Manual Index Social Anxiety
- Social Anxiety and Virtual Reality
- Psious-based Evaluated protocol
- Psious-based Treatment protocol
- Recommended Bibliography
- Annexes
1. Social Anxiety and Virtual Reality
The fifth version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V), replaces the old term of social phobia with social anxiety disorder. This modification represents a change in the conceptualization of the disorder, in which is understood that the condition exists in a variety of social settings.
Virtual Reality (VR) is a beneficial tool for the treatment of Social Phobia, as it exposes the patient to social interactions, cognitive restructuring, social skills training and allows to train the patient on relaxation techniques. Moreover, the virtual exposure can be applied in an anxiogenic or unfavorable situation (seated, noisy, mid-conversation, etc), which is useful to design the exposure to the needs to the patient’s needs.
2. Psious-based Evaluation protocol
Aside of the virtual exposure to social anxiety, this environment can also be used as an evaluation tool to test the patient’s social skills.
Launch the environment after giving the minimal explanation to the patient about what he/she will see. Evaluate the patient’s behavior while the environment is reproduced, at a verbal and nonverbal level:
Non verbal
- Body language
- Visual contact
- Gestures
- Body orientation
Verbal
- Speech characteristics: fluent language, articulation, tone, volume, etc.
Finally, after the session evaluate what happened at a cognitive level by asking specific questions.
3. Psious-based Treatment protocol
Protocol
General workflow for VR sessions for Social Anxiety and Social Skills
– Introduce the environment to the patient, saying, for example: “You are in a pub with your friends chatting about a variety of topics, you should intervene in specifics moments giving your opinion…”
- Make a simulation before the exposure
- Stimulate the patient to talk about a particular topic, ideally one that is also discussed in the environment.
- Give a model of an assertive behavior (ie. giving an opinion, making a request, etc).
- After the exposure
- Give feedback on the patient’s performance
- Behavior positive reinforcement and proposals for improvement with alternative models for the patient to practice at the consultation and at home.
Session description
SESSION 1 PSYCHOEDUCATION
- Information of social anxiety, explanation of the role of breathing and thoughts in the disorder.
- Treatment overview:
- Exposure with VR
- Modelling
- Cognitive restructuring
- Social skills training
- Relaxation techniques
- The hierarchy of the exposure is designed by:
- The topic
- Opinion during the conversation: cinema, maternity, sports, holidays, etc.
- Requests: toilet, temperature, drink change and the bill.
The hierarchy will have two levels: easy and difficult, according to the configuration variables: mates and waitress’ kindness.
SESSION 2 RELAXATION
- Familiarization with the platform:
- Show the patient how to use the VR glasses.
- Training in relaxation techniques
- Entrenamiento en técnicas de relajación
Homework:
- Practice relaxation techniques and complete the self-recording (Annexes 6.1).
SESSION 3-8 VR EXPOSURE + TRADITIONAL TECHNIQUES
- Homework revision
- Training on social skills: modelling
- Systematic and gradual exposure to VR environment is started using the modelling technique.
- Feedback about the patient’s performance
- Combine with cognitive restructuring and relaxation techniques if needed.
Homework:
- Practice of the relaxation techniques, carry out self-exposure and complete selfrecordings (annexes 6.1 and 6.2).
SESSION 9 RELAPSE PREVENTION
- The therapy is assessed and future self-exposure tasks and reinforcement sessions are scheduled.
- Management and prevention of future relapses
4. Bibliography
Gebara, C., Barros-Neto, T., Gertsenchstein, L., Lotufo-Neto, F. (2015). Virtual reality exposure using three-dimensional images for the treatment of social phobia.
Hartanto, D., Kampmann, I.L., Morina, N., Emmelkamp, P.G., Neerincx, M.A. y Brinkman, W. (2014). Controlling social stress in virtual reality environments. PLos ONE, 9(3), 1-17-. doi: 10.1371/journal. Pone.0092804
Herbelin, B., Vexo, F. y Thalmann, D. (2002). Sense of presence in virtual reality exposures therapy. Virtual Reality Laboratory, Federal Institute of Technology (EPFL). Recuperado de: http://citeseerx.ist. psu.edu/viewdoc/download?doi=10.1.1.9.9590&rep=rep1&type=pdf
Klinger, E., Bouchard, S., Légeron, P., Roy, S., Lauer, F., Chemin, I. y Nugues, P. (2005). Virtual Reality Therapy versus Cognitive Behavior Therapy for Social Phobia: A preliminary controlled study. CyberPsychology & Behavior, 8(1):76-88. DOI: 10.1089/cpb.2005.8.76
McNeil, D.W. y Randall, C.L. (2014). Conceptualizing and describing Social Anxiety and its disorders. En S.G. Hofmann y P.M. DiBartolo (Eds.), Social Anxiety. Clinical, developmental, and social perspectives (pp. 3-21). Londres: Elsevier.
Morrison, J. (2015). DSM-5: Guía para el diagnóstico clínico. México, D.F.: El Manual Moderno
5. Annexes
5.1. ARelaxation Self-recording.
Name: ………………………………………………………………….
Date:……………………..
| Date | Time | DEGREE of relaxation (0-100) Before | DEGREE of relaxation (0-100) After | Duration | Difficulties or comments |
5.2. Self-exposure Self-recording
Nombre: ………………………………………………………………….
Fecha:……………………..
| Day | Time | DESCRIPTION OF THE SITUATION (in the case of self-exposure to the feared situation) | ANXIETY LEVEL (0-10) | COMMENTS |