Flying Phobia Manual – Psious Professionals

Index Flying Phobia Manual

Flying Phobia and Virtual Reality
Psious-based Treatment Protocol
Use recommendations
Recommended Bibliography
Annexes
1. Relaxation self-assessment
2. Negative thoughts selfassessmen

1. FLYING PHOBIA AND VIRTUAL REALITY

Virtual Reality (VR) is a less complex, cheaper alternative to in vivo exposure for 2.2. Going to the airport 2.3. Boarding Gate 2.4. The Plane the treatment of flying phobia. This technology does not require a high imagination capacity on the patient as the case of the typical exposure techniques. Also, the exposure can be modified to the patients needs when using VR, as the therapist can control different parameters such as duration of the flight, weather conditions, people on the flight,etc

Many studies demonstrate the efficiency of VR as a treatment for specific phobias. A systematic review about the use of VR as a treatment of flying phobia showed that Cognitive Behavioral Therapy (CBT) combined with relaxation techniques and VR exposure is effective for the treatment of flying phobia ( Costa et al. 2008). Also, a study by Botella ( 2004), demonstrated the efficiency of VR as the only line of treatment for flying phobia at short and long term.

2. PSIOUS-BASED TREATMENT PROTOCOL

A treatment protocol is shown below in which Psious is combined with traditional treatment techniques. However, it is recommended that each psychotherapist adapt and implement VR strategies to the treatment protocols they already use in their clinical practice. Similarly, exposure sessions should progress at their own pace and according to the needs of each patient. The proposed treatment protocol consists of 13 weekly sessions lasting approximately one hour.

Description of treatment sessions

SESSION 1: PSCOEDUCATION

Information about flying phobia is provided (origin, upkeep and appearance the triple system cognitive, physiological and motor).

Information about the functioning and safety of planes.

Treatment techniques that will be used throughout the protocolare explained (emphasizing the exposure to the Virtual Reality environments).

Homework:

Hand out of the Psychoeducation file (see annex 5.1).

SESSION 2- 3: RELAXATION

The patient learns and practices two types relaxation techniques: controlled breathing and Jacobsons progressive muscular relaxation.

Familiarization with the Psious platform. The patient learns to use the VR helmets and navigate inside the virtual scenes.

Homework:

Daily practice of relaxation techniques. The self-registers of relaxation and negative thoughts are completed (see annex 5.2)

SESSION 4: COGNITIVE RESTRUCTURING

Revision and adjustment of the patients negative thoughts.

Cognitive restructuring for each of the negative thoughts. Two kinds of cognitive therapy may b used: the one proposed by Beck or the one belonging to Ellis.

Homework:

Daily practice of relaxation technique Self-registers of relaxation and negative thoughts are completed (see annex 5.2).

SESSION 5: VR EXPOSURE + TRADITIONAL TECNIUES

As of the fifth session of treatment the gradual and systematic exposure to the virtual environments begins. Throughout all exposure sessions, VR is combined with techniques of relaxation and cognitive restructuring.

The patient is exposed to:

Patients house on a sunny day (the news is on TV).

Taxi ride on a sunny day (the news is on the radio).

Boarding gate on a sunny day.

Homework:

Daily practice of the relaxation techniques and tasks of self-exposure to stimulus related to planes.

SESSION 6: VR EXPOSURE + TRADITIONAL TECHNIQUES

Homework review.

The patient is exposed to

Taxi ride on a sunny day

Boarding gate on a sunny day. The display with the flight schedule is shown, also the window with planes taking off and landing.

Plane take-off on a sunny day.

Homework:

Daily practice of relaxation techniques and tasks of self-exposure to stimulus related to planes.

SESSION 7: VR EXPOSURE + TRADITIONAL TECHNIQUES

Homework review.

The patient is exposed to:

Boarding gate on a sunny day and with comments from other passengers. The screen with the flight schedule and the window with planes taking off and landing are observed.

Plane take-off on a sunny day.

) Flight situation. Elements of internal sense exposure are introduced.

Homework:

Daily practice of relaxation techniques and self-exposure tasks to stimuli related to planes.

SESSION 8: VR EXPOSURE + TRADITIONAL TECHNIQUES

Homework review.

The patient is exposed to:

Plane take-off on a sunny day. Turn on comments.

Flight situation and short turbulence. Internal sense exposure.

Landing.

Homework:

Daily practice of relaxation techniques and self-exposure tasks to stimulus related to planes.

SESSION 9 VR EXPOSURE + TRADITIONAL TECHNIQUES

As of the ninth session of treatment the exposure is re-started to the virtual environments but with a higher level of difficulty. Like in the rest of the exposure it is used in combination with relaxation and cognitive restructuring.

The patient is exposed to:

At home on a rainy day (the news is on TV).

Taxi ride on a rainy day (the news is on the radio).

Boarding gate on a rainy day.

Homework:

Daily practice of relaxation techniques and self-exposure tasks to stimulus related to planes.

SESSION 10 VR EXPOSURE + TRADITIONAL TECHNIQUES

The patient is exposed to:

Taxi ride on a rainy day with the radio on. Elements of internal sense exposure are introduced.

Boarding gate on a rainy day. The screen with the flight schedule and window with planes landing and taking off is observed.

Plane take-off on a rainy day.

Homework:

Daily practice of relaxation techniques and self-exposure tasks related to planes.

SESSION 11 VR EXPOSURE + TRADITIONAL TECHNIQUES

Homework revision.

The patient is exposed to:

Boarding gate on a rainy day. Elements of internal sense exposure are introduced.

Plane take-off on a rainy day. Elements of internal sense exposure are introduced.

Flight situation on a rainy day with comments. Elements of internal sens exposure are introduced.

Homework:

Daily practice of relaxation techniques and self-exposure tasks to stimulus related to planes.

SESSION 12 VR EXPOSURE + TRADITIONAL TECNIUES

Homework review

The patient is exposed to:

Plane take-off on a rainy day. Turbulence appears.

Flight situation on a rainy day with turbulence. Elements of internal sense exposure plus comments

Landing on a rainy day with turbulence.

Homework:

Daily practice of relaxation techniques and tasks of self-exposure to flight-related stimuli.

SESSION 13: VR EXPOSURE + TRADITIONAL TECHNIQUES

The therapeutic process is evaluated and future self-exposure tasks are programmed, as well as booster sessions.

Relapse management and prevention.

3. USE RECOMMENDATIONS

It is important to support the exposure with comments, questions or indications, in order for the patient to enhance their immersion, and to provide them with a more realistic experience. Some suggestions for flying phobia are:

Waiting at home, or in the taxi:

Today you are going to catch a flight to (choose a city). The plane leaves at 6 a.m., but we should be at the boarding gate by 11.15 a.m. Also, we have to go through the security controls… It is now 10 a.m., and the taxi will come pick you up in 5 minutes.

Would you want to watch the weather news before we leave home?

They just said that it is rainy. Does that make you more anxious? Can toy tell me why?

You have to be aware that, even though it is raining, the taxi is still going to come pick you up to take you to the airport.

You are going to catch a plane by yourself. hen was the last time you flew lone?

At the Gate area, or during the flight:

Now we are going to watch the planes taking off through the window. In a while you are going to be inside one of those planes.

What does the person beside you/in front of you evoke in you?

Now we are going to look at the displays where the boarding gates are indicated.

Do you think your mate is nervous?

Would you ask the lady sitting next to you for help if you felt an increase in your levels of anxiety?

Its been a while since you last saw a flight attendant in the aisle. Does that make you feel more insecure?

(In the middle of a turbulence) ould you like to call the flight attendant in a Versión de Prueba moment like this?

4. RECOMMENDED BIBLIOGRAPHY

Botella, C., Osma, J., García-Palacios, A., Quero, S. & Baños, R.M. (2004). Treatment of Flying Phobia using Virtual Reality: Data from a 1-Year Follow-up using a Multiple Baseline Design. Clinical Psychology & Psychotherapy, 11(5), 311-323.

Da Costa, R.T., Sardinha, A. & Nardi, A.E. (2008). Virtual reality exposure in the treatment of fear of flying. Aviation, Space, and Environmental Medicine, 79(9), 899-903.

Hirsch, J.A. (2012). Virtual reality exposure therapy and hypnosis for flying phobia in a treatmentresistant patient: A case report. American Journal of Clinical Hypnosis, 55(2), 168-173.

Wallach, H.S. & Bar-Zvi, M. (2007). Virtual-reality-assisted treatment of flight phobia. Israel Journal of Psychiatry and Related Sciences, 44(1), 29-32.

Wiederhold, B.K., Jang, D.P., Gervirtz, R.G., Kim, S.I., Kim, I.Y. & Wiederhold, M.D. (2002). The Treatment of Fear of Flying: A Controlled Study of Imaginal and Virtual Reality Graded Exposure Therapy. IEEE Transactions on Information Technology in Biomedicine, 6(3), 218-223.

5. ANNEXES

5.1 Relaxation self-assessment

Name:______________________________ Date:____________________

Date	Hour	Degree of Relaxation (0-100) Before	Degree of Relaxation (0-100) After	Time Used	Difficulties or Comments

5.2 Negative thoughts self-assessment

Name:______________________________ Date:____________________

Date	Hour	Activity he /she is doing	Thought	Level of anxiety (0-10)	Degree of belief (0-10)