Virtual reality in psychotherapy: review.

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

Consequences of brain tumour resection on emotion recognition

Emotion processing impairments are common in patients undergoing brain surgery for fronto-temporal tumour resection, with potential consequences on social interactions. However, evidence is controversial concerning side and site of lesions causing such deficits. This study investigates visual and auditory emotion recognition in brain tumour patients with the aim of clarifying which lesion sites are related to impairments in emotion processing from different modalities. Thirty-four patients were evaluated, before and after surgery, on facial expression and emotional prosody recognition; voxel-based lesion–symptom mapping (VLSM) analyses were performed on patients’ post-surgery MRI images. Results showed that patients’ performance decreased after surgery in both visual and auditory modalities, but, in general, recovered 3 months after surgery. In facial expression recognition, left brain-damaged patients showed greater post-surgery deterioration than right brain-damaged ones, whose performance specifically decreased for sadness and fear. VLSM analysis revealed two segregated areas in the left hemisphere accounting for post-surgery scores for happy (fronto-temporo-insular region) and surprised (middle frontal gyrus and inferior fronto-occipital fasciculus) facial expressions. Our findings demonstrate that surgical removal of tumours in the fronto-temporal region produces impairment in facial emotion recognition with an overall recovery at 3 months, suggesting a partially different representation of positive and negative emotions in the left and right hemispheres for visually – but not auditory – presented emotions; moreover, we show that deficits in specific expression recognition are associated with discrete lesion locations.     

The layers of presence: a bio-cultural approach to understanding presence in natural and mediated environments.

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

Training with computer-supported motor imagery in post-stroke rehabilitation.

Converging lines of evidence suggest that motor imagery (the mental simulation of a motor act within working memory) is associated with subliminal activation of the motor system. This observation has led to the hypothesis that cortical activation during motor imagery may affect the acquisition of specific motor skills and help the recovery of motor function. In this paper, we describe a clinical protocol in which we use interactive tools to stimulate motor imagery in hemiplegic stroke patients, thereby helping them to recover lost motor function. The protocol consists of an inpatient and an outpatient phase, combining physical and mental practice. In the inpatient phase, patients are trained in a laboratory setting, using a custom-made interactive workbench (VR Mirror). After discharge, patients use a portable device to guide mental and physical practice in a home setting. The proposed strategy is based on the hypotheses that: (a) combined physical and mental practice can make a cost-effective contribution to the rehabilitation of stroke patients, (b) effective mental practice is not possible without some form of support, from a therapist (as in our inpatient phase) or from technology (as in the outpatient phase), (c) the inclusion of an outpatient phase will allow the patient to practice more often than would otherwise be possible, therefore increasing the speed and/or effectiveness of learning, and (d) the use of interactive technology will reduce the patient's need for skilled support, therefore improving the cost-effectiveness of training.     

Application of a family systems approach to working with people affected by HIV disease – two case studies

HIV infection, with its particular modes of transmission, affects relationships, interrupts the normal life-cycle and brings different challenges to patients and their contacts as they pass through the asymptomatic and symptomatic phases to the terminal stages of illness. This paper describes a family systems approach to therapy with people affected by HIV disease, illustrated by two case examples.     

Counselling children and adults about AIDS/HIV: The ripple effect on haemophilia care settings

Haemophilia and HIV/AIDS are life-long, life-threatening conditions for which there is treatment but no cure. Both affect not only the patient but all members of the family. This paper focusses on how the counselling of those with AIDS/HIV has been affected by dilemmas such as treatment, infectious aspects, blood donation, sex, the media and having children. The impact of haemophilia and AIDS on the family and the ripple effect on health care staff is addressed.     

Complementarity in relationships of couples affected by HIV

Psychological interventions with patients with HIV infection may affect the stability of the patient's relationship with others. Two clinical cases are described to illustrate this. Both the impact of AIDS on patients and their relationships, and the impact of psychological interventions on the index patient and others, should always be considered when HIV-infected patients are referred to psychiatrists and other mental health care workers.     

A systems approach to AIDS counselling

The initial tasks of a systemic AIDS Counsellor in accepting a referral are described. These include: (a) describing the context of the problem; (b) obtaining a clear definition of the problem; (c) responding to changing views of the problem over time; and (d) identifying whom the problem affects. Failure to consider these issues can give rise to extraneous difficulties in counselling sessions,