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Interreality for the treatment of psychological

stress in soldiers:
rationale and protocol of the INTERSTRESS
project
Andrea GAGGIOLIa,b1, Alessandra GORINIa, Brenda WIEDERHOLDc, Federica PALLAVICINI a,d, Simona
RASPELLIa, Davide ALGERIa and Giuseppe RIVAa,b
a
Istituto Auxologico Italiano IRCSS, Applied Technology for Neuro-Psychology Laboratory, Milan, Italy
b
Department of Psychology, Catholic University of Milan, Italy
c
Virtual Reality Medical Center, San Diego, CA, USA
d
University of Milano Bicocca, Italy

Abstract. The use of virtual reality is not new in the treatment of psychological stress and anxiety disorders:
virtual worlds are used to facilitate the activation of the stressful events during the exposure therapy.
However, during the therapy, the virtual worlds are new and distinct realms, separate from the real-life
emotions and behaviors. In fact, the patient’s behavior in the virtual world has no direct effects on his/her
real-life experience, and emotions and problems experienced by the patient in the real world are not directly
addressed in the virtual exposure. In this paper we present the INTERSTRESS project, a new technological
paradigm for the treatment of psychological stress in soldiers, based on interreality. The main feature of
interreality is a twofold link between the virtual and the real worlds: (a) behavior in the physical world
influences the experience in the virtual one; (b) behavior in the virtual world influences the experience in the
real one. This is achieved through 3D shared virtual worlds; biosensors and activity sensors (from the real to
the virtual world); and personal digital assistants and/or mobile phones (from the virtual world to the real one).
We will describe the different technologies involved in the interreality approach and the clinical rationale of
the protocol. To illustrate the concept of interreality in practice, a clinical scenario regarding a soldier affected
by acute psychological stress will be also presented and discussed.

Keywords. Psychological stress, virtual worlds, interreality, battlefield stress.

Introduction

The INTERSTRESS project intends to design, develop and test an advanced ICT (Information and
Communication Technology) based solution for the assessment and treatment of psychological stress
occurring in soldiers. According to JAMA [1] psychological stress occurs when an individual perceives that
environmental demands tax or exceed his or her adaptive capacity. Stressful experiences are conceptualized
as person-environment transactions, whose result is dependent on the impact of the external stimulus on the
individual. This process is mediated by:
- the person’s appraisal of the stimulus: when faced with a stimulus, the subject evaluates its potential
threat (primary appraisal) establishing if it is stressful, positive, controllable, challenging or irrelevant.

1
Corresponding Author: Istituto Auxologico Italiano IRCSS, Applied Technology for Neuro-Psychology Laboratory. Via Pellizza
da Volpedo, 41, 20149 Milan, Italy; E-mail: andrea.gaggioli@auxologico.it.
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- the personal, social and cultural resources available: facing a significant stimulus, the second appraisal
follows, which is an assessment of the individual’s coping resources and options. Secondary appraisals
address what one can do about a specific situation.
- the efficacy of the coping efforts: if required by the appraisal process the individual starts a problem
management phase aimed at regulation of the external stimulus.
Stressful events can vary in a number of ways: duration, severity, predictability, degree of loss of
control, self-confidence of the person experiencing the stress, and suddenness of onset. Accidents, natural
disasters, and military combat can cause high levels of stress and may result in a stress disorder. Stress may
also be the result of a personal crisis, such as being raped or bereaved. Stress disorders that require clinical
attention - adjustment disorders, acute stress disorder, and post traumatic stress disorder (PTSD) - are
pathological because they go beyond expected, normal emotional and cognitive reactions to severe personal
challenges. In the adjustment disorder, a recent increase in life stress precedes what is usually a temporary
maladaptive reaction. In the acute stress disorder and PTSD, changes in behavior, thought, and emotion are
linked to an extremely traumatic stressor. Stressful events can influence the pathogenesis of physical diseases
by causing negative affective states (e.g., feelings of anxiety and depression), which in turn exert direct
effects on biological processes or behavioral patterns that influence disease risk. The way in which people
cope with stress depends on their vulnerability and resilience. Vulnerability increases the likelihood of a
maladaptive response to stress; resilience decreases it. Having a positive self-concept, enjoying new
experiences, and having good interpersonal relationships contribute to resilience.
Today, most clinicians recognize the need for more research on treatments of the stress-related
disorders. They also acknowledge the need to treat stress-related disorders with a combination of the
following components:
• acceptance of what the individual is going through;
• education and training regarding useful coping responses to stressors;
• overcoming fear of trauma-related memories;
• cognitive restructuring (e.g., questioning and revising trauma-related schemas).
According to the Cochrane Database of Systematic Reviews [2; 3; 4], the best validated approach
covering both stress management and stress treatment is the Cognitive Behavioral Therapy (CBT) approach.
This approach may include both individual and structured group interventions (10 to 15 sessions) interwoven
with didactics. It also includes in-session didactic materials and experiential exercises (learning to cope with
daily stressors (psychological stress) or traumatic events (PTSD), and optimizing one's use of personal and
social resources) and out-of-session assignments (practicing relaxation exercises and monitoring stress
responses). The CBT approaches also:
- use group members and group leaders as role models (for positive social comparisons and social
support);
- encourage emotional expression;
- replace doubt appraisals with a sense of confidence by means of cognitive restructuring;
- hone skills in anxiety reduction (by progressive muscle relaxation or diaphragmatic breathing and
relaxing imagery), interpersonal conflict resolution, and emotional expression (by means of assertion
training).
The CBT package thus includes both problem-focused (e.g., resource optimization and better planning)
and emotion-focused (e.g., relaxation training, use of emotional support) coping strategies. Even if CBT is
the best validated approach for the treatment of stress, further clinical research is needed to tune existing
protocols and fully exploit its clinical potential. As suggested by Cohen and colleague in their JAMA review
[1]: “The development of interventions that can reduce the behavioral and biological sequelae of
psychological stress and the demonstrated efficacy of such interventions in randomized clinical trials would
provide critical data on the clinical importance of this work”.
Another critical point is that, because stress-related problems stem from a wide variety of stressors, the
selection of an appropriate treatment depends on a number of factors associated with the way in which
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individuals experiencing their own difficulties. The main challenge in treating stress is that it is a very
personal experience. For these reasons the focus for assessment, prediction and treatment has to be the
situated experience of the patient.

1.1. The Project Objectives

The main aim of the INTERSTRESS project is to develop a completely new concept for the treatment of
psychological stress defined interreality. This innovative approach combines CBT with a hybrid, closed-loop
empowering experience bridging real and virtual worlds.
From the technological point of view interreality is based on the below devices/platforms:
• 3D individual and/or shared virtual worlds (3DWs) aimed to provide objective assessments and
provision of motivating feedback. They will be immersive (in the health care centre) or non-immersive (at
home) role-playing experiences in which one or more users mutually interact through their avatars. 3DWs
provide an advanced social network service combined with the general aspects of fully immersive 3D virtual
spaces. Residents can explore the worlds, meet other users, socialize, and participate in individual and group
activities;
• personal biomonitoring system (PBS) that connects the real world to the virtual one allowing objective
and quantitative assessment and decision support for treatment. Typically 3DWs are closed worlds that do
not reflect the real activities and the status of their users. In interreality, instead, the PBS is used to track the
emotional/health status of the user and to influence his/her experience in the virtual world (aspect, activity
and access). Data coming from the PBS will be integrated by a data fusion module and analyzed by a
Decision Support System. The PBS will consist of independent lycra-based wearable bands for the
examination of the physiological and behavioral signs. In this way the link between the real and the virtual
worlds will be both in real-time - allowing the development of advanced dynamic biofeedback settings - or
not, to ensure health tracking also in situations where an Internet connection is not immediately available;
• personal digital assistants (PDAs) and/or mobile phones that connect the virtual world with the real one
giving an objective assessment and provision of warnings and motivating feedbacks. As explained before,
virtual worlds are closed and have not a direct impact on the real life of the user. On the contrary, in the
interreality paradigm, the social and individual user activity in the virtual world has a direct link with the
users’ life through a mobile phone/digital assistant. The clinical use of these technologies in the interreality
paradigm is based on a closed-loop concept that involves the use of technology for assessing, adjusting
and/or modulating the emotional regulation of the patient, his/her coping skills and appraisal of the
environment (both virtual, under the control of a clinician, and real, facing actual stimuli) based on a
comparison of the patient’s behavioral and his/her physiological responses with a baseline (Figure 1).
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Figure 1. The INTERSTRESS subsystem

These devices are integrated around two subsystems: the clinical platform (used for the inpatient
treatment, and fully controlled by the therapist) and the personal mobile platform (the real world support,
available to the patient and connected to the therapist) that allow to:
a. monitor the patient behavior and his/her general and psychological status, through an early detection
of symptoms of critical evolutions and a timely activation of the appropriate feedback;
b. monitor the response of the patient to the treatment, supporting the doctors in their therapeutic
decisions.
In conclusion, in the INTERSTRESS approach, behaviors in the physical world influences the
experience in the virtual world, and behaviors in the virtual world influences the experience in the real
world.
More in details, the specific objectives of the project are the following:

• Objective 1: to design, develop and test an advanced ICT based solution for the diagnosis and
treatment of psychological stress.
Actual CBT approach can be crudely described as “imagining evokes emotions and the meaning of the
associated feelings can be changed through reflection and relaxation”. The interreality-based approach
suggests the following alternative: “controlled experience evokes emotions that result in meaningful new
feelings which can be reflected upon and eventually changed through reflection and relaxation” (Figure 2).
On one side, the assessment will be conducted continuously in the virtual and real worlds tracking the
individuals’ behavioral and emotional status over time in the context of realistic task challenges. On the other
side, the information will be constantly used to improve both the appraisal and the coping skills of the patient
through a conditioned association between the effective performance state and the task execution behaviors.
The clinical platform and the personal mobile platform will provide:
- an objective and quantitative assessment of symptoms obtained by biosensors and behavioral analysis:
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monitoring the patient’s behavior and his/her psychological status, the system will provide an early detection
of symptoms and a timely activation of feedback in a closed loop approach;
- a decision support for treatment planning through data fusion and detection algorithms that monitor the
patient’s response to the treatment, supporting the doctors in their therapeutic decisions;
- a provision of warnings and motivating feedback to improve the compliance and the long-term
outcome: the “sense of presence” provided by this approach affords the opportunity to deliver behavioral,
emotional and physiological self-regulation training in an entertaining and motivating way.

Figure 2. The interaction between real and virtual worlds

• Objective 2: to obtain an objective and quantitative assessment of psychological stress symptoms.

a) Using biosensors and behavioral analysis. A wireless Personal Biomonitoring System (PBS) will
collect, fuse, analyze, and visualize data originating from various sensors integrated to different service
infrastructures. Specifically, the PBS will unobtrusively perform an ecological tracking of full body motion
through a 3D wearable motion analysis platform that integrate the heart rate variability (HRV), the
electrodermal response (EDR) and the peripheral temperature, as well as the EEG. Stressful event
recognition is the most challenging goal since it involves going from raw signals to events related to the
user’s behavior, physical state, mental state, context, communication with others, etc. Algorithms will be
developed for the detection and recognition of specific trigger events/ external stimuli that have
discriminating potential and may be used by a decision support system for treatment planning and
contextualized guidelines and provisions.
b) Identifying new biomarkers for the evaluation of the interreality therapeutic outcome. These
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biomarkers can be measured in blood and/or spittle using existing technologies.

• Objective 3: to design and develop a decision support system for treatment planning through data
fusion and detection algorithms.
The decision support system will be trained:
- by the therapist, using the patient’s responses in the virtual environments;
- by the patient, by pressing a “stress” button in the real world context.
In the therapist’s office, the system will collect data from different sensors during the virtual reality
experience and will integrate them using a data fusion technique to facilitate the assessment process. These
data will be used by the therapist to initially train the decision support system. On the other side, in the real
world setting, the system will provide contextualized support using advice (warnings and feedback) and
exercises (homework). The patient will train the decision support system by pressing a “stress” button. This
involves also the development of a flexible, scalable, context-aware, secure, and resilient architecture and
technologies to enable dynamic management policies that ensure end-to-end secure transmission of data
across heterogeneous local infrastructures and networks, including dynamic networks of tiny insecure sensor
devices.

• Objective 4: to test the new interreality paradigm based on a dual-change closed-loop approach.
How is it possible to change a patient? Even if this questions has many different answers, in general change
comes through an intense focus on a particular instance or experience [5]: by exploring it as much as
possible, the patient can relive all of the significant elements associated with it (i.e., conceptual, emotional,
motivational, and behavioral) and make them available for a reorganization.
Within this general model we have the insight-based approach of psychoanalysis, the schema-
reorganization goals of cognitive therapy or the enhancement of experience awareness in experiential
therapies. According to Safran and Greenberg [6], behind each specific therapeutic approach we can find two
different models of change: bottom-up and top-down (Figure 3). These two models of change are focused on
two different cognitive systems, one for information transmission (top-down) and the other for conscious
experience (bottom-up), both of which may process sensory inputs. Even if many therapeutic approaches are
based on just one of the two change models, a therapist usually requires both. Our claim is that bridging
virtual experiences – fully controlled by the therapist, used to learn coping skills and emotional regulation -
with real experiences – that allows both the identification of any critical stressors and the assessment of what
has been learned – using advanced technologies (virtual worlds, biosensors and advanced PDA/mobile
phones) is the best way to address both these two change models.
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Figure 3. The Top-Down and Bottom-Up approaches to clinical change

The INTERSTRESS project is interested in validating this approach in the real clinical setting related to
the battlefield stress giving: (i) an objective and quantitative assessment of symptoms using biosensors and
behavioral analysis; (ii) a decision support system for treatment planning based on data fusion and detection
algorithms and (iii) warnings and motivating feedbacks to improve compliance and long-term outcome. To
our knowledge, this is the first attempt worldwide to use this approach in healthcare.

1.2. The Battlefield Stress: When Acute Stress Afflicts Soldiers

Battlefield stress is the consequence of man being exposed to the hostile environment of combat [7].
Combat stress is specifically caused by man's feat of the dangers of combat, and is fueled and tempered by
other variables such as morale, cohesion, fatigue, confidence, training and intensity of the combat. The
history shows that a stressed soldier may be a significant problem. In the battles of Faid-Kasserine, the first
major engagements of US forces in World War II, 20 to 34 percent of the casualties were caused not by
direct wounds and disease but by battlefield stress [8]. And the situation is not significantly changed. As
demonstrated recently by Morgan and colleagues [9], acute stress may impair working memory and visuo-
spatial ability even in elite soldiers. In their study, including 184 Special Operations warfighters, stress
exposure impaired visuo-spatial capacity and working memory of the sample, potentially reducing
performance of duty. For these reasons, stress management is a critical issue for the Army. The Field Manual
26-2 provides different techniques and consideration for the management of stress in the US Army operation
[10]. Specifically, it depicts three different and increasing levels of support (Stress Management Module)
based on installation resources:
- Level one: it is designed as a minimum program that includes placement of
pamphlets/brochures/posters around the military community, making sure that welcome packets are provided
to all new members and ensuring sponsorship of new arrivals;
- Level two: it includes level one plus community education classes (learning new skills and activities)
and the use of radio/TV spots;
- Level three: it includes level one and level two plus specific intervention programs conducted by
qualified health care professionals. These programs include, as the traditional CBT programs, relaxation
techniques, problem solving, cognitive restructuring and clarification of life goals.
The limitations of this approach is twofold. First, given the limited number of qualified professionals on
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the battlefield, treatment is often as simple as giving soldiers time to rest for a few hours or days, to get a
shower and some sleep, and to talk about the feelings they have in the presence of a counselor. Second, in the
civilian population there is a broad spectrum of techniques available; however, the available techniques are
much less when applied to the battlefield. Because the duration of stress and the intensity of the battle
usually also reduce imagination and relaxation abilities, the stress coping strategies requested in the military
context are even more challenging.
In the next paragraph we will suggest the application of the interreality paradigm for the provision of
advanced coping techniques for the treatment of an acute stress disorder occurred in a soldier involved in the
last conflict in Afghanistan.

1.3. The INTERSTRESS Project in Practice

The clinical scenario

Paolo is a 30-year-old Italian soldier. Four months ago he went to Afghanistan for a Peace Mission,
immediately after his girlfriend decided to interrupt their 5-year relationship. Ten days later his command
was involved in a terrible explosion and 5 of his comrade-in-arms died in front of his eyes. One of them was
also one of his best friend. He was immediately sent back home, but everybody closed to him noticed that he
was completely changed. In particular, Paolo had difficulty accepting the true reality that his girlfriend left
him and his best friend died. Furthermore, he was convinced he lost his job because he felt himself unable to
combat again. These events caused him to think he has lost two of the most important things of his life,
making him feel totally alone. Moreover, Paolo felt like no one can help him: their parents live far away
from him and his friends cannot understand. He though that “those who have not directly experienced such a
situation can never really understand it”.
What makes the situation even more difficult is the fact that Paolo believes his coping efforts were
ineffective: he believes he had no control over the situation and insufficient resources to cope with such it.
Paolo was exposed to a situation of chronic stress and was manifesting many of the difficulties associated
with psychological stress: indeed he appeared to have effectively dealt with previous stressors but not the
current one (Figure 4).
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Figure 4. A schematic view of the INTERSTRESS rationale

1.3.1 The applied protocol

Paolo will first need to accept what he is going through. This will require a cognitive restructuring
activity to allow for re-appraisal of the event followed by education and training regarding useful coping
responses to the type of stressors he is dealing with.
Considering the severity of the situation, the medical military staff decides to send Paolo a therapist.
When he arrives, the therapist welcomes him giving him an immediate sense of being less alone and makes
him begin to feel better.
After a short interview and some paper-and-pencil self-report questionnaires, the therapist decides to
apply the INTERSTRESS protocol. He helps Paolo to wear biosensors to monitor his physiological
parameters, explaining him how they work and beginning the education process. Then the therapist
introduces Paolo to the first virtual world, called the Experience Island (Figure 5) where he was
progressively exposed to a virtual traumatic situation similar to the one that he had experienced in
Afghanistan. Within this virtual environment Paolo had to walk in the city streets and to drive a military jeep
in different conditions (from a very safe condition to a very dangerous one). In the meantime the data fusion
system allows the therapist to directly index how the various stressors are impacting Paolo’s
neurophysiological reactions, thus providing an objective understanding of the different stressors and their
importance and impact on his well-being.
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At the end of the clinical session, the therapist “prescribes” Paolo some homework. This, the therapist
explains, will allow Paolo to be an active participant in his own well-being and to practice the skills he has
started to learn, thus making them become more readily available to him during real-life stressful situations.
The homework: First Paolo is asked to expose himself to the critical situation recorded in the virtual
world and displayed on her PDA. Then he must expose himself to the real world situation. In real world
situations, the biosensors will track his response, and the Decisions Support System, according to the
difference from his baseline profile, will provide positive feedback and /or warnings.
Finally the therapist explains Paolo that he can press a “stress” button in the PDA if he feels excessively
stressed: this will record the most critical experiences that will be discussed with the therapist in the next
face-to-face session. In this way the therapist will teach the patient how to effectively handle the future
situational stressors.
At the start of any new session, the therapist uses the compliance data and warning log to define the
structure of the clinical work. Also, the Decision Support System will analyze the stressful situations
indicated by Paolo to understand more what happened and the context in which they occurred.
By showing the patient what situations caused him the most physiological arousal, he often develop a
new awareness, that brings on added insight and allows for self-treatment to proceed more effectively.
Moreover, utilizing new skills and coping mechanisms taught by the therapist, the patient is able to employ
these skills prior to stress becoming overwhelming. This is where Virtual Worlds have an immensely
beneficial advantage.
In the following sessions, the virtual world is not only used for assessment but also for training and
education. Within the environment, Paolo has the opportunity to practice different coping mechanisms:
relaxation techniques, emotional/relational management and general decision-making and problem- solving
skills. For example, if Paolo’s real world outcome is poor (e.g., he can not do a task without feeling irritable
and impatient when his friends and relatives) he will experience again a similar experience in the virtual
environment and will be helped in developing specific strategies for coping with it. Later, in the relaxation
areas he will enjoy a relaxing environment and learn some relaxation procedures. As with any new skill, as
Paolo has the opportunity to practice the coping skills, they become second nature, and these new behaviors
replace the older, outdated behavior patterns which caused the initial overwhelming stress.
The therapist now prompts Paolo to visit another virtual world – the Learning Island. Within it, Paolo
learns how to improve his stress management skills and receives information about the main causes of stress
and about how to recognize its symptoms, to learn stress-management skills such as better planning, to learn
stress relieving exercises such as relaxation training and to get the information needed to succeed.
After some other sessions, the therapist invites Paolo to participate in a virtual community where he will
meet other patients who suffer of the same problem. Within this virtual world – called Community Island -
Paolo has the opportunity to discuss and share his experience with other users who may be facing a similar
situation.
However, sometimes Paolo experiences new critical situations that may raise his level of stress. For
example, he had to discuss with her boss in the morning and this left him feeling very upset during the rest of
the day. At the end of the work day, when he returned home he felt very excited/stressed and nervous and the
Decision Support System alerted him twice about this. Both the signals were sent also to the therapist who
appeared on his PDA display as an avatar suggesting Paolo to practice some of the acquired relaxation
techniques.
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Figure 5. The virtual worlds used in the interreality approach

Paolo is scheduled to see the therapist the next day. The therapist asks him if the avatar was helpful and
his answer is positive: the avatar gave him an emotional boost appearing in the exact moment he needed it
and suggesting him helpful relaxation techniques he had previously learned.
Then the therapist asks Paolo about the experienced difficulties. In particular, the therapist wants to get
information about where Paolo was: what he was doing and thinking, and what his reactions were. Paolo
relates all the information to the therapist: he was in his office and was quarrelling with a colleague, causing
his stress level to become higher. The information provided by Paolo is compared by the therapist with the
information provided by the Decision Support System. Any difference is explored and interpreted.
By working as a team, Paolo is taught a new skill of interpretation, and his therapist is more able to
understand any differences in his self-perception of stress and the objective measurements shown by the
DSS. This will help to more effectively individualize and guide future training and therapy sessions.
In the following sessions, Paolo tells the therapist that he feels better thanks to being able to frequently
experience stressful situations within safe virtual environments. He also says that meeting other people in the
community has helped him to find much-needed support and to discover new strategies to manage his
emotions. With regard to this, he also says the community experience has helped him with seeing the stressor
in a new perspective. Moreover, by listening to other’s experiences, he was facilitated in adopting new
coping skills.
The therapist helps Paolo to cognitively restructure the critical situation, which now he is more able to
deal with through the strategies he has learned. The last session ends with advice on the prevention of
relapse.
In general, the patient reports that this kind of highly personalized treatment is very useful because
allows to experience different stressful situations specifically related to his own traumatic experience in a
safe virtual environment. Paolo also reports that receiving correct information about the disorder and meeting
other people is useful for him to find the needed psychological support and to discover new strategies to
manage his negative emotions. Finally, having full-time support through the PDA increases his self-efficacy
and the benefit obtained from the therapy.
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1.4. Conclusion

In the last year virtual reality and virtual worlds have been extensively used to facilitate the activation of
certain emotions and to expose patients to specific critical events during the exposure phase of a CBT
protocol. However, the actual virtual reality-based CBT protocols for the treatment of anxiety related
disorders do not address the following issues:
1. Virtual worlds are new and distinct realms, separate from the emotions and behaviors experienced by
the patients in the real world;
2. The treatment protocol is not customized to the particular characteristics of the single patient.
3. CBT focuses on patients’ thoughts and behaviors but does not address relationship change and self-
efficacy.
On the contrary, the interreality protocol integrates the assessment and treatment within a hybrid
environment, bridging the physical and virtual worlds. The clinical use of interreality is based on a closed-
loop concept that involves the use of technology for assessing, adjusting, and/or modulating the emotional
regulation of the patient, his or her coping skills, and appraisal of the environment based on a comparison of
the patient’s behavioral and physiological responses with a training or performance criterion:
1. The assessment is conducted continuously throughout the virtual and real experiences.
2. The information is constantly used to improve both the emotional management and the coping skills
of the patient.
Finally, the idea to test the interreality protocol on the military members affected by anxiety disorders
caused by the excessive battlefield stress is perfectly in line with the “2006 Army Modernization Plan”, an
operationally based report that describe the modernization and investment strategies for providing the best
capabilities to the US Army, supporting a sustained transformation process [11] based on the use of the
emerging technologies.
In conclusion, although CBT focuses on directly modifying the content of dysfunctional thoughts
through a rational and deliberate process, interreality focuses on modifying an individual’s relationship with
his or her thinking through more contextualized experiential processes based on: an extended sense of
presence, an extended sense of community, and a real-time feedback between the physical and virtual
worlds. The proposed approach needs to be tested on a sample of patients before being considered a valid
solution for the treatment of anxiety disorder. This is what we will intend to do thanks to the recently funded
European project, INTERSTRESS—interreality in the management and treatment of stress-related disorders
(FP7-247685), that will offer the right context to test and tune the presented ideas.

Acknowledgments
This work was partially supported by the European-funded project ‘‘INTERSTRESS’’—Interreality in
the management and treatment of stress-related disorders (FP7-247685).

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