This study examines the impact of Large Language Model-generated narratives in a climate-change-themed Visual Novel, comparing two versions: First, the story is generated using thematic keywords in the prompts, and second, the story is generated without keywords. Fifty participants (21 female, 29 male) completed the study. Results showed that participants in the group without thematic keywords had higher levels of narrative engageability score, as measured by the Narrative Engageability Scale, than those with thematic keywords. This indicated that the ability to engage with the story was stronger in the group without keywords. However, when assessing the narrative experience using the Game User Experience Satisfaction Scale, both groups reported similar levels of satisfaction, suggesting that while the ability to engage with the narrative differed between groups, the overall narrative experience was mainly the same. These findings suggested that thematic keywords in prompts significantly impacted participants’ narrative experience of the game.

This study investigates the emotional dynamics from different cultural backgrounds using a multimodal approach that combines Facial Emotion Recognition and Heart Rate Variability (HRV) analysis. A total of 109 participants from Italy, Japan, and Korea (mean age = 24.5 years) played two casual games, namely Snake and Matching Pairs, to investigate cultural differences in emotional and physiological responses. The results revealed distinct cultural patterns in static emotional expression using generalised linear mixed models (GLMMs). The Italian cultural group showed higher levels of positive facial expressions (FE), particularly happiness; the Korean cultural group showed more frequent negative FE, while the Japanese cultural group showed restrained FE, particularly related to fear. Moreover, emotional transitions were analysed using a Markov-inspired continuousstate operator derived from probabilistic FE vectors, which characterised the temporal structure of emotional changes and uncovered systematic cross-cultural and task-dependent differences in emotional latency. These findings show that emotional transitions are shaped by cultural norms and the cognitive demands of the games. Furthermore, integrating FE and HRV features into GLMMs showed that autonomic indices predict performance and vary across game types. Overall, this study provides three key contributions. First, it indicates that FEs of emotion during gameplay differ significantly across cultures, in accordance with cultural display norms. Second, it demonstrates that emotional transitions are dynamic and influenced by game performance, with cultural background shaping these patterns. Third, it identifies cross-cultural differences in physiological responses, specifically bodily signals such as HRV. These findings enhance understanding of how games elicit and regulate emotional and physiological responses, suggesting applications beyond entertainment.

Biofeedback in serious games is becoming increasingly relevant to objectively assessing players’ engagement and performance. This study administered a Matching Pairs (MP) game to a group of healthy volunteers while acquiring eye-tracking data, specifically pupil dilation and blinking behavior. A dedicated algorithm has been implemented for game score assessment. A set of linear and nonlinear features were extracted from physiological signals. Statistical analysis was performed to understand whether oculometric parameters differ between the best and worst MP game trials. Moreover, correlation analysis investigated possible relationships between physiological measures and players’ performance. Results showed statistically significant smaller pupil dilation velocity, higher Index of Pupillary Activity (IPA), and shorter blink rate in the best MP trial than in the worst one. Our outcomes could highlight better cognitive resource management and greater focus in the best trial. Moreover, participants’ scores were negatively correlated with blinking rate and the time the eyes were closed during the game. It showed that more focus on specific game tasks leads to better performance, therefore limiting interruptions of the information flow due to blinking. These findings may suggest that eye parameters in serious gaming platforms could be a powerful tool for intervention programs targeting older populations or people with cognitive impairments.

In this study, we investigated brain dynamics from electroencephalographic (EEG) signals during affective tactile stimulation conveyed by the dynamical contact with different fabrics. Thirty-three healthy subjects (16 females) were enrolled to interact with a haptic device able to mimic caress-like stimuli conveyed by strips of different fabrics moved back and forth at different velocities. Specifically, two velocity levels (i.e., 9.4 and 65 mm/sec) and two kinds of fabric (i.e., burlap and silk) were selected to deliver pleasant and unpleasant affective elicitations, according to subjects' self-assessment. EEG power spectra and functional connectivity were then calculated and analyzed. Experimental results, reported in terms of p-value topographic maps, demonstrated that caresses administered through unpleasant fabrics increased brain activity in the θ (4-8 Hz), α (8-14 Hz), and β (14-30 Hz) bands, whereas the use of pleasant fabrics enhanced functional connections in specific areas (e.g., frontal, occipital, and temporal cortices) depending on the oscillations frequency and caressing velocity. Furthermore, we adopted K-NN algorithms to automatically recognize the pleasantness of the haptic stimulation at a single-subject level using EEG power spectra, achieving a recognition accuracy up to 74.24%. Finally, we showed how brain oscillation power in the α and β bands over contralateral frontal- and central-cortex were the most informative features characterizing the pleasantness of a tactile stimulus on the forearm.

The papers in this special section focus on the topic of sensor informatics for mental health applications. The papers provide novel insights on advances in detection, sensing, analysis, and modeling of central and/or autonomic correlates useful in psychophysiological states assessment.

Bipolar Disorder (BD) is characterized by an alternation of mood states from depression to (hypo)mania. Mixed states, i.e., a combination of depression and mania symptoms at the same time, can also be present. The diagnosis of this disorder in the current clinical practice is based only on subjective interviews and questionnaires, while no reliable objective psychophysiological markers are available. Furthermore, there are no biological markers predicting BD outcomes, or providing information about the future clinical course of the phenomenon. To overcome this limitation, here we propose a methodology predicting mood changes in BD using heartbeat nonlinear dynamics exclusively, derived from the ECG. Mood changes are here intended as transitioning between two mental states: euthymic state (EUT), i.e., the good affective balance, and non-euthymic (non-EUT) states. Heart Rate Variability (HRV) series from 14 bipolar spectrum patients (age: 33.439.76, age range: 23-54; 6 females) involved in the European project PSYCHE, undergoing whole night ECG monitoring were analyzed. Data were gathered from a wearable system comprised of a comfortable t-shirt with integrated fabric electrodes and sensors able to acquire ECGs. Each patient was monitored twice a week, for 14 weeks, being able to perform normal (unstructured) activities. From each acquisition, the longest artifact-free segment of heartbeat dynamics was selected for further analyses. Sub-segments of 5 minutes of this segment were used to estimate trends of HRV linear and nonlinear dynamics. Considering data from a current observation at day t0, and past observations at days (t􀀀1, t􀀀2,...,), personalized prediction accuracies in forecasting a mood state (EUT/non-EUT) at day t+1 were 69% on average, reaching values as high as 83.3%. This approach opens to the possibility of predicting mood states in bipolar patients through heartbeat nonlinear dynamics exclusively.

This paper reports on how emotional states elicited by affective sounds can be effectively recognized by means of estimates of Autonomic Nervous System (ANS) dynamics. Specifically, emotional states are modeled as a combination of arousal and valence dimensions according to the well-known circumplex model of affect, whereas the ANS dynamics is estimated through standard and nonlinear analysis of Heart rate variability (HRV) exclusively, which is derived from the electrocardiogram (ECG). In addition, Lagged Poincaré Plots of the HRV series were also taken into account. The affective sounds were gathered from the International Affective Digitized Sound System and grouped into four different levels of arousal (intensity) and two levels of valence (unpleasant and pleasant). A group of 27 healthy volunteers were administered with these standardized stimuli while ECG signals were continuously recorded. Then, those HRV features showing significant changes (p $<;$ 0.05 from statistical tests) between the arousal and valence dimensions were used as input of an automatic classification system for the recognition of the four classes of arousal and two classes of valence. Experimental results demonstrated that a quadratic discriminant classifier, tested through Leave-One-Subject-Out procedure, was able to achieve a recognition accuracy of 84.72 percent on the valence dimension, and 84.26 percent on the arousal dimension.

This study discusses a personalized wearable monitoring system, which provides information and communication technologies to patients with mental disorders and physicians managing such diseases. The system, hereinafter called the PSYCHE system, is mainly comprised of a comfortable t-shirt with embedded sensors, such as textile electrodes, to monitor electrocardiogram-heart rate variability (HRV) series, piezoresistive sensors for respiration activity, and triaxial accelerometers for activity recognition. Moreover, on the patient-side, the PSYCHE system uses a smartphone-based interactive platform for electronic mood agenda and clinical scale administration, whereas on the physician-side provides data visualization and support to clinical decision. The smartphone collects the physiological and behavioral data and sends the information out to a centralized server for further processing. In this study, we present experimental results gathered from ten bipolar patients, wearing the PSYCHE system, with severe symptoms who exhibited mood states among depression (DP), hypomania(HM), mixed state (MX), and euthymia (EU), i.e., the good affective balance. In analyzing more than 400 h of cardiovascular dynamics, we found that patients experiencing mood transitions from a pathological mood state (HM, DP, or MX-where depressive and hypomanic symptoms are simultaneously present) to EU can be characterized through a commonly used measure of entropy. In particular, the SampEn estimated on long-term HRV series increases according to the patients' clinical improvement. These results are in agreement with the current literature reporting on the complexity dynamics of physiological systems and provides a promising and viable support to clinical decision in order to improve the diagnosis and management of psychiatric disorders.

The analysis of cognitive and autonomic responses to emotionally relevant stimuli could provide a viable solution for the automatic recognition of different mood states, both in normal and pathological conditions. In this study, we present a methodological application describing a novel system based on wearable textile technology and instantaneous nonlinear heart rate variability assessment, able to characterize the autonomic status of bipolar patients by considering only electrocardiogram recordings. As a proof of this concept, our study presents results obtained from eight bipolar patients during their normal daily activities and being elicited according to a specific emotional protocol through the presentation of emotionally relevant pictures. Linear and nonlinear features were computed using a novel point-process-based nonlinear autoregressive integrative model and compared with traditional algorithmic methods. The estimated indices were used as the input of a multilayer perceptron to discriminate the depressive from the euthymic status. Results show that our system achieves much higher accuracy than the traditional techniques. Moreover, the inclusion of instantaneous higher order spectra features significantly improves the accuracy in successfully recognizing depression from euthymia.

This paper reports on the autonomic nervous system (ANS) changes and driving style modifications as a response to incremental stressing level stimulation during simulated driving. Fifteen subjects performed a driving simulation experiment consisting of three driving sessions. Starting from a first session where participants performed a steady motorway driving, the experimental protocol includes two additional driving sessions with incremental stress load. More specifically, the first stressing load consists of randomly administering mechanical stimuli to the vehicle during a steady motorway driving by means of a series of sudden and unexpected skids, such as those produced by a strong wind gust. These skids were supposed to produce in the driver a given level of stress. In order to assess this mental workload, dedicated psychological tests were performed. The second stressing load implied an incremental psychological load, consisting of a battery of time pressing arithmetical questions, added to the mechanical stimuli. For the whole experimental session, the driver's physiological signals and the vehicle's mechanical parameters were recorded and analyzed. In this paper, the ANS changes were investigated in terms of heart rate variability, respiration activity, and electrodermal response along with mechanical information such as that coming from steering wheel angle corrections, velocity changes, and time responses. Results are satisfactory and promising. In particular, significant statistical differences were found among the three driving sessions with an increasing stress level both in ANS responses and mechanical parameter changes. In addition, a good recognition of these sessions was carried out by pattern classification algorithms achieving an accuracy greater than 90%.

This paper reports on results of a pattern recognition technique for classifying pathological mental states of bipolar disorders using information gathered from the electrodermal response. The rationale behind this work is that the autonomic nervous system dynamics, non-invasively quantified through the electrodermal response processing, is altered by the specific mood state. Starting from the hypothesis that bipolar disorders are associated with affective dysfunctions, we processed data gathered from four bipolar patients through eleven experimental trials while an ad-hoc emotional stimulation is administered. Intra- and inter-subject variability were investigated. We show that, using a deconvolution-based approach to estimate sympathetic ANS markers and simple k-Nearest Neighbor algorithms, the proposed methodology is able to discern up to three mood states such as depression, hypo-mania, and euthymia with an average intra-subject accuracy greater than 98% and inter-subject accuracy greater than 82%.

Bipolar patients are characterized by a pathological unpredictable behavior, resulting in fluctuations between states of depression and episodes of mania or hypomania. In the current clinical practice, the psychiatric diagnosis is made through clinician-administered rating scales and questionnaires, disregarding the potential contribution provided by physiological signs. The aim of this paper is to investigate how changes in the autonomic nervous system activity can be correlated with clinical mood swings. More specifically, a group of ten bipolar patients underwent an emotional elicitation protocol to investigate the autonomic nervous system dynamics, through the electrodermal activity (EDA), among different mood states. In addition, a control group of ten healthy subjects were recruited and underwent the same protocol. Physiological signals were analyzed by applying the deconvolutive method to reconstruct EDA tonic and phasic components, from which several significant features were extracted to quantify the sympathetic activation. Experimental results performed on both the healthy subjects and the bipolar patients supported the hypothesis of a relationship between autonomic dysfunctions and pathological mood states.

Current clinical practice in diagnosing patients affected by psychiatric disorders such as bipolar disorder is based only on verbal interviews and scores from specific questionnaires, and no reliable and objective psycho-physiological markers are taken into account. In this paper, we propose to use a wearable system based on a comfortable t-shirt with integrated fabric electrodes and sensors able to acquire electrocardiogram, respirogram, and body posture information in order to detect a pattern of objective physiological parameters to support diagnosis. Moreover, we implemented a novel ad hoc methodology of advanced biosignal processing able to effectively recognize four possible clinical mood states in bipolar patients (i.e., depression, mixed state, hypomania, and euthymia) continuously monitored up to 18 h, using heart rate variability information exclusively. Mood assessment is intended as an intrasubject evaluation in which the patient's states are modeled as a Markov chain, i.e., in the time domain, each mood state refers to the previous one. As validation, eight bipolar patients were monitored collecting and analyzing more than 400 h of autonomic and cardiovascular activity. Experimental results demonstrate that our novel concept of personalized and pervasive monitoring constitutes a viable and robust clinical decision support system for bipolar disorders recognizing mood states with a total classification accuracy up to 95.81%.

This paper reports on a new methodology for the automatic assessment of emotional responses. More specifically, emotions are elicited in agreement with a bidimensional spatial localization of affective states, that is, arousal and valence dimensions. A dedicated experimental protocol was designed and realized where specific affective states are suitably induced while three peripheral physiological signals, i.e., ElectroCardioGram (ECG), ElectroDermal Response (EDR), and ReSPiration activity (RSP), are simultaneously acquired. A group of 35 volunteers was presented with sets of images gathered from the International Affective Picture System (IAPS) having five levels of arousal and five levels of valence, including a neutral reference level in both. Standard methods as well as nonlinear dynamic techniques were used to extract sets of features from the collected signals. The goal of this paper is to implement an automatic multiclass arousal/valence classifier comparing performance when extracted features from nonlinear methods are used as an alternative to standard features. Results show that, when nonlinearly extracted features are used, the percentages of successful recognition dramatically increase. A good recognition accuracy (>;90 percent) after 40-fold cross-validation steps for both arousal and valence classes was achieved by using the Quadratic Discriminant Classifier (QDC).

In the last few years, much effort has been devoted to the development of wearable sensing systems able to monitor physiological, behavioral, and environmental parameters. Less has been done on the accurate testing and assessment of this instrumentation, especially when considering devices thought to be used in harsh environments by subjects or operators performing intense physical activities. This paper presents methodology and results of the evaluation of wearable physiological sensors under these conditions. The methodology has been applied to a specific textile-based prototype, aimed at the real-time monitoring of rescuers in emergency contexts, which has been developed within a European funded project called ProeTEX. Wearable sensor measurements have been compared with the ones of suitable gold standards through Bland-Altman statistical analysis; tests were realized in controlled environments simulating typical intervention conditions, with temperatures ranging from 20 °C to 45 °C and subjects performing mild to very intense activities. This evaluation methodology demonstrated to be effective for the definition of the limits of use of wearable sensors. Furthermore, the ProeTEX prototype demonstrated to be reliable, since it produced negligible errors when used for up to 1 h in normal environmental temperature (20 °C and 35 °C) and up to 30 min in harsher environment (45 °C).

The objective of this study is to investigate the synchronization between breathing patterns and heart rate during emotional visual elicitation, that is, using sets of images gathered from the international affective picture system having five levels of arousal and five levels of valence, including a neutral reference level. Thirty-five healthy volunteers were emotionally elicited in agreement with a bidimensional spatial localization of affective states, i.e., arousal/valence plane, while two peripheral physiological signals, ECG and Respiration activity, were acquired simultaneously. The synchronization was then quantified by applying the concept of phase synchronization of chaotic oscillators, i.e., the cardio-respiratory synchrogram. This technique allowed us to estimate the synchronization ratio m:n as the attendance of n heartbeats in each m respiratory cycle, even for noisy and nonstationary data. We found a stronger evidence of cardiorespiratory synchronization during arousal than during neutral states.

The purpose of this study is to comparatively evaluate the performance of different wearable systems based on indirect breathing monitoring in terms of susceptibility to motion artifacts. These performances are compared with direct respiratory measurements using a spirometer, which is accurate, reliable, and less sensitive to movement artifacts, but cannot be integrated into truly wearable form. Experiments were carried out on four indirect methods implemented into wearable systems, inductive plethysmography, impedance plethysmography, piezoresistive pneumography, and piezoelectric pneumography, to ascertain the performance of each of them in terms of noise due to movement artifacts, as well as to study the effects of different movements or gestures during each test. A group of volunteers was asked to wear all of the breath monitoring systems simultaneously along with the face mask of the spirometer while carrying out four physical exercises in a gym under controlled conditions. Data are analyzed in the time and frequency domain to estimate the frequency respiration from each wearable system and compare it with those of the spirometer. Results confirmed that all the wearable systems are somehow affected by movement artifacts, but statistical investigation showed that for most of the physical exercises, three out of four, piezoelectric pneumography provided best performance in terms of robustness and reduced susceptibility to movement artifacts.

This paper is concerned with a new wearable system, which is able to monitor several vital signals and physiological variables in order to determine the cardiopulmonary activity status during emergencies. The innovative system consists of a multimodal broadband piezoelectric transducer based on polyvinylidene fluoride polymer integrated into a textile belt wrapped around the chest. An advanced electronic control unit, floating power supply, and wireless communication support make it suitable for portable monitoring during critical cardiopulmonary failures. The multimodal transducer is innovative in that only one sensitive element is employed to work as either an ultrasound (US) transceiver or piezoelectric sensor. The US transceiver is enabled to work at high frequency, i.e., it is excited by suitable pulses to emit an ultrasonic wave, which penetrates the body and receives the echo signals bouncing off the biological interfaces having different acoustic impedances. The piezoelectric sensor works at low frequency and acquires both signals generated by heart apex movements and the mechanical movement of the chest induced by respiration. This multimodality is allowed by a broadband of sensitivity jointly at a low value of the figure of merit (Q). Moreover, the transducer thickness is thin enough to assure a good adaptability to the biological site, and it is equipped with an advanced control unit enabling to switch from a high to a low working frequency. If jointly used along with an ECG wearable Holter, this transducer can be used to provide an exhaustive picture of the health status of the subject in the diagnostic and prognostic domains.

The aim of this paper is constituted by the feasibility study and development of a system based on Field Programmable Gate Array for the most significant cardiac arrhythmias recognition by means of Kohonen Self-Organizing Map. The feasibility study on an implementation on the XILINX Virtex®-4 FX12 FPGA is proposed, in which the QRS complexes are extracted and classified in real time between normal or pathologic classes. The whole digital implementation is validated to be integrated in wearable cardiac monitoring systems.