A Self-Help Virtual Therapeutic Experience Intervention for Overcoming Psychological Distress Related to the COVID-19 Pandemic: Results From the European Multicentric COVID Feel Good Trial.

OBJECTIVE: The general objective of the current study was to investigate the efficacy of a novel self-help virtual therapeutic experience (specifically, the COVID Feel Good intervention) in lowering the psychological burden experienced during the COVID-19 lockdowns in four European countries. METHODS: We focused on participants recruited from June 2020 to May 2021 in the context of a European multicenter project including four university/academic sites. The total number of participants in the longitudinal studies was 107 (study 1, N = 40; study 2, N = 29; study 3, N = 38). The randomized controlled trial (study 4) included 31 participants in total, 16 in the intervention group and 15 in the control group. Primary outcome measures were depression, anxiety, stress symptoms, perceived stress level, and perceived hopelessness. The secondary outcome was experienced social connectedness. RESULTS: Using separate linear mixed-effects models, the most consistent result across countries was a reduction in perceived stress after the participation in the COVID Feel Good intervention. By pooling the results of the models using a random-effects meta-analysis, we found that after the COVID Feel Good intervention, participants reported a decrease in perceived general distress (mean standardized effect size for general distress in the treatment groups compared with the control conditions was -0.52 [ p = .008, 95% confidence interval = -0.89 to -0.14]) and an increase in the perceived social connection (mean standardized effect size for social connection using COVID Feel Good compared with the control conditions was 0.50 [ p ≤ .001, 95% confidence interval = 0.25 to 0.76]). CONCLUSIONS: Findings of this study indicate that a virtual self-help intervention is effective in reducing psychological distress. These results contribute to the growing literature supporting the use of digital psychological therapies to relieve psychological distress among the general population during the COVID-19 pandemic.Trial Registration : ISRCTN63887521.

Integrating virtual realities and psychotherapy: SWOT analysis on VR and MR based treatments of anxiety and stress-related disorders.

The use of virtual reality (VR) and mixed reality (MR) technology in clinical psychology is growing. Efficacious VR-based treatments for a variety of disorders have been developed. However, the field of technology-assisted psychotherapy is constantly changing with the advancement in technology. Factors such as interdisciplinary collaboration, consumer familiarity and adoption of VR products, and progress in clinical science all need to be taken into consideration when integrating virtual technologies into psychotherapies. We aim to present an overview of current expert opinions on the use of virtual technologies in the treatment of anxiety and stress-related disorders. An anonymous survey was distributed to a select group of researchers and clinicians, using an analytic framework known as Strengths, Weaknesses, Opportunities, and Threats (SWOT). Overall, the respondents had an optimistic outlook regarding the current use as well as future development and implementation of technology-assisted interventions. VR and MR psychotherapies offer distinct advantages that can overcome shortcomings associated with traditional therapy. The respondents acknowledged and discussed current limitations of VR and MR psychotherapies. They recommended consolidation of existing knowledge and encouraged standardisation in both theory and practice. Continued research is needed to leverage the strengths of VR and MR to develop better treatments.Abbreviations: AR: Augmented Reality; MR: Mixed Reality; RCT: Randomised Controlled Trial; SWOT: Strengths, Weaknesses, Opportunities, and Threats; VR: Virtual Reality; VR-EBT: Virtual Reality Exposure-Based Therapy.

Glucocorticoids enhance extinction-based psychotherapy.

Behavioral exposure therapy of anxiety disorders is believed to rely on fear extinction. Because preclinical studies have shown that glucocorticoids can promote extinction processes, we aimed at investigating whether the administration of these hormones might be useful in enhancing exposure therapy. In a randomized, double-blind, placebo-controlled study, 40 patients with specific phobia for heights were treated with three sessions of exposure therapy using virtual reality exposure to heights. Cortisol (20 mg) or placebo was administered orally 1 h before each of the treatment sessions. Subjects returned for a posttreatment assessment 3-5 d after the last treatment session and for a follow-up assessment after 1 mo. Adding cortisol to exposure therapy resulted in a significantly greater reduction in fear of heights as measured with the acrophobia questionnaire (AQ) both at posttreatment and at follow-up, compared with placebo. Furthermore, subjects receiving cortisol showed a significantly greater reduction in acute anxiety during virtual exposure to a phobic situation at posttreatment and a significantly smaller exposure-induced increase in skin conductance level at follow-up. The present findings indicate that the administration of cortisol can enhance extinction-based psychotherapy.

Searching for the Metaverse: Neuroscience of Physical and Digital Communities.

What distinguishes real-world communities from their online counterparts? Social and cognitive neuroscience research on social networks and collective intentionality will be used in the article to answer this question. Physical communities are born in places. And places engage "we-mode" neurobiological and cognitive processes as behavioral synchrony, shared attention, deliberate attunement, interbrain synchronization, and so on, which create coherent social networks of very different individuals who are supported by a "wisdom of crowd." Digital technologies remove physical boundaries, giving people more freedom to choose their activities and groups. At the same time, however, the lack of physical co-presence of community members significantly reduces their possibility of activating "we-mode" cognitive processes and social motivation. Because of this, unlike physical communities that allow interaction between people from varied origins and stories, digital communities are always made up of people who have the same interests and knowledge (communities of practice). This new situation disrupts the "wisdom of crowd," making the community more radical and less accurate (polarization effect), allowing influential users to wield disproportionate influence over the group's beliefs, and producing inequalities in the distribution of social capital. However, a new emergent technology-the Metaverse-has the potential to reverse this trend. Several studies have revealed that virtual and augmented reality-the major technologies underlying the Metaverse-can engage the same neurobiological and cognitive "we-mode" processes as real-world environments. If the many flaws in this technology are fixed, it might encourage people to engage in more meaningful and constructive interactions in online communities.

Toward a Humane Metaverse: Challenges and Opportunities.

The metaverse, an emerging digital universe blurring the lines between reality and virtuality, offers a view into a future where human interaction transcends physical boundaries. In this article, we analyze the multidimensional facets of the metaverse, scrutinizing the landscape of challenges and opportunities it offers. The article delves into the challenges faced by human society in adapting to the metaverse, including the digital divide, ethical dilemmas, the level of trust, and the potential erosion of social and physical reality. Amid the allure of boundless creativity, questions arise about the very essence of human experience-identity, empathy, social relationships, life satisfaction, and the nature of reality itself. The metaverse, with all its complexities, challenges us to redefine the boundaries of human interaction, urging us to tread cautiously while embracing the limitless possibilities it presents. As we venture "toward a humane metaverse," we must navigate the intricate interplay of technology and humanity, shaping a future where the virtual realm enhances, rather than diminishes, the richness of the human experience.

Enhancing Aviation Safety through AI-Driven Mental Health Management for Pilots and Air Traffic Controllers.

This article provides an overview of the mental health challenges faced by pilots and air traffic controllers (ATCs), whose stressful professional lives may negatively impact global flight safety and security. The adverse effects of mental health disorders on their flight performance pose a particular safety risk, especially in sudden unexpected startle situations. Therefore, the early detection, prediction and prevention of mental health deterioration in pilots and ATCs, particularly among those at high risk, are crucial to minimize potential air crash incidents caused by human factors. Recent research in artificial intelligence (AI) demonstrates the potential of machine and deep learning, edge and cloud computing, virtual reality and wearable multimodal physiological sensors for monitoring and predicting mental health disorders. Longitudinal monitoring and analysis of pilots' and ATCs physiological, cognitive and behavioral states could help predict individuals at risk of undisclosed or emerging mental health disorders. Utilizing AI tools and methodologies to identify and select these individuals for preventive mental health training and interventions could be a promising and effective approach to preventing potential air crash accidents attributed to human factors and related mental health problems. Based on these insights, the article advocates for the design of a multidisciplinary mental healthcare ecosystem in modern aviation using AI tools and technologies, to foster more efficient and effective mental health management, thereby enhancing flight safety and security standards. This proposed ecosystem requires the collaboration of multidisciplinary experts, including psychologists, neuroscientists, physiologists, psychiatrists, etc. to address these challenges in modern aviation.

Artificial Intelligence: A Game-Changer for Mental Health Care.

Starting from the escalating global burden of mental health disorders, exacerbated by the COVID-19 pandemic, the article examines the potential of artificial intelligence (AI) to revolutionize mental health care. With nearly one in five adults facing mental health issues and suicide ranking as a leading cause of death among the young, the strained mental health system seeks innovative solutions. The text discusses the rapid evolution of AI, particularly in image analysis for early physical health diagnoses, and its promising applications in mental health, including predictive analytics for various disorders. AI's ability to analyze written language, speech characteristics, and physiological signals from wearables offers avenues for remote monitoring and early prognosis. Despite the need to address ethical considerations, particularly biases in data sets and concerns about potential patient detachment, the article advocates for AI as a complementary tool rather than a replacement for human involvement in mental health services. Overall, the article emphasizes the transformative potential of AI in enhancing diagnostics, monitoring, and treatment strategies for mental health disorders.

Virtual Reality Visual Perceptual Plastic Training Promotes Retinal Structure and Macular Function Recovery in Glaucoma Patients.

Twenty-seven glaucoma patients (54 eyes in total) with well-controlled intraocular pressure were trained with binocular virtual reality visual software for 3 months to investigate whether virtual reality visual perceptual plastic training promotes macular retinal structure and macular function recovery in glaucoma patients. The thickness of peripapillary retinal nerve fiber layer (pRNFL), macular ganglion cell layer-inner plexiform layer (mGCIPL), and mean macular sensitivity (mMS) were evaluated 3 months after training. The mean value of pRNFL thickness in glaucoma patients did not change significantly (Z = 0.642, p = 0.521), nor did the mean value (t = 1.916, p = 0.061) and minimum value (Z = 1.428, p = 0.153) of mGCIPL after 3 months. However, the significant increases were found in superior temporal mGCIPL thickness (t = 2.430, p = 0.019) as well as superior mGCIPL thickness (t = 2.262, p = 0.028). Additionally, the mMS was increased (Z = 2.259, p < 0.05), with the inferior square to be a more pronounced mMS increase (Z = 2.070, p = 0.038). In conclusion, virtual reality visual perceptual plastic training can increase the thickness of retinal ganglion cells complexes in the macular area of glaucoma patients and improve the macular function of the corresponding area. Clinical Trial registration number: ChiCTR1900027909.

Predicting Post-Traumatic Stress Disorder Treatment Response Using Heart Rate Variability to Virtual Reality Environment and Modified Stroop Task: An Exploratory Study.

Predicting treatment response can inform treatment decisions, expectations, and optimize use of mental health treatment resources. This study examined heart rate (HR), heart rate variability (HRV), and a modified Stroop task (mStroop) to predict post-traumatic stress disorder (PTSD) treatment response. We report on an observational, longitudinal study with 45 U.S. veterans in outpatient PTSD care, who had deployed to Iraq or Afghanistan. HR and HRV were collected before, during, and after virtual reality (VR) combat and civilian scenes. HRV recovery was defined as HRV after a 3-minute VR simulation minus HRV during a VR scene. mStroop threat variables included index scores for combat and general threat. Self-report data were collected at baseline and 6 months later. The outcome variable was the 17-item Clinician Administered PTSD Scale (CAPS). Controlling for baseline CAPS and number of combat experiences, the following baseline HRV recovery variables were significant predictors of 6-month CAPS: standard deviation of normal beat to beat interval (SDNN) after combat scene minus SDNN during combat scene and low-frequency (LF HRV) after civilian scene minus LF during civilian scene. HRV at rest, HR reactivity, HR recovery, and mStroop scores did not predict treatment response. In conclusion, HRV recovery variables in the context of a standardized VR stressor were significant predictors of PTSD treatment response after controlling for baseline CAPS and number of combat experiences. The direction of this relationship indicates that greater baseline HRV recovery predicts lower 6-month PTSD symptom severity. This was an exploratory study in need of replication.

Effectiveness of a Virtual-Reality-Based Self-Help Intervention for Lowering the Psychological Burden during the COVID-19 Pandemic: Results from a Randomized Controlled Trial in Iran.

BACKGROUND: The COVID-19 pandemic. In this framework, digital self-help interventions have the potential to provide flexible and scalable solutions for delivering evidence-based treatments that do not necessitate face-to-face meetings. OBJECTIVE: as part of a multicentric project, the purpose of the current randomized controlled trial was to evaluate the efficacy of a Virtual-Reality-based self-help intervention (namely, COVID Feel Good) in lowering the psychological distress experienced during the COVID-19 pandemic in Iran. METHODS: 60 participants were randomly assigned to the experimental (COVID Feel Good intervention group) or the control (no-treatment control group) condition. At the beginning of the intervention (Day 0), at the end of the intervention (Day 7), and after a 2-week follow-up (Day 21), measurements of depressive and anxiety levels, general distress, perceived levels of stress, hopelessness (primary outcome measures), perceived interpersonal closeness with the social world, and fear of COVID-19 (secondary outcome measure) were collected. The protocol consists of two integrated parts: the first part includes a relaxing 10-min three-hundred-sixty-degree (360°) video, while the second one includes social tasks with specified objectives. RESULTS: In terms of the primary outcomes, participants in the COVID Feel Good intervention group improved in depression, stress, anxiety, and perceived stress but not hopelessness. Secondary outcome results showed an improvement in perceived social connectedness and a substantial decrease in fear of COVID-19. CONCLUSIONS: these findings on the efficacy of COVID Feel Good training add to the growing body of evidence demonstrating the feasibility of digital self-help interventions in promoting well-being during this unique period.

Digital Therapy for Visual Acuity and Binocular Function in Children with Anisometropic Amblyopia.

Amblyopia affects development of children's monocular vision and binocular function and becomes a largely intractable problem with increasing aging. This study is to investigate the binocular function and evaluate efficacy of digital therapy in children 8-13 years of age with anisometropic amblyopia. The patients in the digital therapy group performed the training with the digital amblyopia therapeutic software. The visual acuity and binocular function (perceptual eye position [PEP], suppression, and stereopsis) were examined at the first visit and 3-month post-treatment. Twenty-three cases in the control group and 25 cases in the digital therapy group were enrolled. The results revealed that 3-month digital therapy can effectively improve corrected distance visual acuity (CDVA) and improve the binocular function, including PEP, suppression, and second-order stereopsis in children with anisometropic amblyopia, 8-13 years of age. Digital therapy for amblyopia can effectively improve monocular CDVA of amblyopic eyes and binocular function in older children with anisometropic amblyopia.

Effectiveness evaluation for short-term group pre-deployment VR computer-assisted stress inoculation training provided to Polish ISAF soldiers.

The goal of this study was to assess effectiveness of a short collective stress inoculation training (SIT) conducted according to the methodology of the Virtual Reality Medical Center of San Diego (Training of Physiological Control Exposure to Virtual Stressor while Maintaining Physiological Control). The results obtained indicate a short-term effectiveness of the training as a method of tension reduction. However, in the long-term perspective these results are ambiguous and they suggest a need of further research. In order to extend the analysis effects of temperamental factors on training effectiveness was presented.

What the Metaverse Is (Really) and Why We Need to Know About It.

Major technology companies are investing significant sums of money in the creation of the metaverse whose main feature will be the fusion between the virtual world and the physical world. To allow this possibility is one of the less obvious features of the metaverse: the metaverse works like our minds. This ability makes the metaverse a significantly different technology from its predecessors. If television and social media are persuasive technologies, because of their ability to influence people's attitudes and behaviors, the metaverse is instead a transformative technology, capable of modifying what people think reality is. To achieve this goal, the technologies of the metaverse hack different key cognitive mechanisms: the experience of being in a place and in a body, the processes of brain-to-brain attunement and synchrony, and the ability of experiencing and inducing emotions. Clearly, these possibilities define totally new scenarios with positive and negative outcomes. Educating ourselves as to its promise, and the challenges it may present, is a necessity. This requires a "humane," integrated, and multidisciplinary approach, with stakeholders at the supranational level joining in the conversation.

Zero Sales Resistance: The Dark Side of Big Data and Artificial Intelligence.

Big data (BD) is the hue and cry of modern science and society. The impact of such data deluge is huge and far reaching for both science and society. Moreover, given the effort required for collecting and analyzing these data, artificial intelligence (AI) has replaced the human mind in accomplishing the enormous task of deriving insight out of the information. In this article, we analyze the role of BD and AI in steering the world population toward the state of Zero Sales Resistance (ZSR): the inability to exert critical judgment over the most seductive aspects of the aforementioned data deluge. Moreover, we discuss the alarming consequences of presenting the merging of BD and AI as a universal panacea even if, to date, they have proven far more efficient for predicting human decisions and behaviors (predictive analytics) than for solving the most critical problems in science and society. Why? Our answer is simple. The causal structures associated with such challenges command a detailed understanding of the underlying mechanisms (causal explanation), typically acting nonlinearly and on a broad range of scales in space and time. In contrast, personality and behavior can be predicted with no need of a microscopic theory and understanding of the brain-mind system (empirical prediction). This is a direct consequence of the fact that our mind, at least for the intuitive level, uses the same prediction techniques applied by AI (bayesian predictions based on our experience). However, prediction is not explanation, and without joining them it will be impossible to achieve a major advance in our understanding of complex systems.

Preliminary Study of Short-Term Visual Perceptual Training Based on Virtual Reality and Augmented Reality in Postoperative Strabismic Patients.

The study aimed to explore the potential effect of short-term visual perceptual training based on virtual reality (VR) and augmented reality (AR) platforms in postoperative strabismic patients. We enrolled 236 postoperative strabismic patients, among whom 111 patients received VR-based training, and 125 patients received AR-based training. The stereoacuity of 1.5 m and dynamic stereopsis were improved by VR training; meanwhile, AR training exhibited more improvement in stereoacuity of 0.8 and 1.5 m, dynamic and coarse stereopsis. It was suggested that the visual perceptual training based on VR and AR technology can be potentially applied in postoperative strabismus treatment to promote the recovery of binocular vision.

Exploring the use of virtual reality to manage distress in adolescent patients in emergency departments: A feasibility study.

OBJECTIVE: The present study aimed to explore the feasibility and potential benefits of deploying virtual reality (VR) for adolescents in the ED. METHODS: This multi-centre study was undertaken in paediatric and adult EDs in two university teaching hospitals. Twenty-six participants who had voluntarily attended the ED received the VR intervention. Pre- and post-measures assessing changes in state anxiety, stress and affect, and physical biomarkers were obtained. RESULTS: The use of VR intervention was associated with significant reductions in distress (Short State Stress Questionnaire - Distress Subscale; t = 4.55, P < 0.001) and negative affect (the International Positive and Negative Affect Scale - Short Form version; t = 4.99, P < 0.001). Most participants chose 'Netflix' as their content of choice. The technology was well received by the participants with subjective reports indicating that receiving VR intervention was 'insanely cool', 'takes you away from what's actually happening' and some participants felt 'privileged to get this experience in a hospital'. CONCLUSIONS: VR technology can effectively be used in EDs to assist adolescents and young adults better manage their distress and take steps towards activating more self-control mechanisms that will in turn allow for more meaningful engagements to be established with health clinicians. This technology has broad implications for reducing distress in adolescents in a variety of clinical contexts.

COVID Feel Good: Evaluation of a Self-Help Protocol to Overcome the Psychological Burden of the COVID-19 Pandemic in a German Sample.

The COVID-19 pandemic has severe consequences for physical as well as mental well-being. In times of restricted social contact, online self-help programs offer a low-threshold first aid to cope with the psychological burden. This current study evaluates the online self-help protocol "COVID Feel Good" in a German sample. The multicentric study was designed as a single cohort with a waiting list control condition. The convenience sample consisted of 38 German individuals who experienced at least two months of restrictions during the COVID-19 pandemic. The 7-day self-help protocol included the VR video "Secret Garden" as well as a social or cognitive exercise each day. General distress, depression, anxiety, stress, and hopelessness were assessed as primary outcomes. Social connectedness and fear of coronavirus were measured as secondary outcomes. Results showed a significant decrease in all primary outcomes except for hopelessness. Furthermore, the results indicated a significant improvement in social connectedness. Treatment effects on general distress, depression, stress, and anxiety persisted for two weeks after participation. The present study indicates that VR-based self-help protocols can mitigate the psychological burden associated with the pandemic, supporting recent findings.

Exploring the Relationship Between Binocular Imbalance and Myopia: Refraction with a Virtual Reality Platform.

To explore the relationship between binocular imbalance (BI) and the abnormal development of binocular refraction. BI data were collected by enrolling the first 1,000 adolescents and children aged 6-18 years in Shenzhen Eye Hospital from April 2020 to January 2021. In this cross-sectional study, the imbalance value (IV) did not show a statistical correlation with the spherical equivalent (SE) (oculus dexter [OD]: r = 0.022, p = 0.586; oculus sinister [OS]: r = -0.021, p = 0.606), and had little correlation with the uncorrected visual acuity (VA) (OD: r = -0.084, p = 0.039; OS: r = -0.034, p = 0.408). The proportion of binocular contrast imbalance (BCI) (the absolute value) maintained the highest level (from 54.42 to 79.17 percent) with the increase of bilateral SE difference in the four subcategories (binocular balance, monocular suppression, binocular rivalry, and BCI). From -100 to +100 of IV, the SE of the left eye tends to increase negatively when compared with the right eye (from -95 < IV ≦ -80, SE difference = -0.83 ± 1.58, to -20 < IV ≦ -10, SE difference = -0.14 ± 0.61; from 10 ≦ IV <20, SE difference = -0.05 ± 0.80, to 80 ≦ IV <95, SE difference = 1.48 ± 2.77). BI widely exists within the general pediatric population. The BI did not show significant correlation with the unilateral eye refractive state and the VA. However, the BI may be accompanied by imbalanced development of the eye refractive system. Furthermore, the SE of the dominant eye (from the prospective of BI) tends to be more negative than that of the opposite eye as the value increases. Clinical Trial Registration number: ChiCTR2100045457.

The effectiveness of technology-enhanced relaxation techniques for military medical warriors.

Combat zones can be very stressful for those in the area. Even in the battlefield, military medical personnel are expected to save others, while also staying alive. In this study, half of a sample of deployed military medical warriors (total n = 60) participated in technology-assisted relaxation training. Learning relaxation skills with a video clip of virtual reality relaxing scenes showed a statistically significant impact on the anxiety levels of the Experimental Group.

Personal health systems for mental health: the European projects.

Since the European funded project VREPAR--Virtual Reality in Neuro-Psycho-Physiology (1995)--different European research activities have been using virtual reality and advanced information and communication technologies to improve the quality of care in the treatment of many different mental health disorders including anxiety disorders, eating disorders and obesity. Now the European Commission funding is shifting from the traditional hospital-centred and reactive healthcare delivery model toward a person-centred and preventive one. The main outcome of this shift is the "Personal Health Systems" (PHS) paradigm that aims at offering continuous, quality controlled, and personalized health services to empowered individuals regardless of location. The paper introduces four recently funded projects--Interstress, Monarca, Optimi and Psyche--that aim at using PHS based on virtual reality, biosensors and/or mobile technologies to improve the treatment of bipolar disorders, depression and psychological stress.