The goals of the project     The main objective of the project is to prove the technical and clinical viability of using Virtual Reality Therapy (VRT) in clinical psychology. Using VRT it is possible both to offer exposure therapy, the most effective form of behavioral therapy for many conditions, and to integrate it with other behavioural and cognitive methods in order to improve their effectiveness. Previous work (including work by some of the current partners) has shown that even relatively unsophisticated Virtual Reality tools can prove a valuable tool in psycho-neurological assessment and rehabilitation To date however the use of VR-technologies has been limited to single locations - typically hospital or rehabilitation centers. In theory new multiuser VR technologies (demonstrated in a number of European projects), combined with rapid increases in Internet bandwidth and performance and steep reductions in the cost of hardware and   software,make it possible to bring distributed VR environments directly to clients'     homes - thereby offering improved access for users who are inadequately served by current services. In order to achieve this goal it will first be necessary to overcome a number of clinical, ergonomic, technological and organizational challenges. VEPSY's main contribution to innovation will be to design, test and validate solutions to these challenges. In particular the project will provide both innovative tools (Telemedicine and Portable tools) for the treatment of patients, clinical trials to verify their viability and action plans for dissemination of its results to an Extended Audience (potential users and influential groups). In particular, VEPSY aims at:   a) designing and developing 4 clinical modules to be used with the Virtual Reality Modular System (VRMS) defined by two successful 4FP EC funded projects, coordinated by Partner 1.The selected disorders are: · panic disorder and   agoraphobia; · male impotence and premature ejaculation; · obesity, bulimia and     binge-eating disorders; · social phobia. To ensure the broadest user base, the developed modules will be available both as shared telemedicine tools available through Internet by using a plug-in for the most common browsers (Explorer and Navigator) and as portable tools based on Speed-Step notebook PCs (PIII, 128Mb Ram) This choice ensures wide availability, an open architecture and the possibility of benefiting from the improvements planned for these machine by INTEL, mainly faster processors and enhanced multimedia support. Both solutions will allow the support of end-users in their living environment. b) Defining new treatment protocols for the use of the clinical modules in assessment and therapy. In doing this the project will follow a User Centered Strategy - where feedback from individual users (and from groups representing users) will play a key role in driving the design and implementation process. c) Testing their efficacy at a scale of operation representing reality. In particular the project plans a 9-months Demonstration phase involving no less than 30 patients and a 15-months Validation phase involving no less than 240 patients from at least three different EC countries. d) Disseminating the obtained results to Extended Audience. Both clinicians and end users will be reached.     The possible advantages of the project       The advantages expected by this approach are: o Cost Effective: Many stimuli for exposure are difficult to arrange or control, and when exposure is conducted outside of the therapist's office, it becomes more expensive in terms of time and money. The ability to conduct exposures of virtual airplanes for flying phobics or virtual highways for driving phobics, for example, without leaving the therapist's office would make better treatment available to more sufferers at a lower cost. o Effective Therapy: In addition to cost reduction, VR therapy offers innovative treatment alternatives for patients. Like in vivo therapy, VRT can provide stimuli for patients who can not imagine well. Unlike therapists assisted by in vivo techniques, VRT will be performed within the confines of a room, thus avoiding public embarrassment and violation of patient confidentiality. Virtual environments have the great advantage of giving the therapist greater control over multiple stimulus parameters as well as the ability to isolate the specific parameters that determine the phobic response. VRT therapy could also be used as an intermediate step in preparing patients for maintenance therapy involving self-directed in vivo exposure. o Patient Acceptance: As reported by previous researchers a consistent theme amongst people who suffer from psychological disturbances has been that they would be much more willing to undergo exposure therapy in a virtual environment than in a real physical environment. · Telemedicine Applications: Virtual reality therapy is appropriate for networked delivery of clinical psychology and psychiatry services to remote locations. Since the patient is receiving therapy within a virtual environment, the clinician conducting the therapy session could be present physically or participate via computer networks from a remote location. In particular using VRML, a standard based on the Internet, is possible to offer a low cost treatment also in remote locations. The Virtual Reality Modeling Language (VRML) is a file format and run-time description for 3D graphic elements for use on the World Wide Web. It includes interaction and animation elements as well as interfaces to scripting languages to provide more general simulation behaviors and interfaces to network services. Currently VRML worlds can be scripted with Java and JavaScript, both of which are familiar to most web programmers. VRML 2.0 was designed and implemented in 1995 and has been an ISO standard since 1997 (referred to as VRML97). VRML97 is the only existing open standard for describing 3D graphics on the web, though several proprietary packages with similar capabilities exist. The development and maintenance of VRML97 is over-seen by the Web3D Consortium which counts Sun, Microsoft, SGI, Apple and Intervista amongst its members. However, only a small number of real-world applications have been developed for use in clinical psychology: the largest sample ever reported in any published study is 72 students (sources: MedLine, Science Citation Index, PsycLit, Dec. 1999). This makes investigations into the feasibility of VR based psychological applications of considerable importance. In a recent report, the US National Advisory Mental Health Council suggested that "Research is needed to understand both the positive and the negative effects [of VEs]... on children's' and adult's perceptual and cognitive skills... and to exploit the enormous clinical potential of this technology" (1995, p.51). To reach this goal in 1999 different US government institutions (i.e. Office of Naval Research, National Science Foundation, and Defence Advanced Research Projects Agency) funded the research in this area to the amount of 22 million US$ (Source: DARPA bullettin, 1999). In the same year the European institutions funded research in this field with less that 1 million Euros (estimated from CORDIS database, 1999): less than 1/20 of the US effort. Up to now, Europe has matched the reduced funds with the creativity of its researchers. In fact, the main applications of VEs in psychological assessment and rehabilitation come from Italian, Spanish, and English institutions. In 1997, European researchers authored 72% of all the published papers in this area on peer-reviewed journals. This percentage slipped to 56% in 1998 and to 51% in 1999 (Sources: MedLine, Science Citation Index, PsycLit, Apr. 2000). In this sense VEPSY, joining in its Consortium the major European players in the field, aims at creating a sufficient critical mass to make the EU-based research more competitive. Moreover, this could help also European companies working in the field. The latest Frost & Sullivan's VR market report stated that about 250 companies existed in the USA and only 25 in other countries which claim to make even part of their revenue from VR. Of these, no one firm earned more than $10 million (MEUROs 8.9) from VR alone. A recent Financial Times Report listed four types of commercial VR company - software companies, component manufacturers, system companies and "other industry participants". As might be expected, the vast majority of such companies are US-based. The VEPSY consortium includes two young spin-off companies (SMEs), linked to the research institutions working in the project, and two expert companies with a long expertize in the Health Care IT industry that will help the project to exploit commercially the results developed. Both the strict link between companies and researchers, and the clear focus on clinical oriented VR-based products, will help in creating a market-oriented approach, not always present in many IT big players. The end-users of the applications are: individuals who can individually access low-cost information technologies (PC) and Internet, private and public institutions, hospitals, schools for prevention activities, associations, care givers, home care providers, and other similar cases. Anticipated deliverables are: improved methods to prevent, delay the onset, diagnose and treat major psychopathological illnesses; more competitive and adapted technological products and services for coping with major disturbances and for promoting the quality of life, autonomy and social integration of psycho-pathological patients.