Intervention proposal
“All the information contained in this section is for guidance only. Psious environments are therapy supporting tools that must be used by the healthcare professional within an evaluation and intervention process designed according to the characteristics and needs of the user.
Also remember that you have the General Clinical Guide in which you have more information on how to adapt psychological intervention techniques (exposure, systematic desensitization, cognitive restructuring, chip economy…) to Psious environments.”
Intervention example on agoraphobia
SESSION 1
- Inform the patient about agoraphobia (causes, symptoms, prevalence…)
- Present and justify the techniques that will be used throughout the treatment: the exposure with virtual reality and live exposure.
- Elaboration of the hierarchy of exposure and exposure to items from the hierarchy of 20-30 USA’s (example)
- Start exposure hierarchy with an item close to 30 USA’s. The main objective will be the patient’ s familiarization with the virtual reality and the work dynamics
| ITEM | SUD’s | ENVIRONMENT | CONFIGURATION | EVENT |
|---|---|---|---|---|
| Being in the square next to your house with few people | 20 | Square | ||
| Take a walk on the beach with few people | 20 | Video Environment “The beach” | ||
| Drive around the city during hightraffic hours | 25 | City | Sun, day, driver, minimum | Circuit 1 |
| Drive on the highway | 30 | Highway | Sun, day, driver, show, hide | Tunnel |
SESSION 2
- Review achievements from the previous session and setting objectives of the actual session: entering an elevator
- Starting with the second session of the treatment, we recommend to start the exposure gradually and systematically to environments of virtual reality. If it’s necessary, perform a cognitive restructuring.
- Show clinical advances to the patient, through platform reports.
HOMEWORK
Live exposure to streets away from home, or go out for a drive through the city.
| ITEM | SUD’s | ENVIRONMENT | CONFIGURATION | EVENT |
|---|---|---|---|---|
| Being in a square near home with plenty of people | 40 | Square | Maximum | |
| Walking along a very crowded boulevard | 45 | Environment Very Crowded Boulevard | ||
| Being alone at home | 50 | Home | ||
| Take a walk along the port | 55 | Environment walk | ||
| Entering an elevator | 60 | Small elevator |
SESSION 3
- Review achievements from previous sessions and establish new objectives for this: Being in the underground entrance when there is people there.
- Gradual and systematic exposure to virtual reality environments. Cognitive restructuration, if it’s necessary.
- Show clinical advances to the patient through platform reports.
HOMEWORK
Live exposure by going out for a walk in a busy street, being alone at home or entering an elevator (if you have too much anxiety you can do imagery at home, imagining the situations treated in the session).
| ITEM | SUD’s | ENVIRONMENT | CONFIGURATION | EVENT |
|---|---|---|---|---|
| Be in the waiting room of a hospital | 60 | Magnetic resonance imaging | Waiting room | |
| Go into the elevator | 65 | Big elevator | Maximum | Into the elevator |
| Being in the entrance of the Metro without people | 70 | Metro | Non, clean | |
| Being in the entrance of the Metro surrounded by people | 70 | Metro | Maximum, clean |
SESSION 4
- Review the achievements from the previous session and setting new goals: Being on the underground platform
- Gradual and systematic exposure to virtual reality environments. Cognitive restructuration if it’s necessary.
- Show clinical advances to the patient, through platform reports.
HOMEWORK
Live exhibition in the underground, you can start at the entrance and walk down stairs to the ticket machines or do the same with imaginary exposure at home.
| ITEM | SUD’s | ENVIRONMENT | CONFIGURATION | EVENT |
|---|---|---|---|---|
| Very crowded boulevard. | 70 | Very crowded boulevard | ||
| Underground entrance | 75 | Metro | Maximum, dirty | |
| Environment Crowded market | 75 | Video crowded market | ||
| Go to the underground platform | 80 | Metro | Maximum, dirty | Platform |
SESSION 5
- Review of previous session achievements and establish the new objective of the session: Enter the underground train
- Gradual and systematic exposure to virtual reality environments. Cognitive restructuration if it’s necessary.
- Repeat each one of the exercises twice.
- Show clinical advances to the patient, through platform reports.
HOMEWORK
Live exposure in crowded streets (if reducing anxiety levels is required, the patient can be accompanied), start to enter into the underground (can be done at timetables when there is not many people)
| ITEM | SUD’s | ENVIRONMENT | CONFIGURATION | EVENT |
|---|---|---|---|---|
| Exit from the underground where there is not many people | 80 | Metro | None, dirty | Activate “metro” (if you want to be inside) and then click on “leave metro” ( without being a inside for very long) |
| See how the train arrives without getting in it and waiting for another | 80 | Metro | None, dirty | No event (do not look at the input viewer) |
| Exit a subway where there is plenty of people | 85 | Metro | Maximum, dirty | Activate “metro” (to be inside) and then click on “ leave metro” (without being inside for very long) |
| Enter a plane and close the doors | 90 | Plane | Maximum, sun, day, window, non, off | Taxi |
| Being in the subway near the door | 90 | Agorafobia | Maximum, dirty | “Metro arrival” (and enter with the viewer) |
SESSION 6
- Review of previous session achievements and establish the new objective of the session: Be inside a subway wagon with many people when a breakdown occurs.
- Gradual and systematic exposure to virtual reality environments. Cognitive restructuration if necessary
- Repeat each one of the exercises twice
- Show clinical advances to the patient, through platform reports.
HOMEWORK
Live exposure in the subway, you can start with a small amount of people in the station and increase the level of crowdedness. First, the patient stands near the door, gets into the subway and takes it until the next stop. Gradually increase the exposure as the session progresses.
| ITEM | SUD’s | ENVIRONMENT | CONFIGURATION | EVENT |
|---|---|---|---|---|
| See how the train arrives without getting on it | 85 | Metro | Maximum, dirty | “Metro arrival ” and not entering ( let 30 seconds pass) |
| Entering the train with few people | 90 | Metro | None, dirty | “Metro arrival” (and enter with the viewer) |
| Enter the train full of people | 95 | Metro | Maximum, dirty | “Metro arrival” (and enter with the viewer |
| Entering the train and staying inside for a few stops | 100 | Metro | Maximum, dirty | “Inside the metro” and “next station” (several stops) |
| Being on a full train while a breakdown occurs | 100 | Metro | Maximum, dirty | “Inside Metro” and “Breakdown” |
Intervention Example on Agoraphobia with 360º Format Environments
In addition to virtual environments, the agoraphobia scene has several 360º format environments that will allow you to make a more effective intervention. The environments described previously can be used to create a storyline for the agoraphobic patient that are similar to situations that he/she could be experiencing in their everyday life. Gradually increasing the level of difficulty of each of these situations will allow the patient to progressively confront and overcome their fears at a much quicker rate. For example, storylines that can be created are prompting a patient to go inside a market (ground floor) and then having them go inside a mall (first and second floor).
To create this storyline, the following environments can be used: The environment with the stair landing (leaving the house), the one in the subway (going to the market), the market environments (ground floor) and the one in the mall (elevator, first floor, second floor…) The use of different environments can be used to create a hierarchy of exposure that will help the patient become used to visiting a mall or a market.
SESSION 1
- Inform the patient about agoraphobia (Causes, symptoms, prevalence…)
- Discuss the techniques that will be used throughout the treatment: Exposure with virtual reality and live exposure.
- Prepare the exposure hierarchy and the 20-30 USA’s hierarchy item exposure. (example)
- Initiate exposure hierarchy with an item close to 30 USA’s. The main goal will be to make sure the patient gets comfortable with the virtual reality and the dynamics of the work.
| Item | SUD’s | Environment |
|---|---|---|
| After having left the mall, he/she is out on the street surrounded by people and cars. | 20 | 360º environment outside the mall |
| On the elevator, going from the last floor to the ground floor to leave the mall. | 25 | 360º environment inside the elevator |
| Waiting for the elevator to leave the top floor of the mall. | 30 | 360º environment waiting for the elevator |
| Being at the market’s exit, observing people come in and out. | 40 | 360º environment entering a crowded market |
SESSION 2
- Review the achievements from the previous session and establish session goals: Be on the ground floor of a very crowded market, and watch people shop and walk.
- From the second session onwards, it is highly recommended to begin the gradual and systematic exposure to virtual reality environments. Do cognitive restructuring, if necessary.
- Show clinical advances to the patient through platform reports.
HOMEWORK
Live exposure, going out into the street and going to a market or a mall. The patient doesn’t have to enter it.
| Item | SUD’s | Environment |
|---|---|---|
| Observe people leaving the subway station, right before entering it to go home. | 40 | 360º environment Subway Exit |
| Being in the entrance hall of their own home after coming back from the mall. | 50 | 360º environment Hall |
| Being out on the street , observing (from a distance) the mall he/she intends to go to. | 55 | 360º environment Outside the Mall |
| Being on the ground floor of a crowded market to observe the massive amount of people shopping and walking around. | 60 | 360º environment Ground Floor |
SESSION 3
- Review achievements from the previous session and establish session goals: To be on the first floor of a mall and see the exit doors from a distance.
- Gradual and systematic exposure to virtual reality environments. Use cognitive restructuring, if necessary.
- Show clinical advances to the patient, through platform reports.
HOMEWORK
Live exposure, going to market that isn’t as crowded or just standing outside a mall to observe + image exposure to review session goals.
| Item | SUD’s | Environment |
|---|---|---|
| Taking a slightly crowded elevator to go up to the second floor of the mall | 65 | 360º environment inside the elevator |
| Waiting to take an elevator to the first floor at a market surrounded by a few people. | 70 | 360º environment waiting for the elevator |
| On the first floor of a mall with the exit in view in the far distance. | 75 | 360º environment inside the mall. Vídeos |
SESSION 4
- Review achievements from the previous session and establish session goals : To be on the first floor of a market to observe people walk around with city buildings in view in the background.
- Gradual and systematic exposure to virtual reality environments . Use cognitive restructuring, if necessary.
- Show clinical advances to the patient through platform reports.
HOMEWORK
Live exposure going to a crowded market or to a busy mall.
| Item | SUD’s | Environment |
|---|---|---|
| Watching people (in the hall of the subway exit) coming in and out of the subway before entering a busy market. | 80 | 360º environment Subway Exit |
| At the subway entrance on the way to the market and watching people enter and leave the platform to go out into the street | 80 | 360º environment Subway Exit |
| On the first floor of a mall with escalators in the distance (use them to go up to the last floor). | 90 | 360º environment Inside the Mall Vídeos |
| At the roof terrace (on the top floor of the mall), observing people wandering around with buildings in view in the background. | 100 | 360º environment Second Floor |