Fear of darkness and storms Manual – Psious Professionals

Index Fear of darkness and storms manual

Fear of darkness and storms
Evaluation protocol/ Psious Psychological intervention
1. Fear of darkness and storm Evaluation
  1. Evaluation objectives
  2. Useful tools for fear of darkness and or storm evaluation (children and adults)
  3. Hierarchy preparation/development and exposure with Psious environments
  4. Exposure Hierarchy Development with Psious environments
2. Intervention example and fear of darkness in children
3. Intervention example and fear of storms in children
Usage Recommendations
Recommended bibliography
Appendix

1. Fear of darkness and storms

This Psious virtual reality environment (VR) will assist you in the intervention and evaluation of children and adults who are showing signs of fear of darkness and or storms. With the help of the events and the environment settings provided in the platform each environment can be adapted to the therapeutic procedure requirements. For example, a behavioral approach test or alike, can be carried out (Orgilés, Méndez y Espada, 2005) or the psychological intervention through procedures that have demonstrated stronger observational, in this instance multicomponent programs (systematic desensitization, exposure, modelling, token economy approach, parents training…). Amongst them, one worthy of mention is that of Mikulas y Coffman (1989) and the “emotive performances technique” ( EPT) by Méndez (1986) that suggested using EPT as an alternative to emotive imagery by Lazarus y Abramovitz (1979). Furthermore, an environment can be used to carry out gradual exposure, psychoeducation, cognitive reconstruction, relaxation…

Lastly, let’s focus on the advantages that VR brings to this type of intervention and denote that VR has already demonstrated to be very effective as a treatment in phobias (Capafons, J.I, 2001). With respect to darkness phobia in children, as already indicated, multicomponent programs have shown greater effectiveness than other intervention techniques. For example, in the emotive performances technique counterconditioning components are clearly combined (a child being introduced to a game should be sufficiently attractive to offset the effects of the feared stimulus) with other operant conditioning techniques, not only the strengthening of approach behaviors to the phobic stimulus, but also the elimination of possible conduct behaviors that parents or adults involved in the treatment could apply.The control that the therapist acquires in addition to the gradual process that patients undergoes, on the one hand, facilitates the transition from the simulated environment to the real environment, delivering greater levels of accuracy, and on the other hand, due to the fact that this type of coaching encourages acceptance of the intervention. Thereby, favoring the coaching of parents through observation during the visit and lastly, allowing us to easily “gamify” the intervention.

When it comes to storm phobias, VR provides the solution to solving one of the major drawbacks to in vivo exposure: unpredictability and the lack of frequency. Exposures in Psious can be exposed to patients systemically and the levels of anxiety can be adjusted accordingly to the degree of: night or day, amount of light, intensity of rain or storms.

Ultimately, it combines your knowledge with the tools that you are provided with by Psious, thus enhancing user experiences and achieving better results.

2. Evaluation Protocol/ Psychological Intervention proposed by Psious

All the information contained in this section is intended as a guideline. Psious environments are therapeutic tools which must be used by health professionals in an evaluation process and interventions designed according to the characteristics and needs of the user. There is also a General Clinical Guide available for your attention where you will find further information on how to adapt the psychological intervention techniques in environments with Psious (exposure, systematic desensitization, cognitive reconstruction, token economy approach…).

2.1 Fear of darkness and storms evaluation

2.1.1. Evaluation Objectives:

Evaluate the presence and comorbidity of other emotional disorders, in particular anxiety from separation, night terrors, sleep alterations, other phobias…

Evaluate anxiety associated with dimensions:

Darkness:

personal safety (eg. rapture, robbers)

loss or separation (eg. in children, their parents)

nightmares

imaginary creatures

darkness

Storms:

personal safety/damage

intense sounds

Set the feared stimulative settings for the patient and define to what extent. Exposure hierarchy development, assess if there is only fear of darkness or storms or both collectively.

Measure the presence of distorted thoughts, monsters, robbers, lightning coming through the windows…

2.1.2. Some useful instruments for fear of darkness and/or storms evaluation (children and adults)

Taking the evaluation objectives into account let’s proceed onto listing some tools and devices that can be useful in gathering relevant information on the user characteristics. Always remember good goal setting, patient characterization and intervention planning are important in effective and efficient therapies, as that of your patients’ satisfaction. The following are the articles you will find in the bibliography where you can refer to the proposed tool characterization:

Child evaluation:

Interviews

Structured interview: ADIS-IV:C (Children)

Interview with one or both parents: education background, coping with fear…

Natural observation procedures for parents (similar to Orgilés proposal, Méndez y Espada, 2005): Register of Behavior to Darkness and Register at Bedtime.

Artificial observation procedures for parents (based on Orgilés, Méndez y Espada, 2005): behavioral approach test to darkness and darkness tolerance test.

Fear level thermometer for children applicable to the observation procedures.

Bedtime register (BD)

Self-reporting :

General diagnosis examination questionnaire for parents: e.g CBCL.

General questionnaire of fears for children: e.g FSSC-R

Fear of Darkness assessment scale (EMO)

Electromyography biofeedback. Set the baseline in neutral environment.

Evaluation in Adults:

Structured interview: ADIS-IV

Behavioral approach test/behavior avoidance (in vivo or with virtual reality)

Self-reporting:

Fear Survey Schedule FSS-III (Fear Survey Schedule)

Electromyography biofeedback. Set the baseline in neutral environment.

2.1.3 Exposure Hierarchy development with Psious environments:

Once we have received the evaluation information we can then proceed to develop the hierarchy exposure. To do this, in addition to using the data obtained during the initial evaluation, we can carry out a series of questions, (e.g What level of discomfort is generated, on a scale of 0 to 100, when left alone without any light in the living room? What level of discomfort is generated, on a scale of 0 to 100, when left alone without any light in this bedroom? Can you think of anything else that would generate even more discomfort?…) all geared at the planning of the intervention via the virtual reality

2.2 An example of the Fear intervention to darkness in children

Example protocol designed to be applied on a biweekly or weekly basis, made up of 8 to 12 sessions, lasting 30-45 minutes. A follow-up in 3 to 6 months is recommended.

Session 1

POn introducing the virtual reality, show a neutral environment such as an island or underwater in the sea

The objective in the opening session is to create a game where the child feels relaxed and is willing to participate. Explain to the child that he is going to meet Psicobot, the teleportation who he/she can use for help when needed, be shown the rooms in the house which they can visit, and gain tokens for exploring the house, which the child can exchange for prizes at the end of the session (in the case of using token economy)…

When using the token economy, clarify the operating rules before starting the virtual session. Get the child to interact with the environment and collect tokens easily and exchange the tokens for prizes (in the case of using token economy) at the end of the session .

Item	Environment	Scene/setting	Event
Virtual Reality Presentation	Underwater in the sea	Fish: maximum
Training Zone	Fear of darkness and storms	Cotherapist: Activated Points: easy. Climate: Clear spells	Introduction Teleportation (on child’s request) Help (on child’s request)
In the living room	Fear of darkness and storms	Cotherapist: Activated Points: easy. Climate: Clear spells	Introduction Teleportation (on child’s request) Help (on child’s request)
In the hall-attic zone	Fear of darkness and storms	Cotherapist: Activated Points: easy. Climate: Clear spells	Teleportation (on child’s request) Help (on child’s request)
In the bedroom	Fear of darkness and storms	Cotherapist: Activated Points: easy. Climate: Clear spells	Introduction Teleportation (on child’s request) Help (on child’s request)
Lying down on bed	Fear of darkness and storms	Cotherapist: Activated Points: easy. Climate: Clear spells	Introduction Teleportation (on child’s request) Help (on child’s request) Lying down on bed (on child’s request)
In the Living room area and dimming the light	Fear of darkness and storms	Cotherapist: Activated Points: easy. Climate: Clear spells	Introduction Teleportation (on child’s request) Help (on child’s request) Ambient light)

Session 2

Review achievements from the last session and the objectives set in the session: Continue exploring the house to gain tokens and carry out missions with levels of less lighting.

To favor confrontation and, in particular in the case of implementingemotive performances techniques, games (counterconditioning) could be introduced in the individual spaces. For example, count the number of vases there there are in the living room (5), the number of pictures on the wall in the training zone and in the living room (7)…count the windows in the house, find the contingency/tokens table (bedroom wall) where you can take note of the tokens obtained.

If you use gradual exposure, playing games or distracting is not recommended, use the tokens as a confrontational reinforcement and repetition as a strategy in promoting the bedroom and end to the conditioned biofeedback. As and from the second session in treatment, introducing the systematic and gradual exposure to the distinct spaces in the house is recommendable. In function with the minor’s progress, reduce the light intensity progressively.

• Use the cognitive reconstruction, if necessary.

Remember you have been given TOKENS, set up a token economy, if need be, so that confrontational behavior can be positively reinforced. In the beginning, exchanging tokens for prizes is recommendable at the end of the session

Exercises at home:

Programme activities to be carried out with the parents and the minor between sessions. These activities should be similar to the ones carried out by the consultant via VR. For example, when it’s night-time, using enough lighting, go through the individual rooms in the house, and play teleportation, looking for a specific toy that has been previously hidden by the parents. If you using the token economy, using tokens at home is also recommendable: for finding toys and exploring the rooms. Teach the parents never to force the child to do something he/she does not want to do. Whether scenes such as those which are used in gradual exposure are applied, it would also be a good idea for the parents to be present for the sessions so they can see how the coping develops during the VR sessions.

Item	Environment	Scene/setting	Event
Training zone	Fear of darkness and storms	Cotherapist: Activated Points: easy. Climate: Mild	Introduction Teleportation (on child’s request) Help (on child’s request)
In the hall-attic area	Fear of darkness and storms	Cotherapist: Activated Points: easy. Climate: Mild	Teleportation (on child’s request) Help (on child’s request) Ambient light 75%
In the bedroom	Fear of darkness and storms	Cotherapist: Activated Points: easy. Climate: Mild	Teleportation (on child’s request) Help (on child’s request) Ambient light 75%
Lying down on the bed	Fear of darkness and storms	Cotherapist: Activated Points: easy. Climate: Mild	Teleportation (on child’s request) Help (on child’s request) Lying down on bed (on child’s request) Ambient light 75%

Session 3 to SessionN

Review achievements from the last session, go over the activities done at home and objectives set in the last session: Continue exploring the house to gain tokens and carry out missions.

Emotive performance techniques/Gradual and systematic exposure to the distinct spaces in the house. In function with the minor’s progress, gradual light intensity reduction. REMEMBER BY SETTING THE TOKENS CONFIGURATION SETTINGS (Easy, Medium, Difficult) YOU WILL IN TURN INCREASE THE TIME SPENT IN GAINING TOKENS.

Cognitive reconstruction, if necessary.

To favor confrontation and, in particular in the case of implementing emotive performances techniques, games (counterconditioning) could be introduced in the individual spaces. Be creative by offering a variety of games, get the child to make suggestions….

If you use gradual exposure playing games or distracting the child will not be necessary, use the tokens system as a confrontational reinforcement and repetition as a strategy in promoting the bedroom and end to the conditioned response.

• If you have used a token economy, within the last 2-3 sessions schedule a fading to the token economy: the exchanging of tokens for prizes becomes further apart and reinforcement becomes more social, from the environment itself (child’s autonomy) and self-administered.

Exercises at home:

When based on the emotive performance technique, continue with the kitchen, which will not be accessible, will also be visible from the zones described above, starting at the training zone.

Final session

Review achievements and objectives set from previous session. Lie down on bed with the light turned off (to proceed use rain and even storms if needed).

Systematic and Gradual exposure/Emotive performances techniques to distinct spaces in the house.”Tokens” configuration settings in difficult mode and lights offs. Cognitive reconstruction, and proceed.

If you have used environment tokens to carry out a token economy, make sure it is has been completely withdrawn: behaviors are maintained from natural and social effort and not from exchanging tokens.

Arrange a follow-up within 3, 6 months.

Item	Environment	Scene/setting	Event
Training zone	Fear of darkness and storms	Cotherapist: Activated Points: Difficult. Climate: Storms	Introduction Teleportation (on child’s request) Help (on child’s request)
Living room	Fear of darkness and storms	Cotherapist: Activated Points: Difficult. Climate: Storms	Teleportation (on child’s request) Help (on child’s request) Ambient Light 25-0%
In the hall-bathroom zone	Fear of darkness and storms	Cotherapist: Activated Points: Difficult. Climate: Storms	Introduction Teleportation (on child’s request) Help (on child’s request)
In the hall-attic zone	Fear of darkness and storms	Cotherapist: Activated Points: Difficult. Climate: Storms	Teleportation (on child’s request) Help (on child’s request) Ambient Light 25-0%
In the bedroom	Fear of darkness and storms	Cotherapist: Activated Points: Difficult. Climate: Storms	Teleportation (on child’s request) Help (on child’s request) Ambient Light 25-0%
Lying down on the bed	Fear of darkness and storms	Cotherapist: Activated Points: Difficult. Climate: Storms	Teleportation (on child’s request) Help (on child’s request) Lying down on bed (on child’s request) Ambient Light 25-0%

PLEASE REFER TO OUR CLINICAL GUIDE ON OBSERVATIONAL EVIDENCE THERAPEUTIC PROCEDURES AND HOW TO ADAPT THE INTERVENTION TO VIRTUAL REALITY ENVIRONMENTS WITH PSIOUS

2.3 An example of Fear Intervention to storms in adults

Example protocol designed to be applied on a biweekly or weekly basis, made up of 6 to 8 sessions, lasting 30- 45 minutes. A follow-up in 3 to 6 months is recommended.

Session 1

Inform the patient about fear of storms (Causes, symptoms, prevalence…)

Present and show sufficient grounds for the techniques that are used overtime in the treatment: virtual reality exposure and exposure in vivo…

Exposure hierarchy development and hierarchy item exposure development from 20-30 USA’s

Start exposure hierarchy with an item close to USA’s 30. The main objective is to familiarize the patient with the virtual reality and the working dynamics.

Ítem	Entorno	Configuración	Evento
Training zone. In the dining room	Fear of darkness and storms	Cotherapist: deactivated Points: easy. Climate: Clear spells	Teleportation (on adult’s request)
In the living room without light turned on	Fear of darkness and storms	Cotherapist: deactivated Points: easy. Climate: Clear spells	Teleportation (on adult’s
Hall-attic without light turned on	Fear of darkness and storms	Cotherapist: deactivated Points: easy. Climate: Clear spells	Teleportation (on adult’s
In the bedroom at night without light turned on	Fear of darkness and storms	Cotherapist: deactivated Points: easy. Climate: Clear spells	Teleportation (on adult’s request)
Lying down on the bed at night	Fear of darkness and storms	Cotherapist: deactivated Points: easy. Climate: Clear spells	Lying down on bed (on adult’s request)

Session 2

Review achievements and objectives set from previous session: reduce light in the environments and increase rain intensity.

From the second treatment session, it is recommended to start systematic and gradual exposure in light of virtual reality environments. Cognitive reconstruction, if applicable.

Show clinical progress to patient, using the reports provided in the platform.Reveal clinical progress to patient, using the reports provided in the platform.

Exercises at home:

Covert and/or assisted exposure by computer to the sound of rain (light-moderate) with heavy overcast imaging. Foster in vivo exposure

Item	Environment	Scene/setting	Event
In the living room with dim light and raining.	Fear of darkness and storms	Cotherapist: deactivated Points: easy. Climate: rain	Teleportation (on adult’s request) Ambient light 50% Rain intensity 30%
Hall-attic zone with dim light and raining	Fear of darkness and storms	Cotherapist: deactivated Points: easy. Climate: rain	Teleportation (on adult’s request) Ambient light 50% Rain intensity 30%
Bedroom with dim light and raining	Fear of darkness and storms	Cotherapist: deactivated Points: easy. Climate: rain	Teleportation (on adult’s request) Ambient light 50% Rain intensity 30%
Lying down on bed with dim light and raining	Fear of darkness and storms	Cotherapist: deactivated Points: easy. Climate: rain	Lying down on bed (on adult’s request) Ambient light 50% Rain intensity 30%
In the living room with dim light and raining	Fear of darkness and storms	Cotherapist: deactivated Points: easy. Climate: rain	Teleportation (on adult’s request) Ambient light 50% Rain intensity 50%
Hall-attic zone with dim light and raining	Fear of darkness and storms	Cotherapist: deactivated Points: easy. Climate: rain	Teleportation (on adult’s request) Ambient light 50% Rain intensity 50%
Bedroom with dim light and raining	Fear of darkness and storms	Cotherapist: deactivated Points: easy. Climate: rain	Teleportation (on adult’s request) Ambient light 50% Rain intensity 50%
Lying down on bed with dim light and raining	Fear of darkness and storms	Cotherapist: deactivated Points: easy. Climate: rain	Lying down on bed (on adult’s request) Ambient light 50% Rain intensity 50%

Session 3

Review achievements and objectives set from previous session: reduce light in the environments and increase rain/storm intensity.

Systematic and gradual exposure in light of virtual reality environments. Cognitive reconstruction, if applicable

Show clinical progress to patient, using the reports provided in the platform.

Exercises at home:

Covert and/or computer-assisted exposure to the sound of rain (light-moderate) with heavy overcast imaging.

Item	Environment	Scene/setting	Event
Training zone with dim light and moderate rain	Fear of darkness and storms	Cotherapist: deactivated Points: easy. Climate: Storms	Teleportation (on adult’s request) Ambient light 50% Rain intensity 30%
Hall-bathroom zone with dim light and moderate rain	Fear of darkness and storms	Cotherapist: deactivated Points: easy. Climate: Storms	Teleportation (on adult’s request) Ambient light 50% Rain intensity 30%
Bedroom with dim light and moderate rain	Fear of darkness and storms	Cotherapist: deactivated Points: easy. Climate: Storms	Teleportation (on adult’s request) Ambient light 50% Rain intensity 30%
Lying down on bed with dim light and heavy rain	Fear of darkness and storms	Cotherapist: deactivated Points: easy. Climate: Storms	Lying down on bed (on adult’s request) Ambient light 50% Rain intensity 30%
In the living room with dim light and heavy rain	Fear of darkness and storms	Cotherapist: deactivated Points: easy. Climate: Storms	Teleportation (on adult’s request) Ambient light 50% Rain intensity 70%
Hall-attic with dim light and heavy rain	Fear of darkness and storms	Cotherapist: deactivated Points: easy. Climate: Storms	Teleportation (on adult’s request) Ambient light 50% Rain intensity 30%
Bedroom with dim light and heavy rain	Fear of darkness and storms	Cotherapist: deactivated Points: easy. Climate: Storms	Teleportation (on adult’s request) Ambient light 50% Rain intensity 70%
Lying down in bed with dim light and heavy rain	Fear of darkness and storms	Cotherapist: deactivated Points: easy. Climate: Storms	Lying down on bed (on adult’s request) Ambient light 50% Rain intensity 70%

Session 4

Review achievements and objectives set from previous session: reduce light in the environments and increase rain/storm intensity (intense).

Systematic and gradual exposure in light of virtual reality environments. Cognitive reconstruction, and proceed.

Repeat each exercise twice.

Reveal clinical progress to patient, using the reports provided in the platform.

Exercises at home:

Covert and/or assisted exposure by computer to the sound of rain (light-moderate) with heavy overcast imaging. Foster in vivo exposure.

Item	Environment	Scene/setting	Event
Training zone with light rain and storms	Fear of darkness and storms	Cotherapist: deactivated Points: easy. Climate: Storms	Teleportation (on adult’s request) Ambient light 50% Rain intensity 80%
Living room with dim light and scant storms	Fear of darkness and storms	Cotherapist: deactivated Points: easy. Climate: Storms	Teleportation (on adult’s request) Ambient light 25% Rain intensity 80%
Hall-attic zone with dim light and scant storms	Fear of darkness and storms	Cotherapist: deactivated Points: easy. Climate: Storms	Teleportation (on adult’s request) Ambient light 25% Rain intensity 80%
Bedroom with dim light and scant storms	Fear of darkness and storms	Cotherapist: deactivated Points: easy. Climate: Storms	Teleportation (on adult’s request) Ambient light 25% Rain intensity 80%
Lying down on the bed with dim light and scant storms	Fear of darkness and storms	Cotherapist: deactivated Points: easy. Climate: Storms	Lying down on bed Ambient light 50% Rain intensity 80%

Session 5

Review achievements and objectives set from previous session: reduce light in the environments and increase rain/storm intensity (very intense).

Systematic and gradual exposure in light of virtual reality environments. Cognitive reconstruction, and proceed.

Repeat each exercise twice.

Reveal clinical progress to patient, using the reports provided in the platform.

Exercises at home:

Covert and / or computer-assisted exposure to the sound of light-moderate rain) and images of very cloudy skies. Promote live exhibition

Item	Environment	Scene/setting	Event
Training zone with dim light and very intense storms	Fear of darkness and storms	Cotherapist: deactivated Points: easy. Climate: Storms	Teleportation (on adult’s request) Ambient light 25-0% Rain intensity 90%-100
Living room with dim light and very intense storms	Fear of darkness and storms	Cotherapist: deactivated Points: easy. Climate: Storms	Teleportation (on adult’s request) Ambient light 25-0% Rain intensity 90%
Hall-attic with dim light and very intense storms	Fear of darkness and storms	Cotherapist: deactivated Points: easy. Climate: Storms	TTeleportation (on adult’s request) Ambient light 25-0% Rain intensity 90%-100
Hall-bathroom with dim light and very intense storms	Fear of darkness and storms	Cotherapist: deactivated Points: easy. Climate: Storms	Teleportation (on adult’s request) Ambient light 25-0% Rain intensity 90%-100
Bedroom with dim light and very intense storms	Fear of darkness and storms	Cotherapist: deactivated Points: easy. Climate: Storms	Teleportation (on adult’s request) Ambient light 25-0% Rain intensity 90%-100
Lying down on bed with dim light and very intense rain	Fear of darkness and storms	Cotherapist: deactivated Points: easy. Climate: Storms	Lying down on bed Ambient light 25-0% Rain intensity 90%-100

Sesion 6 & 7

Review achievements from previous session and and set objectives for current session: generalization and overlearning

Systematic and gradual exposure in light of virtual reality environments. Cognitive reconstruction, and proceed.

Repeat each exercise twice, in function with levels of discomfort.

Reveal clinical progress to patient, using the reports provided in the platform.

Foster in vivo exposure and set follow-up at 3-6 months.

Item	Environment	Scene/setting	Event
At home watching television and it’s raining. One family member is not at home	Generalized Anxiety	Concerns about family	Reproduce
At home, just on way to do some errands. TV weather forecast warns of storms	Fear of flying	At home: daytime, rain	Forecast
Driving in the city at night in a storm.	Fear of driving	City: night, rain, maximum, driving, minimum	Circuit 1
Driving on the road at night in a storm	Fear of driving	Road, night, rain, driver, show, hide.	Highway, Medium speed,Bends
Taking a taxi by day in a storm	Fear of flying	On the way to the airport: day, rain.	Weather forecast on radio
At the airport, going to travel in bad weather	Fear of flying	Boarding area:day, rain, maximum	Window, Boarding call
Traveling on a plane in bad weather	Fear of flying	Plane:maximum day, rain, window,middle,off
Traveling on a plane in bad weather	Fear of flying	Plane:maximum, storm,- day window, behind,off	Taxi, Landing
Traveling on a plane in bad weather	Fear of flying	Plane: maximum, storm,day window, behind,off	Flight, Take-off, Light,Turbulences

3. Usage Recommendations

INTERVENTION IN CHILDREN:

When using emotive performances techniques, do remember to give a good introduction making it feel like a game. Psicobot will naturally give a clear explanation on how to “play” but don’t forget to give him a brief introduction. You could let the child meet Psicobot in video format, let him watch a Thor or Star Trek clip showing the child who teleportation is. Practise using the reinforcement “gesture” and say “Teleportation to…”: You could get the child to look at the mobile at the same time (before putting on the virtual reality glasses) so that the child already knows what movement he needs to make. Also practise naming the places the child can go to before beginning the game (training room, living room, bathroom, hall, bedroom).

Adapt the room to each session where the intervention is carried out. In general, feeling disorientated is common when wearing the glasses and feeling familiar with the room is always advisable, for example touch the seat with their calves when standing up. When using the emotive performances technique with children this is of utmost importance: getting them to play out “superhero” will make them get into the role in a jiffy!

Asking for a brief summary on what the child has understood is advisable, after listening to Psicobot’s instructions, and before beginning “the game”. Clarify and doubts or misunderstandings at this point.

If a child asks why he/she cannot go to the kitchen, bathroom or attic, tell him/her that these zones have a force field that is blocking teleportation, and Psicobot is looking for ways to unblock them…

If at any time the child plays a game “unenthusiastically” or is not “motivated”, let the child know they are not concentrating. And as a result that the counterconditioning is not working properly. Tell the child to copy the gesture they practised at the beginning of the session better to make it work.

The effect of the teleportation will be fascinating to the the child when he/she looks up down and down. Try to make sure the child looks up or down when making the “lively” movement associated with teleportation.

Make up games you can use during VR that parents can practise in vivo at home. For example finding a hidden object without them knowing (“Do not turn on lights!”), counting the objects in the rooms where it’s getting darker and darker, finding an object that we have requested, starting in the training area (e.g the tokens chart), playing hide and seek: where the child hides in one of the rooms (e.g lying down on the bed) asking them questions and he/she responds with hot or cold until we guess correctly. Try to be imaginative and let the child suggest the activities of interest.

If you use the token economy don’t forget to plan the intervention well which will in turn be very useful in setting the objectives between the work done at the consultation and the work done at the home of the minor.

INTERVENTION IN ADULTS:

Help the patient by introducing the items you are going to work on, before you start to work on the VR, is always a good way of starting the activation, and thus stimulates a sense of presence. Tell you patient that they are going to work at night, at home, in a storm and that they will sometimes be situated close to the window in the living room.

Remember the general sound in the platform will help you adjust the exposure. For example, you can lower the sound to lower the storm intensity in the case of storms.

Be imaginative! Use the different environments that Psious provides with the climate configuration settings (driving, generalized anxiety, travelling on a plane) to promote the generalized habituation.

GENERAL:

You can use the environments such as the house “travelling on a plane” so as to gain more flexibility in situations. You could also work bad weather and night in this situation. The generalized anxiety environment and, concerns for families will also enable you to work on the bad weather exposure, particularly, in managing cognitive distortions.

You can use the relaxation environments (diaphragmatic breathing and/or Jacobson) and mindfulness as a counterconditioning tool to promote the reciprocal inhibition procedure, if you use systematic desensitization in adults and emotive performance scenes in children.

You can use the fear of dark environment to help train diaphragmatic breathing lying down on the bed, at night to the sound of rain.

The electrodermal definition register will help you show your patient how physiological discomfort will vary during the sessions.

4. Recommended Bibliography

Antony, M.M., Craske, M.G. y Barlow, D.H. (2006). Mastering your fears and phobias: Client workbook (2a ed.). Londres Oxford University Press.

Arrindell, W. A. Dimensional structure and psychopathology correlates of the fear survey schedule (FSS-III) in a phobic population: A factorial definition of agoraphobia, Behaviour Research and Therapy, Volume 18, Issue 4, 1980, Pages 229-242, ISSN 0005-7967

Brown, T. A., DiNardo, P. A., & Barlow, D. H. (1994). Anxiety disorders interview schedule for DSM-IV (ADIS-IV), adult version. Albany (NY): Graywind Publications Inc.http://www.libreriaolejnik.com/ventana. php?codig=31669

Carrobles, J.A. (1986). Cuestionario de Temores de Wope y Lang, FSS-III-122. En J.A.I. Carrobles, P. Bartolomé, P.T. Costa y T del Ser. La práctica de la terapia de conducta: Valencia: Promolibro.

Craske, M.G., Antony, M.M. y Barlow, D.H. (2006). Mastering your fears and phobias: Therapist guide (2a ed.). Londres: Oxford University Press.

Gutiérrez, C. et al.(2012): Características psicométricas del inventario de Miedos de Ollendick. CUaDERNos HisPaNoaMERiCaNos DE PsiCología, Vol 12 No 1, 85-93

Mikulas, W. L. y Coffman, M. G. (1989). Home-based treatment of children’s fear of the dark. En C.E. Schaefer y J.M. Briesmeister (Eds.), Handbook of parent training (pp. 179-202). Nueva York: John Wiley and Sons.

Matesanz, L. (2006): Datos para la adaptación castellana de la Escala de Temores (FSS). Análisis y Modificación de Conducta. Vol. 32, Nº 144.

Méndez, X. , Orgilés, A. y Espada, J.P. (2003). Escenificaciones emotivas para la fobia a la oscuridad: un ensayo controlado. International Journal of Clinical and Health Psychology. ISSN 1697-2600 2004, Vol. 4, No 3, pp. 505-520

Méndez, X. , Orgilés, A. y Rosa, A. I. (2005). Los tratamientos psicológicos en la fobia a la oscuridad: Una revisión cuantitativa. Anales de psicología. Vol. 21, no 1 (junio), 73-82

Muris, P., Merckelbach, H., Ollendick, T. H., King, N. J., & Bogie, N. (2001). Children’s nighttime fears: Parent-child ratings of frequency, content, origins, coping behaviors and severity. Behaviour Research and Therapy, 39(1), 13-28. doi: 10.1016/S0005-7967(99)00155-2

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5. Appendix

5.1. Token economy contingency table

5.2. Psicobot tokens

5.3 Hierarchy darkness and storms self-reporting (adults)

5.4 Hierarchy darkness and storms self-reporting (children)

5.5 Hierarchy darkness self-reporting (children)