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.”
Treatment in a single session of Öst
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 from 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.
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.
| ITEM | SUD’s | ENVIRONMENT | CONFIGURATION | EVENT |
|---|---|---|---|---|
| Being at a table having a terrarium over | 20 | rooms with spiders, | minimal terrarium, small | Maximum distance |
| See a very small spider in a terrarium | 30 | rooms with spiders, | minimal terrarium, small | Maximum distance |
| See a few small spiders inside of a terrarium | 40 | Room with spiders | maximum, terrarium, small | Maximum distance |
SESSION 2
- Review achievements of the previous session and set objectives of the session: See large spiders in a terrarium.
- The exhibition begins with 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.
| ITEM | SUD’s | ENVIRONMENT | CONFIGURATION | EVENT |
|---|---|---|---|---|
| See a medium spider inside a terrarium | 45 | Room with spiders | minimum, terrarium, medium | Maximum distance |
| See some large spider inside the terrarium and that moves | 50 | Room with spiders | minimum, terrarium, large | Disorder |
| See a medium spider in a terrarium quite close | 55 | Room with spiders | minimum, terrarium, medium Medium | distance |
| See enough large spiders inside a terrarium | 60 | Room with spiders | maximum, terrarium, large | Maximum 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 Exposure with 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.
| ITEM | SUD’s | ENVIRONMENT | CONFIGURATION | EVENT |
|---|---|---|---|---|
| View some small spiders to the other side of the table | 60 | room with chandeliers, | minimal table, small | maximum distance |
| that a few large spiders you begin to move much while in a terrarium | 65 | room with spiders, | maximum terrarium, large | disorder |
| See a small group of medium sized spiders to the other side of the table | 65 | room with chandeliers, | minimal table medium | maximum distance |
| See some large spider to the other side of the table | 70 | room with chandeliers, | minimal table, large | maximum 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 Exposure With 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.
| ITEM | SUD’s | ENVIRONMENT | CONFIGURATION | EVENT |
|---|---|---|---|---|
| Stand in front of a small spider does not move | 70 | Augmented Reality: Spiders | small, low | |
| See some spider medium halfway between the end of the table and your hands | 75 | roomspiders | minimum, table, mediumMedium | distance |
| Have a small number of medium moving | 80 | spidersRoom with spiders | medium, medium, walk |
SESSION 5
- Review previous session achievements and set session objectives: Have a group of spiders in front and move.
- is carried out Exposure With 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.
| ITEM | SUD’s | ENVIRONMENT | CONFIGURATION | EVENT |
|---|---|---|---|---|
| Have a spiders few close and not move: | 80 | Augmented Reality Chandeliers | large, medium | |
| View as many medium sized spiders are close to you | 85 | Augmented Reality: Chandeliers | large, maximum, ride | |
| Having a large group of spiders moving forward you | 90 | Room with spiders, | maximum table, middle | distance Reduce |
SESSION 6
- achievementsReview previous session and session establishment objectives: that many large spiders walk by your hand
- is made gradual exposure prevention 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.
| ITEM | SUD’s | ENVIRONMENT | CONFIGURATION | EVENT |
|---|---|---|---|---|
| Having a medium-sized spider walking by your hand | 85 | Video: Spider | ||
| Having enough spiders in front, a loud noise is heard and they begin to move | 90 | Room with spiders | maximum, table, large | Minimum distance + Disorder |
| See in front of you a large group of large spiders that move | 95 | Augmented Reality:spiders | Large, maximum, walk | |
| Have many large spiders nearby and walk by your hand | 100 | Room with spiders | maximum, table, large | Minimum distance + Walk by hand |
[ DISCLAIMER: This document has been automatically translated using Google Translate. ]