Influence of cognitive stance and physical perspective on subjective and autonomic reactivity to observed pain and pleasure: An immersive virtual reality study

Protocol of the study for predicting empathy during VR sessions using sensor data and machine learning

Virtual reality (VR) technology is often referred to as the 'ultimate empathy machine' due to its capability to immerse users in alternate perspectives and environments beyond their immediate physical reality. In this study, participants will be immersed in 3-dimensional 360° VR videos where actors express different emotions (sadness, happiness, anger, and anxiousness). The primary objective is to investigate the potential relationship between participants' empathy levels and the changes in their physiological attributes. The empathy levels will be self-reported with questionnaires, and physiological attributes will be measured using different sensors. The main outcome of the study will be a machine learning model to predict a person's empathy level based on their physiological responses while watching VR videos. Despite the existence of established methodologies and metrics in research and clinical domains, our aim is to contribute to addressing the gap of a universally accepted "gold standard" for assessing empathy. Additionally, we expect to deepen our understanding of the relationship between different emotions and psychological attributes, gender differences in empathy, and the impact of narrative context on empathic responses.

Topographic mapping of the sensorimotor qualities of empathic reactivity: A psychophysiological study in people with spinal cord injuries

The experience of empathy for pain is underpinned by sensorimotor and affective dimensions which, although interconnected, are at least in part behaviorally and neurally distinct. Spinal cord injuries (SCI) induce a massive, below-lesion level, sensorimotor body-brain disconnection. This condition may make it possible to test whether sensorimotor deprivation alters specific dimensions of empathic reactivity to observed pain. To explore this issue, we asked SCI people with paraplegia and healthy controls to observe videos of painful or neutral stimuli administered to a hand (intact) or a foot (deafferented). The stimuli were displayed by means of a virtual reality set-up and seen from a first person (1PP) or third person (3PP) visual perspective. A number of measures were recorded ranging from explicit behaviors like explicit verbal reports on the videos, to implicit measures of muscular activity (like EMG from the corrugator and zygomatic muscles that may represent a proxy of sensorimotor empathy) and of autonomic reactivity (like the electrodermal response and Respiratory Sinus Arrhythmia that may represent a general proxy of affective empathy). While no across group differences in explicit verbal reports about the pain stimuli were found, SCI people exhibited reduced facial muscle reactivity to the stimuli applied to the foot (but not the hand) seen from the 1PP. Tellingly, the corrugator activity correlated with SCI participants' neuropathic pain. There were no across group differences in autonomic reactivity suggesting that SCI lesions may affect sensorimotor dimensions connected to empathy for pain.

Development and validation of a pictographic assessment embodiment scale

Embodiment is a complex concept related to the subjective perception of an object as it belongs to its own body. In general, this construct has been evaluated by means of questionnaires, but validation studies in other cultures and limitations related with barriers of language received little attention. The purpose of the present investigation was twofold: to validate the factorial structure of embodiment questionnaire (EQ) and to construct a pictographic scale (PAE) to measure embodiment without relapse verbal representations. In the first experiment, 136 participants underwent a Rubber Hand Illusion (RHI) procedure following both congruent and incongruent (control) visuo-tactile stimulations. Then, they evaluated embodiment illusion in EQ using a Likert-type scale to rate their agreement or disagreement with 27 statements and with a pictographic scale designed to assess their subjective experience of the illusion. Principal components analysis in EQ scores identified four components that emerged in both conditions: Embodiment, Disembodiment, Affect and Deafference. PAE scale was highly correlated with embodiment factor and can differentiate between conditions. In a second experiment, 30 participants underwent the RHI procedure, and they were assessed using PAE and proprioceptive drift. Results indicate a high positive correlation between PAE and post-illusion drift score. These results provide evidence about the consistency of the factorial structure of EQ across cultures, and we also provide a new pictographic tool that allows quick measurement of embodiment overcoming language barriers.

Visual perspective and body ownership modulate vicarious pain and touch: A systematic review

We conducted a systematic review investigating the influence of visual perspective and body ownership (BO) on vicarious brain resonance and vicarious sensations during the observation of pain and touch. Indeed, the way in which brain reactivity and the phenomenological experience can be modulated by blurring the bodily boundaries of self-other distinction is still unclear. We screened Scopus and WebOfScience, and identified 31 articles, published from 2000 to 2022. Results show that assuming an egocentric perspective enhances vicarious resonance and vicarious sensations. Studies on synaesthetes suggest that vicarious conscious experiences are associated with an increased tendency to embody fake body parts, even in the absence of congruent multisensory stimulation. Moreover, immersive virtual reality studies show that the type of embodied virtual body can affect high-order sensations such as appropriateness, unpleasantness, and erogeneity, associated with the touched body part and the toucher's social identity. We conclude that perspective plays a key role in the resonance with others' pain and touch, and full-BO over virtual avatars allows investigation of complex aspects of pain and touch perception which would not be possible in reality.

Whose emotion is it? Perspective matters to understand brain-body interactions in emotions

Feeling happy, or judging whether someone else is feeling happy are two distinct facets of emotions that nevertheless rely on similar physiological and neural activity. Differentiating between these two states, also called Self/Other distinction, is an essential aspect of empathy, but how exactly is it implemented? In non-emotional cognition, the transient neural response evoked at each heartbeat, or heartbeat evoked response (HER), indexes the self and signals Self/Other distinction. Here, using electroencephalography (n = 32), we probe whether HERs' role in Self/Other distinction extends also to emotion - a domain where brain-body interactions are particularly relevant. We asked participants to rate independently validated affective scenes, reporting either their own emotion (Self) or the emotion expressed by people in the scene (Other). During the visual cue indicating to adopt the Self or Other perspective, before the affective scene, HERs distinguished between the two conditions, in visual cortices as well as in the right frontal operculum. Physiological reactivity (facial electromyogram, skin conductance, heart rate) during affective scene co-varied as expected with valence and arousal ratings, but also with the Self- or Other- perspective adopted. Finally, HERs contributed to the subjective experience of valence in the Self condition, in addition to and independently from physiological reactivity. We thus show that HERs represent a trans-domain marker of Self/Other distinction, here specifically contributing to experienced valence. We propose that HERs represent a form of evidence related to the 'I' part of the judgement 'To which extent do I feel happy'. The 'I' related evidence would be combined with the affective evidence collected during affective scene presentation, accounting at least partly for the difference between feeling an emotion and identifying it in someone else.

Combined EEG and immersive virtual reality unveil dopaminergic modulation of error monitoring in Parkinson's Disease

Detecting errors in your own and others' actions is associated with discrepancies between intended and expected outcomes. The processing of salient events is associated with dopamine release, the balance of which is altered in Parkinson's disease (PD). Errors in observed actions trigger various electrocortical indices (e.g. mid-frontal theta, error-related delta, and error positivity [oPe]). However, the impact of dopamine depletion to observed errors in the same individual remains unclear. Healthy controls (HCs) and PD patients observed ecological reach-to-grasp-a-glass actions performed by a virtual arm from a first-person perspective. PD patients were tested under their dopaminergic medication (on-condition) and after dopaminergic withdrawal (off-condition). Analyses of oPe, delta, and theta-power increases indicate that while the formers were elicited after incorrect vs. correct actions in all groups, the latter were observed in on-condition but altered in off-condition PD. Therefore, different EEG error signatures may index the activity of distinct mechanisms, and error-related theta power is selectively modulated by dopamine depletion. Our findings may facilitate discovering dopamine-related biomarkers for error-monitoring dysfunctions that may have crucial theoretical and clinical implications.

Embodying the avatar of an omnipotent agent modulates the perception of one's own abilities and enhances feelings of invulnerability

Immersive virtual reality can give people the illusion of owning artificial bodies (i.e., avatars) and controlling their actions. Tellingly, people appear to adhere to the newly embodied entities not just on the basis of physical traits but also behaving accordingly with the hallmarks of the represented characters. In two studies we pushed the limits of this process by testing if one's own sense of power could be affected by embodying the anthropomorphic representation of the Christian God, that is considered an omnipotent entity. A human Muscled and a Normotype avatar were used as controls. Results showed that participants embodying the God-avatar: (i) reacted to a threatening event compromising their physical safety by exhibiting a lower skin conductance response and heart rate deceleration compared to the Normotype-control avatar (Study 1); (ii) estimated they had more physical abilities compared to both the Normotype-control and the Muscled-control avatars (Study 2). Taken together, our findings suggest that embodying an omnipotent agent may exert an influence on people's perception of their own limits and capabilities, nourishing feelings of physical invulnerability and strength. Our study indicates that effectively embodying virtual role models may boost achievements and have translational implications in the field of empowerment.

The analgesic power of pleasant touch in individuals with chronic pain: Recent findings and new insights

This mini-review covers recent works on the study of pleasant touch in patients with chronic pain (CP) and its potential use as a treatment. While experiments have demonstrated that pleasant touch, through the activation of CT-afferents and the brain regions involved in its affective value, might reduce the unpleasantness and intensity of induced pain, the interaction between pleasant touch and CP remains under-examined. Some experiments show that CP might disrupt the positive aspects of receiving pleasant touch, while in other studies the perception of pleasantness is preserved. Moreover, only a few attempts have been made to test whether touch can have a modulatory effect on CP, but these results also remain inconclusive. Indeed, while one recent study demonstrated that CT-touch can diminish CP after a short stimulation, another study suggested that pleasant touch might not be sufficient. Future studies should further investigate the psychological and neural interplay between pleasant touch and CP. In the conclusion of this mini-review, we propose a new tool we have recently developed using immersive virtual reality (IVR).

Does Nice or Nasty Matter? The Intensity of Touch Modulates the Rubber Hand Illusion

Our sense of body ownership results from the ongoing integration of perceptual information coming from the different senses (i.e., multisensory integration). The Rubber Hand Illusion (RHI) has been extensively studied to investigate the malleability of body ownership through contrasting multisensory information. Indeed, during the RHI, stroking a visible rubber hand synchronously to participants’ hand hidden from sight generates the illusion of ownership of the rubber hand (embodiment) and the mis-location of participants’ hand as closer to the rubber hand (proprioceptive drift). It is well known that the RHI is optimally evoked by a pleasant stroking (affective) touch, but what of an unpleasant (painful) stroking touch – does hedonic valence matter? To this aim, participants repeated the RHI while receiving different types of touch: pleasant, painful, and neutral. Results showed, for the first time, that the subjective intensity of the tactile stimulation experienced across the different conditions modulates the strength of the proprioceptive drift. Notably, participants reported a stronger RHI (mis-placed body ownership) from stimulation rated as more intense and involving an interoceptive activation (pain and pleasantness vs. neutral). We propose that interoceptive information, regardless of the valence of the stimuli (positive or negative), are perceived as more intense and enhance, through the activation of the limbic system, multisensory integration. In the context of the RHI, this translates to a stronger illusion in terms of proprioceptive drift.

Emotion Regulation by Psychological Distance and Level of Abstraction: Two Meta-Analyses

Self-reflection is suggested to attenuate feelings, yet researchers disagree on whether adopting a distant or near perspective, or processing the experience abstractly or concretely, is more effective. Given the relationship between psychological distance and level of abstraction, we suggest the "construal-matching hypothesis": Psychological distance and abstraction differently influence emotion intensity, depending on whether the emotion's appraisal involves low-level or high-level construal. Two meta-analyses tested the effects of psychological distance (k = 230) and level-of-abstraction (k = 98) manipulations on emotional experience. A distant perspective attenuated emotional experience (g = 0.52) but with weaker effects for high-level (g = 0.29; for example, self-conscious emotions) than low-level emotions (g= 0.64; for example, basic emotions). Level of abstraction only attenuated the experience of low-level emotions (g = 0.2) and showed a reverse (nonsignificant) effect for high-level emotions (g = -0.13). These results highlight differences between distancing and level-of-abstraction manipulations and the importance of considering the type of emotion experienced in emotion regulation.

Wearing same- and opposite-sex virtual bodies and seeing them caressed in intimate areas

Immersive virtual reality enables people to undergo the experience of owning an artificial body and vicariously feeling tactile stimuli delivered to it. However, it is currently unknown how such experiences are modified by the sexual congruency between the human and the artificial agent. In two studies, heterosexual men (Experiment 1) and women (Experiment 2) embodied same-sex and opposite-sex avatars and were asked to evaluate the experience (e.g., pleasantness, erogeneity) of being touched on social or intimate areas of their virtual body by a male or female avatar. Electrocardiogram and galvanic skin response were also recorded. Moreover, participants' implicit and explicit gender biases were examined via a gender-potency implicit association test and the Ambivalent Sexism Inventory. When embodying a same-sex avatar, men and women rated caresses on intimate areas from an avatar of the opposite sex as more pleasant and erogenous. Conversely, body swap-that is, wearing an opposite-sex avatar-enhanced participants' perceptions of pleasantness and erogeneity for caresses on intimate areas from a same-sex toucher. This effect was stronger in men than in women. Furthermore, physiological correlates of enhanced processing of arousing stimuli predicted behavioural outcomes during the body swap illusion. Wearing an opposite-sex avatar affects one's own body representations and may have important implications on people's attitudes and implicit reactivity to touch-mediated interactions. Men seem more susceptible to this type of body swap illusion. Our paradigm may induce profound changes of cross-sex perspective-taking and provide novel tools for promoting empathy and comprehension of sex-related diversity.

Illusory Body Ownership Affects the Cortical Response to Vicarious Somatosensation

Fundamental human feelings such as body ownership (“this” body is “my” body) and vicariousness (first-person-like experience of events occurring to others) are based on multisensory integration. Behavioral links between body ownership and vicariousness have been shown, but the neural underpinnings remain largely unexplored. To fill this gap, we investigated the neural effects of altered body ownership on vicarious somatosensation. While recording functional brain imaging data, first, we altered participants’ body ownership by robotically delivering tactile stimulations (“tactile” stroking) in synchrony or not with videos of a virtual hand being brushed (“visual” stroking). Then, we manipulated vicarious somatosensation by showing videos of the virtual hand being touched by a syringe’s plunger (touch) or needle (pain). Only after the alteration of body ownership (synchronous visuo-tactile stroking) and specifically during late epochs of vicarious somatosensation, vicarious pain was associated with lower activation in premotor and anterior cingulate cortices with respect to vicarious touch. At the methodological level, the present study highlights the importance of the neural response’s temporal evolution. At the theoretical level, it shows that the higher-level (cognitive) impact of a lower-level (sensory) body-related processing (visuo-tactile) is not limited to body ownership but also extends to other psychological body-related domains, such as vicarious somatosensation.

Addressing virtual reality misclassification: A hardware-based qualification matrix for virtual reality technology

Through its unique sensory synchronized design, virtual reality (VR) provides a convincing, user-centred experience of highly controllable scenarios. Importantly, VR is a promising modality for healthcare, where treatment efficacy has been recognized for a range of conditions. It is equally valuable across wider research disciplines. However, there is a lack of suitable criteria and consistent terminology with which to define VR technology. A considerable number of studies have misclassified VR hardware (e.g. defining laptops as VR), hindering validity and research comparisons. This review addresses these limitations and establishes a standardized VR qualification framework. As a result of a comprehensive theoretical and literature review, the hardware-based VR qualification matrix is proposed. The matrix criteria consist of (1) three-dimensional (3D) synchronized sensory stimulation; (2) degrees of freedom tracking; and (3) visual suppression of physical stimuli. To validate the model and quantify the current scale/diversity of VR misclassification, a 2019 sectional review of health-related studies was conducted. Of the 115 studies examined against standardized criteria, 35.7% utilized VR, 31.3% misclassified VR, 18.3% were considered quasi-VR, and 14.8% omitted critical specifications. The proposed model demonstrates good validity and reliability for qualifying and classifying VR. Key Practitioner Messages Virtual reality (VR) therapy has gained rapid empirical support, although many practitioners do not understand the difference between genuine and less-realistic VR variations. That has resulted from an evident lack of suitable criteria to define VR across a range of studies and protocols. Our proposed hardware-based virtual reality qualification matrix addresses issues to do with misclassification, via the introduction of standardised criteria. Applying the matrix to existing literature has revealed that more than 30% of VR studies use hardware that does not fit the high standards of rigour required for immersion in a simulated space. The model is a practical tool researchers and practitioners can use to quality and verify VR standards across research studies.

Owning a virtual body entails owning the value of its actions in a detection-of-deception procedure

The feeling of owning one's body underlies human self-awareness. Body-ownership illusions allow temporarily modulating body ownership, which has observable effects on the behavior and cognitive processes. However, the extent of those effects is unclear. Here, we investigated whether illusory ownership of a virtual body extended to ownership of the value/meaning of its actions. A variation of detection-of-deception procedure (Concealed Information Test) was performed by an embodied virtual avatar (first-person perspective, 1PP), or a non-embodied one (third-person perspective, 3PP), while the skin conductance responses (SCRs) were recorded from passively observing participants. Target stimuli (i.e., concealed information) evoked significantly larger SCRs than the neutral ones only when the avatar was embodied (in 1PP). Such pattern of SCR differences corresponds to that observed when participants perform the task themselves, thus suggesting that the sole experience of owning a virtual body can trigger physiological responses related to the subjective significance of the body's actions.

Interpersonal Motor Interactions Shape Multisensory Representations of the Peripersonal Space

This perspective review focuses on the proposal that predictive multisensory integration occurring in one's peripersonal space (PPS) supports individuals' ability to efficiently interact with others, and that integrating sensorimotor signals from the interacting partners leads to the emergence of a shared representation of the PPS. To support this proposal, we first introduce the features of body and PPS representations that are relevant for interpersonal motor interactions. Then, we highlight the role of action planning and execution on the dynamic expansion of the PPS. We continue by presenting evidence of PPS modulations after tool use and review studies suggesting that PPS expansions may be accounted for by Bayesian sensory filtering through predictive coding. In the central section, we describe how this conceptual framework can be used to explain the mechanisms through which the PPS may be modulated by the actions of our interaction partner, in order to facilitate interpersonal coordination. Last, we discuss how this proposal may support recent evidence concerning PPS rigidity in Autism Spectrum Disorder (ASD) and its possible relationship with ASD individuals' difficulties during interpersonal coordination. Future studies will need to clarify the mechanisms and neural underpinning of these dynamic, interpersonal modulations of the PPS.

Doing it Wrong: A Systematic Review on Electrocortical and Behavioral Correlates of Error Monitoring in Patients with Neurological Disorders

Detecting errors in one's own and other's actions is a crucial ability for learning and adapting behavior to everchanging, highly volatile environments. Studies in healthy people demonstrate that monitoring errors in one's own and others' actions are underpinned by specific neural systems that are dysfunctional in a variety of neurological disorders. In this review, we first briefly discuss the main findings concerning error detection and error awareness in healthy subjects, the current theoretical models, and the tasks usually applied to investigate these processes. Then, we report a systematic search for evidence of dysfunctional error monitoring among neurological populations (basal ganglia, neurodegenerative, white-matter diseases and acquired brain injury). In particular, we examine electrophysiological and behavioral evidence for specific alterations of error processing in neurological disorders. Error-related negativity (ERN) amplitude were reduced in most (although not all) neurological patient groups, whereas Positivity Error (Pe) amplitude appeared not to be affected in most patient groups. Also theta activity was reduced in some neurological groups, but consistent evidence on the oscillatory activity has not been provided thus far. Behaviorally, we did not observe relevant patterns of pronounced dysfunctional (post-) error processing. Finally, we discuss limitations of the existing literature, conclusive points, open questions and new possible methodological approaches for clinical studies.

Heterosexual, gay, and lesbian people's reactivity to virtual caresses on their embodied avatars' taboo zones

Embodying an artificial agent through immersive virtual reality (IVR) may lead to feeling vicariously somatosensory stimuli on one's body which are in fact never delivered. To explore whether vicarious touch in IVR reflects the basic individual and social features of real-life interpersonal interactions we tested heterosexual men/women and gay men/lesbian women reacting subjectively and physiologically to the observation of a gender-matched virtual body being touched on intimate taboo zones (like genitalia) by male and female avatars. All participants rated as most erogenous caresses on their embodied avatar taboo zones. Crucially, heterosexual men/women and gay men/lesbian women rated as most erogenous taboo touches delivered by their opposite and same gender avatar, respectively. Skin conductance was maximal when taboo touches were delivered by female avatars. Our study shows that IVR may trigger realistic experiences and ultimately allow the direct exploration of sensitive societal and individual issues that can otherwise be explored only through imagination.

Visual similarity and psychological closeness are neurally dissociable in the brain response to vicarious pain

Personal and vicarious experience of pain activate partially overlapping brain networks. This brain activity is further modulated by low- and high-order factors, e.g., the perceived intensity of the model's pain and the model's similarity with the onlooker, respectively. We investigated which specific aspect of similarity modulates such empathic reactivity, focusing on the potential differentiation between visual similarity and psychological closeness between the onlooker and different types of models. To this aim, we recorded fMRI data in neurotypical participants who observed painful and tactile stimuli delivered to an adult human hand, a baby human hand, a puppy dog paw, and an anthropomorphic robotic hand. The interaction between type of vicarious experience (pain, touch) and nature of model (adult, baby, dog, robot) showed that the right supramarginal gyrus (rSMG) was selectively active for visual similarity (more active during vicarious pain for the adult and baby models), while the anterior cingulate cortex (ACC) was more sensitive to psychological closeness (specifically linked to vicarious pain for the baby model). These findings indicate that visual similarity and psychological closeness between onlooker and model differentially affect the activity of brain regions specifically implied in encoding interindividual sharing of sensorimotor and affective aspects of vicarious pain, respectively.

Visual appearance of the virtual hand affects embodiment in the virtual hand illusion

Body ownership (the feeling that one’s body belongs to oneself) is commonly studied with Rubber hand illusion (RHI) paradigm that allows inducing a temporary illusory feeling of ownership of a life-sized rubber hand. However, it remains unclear whether illusory ownership of the fake hand relies on the same mechanisms as ownership of one’s own real hand. Here, we directly compared ownership of the own hand (OH) and fake hand (FH) in the same set of conditions within immersive virtual reality. We obtained behavioral (proprioceptive drift) and subjective (questionnaire) measures of ownership and disownership for virtual OH, FH and object (Obj) that were located congruently or incongruently with the participant’s real hand and were stimulated synchronously or asynchronously with the real hand. Both OH and FH (but not Obj) were embodied after synchronous stimulation in both locations. Crucially, subjective ownership of the OH was stronger than of the FH in congruent location after synchronous stimulation. It was also present after asynchronous stimulation, being stronger when the virtual OH was subjectively more similar to the real hand. The results suggest that the detailed appearance of the body might act as an additional component in the construction of body ownership.

Cognitive Processes Unfold in a Social Context: A Review and Extension of Social Baseline Theory

Psychologists often assume that social and cognitive processes operate independently, an assumption that prompts research into how social context influences cognitive processes. We propose that social and cognitive processes are not necessarily separate, and that social context is innate to resource dependent cognitive processes. We review the research supporting social baseline theory, which argues that our default state in physiological, cognitive, and neural processing is to incorporate the relative costs and benefits of acting in our social environment. The review extends social baseline theory by applying social baseline theory to basic cognitive processes such as vision, memory, and attention, incorporating individual differences into the theory, reviewing environmental influences on social baselines, and exploring the dynamic effects of social interactions. The theoretical and methodological implications of social baseline theory are discussed, and future research endeavors into social cognition should consider that cognitive processes are situated within our social environments.

Midline frontal and occipito-temporal activity during error monitoring in dyadic motor interactions

Discrepancies between sensory predictions and action outcome are at the base of error coding. However, these phenomena have mainly been studied focussing on individual performance. Here, we explored EEG responses to motor prediction errors during a human-avatar interaction and show that Theta/Alpha activity of the frontal error-monitoring system works in phase with activity of the occipito-temporal node of the action observation network. Our motor interaction paradigm required healthy individuals to synchronize their reach-to-grasp movements with those of a virtual partner in conditions that did (Interactive) or did not require (Cued) movement prediction and adaptation to the partner's actions. Crucially, in 30% of the trials the virtual partner suddenly and unpredictably changed its movement trajectory thereby violating the human participant's expectation. These changes elicited error-related neuromarkers (ERN/Pe - Theta/Alpha modulations) over fronto-central electrodes during the Interactive condition. Source localization and connectivity analyses showed that the frontal Theta/Alpha activity induced by violations of the expected interactive movements was in phase with occipito-temporal Theta/Alpha activity. These results expand current knowledge about the neural correlates of on-line interpersonal motor interactions linking the frontal error-monitoring system to visual, body motion-related, responses.

Characterizing Body Image Distortion and Bodily Self-Plasticity in Anorexia Nervosa via Visuo-Tactile Stimulation in Virtual Reality

We combined virtual reality and multisensory bodily illusion with the aim to characterize and reduce the perceptual (body overestimation) and the cognitive-emotional (body dissatisfaction) components of body image distortion (BID) in anorexia nervosa (AN). For each participant (20 anorexics, 20 healthy controls) we built personalized avatars that reproduced their own body size, shape, and verisimilar increases and losses of their original weight. Body overestimation and dissatisfaction were measured by asking participants to choose the avatar that best resembled their real and ideal body. Results show higher body dissatisfaction in AN, caused by the desire of a thinner body, and no body-size overestimation. Interpersonal multisensory stimulation (IMS) was then applied on the avatar reproducing participant’s perceived body, and on the two avatars which reproduced increases and losses of 15% of it, all presented with a first-person perspective (1PP). Embodiment was stronger after synchronous IMS in both groups, but did not reduce BID in participants with AN. Interestingly, anorexics reported more negative emotions after embodying the fattest avatar, which scaled with symptoms severity. Overall, our findings suggest that the cognitive-emotional, more than the perceptual component of BID is severely altered in AN and that perspective (1PP vs. 3PP) from which a body is evaluated may play a crucial role. Future research and clinical trials might take advantage of virtual reality to reduce the emotional distress related to body dissatisfaction.

Hyperalgesia when observing pain-related images is a genuine bias in perception and enhances autonomic responses

Observing pain in others can enhance our own pain. Two aspects of this effect remain unknown or controversial: first, whether it depends on the 'painfulness' of the visual stimulus; second, whether it reflects a genuine bias in perception or rather a bias in the memory encoding of the percept. Pain ratings and vegetative skin responses were recorded while 21 healthy volunteers received electric nociceptive shocks under three experimental conditions: (i) observing a painful contact between the body and a harmful object; (ii) observing a non-painful body contact, (iii) observing a control scene where the body and the object are not in contact. Pain reports and vegetative responses were enhanced exclusively when the subjects observed a painful body contact. The effect on perception was immediate, abated 3 sec after the shock, and positively correlated with the magnitude of vegetative arousal. This suggests that (a) hyperalgesia during observation of painful scenes was induced by their pain-related nature, and not by the simple body contact, and (b) hyperalgesia emerged from a very rapid bias in the perceptual encoding of the stimulus, and was not the result of a retrospective bias in memory recollection. Observing pain-depicting scenes can modify the processing of concomitant somatic stimuli, increasing their arousal value and shifting perception toward more painful levels.

Virtual training leads to real acute physical, cognitive, and neural benefits on healthy adults: study protocol for a randomized controlled trial

BACKGROUND

Keeping a certain level of physical activity has beneficial effects on the body itself but also, surprisingly, on cognition: specifically, physical high-intensity intermittent aerobic exercise (HIE) can show improvement on cognitive executive functions. Although, in some cases performing strength or aerobic training is problematic or not feasible. Immersive virtual reality (IVR) can induce the illusory feeling of ownership and agency over a moving virtual body, therefore showing comparable physiological reactions: for example, if an individual is sitting on a chair but his virtual body climbs a hill, the individual's heart rate increases coherently, as if he is actually walking. In this study, we investigate whether this same illusion can show beneficial consequences on the body as well as on executive functions (using the color-word matching Stroop task) and on its neural substrates (using functional near-infrared spectroscopy [fNIRS]).

METHODS

In a cross-over randomized controlled trial, 30 healthy young adults will experience HIE training in IVR (i.e. the virtual body will perform eight sets of 30 s of running followed by 30 s of slow walking, while the participant is completely still) according to two random-ordered conditions: during the experimental condition, the virtual body is displayed in first-person perspective (1PP), while in the control condition, the virtual body is displayed in third-person perspective (3PP). To confirm that individuals have the illusion of ownership and agency over the virtual body in 1PP (and not in 3PP), we will record the heart rate, in addition to subjective questionnaires. Before and after every IVR sessions (one week apart), we will measure cortical hemodynamic changes in the participants' prefrontal cortex using the fNIRS device during the Stroop task's execution.

DISCUSSION

From a theoretical perspective, we could prove that the sense of body ownership and agency can modulate physical and cognitive parameters, even in the absence of actual movements; from a clinical perspective, these results could be useful to train cognition and body simultaneously, in a completely safe environment.

TRIAL REGISTRATION

University Hospital Medical Information Network Clinical Trial Registry, UMIN000034255 . Registered on 1 October 2018.