Author: Alex Asensi

Airplane 

This environment takes the patient to the airplane, which is typically the environment that produces the most anxiety in this disorder. 

SETTINGS VARIABLES

• Show passengers
  No person / Maximum number of people

• Comments
  When this option is activated, comments from someone in a situation of high intensity anxiety are reproduced.

• Row
  • Front (in front of the wing)
  • Middle (above it), 
  • Back (behind the wing)

• Seat position
  Window / Middle / Aisle 

• Time
  Day / Night

• Weather
  Sunny / Rainy / Storm

EVENTS

• Taxi
  The hostesses give the safety  instructions while the plane travels until it reaches the takeoff point.

• Takeoff
  The engines are heard , the  plane accelerates and takes off.

• Flying
  The patient is in full flight.

• Landing
  The captain warns of the arrival at the destination and proceeds  to the landing.

• Ding
  Reproduces the typical sound of  airplanes when they want to indicate an incident.

• Turbulence amount
  Available when the patient is within the flight event.

In order to adapt the session to the patient’s needs , you can skip steps along the path and / or repeat any of these steps as many times as you see fit.

Darkness and Storms

The nocturnal environment, which takes us around the house is made up of 5 rooms graded a priori at various levels of darkness from greater to less lighting: training room (TV room, always lit), Living room, HallBathroom, Hall-Attic and Bedroom (at the start, half-lit). The child/adult can move around the various stimulating environments at a progressive level associated with their discomfort.

ZONE 1 Training Zone

DESCRIPTION

The patient will start off in the living room in the house, close to the TV room. From this area the patient can see the living room and two doors which look onto the hall, the closest room being the living room, right beside the bedroom, leads onto the hall-bathroom as well as the hall-attic at a progressive level. The patient will pass through these three areas (by means of the teleportation event) and the bedroom (which is not visible in the training area). In addition.

FEATURES

The level of lighting in this space will always be good and will not be affected by the activation of events. 

When we are located in this area (working with children) and the active co-therapist environment has been defined, you can activate the introduction event. 

There is a big picture window which will let the patient know it is night-time and allow us to work on the climate settings and the intensity of the rain event. 

ZONE 2 Living room

DESCRIPTION

The work begins in the living room space, the space nearest to the training zone. By means of low levels of discomfort, including both fear of darkness and storms, the visible features here, just by changing your viewpoint, will be the very same as the ones explained in the training zone. 

FEATURES

The lighting here in this space is of lower intensity than in the training zone. 

This zone can be altered with the activation of the ambient Light event, in other words, the light intensity can be modified (ambient Light event).

A window, indicating it is night-time allows us to work on the climate settings and the rain intensity event. 

When the co-therapist setting is activated the patient can gain up to 200 tokens for being in this area, (see environment level). 

ZONE 3 Hall-Bathroom

DESCRIPTION

This space is located at the beginning of the hall. The patient will see a window behind them, the living room is on the left (separated by a door) and the bathroom on the right (not visible, but half visible). The Bedroom will be visible at the back. You can start to work on middle levels of discomfort in this area. 

FEATURES

Lighting is of lower intensity than that of the living room and the training zone.

This zone can be altered with the activation of the ambient Light event, in other words, the light intensity can be modified (ambient Light event).

A window, indicating it is night-time allows us to work on the climate settings and the rain intensity event.  

When the co-therapist setting is activated the patient can gain tokens for exploring this area, (visiting this space). As it is darker than the Living Room area, 300 tokens will be allocated.

ZONE 4 Hall-Attic

DESCRIPTION

Situated at the end of the hall, near the Bedroom door. The patient will be able to see a window at the end of the hall, the attic stairs (not accessible), and a training area, through the door, on the right. Here, middle levels of discomfort can be worked on further in this space.

FEATURES

Lighting is of lower intensity than that of the training zone, living room and bathroom.

This zone can be altered with the activation of the ambient Light event, in other words, the light intensity can be modified (ambient Light event).

A window which is far away, will indicate it is night-time allowing us to work on the climate settings and the rain intensity event. 

When the co-therapist setting is activated the patient can gain tokens for exploring this area, (visiting this space). As it is darker than the HallBathroom area, 500 tokens will be allocated. 

ZONE 5 Bedroom

DESCRIPTION

The patient will now be located in a bedroom, where there is a big window, a bed, table with a computer, a wardrobe, a token economy chart table hanging on the wall (a type of token economy chart) and a door that leads to the hall. The patient will be able to see the window at the end of the hall. Here the patient will be working on high levels of discomfort.

FEATURES

By defect, the light in this zone is of the lowest intensity compared to the other spaces. 

This zone can be altered with the activation of the ambient Light event, in other words, the light intensity can be modified (ambient Light event).

A big window, indicating it is night-time allows us to work on the climate settings and the rain intensity event.

When the co-therapist setting is activated the patient will gain tokens for exploring this area, (visiting this space). As it is darker than the Hall area, 700 tokens will be allocated.

The Lying down event can be activated here, which provides a lying down simulation on a bed and here the highest tokens can be obtained (up to 1000).

SETTINGS CONFIGURATION

Firstly, the environment configuration settings will permit activating or deactivating features depending on whether you carry out the intervention with a child or an adult (with or without co-therapist “Psicobot”), secondly, control the level of difficulty desired (with children: easy achievement, middle to higher tokens) and, lastly, adjust the climate (when working on fear of storms: clear spells, rain and storm).

CO-THERAPIST (A)

Each environment detects when a co-therapist is present throughout the intervention. When the active co-therapist environment is activated, Psicobot will be at hand, a virtual assistant designed for the intervention with children with fear of darkness and /or storms. Whilst the co-therapist is activated all the environment events will be accessible (introduction, teleportation, help…). The following Psicobot functions are available:

• Explain to the child how to interact with the virtual reality environment, through modelling. Explain how to teleport, how the virtual headpiece works, how the tokens system works and how to ask for help out loud.
• Provide assistance (help event) when the child requires it and when asked for out loud.

When in Deactivated Co-therapist the environment will change into an intervention tool for adolescents and adults who fear darkness and storms. When you select this option the environment gamification effects will disappear, that is to say, the environment configuration Points will stop working (even when you change the parameters it will not be depicted in the environment) and the Introduction and Help events will be blocked. 

POINTS (B)

The Points configuration setting will only have an effect on the environment when the Co-therapist environment settings is in activated mode. Otherwise, it will have no effect on the virtual environment.

The objective of the environment is to encourage the exploration of the zones and individual spaces in the house in the form of games. When the healthcare professional feels it would be of advantage, use the token economy. A victory token counter will be made available to the child in the virtual headpiece and an explanation will be given to the child by Psicobot during the introduction event.  

Its function is to allow for the child to obtain tokens for spending time in these areas and for exploring the individual spaces in the environment (Living room, hall-bathroom, hall-attic, Bedroom and Bedroom-lying down). The following is a summary of the Time Relation (seconds)/tokens for spending time in each of the spaces according to the level of difficulty selected.

Time /tokens	Living room	Hall – bathroom	Hall – attic	Bedroom	Lie Down
easy	10/200	10/300	10/500	10/700	10/1000
medium	60/200	60/300	60/500	60/700	60/1000
difficult	120/200	120/300	120/500 1	120/700	120/1000

Other relevant rules related to obtaining tokens:

• Once the maximum amount of tokens have been obtained, and the patient keeps changing spaces, the tokens obtained will be added to the accumulated tokens in the individual zones. 

• Repeating a space in the same session: for example, they go from the training zone to the living room and from the training zone back to the living room:

• If the maximum amount of tokens has already been obtained on a previous occasion, 25% additional time needs to be allocated to obtain the score the next two times they enter the space. For example, when they are in the easy setting and situated in the living room, they will need 10 seconds to get 200 tokens, the second time they visit they will need 12.5 seconds to gain 200 more tokens and the third time, 15 seconds to gain another 200 tokens).

• To avoid the patient getting stuck in the space and, still be able to gain tokens: the patient will no longer gain tokens from the third attempt onwards.

• If the patient abandons the space before the time is up to obtain the total amount of tokens, they will lose tokens. This will not affect the time they need to spend in the space to obtain the tokens.

• The tokens system will reset when the activated session finishes (Finish button or Next scene). In other words, if you want to control the tokens obtained between the sessions or exercises: take note of the tokens already obtained by the minor, e.g, in the table provided in the appendix. 

CLIMATE (C)

• Clear Spells: there will be no rain and it will be night-time. 

• Rain: light rainfall with no lightning or thunder will begin. 

• Storms: rain will become more intense and thunder and lightning will be present. 

The climate Rain and Storm setting modes can be adjusted with the Severity of the rain event. 

EVENTS

Events will be activated or blocked in function with the Co-therapist configuration setting mode (Activated/Deactivated). To find out how they affect the event availability, check the environment settings in the previous section, We shall now proceed onto outlining the features of each of the individual events.

INTRODUCTION (A)

The introduction event will only be disengaged when the Co-therapist configuration setting is in Activated mode and the patient is situated in the Training zone. If the user is placed in another space (Living room, HallBathroom, Hall-Attic or Bedroom) the event will be blocked. 

This event is specifically designed for working with children and serves as a way of relating oneself with the environments via modelling. Once activated the Co-therapist Psicobot will appear in the training Zone and will explain how to use its new teleportation “superpower”, how to gain tokens, how he can be of help… Psicobot will give the patient a virtual headset: a superimposed interface in VR, which the patient will be able to see. The virtual headset will indicate to the child:

• The level of difficulty in the top right-hand corner 

• Tokens in the bottom right-hand corner

• Help in the top left-hand corner

• In the bottom left-hand corner, the name of the space in the house at which they are looking at (Living room, Hall-Bathroom…) and where they can be teleported to. 

Remember that all the gamification of the environment, the introduction, Psychobot, the virtual helmet, the points … will only appear in the VRwith the Co-therapist-Activated configuration variable.

TELEPORTATION (B)

A drop-down menu is available in Teleportation where you will be able to select the area of the house you wish to teleport the patient to, and thus, be able to move around the separate rooms.

• Training zone

• Living room

• Hall-bathroom (Bathroom in the patient’s headset)

• Hall-attic (Hall in the patient’s headset)

• Bedroom

This event will always be activated, regardless of the modes selected in the environment settings. Nevertheless, the way it works will be different in function to whether the Co-therapeutic configuration setting is Activated or Deactivated. 

The Co-therapist Activated mode is designed to work with children. Once activated a sound and visual effect which simulates a type of teleportation Thor in the Marvel movie (bridging the gaps and naturally adapting it to children!) will appear. The work begins in the living room space, the space nearest to the training zone.

Before starting the VR we recommend you practice a sweeping gesture with the child, using the body and arms to help avoid displacements (movement with the virtual reality glasses on could provoke knocks and falls). For instance, lifting up the right arm with the fist closed, whilst looking at the floor. The teleportation visual effect is far more appealing when looking down! Just as Psicobot will indicate in the introduction event and, especially if you are using the performance scenes as an intervention technique, when you wish to use the teleportation, we recommend the child says “Teleportation to“ out loud adding “lively” movements, which you will have already practiced. Activate the teleportation event at that moment and …watch what happens!

In Co-therapist Activated mode, the transition between spaces is executed using a black background. Less “impressive” but just as effective! Remember this configuration mode is aimed at working with adults and/or when you use the gradual exposure technique. 

HELP (C) 

This event will only be disengaged when Cotherapist-Activated mode has been selected. This is a drop-down menu that provides stimulating phrases, coping/social reinforcement… that can be used when the child asks for help from Psicobot, as previously explained in the introduction event. For instance: if the child is in the Hall-Bathroom zone and says “Psicobot help” out loud, select “There is nothing wrong with feeling afraid” sentence…” and Psicobot will then appear in the child’s headset and give the child instructions. Once again you could encourage the child to make a lively and marked gesture (for example, right arm pointing up to the top left part, where Psicobot will appear) and will respond to the child’s request:

• You can teleport whenever you wish, you only have to say the word “teleport and make a really super strong gesture with you arms” 

• “Hello, I am here. You are doing really well. Keep goingí”

• “Try to stay a bit longer, just wait and see, little by little you will start to feel better”

•  “You are doing really well! Look how many tokens you have got!”

• . “¡You have progressed so much!”

• “Don’t worry. Keep on exploring, he who perseveres, succeeds!”

• “As my friend Captain America always says: there is nothing wrong with feeling afraid when you don’t give up” 

• “Very good! Excellent! You have achieved all the tokens in the area!”

LYING DOWN / GET UP (D)

The Lying down on the bed event will only be available when we are situated in the Bedroom. The other spaces (Living room, HallBathroom…) will be disengaged. Here you could change the patient’s viewpoint from standing up inside the bedroom to lying down in the bed. Once lying down on the bed, and you want the patient to get up but still stay in the bedroom, press the recharge button that is beside the event, ”Lie down on the bed”, whilst selecting Bedroom.

AMBIENT LIGHT (F)

This ambient light event will always be activated. You will always be able to adjust the lighting level, whenever you wish, when the patient is present in this space, with this slider. Remember each space has a preset level of darkness and is graded from higher to lower in each space (Training zone, Hall-Bathroom, Hall-Attic and Bedroom). Also remember that the training zone will always have the same level of light, in other words, it won’t be affected by the activation of the ambient light event. 

RAIN INTENSITY (G)

You will always be able to adjust the rain level, which you will hear or see through the windows wherever the patient may be situated to your liking in this slider. Remember this event will not be activated if you have set Climate in Clear Spells, i.e if you want to use it, you must have previously set the climate in Rain or Storm mode.