The experience of pain is affected by remarkable psychological factors. The concept of neuromatrix suggests that pain is an amalgam of affect, cognition, and sensation mediated through diverse brain regions. Moreover, the experience of pain appears to be reduced by environmental stimuli that drive attention away from the noxious events. Accordingly, immersion in a computer-generated, three-dimensional virtual environment has been used as an efficient distraction tool in a number of studies on pain management. However, no systematic approaches have explored the psychological factors that influence the effectiveness of virtual reality (VR) as a distraction technology. This review aims to outline the fundamental psychological factors involved in the use of VR to provide pain management. An analysis of the literature revealed some important elements associated with the patients' subjective experience. Eleven studies met the inclusion criteria and were included in the review. The results suggest the importance of different psychological factors in the effectiveness of the analgesic distraction. While sense of presence influence the effectiveness of VR as a distraction tool, anxiety as well as positive emotions directly affect the experience of pain. Future challenges for pain management via VR include adopting properly validated measures to assess psychological factors and using different experimental conditions to better understand their complex effects.

According to the well known definition of presence as ‘‘disappearance of mediation’’, the answer is no:\ud technology is a barrier, a mediating tool that can only reduce the level of presence experienced in an\ud interaction. However, the increasing diffusion of a technology like augmented reality that adds a technological\ud layer of information to the real world suggests the opposite: the experience of ‘‘being there’’ may\ud be influenced by the ability of ‘‘making sense there’’.\ud To explore this issue we used a sample of 20 university students to evaluate the level of presence experienced\ud in two different settings: an immersive virtual reality job simulation and a real world simulation\ud that was identical to its VR counterpart (same interviewer, same questions) but without technological\ud mediation and without any social and cultural cues in the environment that may give a better meaning\ud to both the task and its social context.\ud Self-report data, and in particular the scores in the Spatial Presence and the Ecological Validity ITC-SOPI\ud scales, suggest that experienced presence was higher during the virtual interview than in the real world\ud simulation. This interpretation was confirmed by subjective (higher in VR) but not by objective (Skin Conductance)\ud anxiety scores. These data suggest a vision of presence as a social construction, in which reality\ud is co-constructed in the relationship between actors and their environments through the mediation of\ud physical and cultural artifacts

The optimal management of screen-detected, localised prostate cancer remains controversial, related to overtreatment issues of screening and the nonrandomised evidence base. Active surveillance (AS) aims to delay or avoid curative therapy but may potentially harm patients' well-being through living with untreated prostate cancer. To systematically review the literature on quality of life (QoL) in patients undergoing AS. Embase, Medline, Psychinfo, Cochrane Central, Web of Science, and PubMed databases were searched in May 2014 using quality of life, active surveillance, prostate cancer, their synonyms, and targeted manual searches. The psychological dimensions related to health-related QoL (HRQoL) outcomes were anxiety and depression, distress, decisional conflict, and mental health. Ten clinical and research-based AS studies worldwide measured HRQoL and related psychological facets in six cross-sectional studies and four cohorts (follow-up: 9-36 mo; published: 2006-2014). Six studies were linked to published AS cohorts. In total, 966 men undergoing AS (mean: 102 per study) were assessed (mean age: 66 yr). AS patients had good overall HRQoL scores, which were comparable or better than those of patients undergoing postradical treatment (comparator group in four studies), men's partners (one study) and population-based data (three studies). Anxiety and depression scores were favourable. Selection bias may be present, as none were randomised comparisons. Decreased psychological well-being may be partly predicted by AS patients' baseline and clinical characteristics. Patients undergoing AS reported good QoL and did not appear to suffer major negative psychological impacts. Longer follow-up is required as well as investigation into which patients are predisposed to negative impact and leaving AS prematurely. We reviewed the published evidence for quality-of-life impact on men with prostate cancer being monitored by active surveillance. The men who were on active surveillance usually reported good levels of well-being and did not appear to suffer major negative psychological impacts. The research findings suggest little presence of anxiety and depression and high overall quality of life related to their disease. However, there are few long-term studies, so more high-quality research is needed to make definitive recommendations.