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- The role of interoceptive processing in prenatal depression and anxietyPublication . Praça, Maiara Silva; Braga, Patrícia Vilela; Marshall, Amanda; Lamela, Diogo; Jongenelen, Inês; Rocha, Nuno Barbosa; Costa, Raquel; Schütz-Bosbach, Simone; Pinto, Tiago Miguel; Feldman, Ruth; Campos, Carlos; Rocha, NunoPregnancy is a complex biological phenomenon that can modify several interoception domains (ability to perceive and subjectively experience inner bodily states). These changes in interoceptive processing may also play a role in the emergence of prenatal psychopathology, namely anxiety and depression. To examine the association between interoceptive processing and psychopathology (depression and anxiety) in first-time pregnant women (3rd trimester). 17 first-time expectant mothers (mean age = 32.71 years) completed data collection at 28-32 gestational age. Interoception was evaluated using self-report measures (Interoceptive Accuracy and Attention Scales), a performance-based interoceptive accuracy task (Heartbeat Tapping Task; participants are required to tap a key whenever they feel a heartbeat), and neural markers of infant-specific interoceptive processing (heartbeat-evoked potentials - HEP - during the Infant Face Repetition-Suppression Task). A cluster mass permutation test was employed to identify the electrodes and time-windows where HEP amplitude was effectively modulated (right frontal-central; 308 - 600 ms). The Edinburgh Postnatal Depression Scale was used to evaluate depressive symptoms, while the State Anxiety Inventory (STAI-S) measured current anxiety levels. Significant positive correlations were found between interoceptive attention and anxiety (r =.645; p = .017), as well as between interoceptive attention and depression (r = .749; p = .003). Interoceptive accuracy was neither correlated with anxiety nor depression. A large (albeit non-significant) negative correlation (r = -.301, p = .368) was found between depressive scores and HEP emotional modulation in the infant condition, suggesting that infant-specific emotional modulation of HEP may be reduced in prenatal depression. These preliminary findings suggest that interoceptive processing is associated with prenatal psychopathology across several levels. Self-perceived beliefs about interoceptive attention were positively associated with both anxiety and depression. Furthermore, infant-specific neural markers of interoceptive processing may also play an important role in prenatal depressive symptomatology.
- Neurophysiological markers of cardiac interoceptive processing in first-time expectant mothersPublication . Braga, Patrícia Vilela; Marshall, Amanda; Lamela, Diogo; Jongenelen, Inês; Rocha, Nuno Barbosa; Costa, Raquel; Pasion, Rita; Schütz-Bosbach, Simone; Pinto, Tiago Miguel; Feldman, Ruth; Campos, Carlos; Campos, Carlos; Rocha, NunoPregnancy is a complex biological phenomenon where two distinct pathways may produce changes in interoception (ability to perceive and subjectively experience inner bodily states). First, pregnancy modifies the parental caregiving brain network, which includes key regions for interoceptive processing, particularly the insula. Second, pregnancy also changes the strength, frequency, and/or nature of interoceptive signals across different modalities (e.g., cardiac, respiratory, gastric). This study investigates pregnancy-related changes in neural markers of cortical interoceptive processing, specifically heartbeat-evoked potentials (HEP), by comparing first-time expectant mothers with non-pregnant, age-matched females. Data were collected from first-time expectant mothers (n = 13; Mage = 32.15 years) and matched controls (n = 8; mean age = 30.88 years) at 28–32 weeks of gestation. EEG recordings, time-locked to R-peaks (ECG), were obtained while participants completed the Infant Face Repetition Suppression Task. This paradigm was designed to induce an emotion (sad vs. neutral) and age-specific (infant vs. adult) modulation of HEP amplitude. A cluster mass permutation test was employed to identify the electrodes and time-windows where HEP amplitude was effectively modulated (right frontal-central; 308 - 600 ms). Repetition-suppression effects on HEP amplitude were observed for adult stimuli (p = .049, d = 0.499), while no modulation was observed in the infant condition (p = .471, d = 0.174). Pregnant participants displayed significantly lower HEP amplitude in adult trials in comparison to non-pregnant controls (p = .046, g = 0.997). Despite significant differences only emerging in the adult trials, pregnant women displayed lower HEP amplitude across all conditions. These findings suggest that pregnancy modifies cardiac interoceptive processing, leading to an overall decrease in HEP amplitude. Contrary to our hypothesis, expectant mothers did not exhibit infant- or emotion-specific changes in neural markers of cardiac interoception.
- Does attention to cardiac sensations modulate heartbeat-evoked potentials even after controlling for cognitive demands?Publication . Braga, Patrícia Vilela; Vieira, Beatriz; Carina, Fernandes; Barbosa, Fernando; Santos, Fernando Ferreira; Pereira, Mariana R.; Rocha, Nuno Barbosa; Mazer, Prune; Pasion, Rita; Schütz-Bosbach, Simone; Paiva, Tiago Oliveira; Campos, Carlos; Campos, Carlos; Rocha, Nuno; Mazer, PruneHeartbeat-evoked potentials (HEP) have been shown to be modulated by attentional focus (cardiac vs. exteroceptive attention), suggesting that HEP are a neural correlate of interoceptive prediction errors. However, this effect has not been consistently replicated, and differences in cognitive effort when contrasting interoceptive vs. exteroceptive attention may be a confounding factor. We devised a modified Heartbeat Attention Task to examine whether cardiac attention can modulate HEP amplitude even when cognitive demands are matched across interoceptive and exteroceptive conditions. In exteroceptive blocks, subjects were required to count subtle bursts of volume increase embedded within a continuous white noise. The bursts’ volume was individually tailored for each participant (near absolute threshold) and were presented in a rhythmic pattern replicating a typical heart rate. In interoceptive blocks, participants were asked to count their heartbeats, whilst the white noise was still presented, ensuring that the neural effects were driven by the attention shift rather than sensory changes. The task was first completed by 50 participants (25F; 28.44y) during a 9-electrode EEG recording: frontal, central and parietal sites. No significant differences were found regarding counted heartbeats (M=122.00) vs white noise bursts (M=118.86) as well as on perceived attentional efforts (heart M=65.00 vs bursts M=67.00), indicating similar task demands across conditions. No significant differences between conditions were found on HEP amplitude across all electrodes (p > .137 for all), suggesting no attentional modulation of HEP amplitude after accounting for cognitive demands. Due to the reduced number of electrodes, a follow-up sample of 26 participants (13F; 21.73y) completed the task using a new EEG geodesic 64-channel sensor net. This dataset is currently under processing and will allow for a more comprehensive data-driven analytic approach (cluster-based permutation test) to ensure whether the attentional modulation of HEP amplitude is indeed absent when accounting for cognitive demands.
- Key principles involving ethical and deontological issues in military stress management training in virtual reality environmentsPublication . Gomes, Paulo Veloso; Vianez, Ana; Curado, Henrique; Marques, António; Pereira, Javier; Machado Veloso Gomes, Paulo Sérgio; Pereira da Silva Marques, António José; Curado, HenriqueThe integration of Virtual Reality in military contexts, which simulates realistic combat and high-risk operational scenarios, provides a controlled environment for developing various skills and psychological resilience. This technology has proven to be a valuable tool for enhancing soldiers’ training and preparedness. The creation and use of VR programs, especially those involving the collection of biofeedback data to study military stress, carry significant ethical and deontological responsibilities. This study examines the regulation of using powerful algorithms to analyse biofeedback data to study military stress, emphasizing informed consent, privacy and confidentiality, beneficence and nonmaleficence, transparency in data usage and compliance with legal and regulatory standards.
- Virtual immersive training model with mixed reality for prosthesis application in orthopedicsPublication . Alves, Diogo; Gomes, Paulo Veloso; Magalhães, Renato; Pereira, João; Vilaça, Adélio; Marques, António; Machado Veloso Gomes, Paulo Sérgio; Pereira da Silva Marques, António JoséTraining medical professionals in Orthopedics faces several technical challenges. The equipment required for practical, hands-on training is often restricted to operating rooms. This constraint presents a significant issue, as developing the necessary skills to perform surgeries requires substantial practice time. This work developed a virtual training model using mixed reality, using a QR code to generate a virtual opaque hemisphere, within which the user operates two virtual tools that simulate an endoscope and a drill. A virtual monitor displays the endoscope’s view to the user, who must then navigate the drill tip to successfully touch specific target cubes. The application has the potential to significantly enhance the orthopedic learning experience by reducing the time and resources.
- Virtual reality exposure therapy for Arachnophobia: A pilot studyPublication . Lopes, Inês; Almeida, Raquel Simões de; Gomes, Paulo Veloso; Sá, Vítor J.; Oliveira, Gonçalo; Marques, António; Machado Veloso Gomes, Paulo Sérgio; Sá, Vítor J.; Pereira da Silva Marques, António José; Simões de Almeida, RaquelArachnophobia is a chronic disorder leading to significant avoidance of spider-related situations. This pilot study examines the effectiveness of Virtual Reality Exposure Therapy (VRET) for treating arachnophobia. The study included 25 participants who completed fear questionnaires and avoidance tests before, after and two weeks after the intervention. The intervention consisted of a session of progressive exposure to a novel and gamified virtual environment containing spiders. The results showed a significant reduction in fear and anxiety in relation to the phobic stimulus, suggesting that VRET is a promising approach for treating phobias, in controlled and safe environments.
- Effectiveness of virtual reality in reducing public speaking anxiety: A pilot studyPublication . Oliveira, Maria; Almeida, Raquel Simões de; Gomes, Paulo Veloso; Donga, João; Marques, António; Teixeira, Bruno; Pereira, Javier; Simões de Almeida, Raquel; Machado Veloso Gomes, Paulo Sérgio; Rucha das Dores da Costa Donga, João Paulo; Pereira da Silva Marques, António JoséPublic speaking anxiety (glossophobia) is a manifestation of social anxiety that affects a significant portion of the population, jeopardizing performance in academic, professional, and social contexts. This pilot study examines the effectiveness of virtual reality (VR) as a therapeutic tool for reducing public speaking anxiety. Over six VR simulation sessions, the physiological responses of 30 participants, including heart rate (HR) and electrodermal activity, were monitored alongside psychometric assessments. Results demonstrated a significant reduction in HR and improved self-efficacy. These findings recommend combining VR with traditional therapeutic approaches and emerging neuroscience-based methods, such as neurofeedback, to create more personalized treatment interventions.
- Interaction devices for multi-sensory exploration in immersive environmentsPublication . Donga, João; Gomes, Paulo Veloso; Sá, Vitor; Marques, António; Pereira, Javier; Machado Veloso Gomes, Paulo Sérgio; Sá, Vítor J.; Pereira da Silva Marques, António JoséImmersive environments, such as virtual reality (VR) and augmented reality (AR), provide users with experiences that blend digital and physical worlds. Interaction devices play a critical role in facilitating these experiences by engaging multiple human senses—sight, sound, touch, smell, taste and vestibular. This paper explores the various interaction devices designed for multi-sensory exploration, their applications, and the challenges associated with creating a fully immersive multi-sensory experience. We analyze input and output devices, hybrid systems, and emerging technologies while addressing the challenges in synchronization, user comfort, and accessibility.
- Mixed reality in surgery: Development of a mixed reality application for surgical trainingPublication . Lima, Ana Carolina; Vilaça, Adélio; Veloso, Rita; Marques, António; Pereira, Javier; Magalhaes, Renato; da Silva Veloso, Rita Sofia; Pereira da Silva Marques, António José; Magalhães, RenatoMixed reality (MR) technology combines the real and the virtual world in an innovative way, where the users can see and interact with both worlds at the same time, having several applications in surgical practice, planning, and training. A MR application was developed to be used in a head mounted display (Microsoft HoloLens 2) for surgical training of the anterior cruciate ligament reconstruction surgery, with the aim of indicating the position of the femoral tunnel. This application was tested by 11 surgeons of the Centro Hospitalar Universitário de Santo António, who have all completed the simulation successfully, with an average time of under a minute. These surgeons answered an inquiry of satisfaction, where they all highlighted the potential that MR has in surgical training.
- Aprendizagem com recurso a pacientes, na perspectiva dos estudantes e alumniPublication . Faias, Joaquim; Trigueiro, Maria JoãoNo âmbito do ensino e da avaliação de habilidades clínicas, a utilização de pacientes constitui um recurso complementar que tem como objetivo preparar os estudantes para uma pratica mais intensiva, assegurando assim que as atividades pedagógicas sejam desenvolvidas repetidamente com mais segurança e menor desgaste para os estudantes e os pacientes.