RESULTS: A total of 28 studies met the inclusion criteria for the publication period 2006-2021. The findings demonstrate the benefit of commercial off-the-shelf video games for reducing stress in children, adults, and older adults. The majority of the retrieved studies recruited young adults, and fewer studies have involved children, middle-aged adults, and older adults. In addition to exergames and casual video games, other genres of commercial off-the-shelf games helped to reduce stress and anxiety. CONCLUSIONS: Efficacy in reducing stress and anxiety has been demonstrated not only for exergames and casual video games but also for other genres such as action games, action-adventure games, and augmented reality games. Various gaming platforms, including consoles, PCs, smartphones, mobile consoles, and virtual reality systems, have been used with positive results. Finally, even single and short sessions of play had benefits in reducing stress and anxiety. TRIAL REGISTRATION: International Platform of Registered Systematic Review and Meta-analysis Protocols INPLASY202130081; https://inplasy.com/?s=INPLASY202130081.

Virtual reality in the treatment of generalized anxiety disorders.

Generalized anxiety disorder (GAD) is a common anxiety disorder characterized by 6 months of "excessive anxiety and worry" about a variety of events and situations. Anxiety and worry are often accompanied by additional symptoms like restlessness, being easily fatigued, difficulty concentrating, irritability, muscle tension and disturbed sleep. GAD is usually treated with medications and/or psychotherapy. In particular, the two most promising treatments seem to be cognitive therapy and applied relaxation. In this study we integrated these approaches through the use of a biofeedback enhanced virtual reality (VR) system used both for relaxation and controlled exposure. Moreover, this experience is strengthened by the use of a mobile phone that allows patients to perform the virtual experience even in an outpatient setting. This paper describe the results of a controlled trial (NCT00602212) involving 20 GAD patients randomly assigned to the following groups: (1) the VR and Mobile group (VRMB) including biofeedback; (2) the VR and Mobile group (VRM) without biofeedback; (3) the waiting list (WL) group. The clinical data underlined that (a) VR can be used also in the treatment of GAD; (b) in a VR treatment, patients take advantage of a mobile device that delivers in an outpatient setting guided experiences, similar to the one experienced in VR.

Interreality in the management of psychological stress: a clinical scenario.

The term "psychological stress" describes a situation in which a subject perceives that environmental demands tax or exceed his or her adaptive capacity. According to the Cochrane Database of Systematic Reviews, the best validated approach covering both stress management and stress treatment is the Cognitive Behavioral (CBT) approach. We aim to design, develop and test an advanced ICT based solution for the assessment and treatment of psychological stress that is able to improve the actual CBT approach. To reach this goal we will use the "interreality" paradigm integrating assessment and treatment within a hybrid environment, that creates a bridge between the physical and virtual worlds. Our claim is that bridging virtual experiences (fully controlled by the therapist, used to learn coping skills and emotional regulation) with real experiences (allowing both the identification of any critical stressors and the assessment of what has been learned) using advanced technologies (virtual worlds, advanced sensors and PDA/mobile phones) is the best way to address the above limitations. To illustrate the proposed concept, a clinical scenario is also presented and discussed: Paola, a 45 years old nurse, with a mother affected by progressive senile dementia.

Virtual Reality Games and the Role of Body Involvement in Enhancing Positive Emotions and Decreasing Anxiety: Within-Subjects Pilot Study.

BACKGROUND: In the last few years, the introduction of immersive technologies, especially virtual reality, into the gaming market has dramatically altered the traditional concept of video games. Given the unique features of virtual reality in terms of interaction and its ability to completely immerse the individual into the game, this technology should increase the propensity for video games to effectively elicit positive emotions and decrease negative emotions and anxiety in the players. However, to date, few studies have investigated the ability of virtual reality games to induce positive emotions, and the possible effect of this new type of video game in diminishing negative emotions and anxiety has not yet been tested. Furthermore, given the critical role of body movement in individuals' well-being and in emotional responses to video games, it seems critical to investigate how body involvement can be exploited to modulate the psychological benefits of virtual reality games in terms of enhancing players' positive emotions and decreasing negative emotions and anxiety. OBJECTIVE: This within-subjects study aimed to explore the ability of commercial virtual reality games to induce positive emotions and diminish negative emotions and state anxiety of the players, investigating the effects of the level of body involvement requested by the game (ie, high vs low). METHODS: A total of 36 young adults played a low body-involvement (ie, Fruit Ninja VR) and a high body-involvement (ie, Audioshield) video game in virtual reality. The Visual Analogue Scale (VAS) and the State-Trait Anxiety Inventory, Form-Y1 (STAI-Y1) were used to assess positive and negative emotions and state anxiety. RESULTS: Results of the generalized linear model (GLM) for repeated-measures multivariate analysis of variance (MANOVA) revealed a statistically significant increase in the intensity of happiness (P<.001) and surprise (P=.003) and, in parallel, a significant decrease in fear (P=.01) and sadness (P<.001) reported by the users. Regarding the ability to improve anxiety in the players, the results showed a significant decrease in perceived state anxiety after game play, assessed with both the STAI-Y1 (P=.003) and the VAS-anxiety (P=.002). Finally, the results of the GLM MANOVA showed a greater efficacy of the high body-involvement game (ie, Audioshield) compared to the low body-involvement game (ie, Fruit Ninja VR), both for eliciting positive emotions (happiness, P<.001; and surprise, P=.01) and in reducing negative emotions (fear, P=.05; and sadness, P=.05) and state anxiety, as measured by the STAI-Y1 (P=.05). CONCLUSIONS: The two main principal findings of this study are as follows: (1) virtual reality video games appear to be effective tools to elicit positive emotions and to decrease negative emotions and state anxiety in individuals and (2) the level of body involvement of the virtual video game has an important effect in determining the ability of the game to improve positive emotions and decrease negative emotions and state anxiety of the players.

Global Storm of Stress-Related Psychopathological Symptoms: A Brief Overview on the Usefulness of Virtual Reality in Facing the Mental Health Impact of COVID-19.

The coronavirus disease 2019 (COVID-19) pandemic is a global health emergency requiring clinicians to be prepared to cope with the increase in the future incidence of trauma and stress-related psychopathological symptoms. The early detection of psychological distress and timely intervention are strongly recommended. Clinicians should also consider integrating new technologies such as virtual reality (VR) in the treatment of these trauma and stress-related psychopathological symptoms. Here we provide a brief overview of how VR can help to cope with the potential short-term and long-term mental health consequences related to this global emergency.

Video Games for Well-Being: A Systematic Review on the Application of Computer Games for Cognitive and Emotional Training in the Adult Population.

Background: Although several excellent reviews and meta-analyses have investigated the effect of video game trainings as tools to enhance well-being, most of them specifically focused on the effects of digital games on brain plasticity or cognitive decline in children and seniors. On the contrary, only one meta-analysis results to be focused on the adult population, and it is restricted to examining the effects of training with a particular genre of games (action video games) on cognitive skills of healthy adults. Objectives: This systematic review was aimed to identify research evidences about the impact on cognitive [i.e., processing and reaction times (RTs), memory, task-switching/multitasking, and mental spatial rotation] and emotional skills of video games training in the healthy adult population. Methods: A multi-component analysis of variables related to the study, the video games, and the outcomes of the training was made on the basis of important previous works. Databases used in the search were PsycINFO, Web of Science (Web of Knowledge), PubMed, and Scopus. The search string was: [("Video Games" OR "Computer Games" OR "Interactive Gaming")] AND [("Cognition") OR ("Cognitive") OR ("Emotion") OR ("Emotion Regulation")] AND ["Training"]. Results: Thirty-five studies met the inclusion criteria and were further classified into the different analysis' variables. The majority of the retrieved studies used commercial video games, and action games in particular, which resulted to be the most commonly used, closely followed by puzzle games. Effect sizes for training with video games on cognitive skills in general ranged from 0.06 to 3.43: from 0.141 to 3.43 for processing and RTs, 0.06 to 1.82 for memory, 0.54 to 1.91 for task switching/multitasking, and 0.3 to 3.2 for mental spatial rotation; regarding video games for the training of emotional skills, effect sizes ranged from 0.201 to 3.01. Conclusion: Overall, findings give evidences of benefits of video games training on cognitive and emotional skills in relation to the healthy adult population, especially on young adults. Efficacy has been demonstrated not only for non-commercial video games or commercial brain-training programs, but for commercial video games as well.

Assessment of Unilateral Spatial Neglect Using a Free Mobile Application for Italian Clinicians.

Background: Unilateral Spatial Neglect (USN) is traditionally assessed with paper-and-pencil tests or computer-based tests. Thanks to the wide-spreading of mobile devices, and the extensive capabilities that they have in dealing complex elements, it is possible to provide clinicians with tools for cognitive assessment. Contemporary 3D engine is, in general generally, able to deploy complex 3D environments for iOS, Android and Windows mobile, i.e., most of the mobile phone and tablet operative systems. Results: This brand-new scenario and pressing requests from professionals, pushed us to build an application for the assessment of USN. Our first attempt was to replicate the classic cognitive tests, traditionally used at this purpose. Ecological assessment is difficult in real scenarios so we implemented virtual environments to assess patients' abilities in realistic situations. At the moment, the application is available only for iPad and iPhone for free, from the Apple Store, under the name of "Neglect App." The App contains traditional tests (e.g., barrage with and without distractors) and ecological tests (e.g., to distribute the tea in a table to close people). Scoring of each test is available to the clinicians through a database with the executed ecological tasks, that are stored locally. Conclusion: In conclusion, Neglect App is an advanced mobile platform for the assessment of Neglect.

Virtual Reality Applications for Stress Management Training in the Military.

INTRODUCTION: Stress Management Training programs are increasingly being adopted in the military field for resilience empowerment and primary stress prevention. In the last several years, advanced technologies (virtual reality in particular) have been integrated in order to develop more innovative and effective stress training programs for military personnel, including soldiers, pilots, and other aircrew professionals. This systematic review describes experimental studies that have been conducted in recent years to test the effectiveness of virtual reality-based Stress Management Training programs developed for military personnel. This promising state-of-the-art technology has the potential to be a successful new approach in empowering soldiers and increasing their resilience to stress. METHODS: To provide an overview from 2001 to 2016 of the application of virtual reality for Stress Management Training programs developed for the military, a computer-based search for relevant publications was performed in several databases. Databases used in the search were PsycINFO, Web of Science (Web of Knowledge), PubMed, and Medline. The search string was: ("Virtual Reality") AND ("Military") AND ["Stress Training" OR ("Stress Management")]. RESULTS: There were 14 studies that met the inclusion criteria and were included in the review. DISCUSSION: The main observation to be drawn from this review is that virtual reality can provide interactive Stress Management Training to decrease levels of perceived stress and negative affect in military personnel. This technology appears to be a promising tool for assessing individuals' resilience to stress and for identifying the impact that stress can have on physiological reactivity and performance.Pallavicini F, Argenton L, Toniazzi N, Aceti L, Mantovani F. Virtual realtiy applications for stress management training in the military. Aerosp Med Hum Perform. 2016; 87(12):1021-1030.

Virtual Reality Body Swapping: A Tool for Modifying the Allocentric Memory of the Body.

An increasing amount of evidence has shown that embodiment of a virtual body via visuo-tactile stimulation can lead to an altered perception of body and object size. The current study aimed to investigate whether virtual reality (VR) body swapping can be an effective tool for modifying the enduring memory of the body. The experimental sample included 21 female participants who were asked to estimate the width and circumference of different body parts before any kind of stimulation and after two types of body swapping illusions ("synchronous visuo-tactile stimulation" and "asynchronous visuo-tactile stimulation"). Findings revealed that after participants embodied a virtual body with a skinny belly (independently of the type of visuo-tactile stimulation), there was an update of the stored representation of the body: participants reported a decrease in the ratio between estimated and actual body measures for most of the body parts considered. Based on the Allocentric Lock Theory, these findings provide first evidence that VR body swapping is able to induce a change in the memory of the body. This knowledge may be potentially useful for patients suffering from eating and weight disorders.