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.”
SESSION 1
Psychoeducation: inform the patient about OCD. What are the causes, symptoms, prevalence, and definition.
- Explain which techniques will be used during the treatment: in anxiogenic situations and in others where relaxation techniques and mindfulness can be used.
- An exposure hierarchy will be elaborated.
- The exposure will be carried out with items that are around the 30 USAs, to familiarize the patient with VR.
The main objective will be familiarizing the patient with virtual reality and the work dynamics.
| ITEM | SUD’s | ENVIRONMENT | CONFIGURATION | EVENT |
|---|---|---|---|---|
| Be at a public toilet’s door | 20 | OCD | Clean | Outside the toilet |
| I place myself in front of a public clean toilet cubicle’s door. | 30 | OCD | Clean | Inside the toilet |
| After entering a clean public toilet, I enter the toilet cubicle and look at the toilet. | 35 | OCD | Clean | Standing inside the cubicle |
SESSION 2
- Revision of the past session’s achievements and establishing of objectives of the actual session: Lower a public toilet’s lid to sit down.
- We begin with gradual exposure and systematic response prevention with virtual reality. Cognitive restructuring, if necessary.
- The reports should be shown to the patient so they can see their clinical progress.
HOMEWORK
Live exposure entering clean public toilets, enter the cubicle and sit on the toilet. Use relaxation if necessary.
| ITEM | SUD’s | ENVIRONMENT | CONFIGURATION | EVENT |
|---|---|---|---|---|
| In front of a clean public toilet, I touch the wall with my left hand. | 40 | OCD | Clean | Touch the wall (standing inside the cubicle) |
| Walk through Ramblas with many people. | 40 | OCD | Dirty | Outside the toilet |
| Inside the cubicle of a clean public toilet. I grab paper and I throw it in the trash | 40 | OCD | Clean | Grab paper |
| I touch the toilet brush in a clean public toilet | 45 | OCD | Clean | Touch toilet brush |
| I lower the toilet lid in a clean public toilet to sit on it | 45 | OCD | Clean | Lower lid |
SESSION 3
- Revision of the past session’s achievements and establishing of objectives of the actual session: Place myself in front of a sink in a clean public toilet.
- We begin with gradual exposure and systematic response prevention with virtual reality. Cognitive restructuring, if necessary.
- The reports should be shown to the patient so they can see their clinical progress.
HOMEWORK
Live exposure by entering a cubicle in a clean public toilet, sit on the toilet, touch the wall and stand in front of the sink. Carry out relaxation exercises if necessary.
| ITEM | SUD’s | ENVIRONMENT | CONFIGURATION | EVENT |
|---|---|---|---|---|
| I sit on a clean public toilet | 50 | OCD | Clean | Sitting on the toilet |
| Sitting on a clean public toilet, I then touch the wall with my left hand | 50 | OCD | Clean | Touching the wall (sitting onthe toilet) |
| I enter a public toilet that doesn’t smell well with paper all over the floor and I place myself in front of the toilet cubicle | 50 | OCD | Dirty | Inside the toilet |
| I flush the toilet after using it (clean public toilet) | 55 | OCD | Clean | Flush the toilet |
| I place myself in front of the sink in a clean public toilet | 60 | OCD | Clean | In front of the sink |
SESSION 4
- Revision of the past session’s achievements and establishing of objectives of the actual session: Touching the walls inside a cubicle of a dirty public toilet.
- We begin with gradual exposure and systematic response prevention with virtual reality. Cognitive restructuring, if necessary.
- The reports should be shown to the patient so they can see their clinical progress.
HOMEWORK
Live exposure entering a clean public toilet. Use the toilet, flush it, and wash hands in a non-compulsive way. Relaxation exercises if necessary.
| ITEM | SUD’s | ENVIRONMENT | CONFIGURATION | EVENT |
|---|---|---|---|---|
| Standing outside a clean public toilet, I open the door, I stand in front of the cubicle, I open the door, I stand in front of the toilet, lower the lid and I sit down | 60 | OCD | Clean | From outside until sitting on the toilet |
| I enter the cubicle and it smells bad, it’s dirty and it has urine drops | 60 | OCD | Clean/Easy | Standing inside the cubicle |
| In the cubicle of a clean public toilet, I grab paper and I throw it in the trash | 65 | OCD | Clean/Easy | Washing hands |
| Sitting on a clean public toilet, I grab paper, I stand up, I flush the toilet, I stand in front of the sink, I wash my hands without touching the faucet, the soap or the dryer. | 70 | OCD | Clean/Easy | Complete |
| I touch the walls of the cubicle of a dirty and smelly toilet | 70 | OCD | Dirty | Touching the wall (standing in the toilet cubicle) |
SESSION 5
- Revision of the past session’s achievements and establishing of objectives of the actual session: Touching the brush inside the cubicle of a dirty public toilet.
- We begin with gradual exposure and systematic response prevention with virtual reality. Cognitive restructuring, if necessary.
- The reports should be shown to the patient so they can see their clinical progress.
HOMEWORK
Live exposure, entering a public toilet, touching several elements inside the cubicle, using the toilet, leaving and washing hands in a non-compulsive way. Relaxation exercises if necessary.
| ITEM | SUD’s | ENVIRONMENT | CONFIGURATION | EVENT |
|---|---|---|---|---|
| I use the sink in a public toilet after using the toilet. I touch the faucet, the soap and the hand dryer | 75 | OCD | Clean/Difficult | Washing hands |
| Sitting on a clean public toilet, I grab paper, I stand up, I flush the toilet, I stand in front of the sink and I use it touching faucet, soap and hand dryer | 75 | OCD | Clean/Difficult | From sitting on the toilet to washing hands |
| I´m outside a clean public toilet, I open the door and I stand in front of the cubicle. I open the door and I stand in front of the toilet. I lower the lid, I sit on the toilet, I grab paper, I stand up, I flush the toilet and I stand in front of the hand dryer. I wash my hands without touching the faucet, soap or hand dryer. | 75 | OCD | Clean/Easy | Complete |
| I grab paper from the cubicle in a dirty public toilet and I then throw it in the trash | 75 | OCD | Dirty | Grabbing paper |
| I touch the toilet brush inside a cubicle of a dirty public toilet | 80 | OCD | Dirty | Touching toilet brush |
SESSION 6
- Revision of the past session’s achievements and establishing objectives of the actual session: Standing outside a dirty public toilet, I open the door, I stand in front of the cubicle, I open the door, I stand in front of the toilet, I lower the lid and sit on the toilet.
- We begin with gradual exposure and systematic response prevention with virtual reality. Cognitive restructuring, if necessary.
- The reports should be shown to the patient so they can see their clinical progress.
HOMEWORK
Live exposure, entering a public toilet, touching several elements inside the cubicle, using the toilet, leaving and washing hands in a non-compulsive way. Relaxation exercises if necessary.
| ITEM | SUD’s | ENVIRONMENT | CONFIGURATION | EVENT |
|---|---|---|---|---|
| Standing outside a dirty public toilet, I open the door, I stand in front of the cubicle I open the door, I stand in front of the toilet, I lower the lid and sit on the toilet, I grab paper, I stand up, I flush the toilet and I stand in front of the sink. I wash my hands, I touch the faucet, soap and hand dryer | 80 | OCD | Clean/Difficult | Complete |
| Lower the lid of a dirty public toilet | 85 | OCD | Dirty | Lower the lid of a dirty public toilet |
| Sitting on a dirty public toilet | 90 | OCD | Dirty | Sitting on the toilet |
| While I’m sitting on a dirty public toilet, I touch the wall with my left hand | 90 | OCD | Dirty | Touching the wall (sitting on the toilet) |
| I’m standing outside a dirty public toilet, I open the door, I stand in front of the cubicle, I open its door, I stand in front the toilet, I lower the lid and I sit on it. | 90 | OCD | Dirty | From standing outside until sitting on the toilet |
SESSION 7
- Revision of the past session’s achievements and establishing of objectives of the actual session: Make a complete sequence, in a dirty public toilet with easy settings.
- We begin with gradual exposure and systematic response prevention with virtual reality. Cognitive restructuring, if necessary.
- The reports should be shown to the patient so they can see their clinical progress.
HOMEWORK
Live exposure, entering a public toilet, touching several elements inside the cubicle, using the toilet, leaving and washing hands in a non- compulsive way. Relaxation exercises if necessary.
| ITEM | SUD’s | ENVIRONMENT | CONFIGURATION | EVENT |
|---|---|---|---|---|
| I flush a dirty public toilet and it smells bad after having used it | 95 | OCD | Dirty | Flushing toilet |
| I stand in front of the sink of a public toilet that stinks | 95 | OCD | Dirty | In front of the sink |
| I wash my hands in a dirty public toilet without touching the faucet, soap or hand dryer. | 95 | OCD | Dirty/Easy | Washing hands |
| I’m standing outside a dirty public toilet, I open the door, I stand in front of the cubicle, I open the door, I standing front of the toilet, I lower the lid, I sit down, I grab paper, I stand up, I flush the toilet, I stand in front of the sink and I wash my hands without touching the faucet, soap and hand dryer. | 95 | OCD | Dirty/Easy | Complete |
SESSION 8
- Revision of the past session’s achievements and establishing of objectives of the actual session: Complete sequence, dirty environment and difficult level.
- We begin with gradual exposure and systematic response prevention with virtual reality. Cognitive restructuring, if necessary.
- The reports should be shown to the patient so they can see their clinical progress.
HOMEWORK
Live exposure by entering both dirty and clean public toilets, enter the toilet cubicle and sit on the toilet, use the sink in a non-compulsive way. relaxation exercises if necessary.
| ITEM | SUD’s | ENVIRONMENT | CONFIGURATION | EVENT |
|---|---|---|---|---|
| I use the sink in a dirty public toilet, touching the faucet, soap and hand dryer | 95 | OCD | Dirty/Difficult | Washing hands |
| Sitting on a dirty public toilet, I grab paper, I stand up, flush the toilet, I stand in front of the sink, and I wash my hands without touching the faucet, soap or hand dryer | 95 | OCD | Dirty/Easy | From sitting down until washing hands |
| Sitting on a dirty public toilet, I grab paper, I stand up, flush the toilet, I stand in front of the sink, and I wash my hands touching the faucet, soap and hand dryer | 100 | OCD | Dirty/Difficult | From sitting down until washing hands |
| I find myself outside a dirty public toilet, I open the door, I stand in front of the cubicle, I open the door, I stand in front of the toilet, I sit on the toilet, I grab paper, I flush the toilet, I stand in front of the sink and i wash my hands touching faucet, soap and hand dryer. | 100 | OCD | Dirty/Difficult | Complete |