Self-efficacy beliefs as key ingredients to healthy and sustainable lifestyles. A five-year longitudinal study on diet and physical activity habits of newly diagnosed patients with acute coronary syndrome.

Cardiovascular diseases represent a significant cause of morbidity and mortality worldwide, and an unhealthy lifestyle notoriously accounts for a large percentage of their risk. Identifying resources to stimulate lifestyle changes is an essential goal of primary and secondary cardiovascular prevention. Self-efficacy beliefs are among the major psychological factors proven to impact health status and lifestyle. This study aimed to confirm the role of self-efficacy beliefs by investigating their associations over 5 years of adherence to healthy lifestyles in terms of diet and physical activity in a sample of 275 newly diagnosed patients with acute coronary syndrome. Longitudinal profiles of lifestyles and self-efficacy beliefs in their improvement were identified through latent class growth analysis. Correlations were then performed to explore the associations between lifestyles and self-efficacy trajectories. Results showed a positive association between virtuous lifestyle profiles and high self-efficacy in implementing behavioural change. Finally, two logistic regressions were performed to test the hypothesis that a high self-efficacy profile would predict better lifestyles 5 years after the coronary event. This hypothesis was confirmed for diet. Overall, current findings confirm the importance of implementing repeated psychological interventions that promote patients' efficacy beliefs in self-regulating their behaviour changes over time.

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.

Space for power: feeling powerful over others' behavior affects peri-personal space representation.

We investigated whether and how social power affects the representation of peri-personal space (PPS). We applied a multisensory interaction task to assess PPS representation and the Personal Sense of Power Scale to assess participants' feelings of power over others' behaviors and over others' opinions. In Study 1, we probed PPS representation in a virtual social context. Participants with a higher sense of power showed a less defined differentiation between the close and far space as compared to participants with a lower sense of power. This effect was replicated in Study 2 when participants performed the task in a non-social context (with no person in the scene), but only after they were reminded of an episode of power. Thus, social power-the perception of power over others' behavior-affects the multisensory representation of the self in space by blurring the differentiation between one's own PPS and the space of others.

The effect of visual perspective on episodic memory in aging: A virtual reality study.

The possibility of flexibly retrieving our memories using a first-person or a third-person perspective (1PP or 3PP) has been extensively investigated in episodic memory research. Here, we used a Virtual Reality-based paradigm to manipulate the visual perspective used during the encoding stage to investigate age-related differences in the formation of memories experienced from 1PP vs. 3PP. 32 young adults and 32 seniors participated in the study. Participants navigated through two virtual cities to encode complex real-life virtual events, from either a 1PP (as if from their egocentric viewpoint) or a 3PP, while actively controlling an avatar. While recognition accuracy was higher in young adults after encoding in 1PP compared to 3PP, there was no benefit in memory formation in 1PP for older adults. These findings are discussed in terms of both age-related changes in episodic memory functioning and self-referencing processes.

Prognostic relevance of gait-related cognitive functions for dementia conversion in amnestic mild cognitive impairment.

BACKGROUND: Increasing research suggests that gait abnormalities can be a risk factor for Alzheimer's Disease (AD). Notably, there is growing evidence highlighting this risk factor in individuals with amnestic Mild Cognitive Impairment (aMCI), however further studies are needed. The aim of this study is to analyze cognitive tests results and brain-related measures over time in aMCI and examine how the presence of gait abnormalities (neurological or orthopedic) or normal gait affects these trends. Additionally, we sought to assess the significance of gait and gait-related measures as prognostic indicators for the progression from aMCI to AD dementia, comparing those who converted to AD with those who remained with a stable aMCI diagnosis during the follow-up. METHODS: Four hundred two individuals with aMCI from the Alzheimer's Disease Neuroimaging Initiative (ADNI) database were included. Robust linear mixed-effects models were used to study the impact of gait abnormalities on a comprehensive neuropsychological battery over 36 months while controlling for relevant medical variables at baseline. The impact of gait on brain measures was also investigated. Lastly, the Cox proportional-hazards model was used to explore the prognostic relevance of abnormal gait and neuropsychological associated tests. RESULTS: While controlling for relevant covariates, we found that gait abnormalities led to a greater decline over time in attention (DSST) and global cognition (MMSE). Intriguingly, psychomotor speed (TMT-A) and divided attention (TMT-B) declined uniquely in the abnormal gait group. Conversely, specific AD global cognition tests (ADAS-13) and auditory-verbal memory (RAVLT immediate recall) declined over time independently of gait profile. All the other cognitive tests were not significantly affected by time or by gait profile. In addition, we found that ventricles size increased faster in the abnormal gait group compared to the normal gait group. In terms of prognosis, abnormal gait (HR = 1.7), MMSE (HR = 1.09), and DSST (HR = 1.03) covariates showed a higher impact on AD dementia conversion. CONCLUSIONS: The importance of the link between gait and related cognitive functions in terms of diagnosis, prognosis, and rehabilitation in aMCI is critical. We showed that in aMCI gait abnormalities lead to executive functions/attention deterioration and conversion to AD dementia.

Phonological similarity between words is represented in declarative memory as spatial distance.

Space can be used as a metaphor to describe semantic and perceptual similarity. Research has shown that similarity and spatial information can influence each other. On the one hand, similarity entails spatial closeness; on the other hand, proximity leads to similarity judgment. This spatial information can be stored in declarative memory and measured later on. However, it is unknown if phonological similarity/dissimilarity between words is represented as spatial closeness/distance in declarative memory. In this study, 61 young adults were tested on a remember-know (RK) spatial distance task. Participants learned noun pairs on the PC screen that were manipulated concerning their phonological similarity (similar vs. dissimilar) and reciprocal spatial distance (near vs. far). In the recognition phase, old-new, RK, and spatial distance judgments were asked. We found that for hit responses in both R and K judgments, phonologically similar word pairs were remembered closer compared to phonologically dissimilar pairs. This was also true for false alarms after K judgments. Lastly, the actual spatial distance at encoding was only retained for hit R responses. Results suggest that phonological similarity/dissimilarity is represented respectively with spatial closeness/distance and that this information is stored in the neurocognitive system of declarative memory.

A post hoc comparison between inpatients with obesity and healthy-weight subjects in the size estimation accuracy of shoulders, waist, and hips widths and circumferences.

PURPOSE: This post hoc study aimed to assess the hypothesis that subjects with obesity could underestimate their body size. METHODS: Data from a previous study with different aims were used to compare 22 female inpatients with obesity with 21 healthy-weight women in the size estimation accuracy of their shoulders, waist, and hips circumferences and widths. The body estimation task with an individualized metric methodology was used to collect data. Frequentist and Bayesian analyses were performed. RESULTS: Samples differed significantly in the accuracy measures of shoulders width and hips as well as waist circumferences: inpatients with obesity underestimated them, while healthy-weight subjects estimated shoulders width accurately but overestimated their hips and waist circumferences. Multiple regression showed that the between-group difference in the accuracy measure of shoulders width was explained by the individuals' education level, while the difference in the accuracy measure of waist circumference resulted to be independent of both age and education level. CONCLUSION: This post hoc study supports the hypothesis that female patients with obesity might underestimate their body size. If these results will be confirmed in future studies, interventions specifically designed to equalize estimations to match the real measures of body size may play a key role in weight-reduction programs for people with obesity. LEVEL OF EVIDENCE: Level III, evidence obtained from cohort or case-control analytic studies.

Virtual reality in the treatment of eating disorders.

Over the last 25 years, virtual reality (VR) has offered innovative solutions for targeting different key symptoms of eating disorders: from craving to negative emotions, from attentional biases to body dissatisfaction. The present narrative review assesses the existing literature in these areas trying to identify their different levels of clinical evidence. Specifically, the review presents four clinical approaches based upon VR and their implications in the treatment of eating disorders: VR cue exposure, VR reference frame shifting, VR for correcting body distortions and attentional biases. In general, existing findings demonstrate the clinical value of VR. On one side, the present review suggests that two VR-based techniques-VR exposure and reference frame shifting-have a significant research support and provide a possible advantage over traditional cognitive-behavioural therapy (CBT) for bulimia nervosa and binge eating disorder. On the other side, two emerging VR applications-multisensory body illusions and the use of VR for the modification of attentional biases-even if supported by preliminary data still need further research.

The differential effect of normal and pathological aging on egocentric and allocentric spatial memory in navigational and reaching space.

BACKGROUND: Topographical disorientation (TD) refers to a particular condition which determines the loss of spatial orientation, both in new and familiar environments. TD and spatial memory impairments occur relatively early as effect of cognitive decline in aging, even in prodromal stages of dementia, namely mild cognitive impairment (MCI). AIMS: (a) To show that components linked to the recall of familiar spatial knowledge are relatively spared with respect to the learning of unfamiliar ones in normal aging, while they are not in MCI, and (b) to investigate gender differences for their impact on egocentric and allocentric frames of reference. METHOD: Forty young participants (YC), 40 healthy elderly participants (HE), 40 elderly participants with subjective memory complaints (SMC), and 40 elderly with probable MCI were administered with egocentric and allocentric familiar tasks, based on the map of their hometown, and with egocentric and allocentric unfamiliar tasks, based on new material to be learned. A series of general linear models were used to analyze data. RESULTS: No group differences were found on egocentric task based on familiar information. MCI performed worse than the other groups on allocentric tasks based on familiar information (YC = HE = SMC > MCI). Significant differences emerged between groups on egocentric and allocentric tasks based on unfamiliar spatial information (YC > HE = SMC > MCI). A gender difference was found, favoring men on allocentric unfamiliar task. CONCLUSION: Familiarity of spatial memory traces can represent a protective factor for retrospective components of TD in normal aging. Conversely, using newly learned information for assessment may lead to overestimating TD severity.

The role of reference frames in memory recollection.

In this commentary on Bastin et al., we suggest that spatial context plays a critical role in the encoding and retrieval of events. Specifically, the translation process between the viewpoint-independent content of a memory and the viewpoint-dependent stimuli activating the retrieval (mental frame syncing) plays a critical role in spatial memory recollection. This perspective also provides an explanatory model for pathological disturbances such as Alzheimer's disease.

A Social Virtual Reality-Based Application for the Physical and Cognitive Training of the Elderly at Home.

Frailty is a clinical condition affecting the elderly population which results in an increased risk of falls. Previous studies demonstrated that falls prevention programs are effective, but they suffer from low adherence, especially when subjects have to train unsupervised in their homes. To try to improve treatment adherence, virtual reality and social media have been proposed as promising strategies for the increase of users' motivation and thus their willingness to practice. In the context of smart homes, this work presents SocialBike, a virtual reality-based application aimed at improving the clinical outcomes of older frail adults in their houses. Indeed, SocialBike is integrated in the "house of the future" framework and proposes a Dual Task training program in which the users are required to cycle on a stationary bike while recognizing target animals or objects appearing along the way. It also implements the possibility of training with other users, thus reducing the risk of social isolation. Within SocialBike, users can choose the multiplayer mode they prefer (i.e., collaborative or competitive), and are allowed to train following their own attitude. SocialBike's validation, refinement, and business model are currently under development, and are briefly discussed as future works.

From avatars to body swapping: The use of virtual reality for assessing and treating body-size distortion in individuals with anorexia.

In the last 30 years, virtual reality (VR) has offered innovative solutions for assessing and treating body representation disturbances in anorexia nervosa (AN). The most recent and innovative trend is the exploitation of the so-called VR-based body swapping illusion. The aim of this case study was to report the use of this VR protocol within a multidisciplinary treatment of AN. A patient with a Diagnostic and Statistical Manual-5 diagnosis of AN underwent an intensive multidisciplinary outpatient treatment. Three sessions of a VR-based body swapping illusion (i.e., the experimental induction of being the owner of a virtual body as a result of a visuotactile stimulation) were delivered within the treatment protocol (i.e., beginning of the treatment; end of one cycle of the treatment; 1 year of follow-up). We report the results obtained, discussing how the VR full body illusion was both able to effectively monitor changes of multisensory bodily integration and to act as a driver for these changes.

Spatial reorientation decline in aging: the combination of geometry and landmarks.

OBJECTIVES: The study is focused on the assessment of reorientation skills in a sample of community-dwelling elderly people, manipulating landmarks and geometric (layout) information. METHOD: A neuropsychological assessment was administered to 286 elderly participants, divided into six groups (healthy controls, HC; four subgroups of participants with mild cognitive impairment, MCI; participants with probable dementia, Prob_D) and tested with the Virtual Reorientation Test (VReoT). VReoT manipulated different spatial cues: geometry and landmarks (proximal and distal). RESULT: Compared with HC, participants with MCI and Prob_D showed to be impaired in tasks involving geometry, landmarks and a combination of them. Both single and multiple domain impairment in MCI had an impact on reorientation performance. Moreover, VReoT was marginally able to discriminate between amnesic and non-amnesic MCI. The occurrence of getting lost events seemed to be associated to learning of geometric information. CONCLUSION: The associative strength between landmark and target plays an important role in affecting spatial orientation performance of cognitively impaired participants. Geometry significantly supports landmark information and becomes helpful with the increase of cognitive impairment which is linked to a decrement in landmark encoding. VReoT seems to represent a reliable evaluation supplement for spatial orientation deficits in prodromal stages of dementia.

Disentangling the Contribution of Spatial Reference Frames to Executive Functioning in Healthy and Pathological Aging: An Experimental Study with Virtual Reality.

A growing body of evidence pointed out that a decline in effectively using spatial reference frames for categorizing information occurs both in normal and pathological aging. Moreover, it is also known that executive deficits primarily characterize the cognitive profile of older individuals. Acknowledging this literature, the current study was aimed to specifically disentangle the contribution of the cognitive abilities related to the use of spatial reference frames to executive functioning in both healthy and pathological aging. 48 healthy elderly individuals and 52 elderly suffering from probable Alzheimer's Disease (AD) took part in the study. We exploited the potentiality of Virtual Reality to specifically measure the abilities in retrieving and syncing between different spatial reference frames, and then we administrated different neuropsychological tests for evaluating executive functions. Our results indicated that allocentric functions contributed significantly to the planning abilities, while syncing abilities influenced the attentional ones. The findings were discussed in terms of previous literature exploring relationships between cognitive deficits in the first phase of AD.

Characteristics, Usability, and Users Experience of a System Combining Cognitive and Physical Therapy in a Virtual Environment: Positive Bike.

We present the architecture and usability evaluation of virtual reality system-"Positive Bike"-designed for improving cognitive and motor conditions in frail elderly patients. The system consists of a cycle-ergometer integrated in an immersive virtual reality system (CAVE) which allows combining motor and cognitive exercises according to a "dual-task" paradigm. We tested the usability and user's experience of the prototype in a pilot evaluation study that involved five elderly patients. The prototype was tested in one-session training to understand the limitations and areas for improvement of our system. The evaluation consisted in (i) usability assessment using the system usability scale; (ii) evaluation of user's engagement using the flow state scale; and (iii) expert evaluation involving interviews with domain experts. Results showed a good usability, both for system usability scale and the semi-structured interview. The level of flow (i.e., enjoyment with the task at hand) measured using the short flow state scale, was also high. Analysis of semi-structured interview carried out with domain experts provided further indications to improve the system. Overall, these findings show that, despite some limitations, the system is usable and provides an enjoyable user's experience.

Classifying Adults with Binge Eating Disorder Based on Severity Levels.

The clinical utility of the severity criterion for binge eating disorder (BED), introduced in the DSM-5 as a means of addressing heterogeneity and variability in the severity of this disorder, was evaluated in 189 treatment-seeking adults with (DSM-5) BED. Participants classified with mild, moderate, severe and extreme severity of BED, based on their weekly frequency of binge eating episodes, differed significantly from each other in body mass index (BMI), eating disorder features, putative factors involved in the maintenance process of the disorder, comorbid mood, anxiety and personality disorders, psychological distress, social maladjustment and illness-specific functional impairment (medium-to-large effect sizes). They were also statistically distinguishable in metabolic syndrome prevalence, even after adjusting for BMI (large effect size), suggesting the possibility of non-BMI-mediated mechanisms. The implications of the findings, providing support for the utility of the binge frequency as a severity criterion for BED, and directions for future research are outlined. Copyright © 2017 John Wiley & Sons, Ltd and Eating Disorders Association.

Predictors of initiation and persistence of recurrent binge eating and inappropriate weight compensatory behaviors in college men.

OBJECTIVE: The transition to college is considered as a risk period for the development of behavioral symptoms of eating disorders (BSEDs) and some evidence suggests that, amongst men, these symptoms occurring on a regular basis remain relatively stable over the college period. Nevertheless, little is known about factors associated with persistent engagement in and initiation of recurrent (or regular) binge eating and inappropriate weight compensatory behaviors in this population. The objective of this report was to address these research gaps. METHOD: Data were examined from 2,555 male first-year college students who completed an assessment of potential vulnerability factors and BSEDs at the beginning of the autumn semester (baseline) and nine months later (end of the spring semester; follow-up). RESULTS: Elevated negative affectivity, body dissatisfaction, self-objectification, and lower self-esteem at baseline were predictive of persistent engagement in regular binge eating and four compensatory behaviors (self-induced vomiting, laxative/diuretic abuse, fasting, exercise) at follow-up, as well as initiation of all these behaviors occurring regularly (i.e., at least weekly for 3 months). Self-objectification (thinking and monitoring the body's outward appearance from a third-person perspective) emerged as the largest contributor of both the initiation and persistence of all behavioral symptoms. DISCUSSION: Data emphasize that the same psychological factors underlie initiation and persistence of recurrent BSEDs and should shape the focus of future interventions for college men. © 2016 Wiley Periodicals, Inc. (Int J Eat Disord 2016; 49:581-590).

Psychometric assessment and behavioral experiments using a free virtual reality platform and computational science.

BACKGROUND: Virtual Reality has been extensively used in a wide range of psychological experiments. In this study, we aimed to introduce NeuroVirtual 3D, a platform that clinicians could use free of charge. IMPLEMENTATION: The platform we developed relies on NeuroVR software, but we extended it to apply to experiments. The software is available free of charge to researchers and clinical practitioners who can also use a large number of virtual environments and objects already developed. RESULTS: The platform has been developed to connect to virtually every device ever produced by the means of Virtual-Reality Peripheral Network (VRPN) protocols; however, a number of these have already been included and tested in the platform. Among the available devices, the Microsoft Kinect low-cost sensor has already been configured for navigation through the virtual environments and to trigger specific action (sounds, videos, images, and the like) when a specific gesture is recognized, e.g., a step forward or an arm up. A task for neglect and a task for spatial abilities assessment were already implemented within the platform. Moreover, NeuroVirtual 3D integrated a TCP-IP-based module (bridge) to collect the data from virtually any existent biosensor (Thought-Technology, Zephyr and StarStim devices have already been included in the platform). It is able to record any psychophysiological signal during any experiment using also the computed indices in real time. CONCLUSIONS: NeuroVirtual 3D is able to record external and internal (e.g., coordinates, keys-press, timestamp) data with a millisecond precision, representing de facto the most advanced technology for experimental psychology using virtual environments available without the needs to program code.

Prospective Psychosocial Predictors of Onset and Cessation of Eating Pathology amongst College Women.

The course of college women's eating pathology is variable. Little is known about psychosocial factors prospectively predicting maintenance/cessation or the new onset of clinically significant disordered eating symptoms. This study aimed to address these research gaps. College women (N = 2202) completed an assessment of eating pathology and potential risk/maintenance factors at two time points, 9 months apart. Logistic regression models indicated that elevated body dissatisfaction, thin-ideal internalization, self-objectification, negative affectivity and lower self-esteem at baseline predicted 'onset' of clinically significant disordered eating symptomatology at follow-up. Greater self-esteem and lower initial levels on the remaining risk factors predicted subsequent 'cessation' of clinically significant disordered eating symptoms. Self-objectification had greater explanatory value with regard to 'cessation' and 'onset' relative to the remaining traditionally accepted factors that demonstrated half as much predictive power or less. Practical implications are discussed.

How different spatial representations interact in virtual environments: the role of mental frame syncing.

This experiment is aimed at understanding how egocentric experiences, allocentric viewpoint-dependent representations, and allocentric viewpoint-independent representations interact when encoding and retrieving a spatial environment. Although several cognitive theories have highlighted the interaction between reference frames, it is less clear about the role of a real-time presentation of allocentric viewpoint-dependent representation on the spatial organization of information. Sixty participants were asked to navigate in two virtual cities to memorize the position of one hidden object. Half of the participants had the possibility to visualize the virtual city with an interactive aerial view. Then, they were required to find the position of the object in three different experimental conditions ("retrieval with an interactive aerial view" vs. "retrieval on a map" vs. "retrieval without an interactive aerial view"). Results revealed that participants were significantly more precise in retrieving the position of the object when immersed in an egocentric experience with the interactive aerial view. The retrieval of spatial information is facilitated by the presence of the interactive aerial view of the city, since it provides a real-time allocentric viewpoint-dependent representation. More participants with high preference for using cardinal points tend to be more accurate when they were asked to retrieve the position of the object on the map. As suggested by the mental frame syncing hypothesis, the presence of an allocentric viewpoint-dependent representation during the retrieval seems to ease the imposition on a specific viewpoint on the stored abstract allocentric viewpoint-independent representation. Our findings represent another significant step toward the comprehension of the organization of spatial representations of our environment.