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Fear of Animals Manual

ESTE DOCUMENTO HA SIDO TRADUCIDO DEL ESPAÑOL MEDIANTE GOOGLE TRANSLATE Y NECESITA SER TRADUCIDO POR UN TRADUCTOR PROFESIONAL

Index Manual Fear of Animals

  1.  Phobia to Animals: Virtual Reality and Augmented Reality
  2. Evaluation protocol / psychological intervention proposed by Psious
    1. Evaluation Fear of animals
      1.  Evaluation objectives
      2. Some useful instruments for the evaluation of Fear of animals
      3. Elaboration of the hierarchy of exposure with Psious environments
    2. Treatment in a single session of Öst
    3. Example of intervention in Fear of spiders
  3. Recommendations for Use Recommended 
  4. bibliography
  5. Annex

1. Animal phobia: virtual reality and augmented reality

The treatment of choice for animal phobia is based on the use of exposure techniques, whose success rate is around 90%. However, sometimes it can be difficult to carry out these sessions due to the difficulty of controlling insect reactions, creating specific situations, getting certain species, etc. Furthermore, most patients refuse to perform live exposure tasks and may even drop out of treatment. It is precisely for this reason that Virtual Reality (VR) and Augmented Reality (RA) are good alternatives for the treatment of this phobia. These technologies help facilitate patient adherence to treatment and allow the therapist to have control over different variables during exposure.

In addition to this advantage, AR is a technology that combines the real world with digital objects, making it easy to show three-dimensional objects superimposed on real situations. This facilitates the construction of systematic, gradual and adapted exposition sessions to the needs of each one. 

This is why the abundant research in this regard has confirmed the therapeutic efficacy of both RV and RA in the treatment of this type of phobias (García-Palacios et al, 2001), as well as the wide range of advantages that make them preferable. to traditional techniques (Miloff et al, 2016).

2. Psychological evaluation / intervention protocol

All the information contained in this section is for guidance only. Psious environments are therapeutic 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, token economy …) to Psious settings.

2.1 Evaluation Fear of animals

2.1.1 Evaluation objectives 

  • To assess the presence and comorbidity of other emotional disorders, especially anxiety disorders and other phobias.
  • Evaluate anxiety associated with components: animals and their movements (especially if they are sudden), their physical appearance, the sounds they make and their tactile properties.
  • Define stimulus configurations feared by the patient and to what degree. Elaboration of exposure hierarchy.
  • Assess presence of distorted thoughts: believe that they will be terrified of an animal, that they will lose control, that they will harm themselves when trying to escape.

2.1.2 Some useful instruments for the evaluation of Fear of animals

Taking into account the evaluation objectives, we will list some tools and instruments that may be useful to obtain relevant information about the characteristics of your user. Remember that a good definition of objectives, characterization of the patient and planning of the intervention are important for the efficiency and therapeutic efficacy, as well as for the satisfaction of your patients. In the bibliography you will find the articles in which to review the characteristics of the instruments proposed below.

For a complete evaluation of the problem, a combination of the following instruments will be used:

  • Open or semi-structured interview.
  • Structured interview: Interview for Anxiety Disorders according to the DSM-IV (ADIS-IV) (Brown, Di Nardo & Barlow, D, 1994) 
  • Observation and self-observation (with self-registration): 
  • In vivo behavioral approach test and / or using virtual reality
  • Self-reports
  • Fear Recognition Inventory III (Fear Survey Schedule III, FSS-III) (Wolpe & Lang, 1977)
  • Inventory of fears (children) (Sosa et al., 1993)
  • Psious self-reports for the elaboration of the hierarchy

2.1 .3 Elaboration of the exposure hierarchy with Psious environments: 

Once we have the evaluation information we can proceed to elaborate the exposure hierarchy. For this, in addition to using the data obtained during the initial assessment, we can ask a series of questions (eg, what level of discomfort, on a scale of 0 to 100, does it generate to see a small spider? What level of discomfort , on a scale of 0 to 100, would it generate you to have a cockroach walking by your hand? Do you think there is something that can generate even greater discomfort? …) aimed at planning the intervention using virtual reality.

Below are a number of items that could be used to create an appropriate hierarchy for dealing with animal fear with Psious. It should be borne in mind that we could ask the patient about the anxiety that these items generate, and from this, graduate the different elements of the hierarchy.

  • Being in a room and seeing a small spider inside a terrarium (environment afraid of animals, room with spiders) 
  • Seeing many pigeons while walking through a plaza (environment afraid of animals, video pigeons in a plaza)
  • What a small cockroach walk by your hand (environment afraid of animals, room with cockroaches)
  • See many quite large spiders move around the table (environment afraid of animals, room with spiders)
  • Petting a cat (environment afraid of animals, video cat)
  • Being around a dog of the Rottweiler breed (animal fear environment, Rottweiler video)
  • Seeing a few cockroaches on the work table (animal fear environment, augmented reality of cockroaches)

2.2 Treatment in a single session by Öst 

More A treatment protocol using Psious is provided below. The suggested protocol is based on the guidelines for single session treatment proposed by Öst (1989), which is currently one of the recommended treatments for specific phobias. It is an intensive exhibition, the duration of which is usually between one and three hours. The main objective is to confront the patient to the phobic situation in a controlled way, allowing him to see that the feared consequences do not happen. 

An alternative is to carry out several sessions in which the total treatment time does not exceed three hours, so it is proposed to distribute it in six sessions. In addition, for its long-term effectiveness, it is recommended that the patient continue with techniques of self-exposure to the feared situations once the treatment ends.  

Exposure using RV and / or RA is normally combined with traditional techniques, such as cognitive restructuring and modeling techniques.

To apply the Öst single-session technique, patients must meet the following characteristics: present a phobia not associated with other pathologies, be motivated enough to tolerate a high level of anxiety for long periods of time, and not obtain positive consequences derived of phobia. Furthermore, the technique will not be used in patients with physical illnesses such as heart disease. 

It is a prolonged exposure, with no possibility of escape and which is generally graduated through the use of aids and closer approximations to the feared element. Each step in the hierarchy continues until anxiety levels are reduced by at least 50% from their highest value, or when the patient’s negative thoughts are modified. 

Next, an adaptation of this treatment of a single session is proposed to the resources available on the Psious platform. This intensive session is designed to last approximately two hours. To begin with, the patient must be informed of the objective: to approach by a small step towards the insect, with the subsequent maintenance of said approach, which will ultimately lead to a decrease in anxiety (Gunnar Götestam and Hokstad, 2002). 

Each session will begin with the exhibition using virtual reality, with the presence of spiders or cockroaches depending on the patient’s phobia. First, you will start with the insect in question inside the terrarium. Little by little, the distance between them will be reduced (always indicating the patient before). Afterwards, the patient should be asked if he feels prepared to be exposed to the animal outside the terrarium. When the patient feels ready, then this will be done. Little by little, the insect will get closer and closer to the patient, always indicating previously. Finally, through the corresponding menu, the virtual insect will be placed on top of the avatar’s hands. As a last step, it is recommended to use the augmented reality environment so that the hands are those of the patient. In this case, you can first touch the insect with an object and then proceed to contact with your hands. The final objective for the patient will be to be able to catch the insect without suffering anxiety.

2.3 Example of intervention in Fear of spiders

SESSION 1

Psychoeducation: Inform the patient about fear of animals (Causes, symptoms, prevalence …).

  • Present and justify the techniques to be used throughout the treatment: virtual reality exposure and live exposure …
  • Elaboration of the exposure hierarchy and exposure to items in the 20-30 USA hierarchy (example)
  • Start exposure hierarchy with an item close to 30 USA’s.

The main objective will be to familiarize the patient with virtual reality and work dynamics.

ItemUSA’sEnvironmentConfigurationEvent
Being at a table having a terrarium over20rooms withspiders,minimal  terrarium, smallMaximum distance
See a very small spider in a terrarium30rooms withspiders,minimal  terrarium, smallMaximum distance
See a few small spiders inside of a terrarium40Room with spidersmaximum, terrarium, smallMaximum distance

SESSION 2

  • Review achievements previous session and set objectives of the session: See large spiders in a terrarium.
  • Thebegins exhibitionwith gradual and systematic response prevention with virtual reality. Cognitive restructuring, if applicable
  • Reports are shown to the patient for clinical progress.

Homework

Live exhibition before an empty terrarium or with a small insect.

ItemUSA’sEnvironmentSettingEvent
See a medium spider inside a terrarium45Room with spidersminimum, terrarium, mediumMaximum distance
See some large spider inside the terrarium and that moves50Room with spidersminimum, terrarium, largeDisorder 
See a medium spider in a terrarium quite close 55Room with spidersminimum, terrarium, medium Mediumdistance
See enough large spiders inside a terrarium60Room with spidersmaximum, terrarium, largeMaximum distance

SESSION 3

  • The achievements of the previous session are reviewed and objectives of the current: See a large spider on the other side of the table.
  • is carried out Exposurewith prevention of gradual and systematic response with virtual reality. Cognitive restructuring, if applicable.
  • Clinical advances are shown to the patient, through platform reports.

Homework

Live exhibition looking at an empty terrarium or with a couple of insects + covert exhibition at home reviewing the session through the imagination.

ItemUSA’sEnvironmentConfigurationEvent
View some small spiders to the other side of the table60 room withchandeliers,minimal  table, smallmaximum distance
that a few large spiders you begin to move much while in a terrarium65room withspiders,maximum  terrarium, largedisorder
See a small group of mediumsized spiders to the other side of the table65room withchandeliers,minimal  table mediummaximum distance
See some large spider to the other side of the table70room withchandeliers,minimal  table, largemaximum distance

SESSION 4

  • are reviewed achievements from the previous session and session objectives are set: Have a small group of medium-sized spiders moving in front of you. 
  • is carried out Exposurewith prevention of gradual and systematic response with virtual reality. Cognitive restructuring, if applicable.
  • Clinical advances are shown, through platform reports, to the patient.

Homeworks

Exhibition covertly through imagination

ItemUSA’sEnvironmentConfigurationEvent
Standfront of a small spider does not move70Augmented Reality: Spiderssmall, low
See some spider medium halfway between the end of the table and your hands75roomspidersminimum, table, mediumMedium distance
Have a small number of medium moving80spidersRoom withspidersmedium, medium, walk

SESSION 5

  • Review previous session achievements and set session objectives: Have a group of spiders in front and move.
  • is carried out Exposurewith prevention of gradual and systematic response with virtual reality. Cognitive restructuring, if applicable.
  • Repeat 2 times each of the exercises
  • Show clinical progress, through platform reports, to the patient.

Homework

Exhibition in imagination reviewing the objectives discussed in consultation.

ItemUSA’sEnvironmentSettingEvent
Having a few spiders nearby and not moving80Augmented Reality:Large, medium
spiders See how many medium spiders approach you85Augmented Reality:spidersLarge, maximum, walking
Having a large group of spiders moving ahead of you90Room with spidersmaximum, table, mediumReduce distance

SESSION 6

  • Review achievements of the previous session and establish objectives of the session: That many large spiders walk by your hand
  • is carried out Exposurewith prevention of gradual and systematic response with virtual reality. Cognitive restructuring, if appropriate.
  • Repeat each exercise twice
  • Show clinical progress, using platform reports, to the patient.

Homework

Covert exposition, reviewing the process followed in the session at home.

ItemUSA’sEnvironmentSettingEvent
Having a medium-sized spider walking by your hand85Video: Spider
Having enough spiders in front, a loud noise is heard and they begin to move90Room with spidersmaximum, table, largeMinimum distance + Disorder
See in front of you a large group of large spiders that move95Augmented Reality:spidersLarge, maximum, walk
Have many large spiders nearby and walk by your hand100Room with spidersmaximum, table, largeMinimum distance + Walk by hand

3. Recommendations for use

It is important to accompany the presentation with comments, questions or indications so that the patient is more in position and experiences the exhibition in a more realistic way.

Some examples for fear of animals

  • Now we are going to take a walk in a square where there will probably be pigeons.
  • How do you feel when the dog approaches you? Does this make you feel uncomfortable? 
  • What sensations does the terrarium in front of you generate, now that it is empty?
  • You are seeing some roaches approaching, what do you think could happen?
  • At this moment you are going to feed a group of pigeons, and you are going to see that they surround you, are you ready?
  • Now that you have a little spider in your hand, what makes you more anxious?
  • The cockroach that just appeared is bigger than the previous one, how does that make you feel?
  • Do you feel comfortable petting this cat? Does the fact that he opens his mouth make you anxious?
  • Now you see that the terrarium is empty, but let’s see how it would look if there were small spiders in it; are you ready?

4. Recommended bibliography

Bados, A. (2005). Specific phobias. Barcelona. University of Barcelona.

Bottle, C., Breton-López. J., Quero, S., Baños, RM, García-Palacios, A., Zaragoza, I. and Alcañiz, M. (2011). Treating cockroach phobia using a serious game on a mobile phone and augmented reality exposure: a single case study. Computers in Human Behavior, 27, 217-227.

Botella, CM, Juan, MC, Baños, RM, Alcañiz, M., Guillén, V. and Rey, B. (2005) Mixing Realities? An Application of Augmented Reality for the Treatment of Cockroach Phobia. Cyberpsychology and Behavior, 8 (2), 162-171.

Brown, TA, Di Nardo, PA & Barlow, DH (1994). Anxity Disorders Interview Schedule for DSM-IV (ADIS-IV). San Antonio: The Psychological Corporation.

García-Palacios, A., Hoffman, HG, Kwong See, S., Tsai, A. and Botella, C. (2001) Redefining Therapeutic Success with virtual reality exposure therapy. Cyberpsychology & Behavior, 4, 341-348

Gunnar Götestam, K. and Hokstad, A. (2002). Single-session treatment of Arachnophobia in a group through Active Rotating Exposure. The European Journal of Psychiatry, 16 (3), 133-138. 

Juan, MC, Alcañiz, M., Montserrat, C., Baños, RM and Guerrero, B. (2005). Using augmented reality to treat phobias. IEEE Computer Graphics and Applications, 25 (6), 31-37.

Miloff, A., Lindner, P., Hamilton, W., Reuterskiöld, L., Andersson, G., & Carlbring, P. (2016). Single-session gamified virtual reality exposure therapy for spider phobia vs. traditional exposure therapy: study protocol for a randomized controlled non-inferiority trial. Trials, 17 (1), 60. https://doi.org/10.1186/s13063-016-1171-1

Öst, LG (1989). One-session treatment for specific phobias. Behavior Research and Therapy, 27, 1-7.

Sosa, CD, Capafóns, JI, Conesa-Peraleja, MD, Martorell, MC, Silva, F. and Navarro, AM (1993). Inventory of fears. In F. Silva and C. Martorell (dirs.), Assessment of childhood and youth personality (vol. 3, pp. 101-124). Madrid: MEPSA

Wolpe, J. and Lang, P. (1977). Manual for the Fear Survey Schedule. San Diego, CA: Educational and Industrial Testing Services. 

6. Annexes

6.1 Self-report hierarchy Augmented Reality spiders / cockroaches Psious environments

* The self-report only talks about cockroaches, but it is applicable to the RA of spiders (both environments work exactly the same)

ItemLevel discomfort (0-100)
Above the table there are some roaches. I can see that they are moving and that they are quite large.
There are a few roaches, neither too big nor too small, that are static on the table.
I have a small roach in front of me, and it does not move.
There are a few roaches, not too large. not too small, they are walking on the table
I have a small cockroach in front of me that is moving
I have a cockroach in front, which is not too big but not too small, and that does not move
I can see many cockroaches that move and they are quite small
I have some roaches in front, they are rather small and they do not move
I can see many roaches in front of me. I see that they do not move but that they are medium, neither too small nor too big.
In front of me I can see a very large cockroach that moves from one side to the other.
I can see many cockroaches that do not move and that are quite small.
I have some cockroaches moving in front, and they are rather small
I have a cockroach in front, which is not too big but not too small, and it is moving 
I have a large group of large cockroaches in front. Still, they don’t move too much.
I can see a lot of roaches in front of me. I see that they move but they are medium, neither too small nor too big. 
In front of me I can see a very large cockroach that does not move.
On the table there are some cockroaches. I can see that they do not move and that they are quite large
I have in front of me a large group of large cockroaches that move all over the table

6.2 Self report hierarchy room spiders / cockroaches Psious environments

* In the self report we only talk about spiders, but it is applicable to the environment of cockroaches (both environments work exactly the same)

ItemLevel discomfort (0-100)
I have a small group of large spiders on the other side of the table, and suddenly a noise is heard that makes the spiders move a lot
I am faced with a table, and I can see that there is some very small spider moving around there 
In the terrarium on top of the table I can see that there are many rather medium-sized spiders, they are not small but not very large
Halfway between the end of the table and my hands there is a small group of spiders that are quite big and they move
I have a couple of small spiders very close to my hands
I am looking at a terrarium and I can see that there are a lot of very small spiders
There are a small number of very large spiders on the table, but they are quite far from my hands.
There are many medium spiders on the table, and they move until they are at a medium distance between my hands and the end of the table.
I am in a room, with a terrarium in front. In it I can see that there are a couple of very large spiders that move.
I have my hands resting on the table, and I can see how a small spider begins to move through them.
When I have many large spiders near me, there is a loud noise and spiders move from side to side
I am at a table and I can see that there are a lot of very small spiders
I am sitting in a chair and at the table in front I can see that there are a couple of very large spiders that move
There are a small number of medium sized spiders on the table, but they are quite far from my hands.myself in
I findfront of a terrarium, and I can see that there is some very small spider inside.
While sitting in a chair I see that there is some medium sized spider above the table.
There are many, many fairly small spiders on the table, but they are quite far from my hands.
I am with my hands resting on the table, and I see how some spider, neither too big nor too small, moves quite close to me.
I have my hands resting on the table, and I can see how many small spiders start to move around them
On the table I can see that there are many, many medium-sized spiders, they are not small but they are not very large either.
I have many large spiders very close, and they start to walk by my hand
While sitting in a chair I see the terrarium in front of me, and in it there is some medium spider.
Halfway between the end of the table and my hands there is a large group of spiders that are quite large and move.
I have a pair of medium spiders very close, and they start to walk by my hand
I am in a room, and on the table there are many spiders that are very large
I am with my hands resting on the table, and I see how many spiders, neither very large nor very small, move quite close to me
I’m in a room, and in the terrarium there on the table there are many spiders that are very large
there are some small spiders near me, and begin to move much when a loud noise heard in the room
have a pa r of large spiders very close, and they start to walk by my hand
There are a small number of quite small spiders on the table, but they are quite far from my hands
As I am looking at the table, I see like a large group of spiders, which are quite large, they move very close to my hands
I have many small spiders very close to my hands
On the table there are some small spiders, and although they are not at the end of the table, they are not touching my hands
On the table there are quite a few spiders small, and although they are not at the end of the table, they are also not touching my hands
There are some medium-sized spider on the table, and they move until they are at a medium distance between my hands and the end of the table 
I have many spiders very large quite far from my hands
While I’m looking at the table, I see a small group of spiders, which are quite large, they move very close to my hands
There are many medium-sized spiders near my hands, and they start walking around one of them
There are a large number of ara Medium-sized nails on the table, but they are quite far from my hands

6.3 Self-report hierarchy environment Fear of Dogs

ItemLevel discomfort (0-100)
I see a dog in the distance sitting muzzled next to its owner and tied on a leash
In the distance I see to a dog sitting, muzzleless next to its owner and on a leash
I can see in the distance a dog with a muzzle sitting on a leash, somewhat separated from its owner
In the distance I see a dog without a muzzle, sitting and separated from its owner but tied on a leash
I see a dog sitting with a muzzle in the distance, without a leash but next to its owner
I see a dog sitting in the distance, without a muzzle, next to its owner and without a leash
I can see a dog with a muzzle in the distance , sitting, without a leash and a little far from its owner 
I observe a dog without a muzzle, sitting, without a leash and a little far from its owner
I observe a dog in the distance standing with a muzzle next to its owner and tied on a leash
A in the distance I see a dog standing, muzzleless next to its owner and on a leash
I can see in the distance a dog with a muzzle standing on a leash, somewhat separated from its owner
In the distance I see a dog without a muzzle, standing and separated from its owner but tied on a leash
I see in the distance a dog with a muzzle standing , without a leash but next to its owner
I see a dog standing in the distance, without a muzzle, next to its owner and without a leash
I can see in the distance a dog with a muzzle, standing, without a leash and a little away from its owner
I see far away a dog without a muzzle, standing, without a leash and a little far from its owner
In the distance I see a dog sitting, without a muzzle next to its owner and tied on a leash and barking
In the distance I see a dog without a muzzle and barking, sitting and separated from its owner but tied on a leash
I observe in the distance a sitting dog, without a muzzle, next to its owner and without a leash and barking
I observe far a dog without a muzzle, sitting, without a leash and a little away from its owner and barking
In the distance I see a dog standing, muzzleless next to its owner, on a leash and barking 
A l or far I see a dog without a muzzle and barking, standing and separated from its owner but tied on a leash
I see in the distance a dog standing, without a muzzle, next to its owner, without a leash and barking
I see far a dog without a muzzle, standing, off leash, slightly away from its owner and barking
I observe a medium-distance dog sitting muzzled next to its owner and tied on a leash
At a medium distance I see a dog sitting, muzzled next to its owner and tied on a leash
I can see at a medium distance a dog with a muzzle sitting on a leash, somewhat separated from its owner
At a medium distance I observe a dog without a muzzle, sitting and separated from its owner but tied on a leash
I observe at a medium distance a dog sitting with a muzzle, without a leash but next to its owner
I observe at a medium distance a dog sitting, without a muzzle, next to its owner and without a leash
I can see at a medium distance a dog with a muzzle, sitting, without a leash and a little away from its owner
I observe at a medium distance a dog or without a muzzle, sitting, without a leash and slightly away from its owner
I observe a dog at a medium distance standing with a muzzle next to its owner and tied on a leash
At a medium distance I see a dog standing, without a muzzle next to it from its owner and on a leash
I can see at a medium distance a dog with a muzzle standing on a leash, somewhat separated from its owner
At a medium distance I see a dog without a muzzle, standing and separated from its owner but on a leash
I observe At a medium distance a white dog standing with a muzzle, without a leash but next to its owner
I observe at a medium distance a dog standing, without a muzzle, next to its owner and without a leash
I can see at a medium distance a dog with muzzle, standing, without a leash and a little far from its owner
I observe at a medium distance a dog without a muzzle, standing, without a leash and a little far from its owner
At a medium distance I see a dog of the sitting dog breed, muzzleless next to its owner and leashed and barking
At a medium distance I watch a dog without a muzzle and barking, sitting and separated from its owner but tied on a leash
I observe at a medium distance a dog sitting, without a muzzle, next to its owner and without a leash and barking
I see far away a dog without a muzzle, sitting, without a leash and slightly away from its owner and barking 
At a medium distance I see a dog of the breed dog standing, without a muzzle next to its owner, tied on a leash and barking 
At a medium distance I see a dog without a muzzle and barking, from standing and separated from its owner but tied on a leash
I observe at a medium distance a dog standing, without a muzzle, next to its owner, without a leash and barking
I observe at a medium distance a dog without a muzzle, standing, without a leash, a little away from its owner and barking 
I see a dog nearby sitting muzzled next to its owner and tied on a leash
Nearby I have a dog sitting muzzleless next to its owner and tied on a leashon a leash
I can see near a dog with a muzzle sittingleash, somewhat detached from its owner. 
Nearby I observe a dog without b ozal, sitting and separated from its owner but tied on a leash
I see a dog sitting near with a muzzle, without a leash but next to its owner
I have a dog sitting nearby, without a muzzle, next to its owner and without a leash
I can see near me a dog with a muzzle, sitting, without a leash and a little far from its owner 
I observe nearby a dog without a muzzle, sitting, without a leash and a little far from its owner
I observe a dog nearby, standing, with a muzzle, next to its owner and on a leash
Near me I see a dog standing, without a muzzle next to its owner and tied on a leash
I have a dog near me with a muzzle standing on a leash, somewhat separated from its owner
Near me I see a dog without a muzzle , standing and separated from its owner but tied on a leash
I see near me a white dog standing with a muzzle, without a leash but next to its owner
I closely observe a dog standing, without a muzzle, next to its owner and without correa
Puedo ver cerca de mí un perro con bozal, de pie, sin correa y un poco alejado de su dueño
Observo de cer ca un perro sin bozal, de pie, sin correa y un poco alejado de su dueño
Cerca de mí veo a un perro de la raza perro sentado, sin bozal al lado de su dueño y atado con correa y ladrando
Cerca puedo observar un perro sin bozal y ladrando, sentado y separado de su dueño pero atado con correa
Observo de cerca un perro sentado, sin bozal, al lado de su dueño y sin correa y ladrando
Tengo cerca un perro sin bozal, sentado, sin correa y un poco alejado de su dueño y ladrando
Cerca de mí veo a un perro de pie, sin bozal al lado de su dueño, atado con correa y ladrando 
Cerca observo un perro sin bozal y ladrando, de pie y separado de su dueño pero atado con correa
Observo cerca de mí un perro de pie, sin bozal, al lado de su dueño, sin correa y ladrando
Observo cerca un perro sin bozal, de pie, sin correa, un poco alejado de su dueño y ladrando