The same as in the audience, when launching this environment, the patient finds themselves seated, and until the “go to stage” event is activated the patient will remain in this position. Even so, differently to the audience, this time the patient is sitting on seats looking at the stage, where they can see a lobby. Once on the stage they are placed in front of this lobby, and as in the previous environment, the patient can make a short personal presentation and, afterwards, make a report on a previously prepared topic.
SETTINGS VARIABLES
Amount of People
None
Low (room practically empty)
Medium (room almost full of people)
Full (room completely full)
Gender Choose between a male or female body. A neutral body is selected by default.
Skin tone Choose the skin tone that best represents your patient to enhance the feeling of immersion.
Difficulty
Easy (audience that listens attentively and with approval)
Hard (audience that is more distracted or disinterested)
EVENTS
Go to the stage The patient goes onto the stage and is placed behind a table to start the presentation.
Positive question One listener from the public asks a question that is easy for the patient to answer. The healthcare professional can choose between a series of questions of this type, for example, if they can explain part of the presentation again.
Negative question In this case, one person from the audience asks a question that is more complicated to answer, something that could make the patient become nervous. The healthcare professional can choose from a series of questions of this type, for example, if they think that their proposal will work, or if they can highlight the weak points of their presentation.
Therapist positive feedback When the healthcare professional selects this event, one of the audience starts to speak although nothing is heard. Therefore, this button allows the healthcare professional to make a positive remark to the patient about their involvement but by introducing themselves into the virtual environment, so that the patient finds they are even more immersed in that environment.
Therapist negative feedback This event develops in exactly the same way as the previous setting, but it is reserved for the healthcare professional to make a more critical or negative remark about the patient’s involvement.
Applause The audience applauds the speaker.
Spectator leaves room One person gets up and leaves the room.
Distraction Choice of a series of distractions: yawning, mobile phone, telephone vibration, laughter, coughing.
APPENDIX
List of positive questions
It’s evident that you are passionate about what you’ve explained. Where did the interest come from?
I’ve attended similar conferences before on the same topic but I’ve never been as enthusiastic about it as today. Do you recommend any author or some reading related to what you told us today?
What’s been the biggest obstacles you’ve had to overcome when preparing the subject?
You’ve approached the matter in a very innovative way. You’ve also explained it very clearly and concisely, is this your first time giving this conference?
Thank you very much for your presentation, it was fascinating. I would like to ask you though, what would you highlight from everything that you just explained?
Are you satisfied with the results of your presentation? Could you talk a bit more on the argument that you’ve exposed?
Do you think you could come back another day to repeat the presentation in front of a larger audience?
Could you give an example by placing it in a different context?
Excuse me, I didn’t understand your last point, could you explain it again?
These results are promising, what impact do you think it may have in the future?
Will you make another presentation during these upcoming weeks? I’d like to attend.
What do you think is the scope or limit of what you have just described?
List of negative questions
Could you highlight the strengths and weaknesses of your proposal?
What resources are available for you to implement your plan?
I don’t quite understand the last thing you explain. Could you give another example?
What difficulties do you think may arise in the future?
It started off so well, but the delivery of the findings isn’t as clear. Could you please summarize them again, briefly?
Do you think the results that you’ve shown are realistic?
Do you think that your proposal will work? The current situation doesn’t seem to be the most suitable.
Can you prove what you just said? In my opinion, your argument shows some weaknesses.
“You have made some very interesting proposals, although some of them are a little bit too daring. Have you thought about how you’ll proceed?”
Are you sure that this information comes from reliable sources?
Don’t you think that your point of view has certain limitations? How did you choose your presentation’s approach?
Some of your conclusions seem outdated. Are you aware of the latest trends on this matter?
In the first moment, the patient is sitting in one of the audience seats. If no event is selected, the patient will remain in this position, and will only be placed on the stage if the healthcare professional selects the event “go on stage”. Once on stage, the user is sitting behind a table, from there they can make a short personal presentation and, afterwards, make a report on a previously prepared topic.
SETTINGS VARIABLES
Amount of People
None
Minimum (room practically empty)
Medium (room almost full of people)
Maximum (room completely full)
Gender Choose between a male or female body. A neutral body is selected by default.
Skin tone Choose the skin tone that best represents your patient to enhance the feeling of immersion.
Difficulty
Low (audience that listens attentively and with approval)
High (audience that is more distracted or disinterested)
Sanitary mask You can choose whether or not the people around you will have a mask.
EVENTS
Go to the stage The patient goes onto the stage and is placed behind a table to start the presentation.
Positive question One listener from the public asks a question that is easy for the patient to answer. The healthcare professional can choose between a series of questions of this type, for example, if they can explain part of the presentation again.
Negative question In this case, one person from the audience asks a question that is more complicated to answer, something that could make the patient become nervous. The healthcare professional can choose from a series of questions of this type, for example, if they think that their proposal will work, or if they can highlight the weak points of their presentation.
Public comments Some members of the audience start talking amongst themselves.
Therapist positive feedback When the healthcare professional selects this event, one of the audience starts to speak although nothing is heard. Therefore, this button allows the healthcare professional to make a positive remark to the patient about their involvement but by introducing themselves into the virtual environment, so that the patient finds they are even more immersed in that environment.
Therapist negative feedback This event develops in exactly the same way as the previous setting, but it is reserved for the healthcare professional to make a more critical or negative remark about the patient’s involvement.
Applause The audience applauds the speaker.
Spectator leaves room One person gets up and leaves the room.
Distraction. Choice of a series of distractions: yawning, mobile phone, telephone vibration, laughter, coughing.
APPENDIX
List of positive questions
It’s evident that you are passionate about what you’ve explained. Where did the interest come from?
I’ve attended similar conferences before on the same topic but I’ve never been as enthusiastic about it as today. Do you recommend any author or some reading related to what you told us today?
What’s been the biggest obstacles you’ve had to overcome when preparing the subject?
You’ve approached the matter in a very innovative way. You’ve also explained it very clearly and concisely, is this your first time giving this conference?
Thank you very much for your presentation, it was fascinating. I would like to ask you though, what would you highlight from everything that you just explained?
Are you satisfied with the results of your presentation? Could you talk a bit more on the argument that you’ve exposed?
Do you think you could come back another day to repeat the presentation in front of a larger audience?
Could you give an example by placing it in a different context?
Excuse me, I didn’t understand your last point, could you explain it again?
These results are promising, what impact do you think it may have in the future?
Will you make another presentation during these upcoming weeks? I’d like to attend.
What do you think is the scope or limit of what you have just described?
List of negative questions
Could you highlight the strengths and weaknesses of your proposal?
What resources are available for you to implement your plan?
I don’t quite understand the last thing you explain. Could you give another example?
What difficulties do you think may arise in the future?
It started off so well, but the delivery of the findings isn’t as clear. Could you please summarize them again, briefly?
Do you think the results that you’ve shown are realistic?
Do you think that your proposal will work? The current situation doesn’t seem to be the most suitable.
Can you prove what you just said? In my opinion, your argument shows some weaknesses.
“You have made some very interesting proposals, although some of them are a little bit too daring. Have you thought about how you’ll proceed?”
Are you sure that this information comes from reliable sources?
Don’t you think that your point of view has certain limitations? How did you choose your presentation’s approach?
Some of your conclusions seem outdated. Are you aware of the latest trends on this matter?
List of public comments
He looks very tense. Yes, it’s true, he could speak louder, it’s not that difficult.
He looks very tense. I bet it’s his first time.
This talk is so boring. I hope it’ll end soon, this is taking forever.
Have you noticed how much he’s shaking? Yes, I’ve noticed. Also he is sweating a lot.
Seems like he lacks self-confidence, he won’t stop turning his head from side to side. You are right.
Can anyone bring some coffee? We are going to end up falling asleep. This is torturing.
Why is his voice trembling? Isn’t he sure about what he’s saying? Does he know what he’s talking about?
This scenario consists in a waiting room, where the patient is initially placed, and an extraction room, where the healthcare professional can later lead the patient to. In both spaces, the patient can hear different commentaries from other patients related to the needles and then, in the extraction room, he can observe a table with the instrument that will be used (syringes, needles, cotton, etc).
SETTINGS VARIABLES
Gender Choose between a male or female body. A neutral body is selected by default.
Skin tone Choose the skin tone that best represents your patient to enhance the feeling of immersion.
Select rol Patient / Escort
Sanitary mask You can choose whether or not the people around you will have a mask.
EVENTS
Another patient enters As long as the patient is in the waiting room, the nurse comes out from the extraction room to call in another patient and they get in the extraction room. After a few minutes the patient comes out.
Enter extraction room The nurse will call in the patient and they will get in the extraction room.
Finger prick The nurse will extract blood from the patient’s finger.
Injection If the healthcare professional chooses this option, the patient will get an injection in his arm.
Small extraction The patient will get a little blood extraction.
Hard extraction A considerable amount of blood will be extracted from the patient’s arm.
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.
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.
The Amelia Virtual Care platform features a virtual reality (VR) environment for spider exposure. In this environment, the patient is seated and can see a terrarium on the table in front of him.
VARIABLES SETTINGS
The configuration variables will allow modifying the environment to suit each patient and each phase, be it the evaluation or the treatment phase. For this, you will have the same configuration variables available, explained below:
Gender Choose between a male or female body. A neutral body is selected by default.
Skin tone Choose the skin tone that best represents your patient to enhance the feeling of immersion.
Spider size The system allows for selecting among small, medium or big insects.
Amount of spiders The number of insects the patient will have to deal with can be determined. One may select between one spider (minimum), or many spiders(maximum).
Zone of exposition The system allows to have the spider on the table or in a terrarium.
EVENTS
Far distance Spiders will be situated in a far distance from the avatar.
Medium distance Spiders will be situated in a medium distance from the avatar.
Near distance Spiders will be situated in a near distance from the avatar.
Move finger The avatar starts to move a finger. This option aims to enhance the immersion of the patient through a rhythmic movement that will have to be done at the same time, facilitating this way to identify the hand you are seeing as your own.
Spider on hand The spiders will get close and walk on the avatar hand.
Play noise A noise can be heard and the spider will begin to move from side to side.
In this scene the patient will find him/herself on top of a hill surrounded by mountains and trees, where he/she will experience a feeling of spaciousness and relaxation. At the same time, the healthcare professional will be able to add an element, such as a sphere or a ring to guide the ocular movements.
SETTINGS VARIABLES
Visual Stimuli Choose between a ring, a sphere or no visual stimulus at all.
Audio Stimuli Choose between Type 1, Type 2 or no auditory stimulus at all (only ambient sound will be heard).
Movement Choose between horizontal, vertical, left-right diagonal or right-left diagonal.
EVENTS
Initiate and stop the stimulus
Duration (minutes) It can last to 10 minutes. It is necessary to stop the stimulus in order to modify the duration values.
Speed in repetitions per minute. The healthcare professional can choose from 15 to 120 repetitions/minute. It is necessary to stop the stimulus in order to modify the speed values.
Ambient darkness He/she can choose from full brightness to complete darkness.
This is a scenario specially designed to work through the cognitive restructuring the distortion of the body image of some patients with eating disorders. This tool allows, on the one hand, for the patient to modulate the body dimensions of a human avatar according to how he perceives himself, and on the other hand, for the healthcare professional to generate a silhouette with the real body dimensions of the patient. This allows the patient to reflect how he perceives his body image, being able to contrast it later with his real body image (by superimposing the silhouette with the objective dimensions of the patient on top of the first avatar). The objective is that the patient can observe and check on his own the difference (and therefore, the distortion) that there is between the perception of his own body and how it really is. The patient must become aware of how body dissatisfaction is maintaining his eating disorder.
Given the high anxiety that some patients often feel in situations that require the measurement or vision of their body (weigh them, measure certain parts of the body, expose them in front of the mirror, etc.), this task can also function as exposure therapy to their own body. In that case, we remind you that the healthcare professional has the option of asking the subjective units of distress (SUDs) experienced by the patient throughout the exercise. Also, to reduce maladaptive emotions, this VR task may also be combined with the systematic desensitization (SD) technique.
SETTINGS VARIABLES
Chest It can be chosen, according to the BMI of the patient, for the size of this part of the body to be: Very slim; Slim; Normal; Wide; Quite wide; Very wide.
Gender It can be chosen, according to the gender of the patient, for the avatar to be a Male or a Female.
Height It can be chosen, according to the height of the patient, the most approximated height for the avatar: 5’ 3”; 5’ 7”; 5’ 11”; 6’ 3”
Hip It can be chosen, according to the BMI of the patient, for the size of this part of the body to be: Very slim; Slim; Normal; Wide; Very wide.
Legs It can be chosen, according to the BMI of the patient, for the size of this part of the body to be: Very slim; Slim; Normal; Wide; Quite wide; Very wide.
Neck It can be chosen, according to the Body Mass Index (BMI) of the patient, for the size of this part of the body to be: Very slim; Slim; Normal; Wide; Quite wide; Very wide.
Skin color It can be chosen, according to the skin color of the patient, for the avatar to be White skin or Black skin.
Waist It can be chosen, according to the BMI of the patient, for the size of this part of the body to be: Very slim; Slim; Normal; Wide; Quite wide; Very wide.
Below is a table of equivalences between the BMI of the patient and the category to be selected for all parts of the body of the real silhouette :
Category
BMI (Kg/m2)
Very slim
<17 (Severely underweight)
Slim
17-18.49 (low weight)
Normal
18.5 – 24.9 (Normal weight)
Wide
25-29.9 (Overweight)
Quite wide(*)
30 – 39.9 (Obesisty)
Very wide
≥40 (Morbid obesity)
(*) For the “Hip” value, the category “Very wide” will be assigned when the BMI is ≥ 30.
Later, when the patient is in the environment, will be able to modify the body dimensions of the avatar through the plus (+) and minus (-) symbols that appear on both sides of each body part, by clicking on the corresponding symbol with the Touch panel to select the VR glasses (or, depending on the model of glasses, staring at the symbol until the circle that appears is completed). You can increase (+) or reduce (-) the size of a certain part of the body as the symbol is selected. In this part, the tool allows the patient to adjust the size of the aforementioned body parts (Neck, chest, waist, hips and legs) through the glasses, to make them correspond to the size that they think they have in their body.
Finally, from the Events tab, the healthcare professional can activate the option Compare Avatars; this will make the contour of a silhouette appear with the actual dimensions of the patient (previously introduced by the therapist through the configuration variables) and superimpose it on the avatar generated by the patient. The difference in body size between the avatar handled by the patient and the actual silhouette will reflect the degree of distortion of the body image presented by the patient.
The patient will be in the position of the student, in a classroom, a few minutes before the class starts, there are 7 students (between 13 and 18 years old) around him. The aggressor and the rest of the students will also be in the class, away from the patient, but in a position where the patient sees them.
When the start event is activated, the aggressor will appear (after a fade to black) in front of the patient along with the rest of the students present. Afterwards, the type of aggression/bullying can be selected in events: verbal, physical or relational. Once the “type of bullying” event is over, the reaction of the audience can be modulated by activating booing, laughing and whispering (by means of the behaviour-observers event). Playing the event option “Evaluation”, will trigger 4 possible responses (2 aggressive and 2 passive) to appear in the patients view in the goggles, so that the patient can choose, guiding the selector by looking at their desired response, what they would do in this situation.
SETTINGS VARIABLES
Gender Choose between a male or female body. A neutral body is selected by default.
Skin tone Choose the skin tone that best represents your patient to enhance the feeling of immersion.
Group of the aggressor Alone / Accompanied This variable determines whether the aggressor will be alone or accompanied in front of our patient. Once the event “Start” is activated, the aggressor will appear near the patient alone or accompanied by two other students, depending on the selection of the drop-down menu
EVENTS
Start Once the configuration variables are defined, this event will make the avatars (the aggressor accompanied or alone), appear near the patient and remain in that situation until a new event is activated. The distance and non-verbal behaviour of the aggressor in relation to the patient will be very close, being already in itself an invasion of the personal space and therefore uncomfortable and aggressive.
Type of aggression After the “Start” event we can activate the type of action we want the offender to take:
Verbal assault of the abuser: By selecting ‘verbal assault’ the avatar will utter a verbalization “Hey, look who’s here… what’s up you idiot!”
Physical assault of the abuser: By selecting ‘physical assault’, the avatar will approach from an intimate distance and say, “I’m going to beat you up.”
Abuser’s relational aggression: By selecting indirect aggression there will be no clear verbalization or invasion of intimate personal space, but there will be a defiant look and threatening paraverbal language.
Evaluation Makes the victim’s reaction options appear, so that the victim can select them and thus enable the evaluation of our user’s coping profile, based on the type of aggression we have previously activated. Passive/aggressive profile.
Observers When this event is activated, the group of 4 students who are neither the aggressor nor his buddies will perform one of these three actions.
Booing: the group makes reproachful sounds towards our user
Laughs: the group laughs looking at our user
Whispers: they will talk to each other looking at the mobile phone and the patient alternately
This option can be activated simultaneously after the type of aggression we have established, or while the user is selecting his response in the “evaluation” event.
End environment:When this event is activated, the students will appear seated in their chairs with the teacher (clinically irrelevant) in the background behind the table ready to start the class.
Therapeutic objectives
To evaluate the type of response of alleged victims of bullying to a situation of school bullying in order to know the profile of the victim (aggressive, submissive…).
To train victims of bullying to a classic situation of school bullying, in order to teach and rehearse social skills and how to manage the situation properly.
There is also the possibility of using this environment to work with aggressors and companions. Putting the aggressor in the victim’s position can facilitate empathic work by encouraging them to feel as the victim would.
