Evaluation
“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.”
Goals of evaluation
- To evaluate the presence and comorbidity of other emotional disorders, especially panic disorder, anxiety disorders and other phobias.
- Evaluate component-related anxiety: being in a public place with many people, feelings of distress and thoughts about not being able to escape.
- Define stimulating configurations feared by the patient and the degree of it. Elaboration Hierarchy of Exposure.
- Evaluate the presence of distorted thoughts: losing control and not being able to escape the situation, suffer a panic attack.
Some useful tools for evaluating agoraphobia
In consideration to the evaluation objectives, we will provide a list of some tools that can be useful to obtain relevant information and characteristics about your patient. Remember that a good definition of objectives, characterization of the patient and planning of the intervention are important for the efficiency and efficacy of the therapy, as well as for satisfaction of your patients. In the bibliography, you will find articles to review the characteristics of the instruments proposed below. A combination of the following tools will be used for a complete evaluation of the problem.
- Open or semi-structured interview.
- Structured interview: Interview for the Anxiety disorders According to DSM-IV (ADIS-IV)
- Observation and self-observation (with auto-registration)
- Diary of anxiety and panic attacks
- Auto-registration of relaxation
- Behavioral approach Test in vivo and/or through virtual reality
AutO-reports
- Mobility Inventory for agoraphobia: to evaluate the avoidance of situations and places
- Body Sensation Questionnaire: to evaluate the fear of various body sensations
- Questionnaire of agoraphobic cognitions: to evaluate the catastrophic thoughts and physical feelings of anxiety
- Agoraphobia Inventory
- Psious Auto-Reports for the elaboration of the hierarchy
Elaboration of the exhibition hierarchy with Psious environments
Once we have the information from the evaluation, we can proceed to develop the exposure hierarchy. In addition to using the data obtained during the initial assessment, we can make a series of questions (for example: on a scale from 0-100, what level of discomfort would you feel being on a platform waiting for the underground?, a scale from 0 to 100, what level of discomfort would you feel going to shop at a mall with a lot of people?, do you think there is anything that can generate a higher discomfort?…) aimed at planning the intervention through virtual reality.
Here are some items that could be used to create an appropriate hierarchy for treating agoraphobia with Psious. It must be noted that we should ask the patient about the anxiety generated by these situations, and based on this, note and grade the different elements of the hierarchy.
- Driving around the city during low-traffic hours
- Driving around the city during high-traffic hours ( Environment fear to driving, city)
- Highway travel
- Being alone at home (Generalized Anxiety Environment, concern…)
- Going inside an elevator (Claustrophobic environment, Small elevator)
- Being in the Underground entrance (Agoraphobia environment, Metro)
- Being at the platform (Agoraphobia environment, Metro)
- Getting on a plane and closing the doors (Environment fear of flying, Plane)
- Being in the subway wagon with a lot of people (Environment agoraphobia, Metro)
- Being on the street away from home with few people (Environment agoraphobia, Square, Boulevard…)