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.”
Systematic desensitization (SD) through exposure is shown to be effective by itself to reduce test anxiety (Hembree, 1988) in addition to having a positive effect on academic results and a decrease in overall anxiety and trait status.
The therapeutic approaches that combine SD with cognitive restructuring and study techniques are the ones that show a greater reduction of the test anxiety (Talbot, 2016). Remember that exposure is an equally effective but more efficient technique than SD and that, in addition, virtual reality exposure is equally effective as exposure by imagination and achieves a greater reduction of avoidance behaviors than exposure by imagination (GutiérrezMaldonado, Alsina, Carvallo, Letosa & Magallón, 2007).
In terms of study techniques, it can be taught the importance of properly managing time and planning, understanding that in order to optimize the study, it is necessary to plan short-, medium- and long-term objectives. Techniques may also be used for the control of activation such as relaxation in case of having a patient with excessive physiological activation.
Another useful technique in these cases is cognitive restructuring, especially in those patients with excessive concern and with distorted thoughts centered on the negative consequences of not being successful in the test. During the preparation for the test, the student can be told to analyze the rationality of his/her thoughts, to think about which ones he/she habitually has and how they can interfere with his/her performance. In addition to this, you can tell the patient to draw up a list of alternative thoughts (self instructions) so they can choose one of them when their mind focuses on a negative thought while they are doing a test. Remember that the patient can practice using all these strategies in the virtual reality environment.
Below is the hierarchy example to use with the Psious environment. In this case the scene used is the university, but the same example could be used with the school environment.
SESSION 1
Psychoeducation: Inform the patient about the test anxiety (causes, symptoms, prevalence…).
- Present and justify the techniques that will be used throughout the treatment: exposure with virtual reality and live exposure…
- Elaboration of the exposure hierarchy and exposure to items of the hierarchy with 20-30 SUD’s (example)
- Start exposure hierarchy with an item close to 30 SUD’s.
The main objective will be to familiarize the patient with virtual reality and the work dynamic.
| ITEM | SUD’s | ENVIRONMENT | CONFIGURATION | EVENT |
|---|---|---|---|---|
| Being at home a few days before an important test | 20 | Home | Sun, Day | |
| Being on the subway before doing a test | 25 | Metro | Illuminated, easy | Enter |
| Being alone in the hallway, waiting for the teacher to arrive and start the test | 35 | University | Easy, alone | |
| Being with a few classmates in the hallway before a test while they look very calm | 40 | University | Easy, few students |
SESSION 2
- Review of the previous session achievements and establishment of the objectives of the session: Waiting for the teacher with a few classmates who seem quite nervous.
- Exposure begins with prevention of gradual and systematic response to virtual reality. Cognitive restructuring, if appropriate.
- Reports are shown to the patient to see clinical progress.
HOMEWORK
Imagination exposure at home reviewing the objectives covered in the session + live exposure going to university even if you don’t have a test.
| ITEM | SUD’s | ENVIRONMENT | CONFIGURATION | EVENT |
|---|---|---|---|---|
| Being alone waiting for the teacher, and when he arrives he nicely ask you to come in | 40 | University | Easy, alone | Teacher appears |
| Being with a lot of people in the hallwaybefore an exam and they seemvery quiet | 45 | University | Easy, a lot of students | |
| Being with a few classmates in the hallway, and when the teacher appears he asks you to come in | 50 | University | Easy, Few students | Teacher appears |
| Waiting for the teacher with some classmates that seem very nervous | 60 | University | Hard, Few students |
SESSION 3
- Review the achievements of the previous session and establish the objectives of the current one: Being in class about to start a test and the classmates are very calm.
- Exposure begins with prevention of gradual and systematic response to virtual reality. Cognitive restructuring, if appropriate.
- Reports are shown to the patient to see clinical progress.
HOMEWORK
Imagination exposure reviewing the process followed in consultation.
| ITEM | SUD’s | ENVIRONMENT | CONFIGURATION | EVENT |
|---|---|---|---|---|
| Waiting for the teacher with a lot of people in the hallway, and they are very nervous and agitated | 60 | University | Hard, A lot of students | No event |
| Be with some classmates waiting in the hallway, the teacher appears and tells you to come in very seriously | 65 | University | Difficult, Few students | Teacher appears |
| Being in class about to start a test, the classmates seem calm | 70 | University | Easy, Few students | Enters the classroom |
SESSION 4
- Review the achievements of the previous session and establish the objectives of the current one: See that the classmates are very nervous while waiting to start the test.
- Exposure begins with prevention of gradual and systematic response to virtual reality. Cognitive restructuring, if appropriate.
- Reports are shown to the patient to see clinical progress.
HOMEWORK
Imagination exposure at home, reviewing previous session.
| ITEM | SUD’s | ENVIRONMENT | CONFIGURATION | EVENT |
|---|---|---|---|---|
| To see the result after doing a test | 70 | University | Easy, Few students | Finish the test |
| Being alone with the teacher while he seems very serious | 75 | University | Hard, Alone | Enters the classroom and then, No event |
| Waiting for the test to begin and see that the large number of colleagues around you seem very nervous | 80 | University | Hard, A lot of students | Enters the classroom and then, No event |
SESSION 5
- Review of the previous session achievements and establishment of the objectives of the session: Note that the teacher watches a lot while doing a short test.
- Exposure begins with prevention of gradual and systematic response to virtual reality. Cognitive restructuring, if appropriate.
- Repeat twice each one of the exercises.
- Reports are shown to the patient to see clinical progress.
HOMEWORK
Imagination exposure at home reviewing the objectives discussed in the session.
| ITEM | SUD’s | ENVIRONMENT | CONFIGURATION | EVENT |
|---|---|---|---|---|
| Be alone with the teacher and start the test | 80 | University | Easy, Alone | Start the exam |
| Doing a short test in a crowded classroom | 85 | University | Easy, A lot of students | Start the exam |
| Doing a short test and notice that the teacher is watching a lot | 90 | University | Hard, A lot of students | Start the exam |
SESSION 6
- Review of the previous session achievements and establishment of the objectives of the session: Performing a long test while several classmates are saying aloud that they have already finished
- Exposure begins with prevention of gradual and systematic response to virtual reality. Cognitive restructuring, if appropriate.
- Repeat twice each one of the exercises
- Reports are shown to the patient to see clinical progress.
HOMEWORK
Imagination exposure at home, reviewing the previous session.
| ITEM | SUD’s | ENVIRONMENT | CONFIGURATION | EVENT |
|---|---|---|---|---|
| The class murmur is being reduced and the teacher starts the test | 90 | University | Easy, Few students | Start the exam |
| Be doing a very long test and the teacher is watching you a lot | 95 | University | Hard, A lot of students | Start the exam |
| Doing a long test and several classmates are announcing aloud that they have already finished | 100 | University | Hard, A lot of people | Start the exam (some time has to pass) |
Remember that you can use the clinical guide to inform you of the therapeutic procedures with empirical evidence and how to adapt them to the intervention with the Psious virtual environments.