Category: Uncategorized

Intervention proposal

“All the information contained in this section is for guidance only. Psious environments are therapy supporting tools that must be used by the healthcare professional within an evaluation and intervention process designed according to the characteristics and needs of the user.

Also remember that you have the General Clinical Guide in which you have more information on how to adapt psychological intervention techniques (exposure, systematic desensitization, cognitive restructuring, chip economy…) to Psious environments.”

SESSION 1

• Inform the patient about the fear of public speaking (causes, symptoms, prevalence…). 

• Present and justify the techniques that will be used throughout the treatment: exposure to virtual reality and live exposure.

• Creation of a hierarchy of exposure and exposure to items on the 20-30 USA’s hierarchy (example). 

• Begin hierarchy of exposition with an item from the 30 USAs. The main objective will be to familiarise the patient with virtual reality and the dynamics of work. 

ITEM	ENVIRONMENT	CONFIGURATION	EVENT
Be in the office alone, preparing the meeting that you will shortly have with some colleagues	Fear of speaking in public	Office, none, easy	No Event
Be in a meeting with one colleague and they are listening attentively to you	Fear of speaking in public	Office, minimum, easy	No Event
Be alone in a conference room, preparing a talk that you will give in a few minutes	Fear of speaking in public	Audience, none, easy	No Event
Be in a meeting with few colleagues and when speaking they give you positive feedback	Fear of speaking in public	Office, medium, easy	Positive remark
They ask you to give an example of something that you have explained in a job interview	Fear of speaking in public	Office, minimum, easy	Neutral remark

SESSION 2

• Review the previous session achievements and establish objectives for the session: You are speaking in a meeting with several work colleagues and you receive a negative remark. 

• After the second session of treatment, it is recommended to start the gradual and systematic exposure to the virtual reality environments. Cognitive restructuring, if applicable.  

• Show clinical advances, through reports on the platform, to the patient. 

HOMEWORK
Live exposure by preparing some type of talk as if later they would have to present it in a meeting, and also they can practice this talk with a very close person.

ITEM	ENVIRONMENT	CONFIGURATION	EVENT
Be in a meeting with few colleagues and while you are talking a mobile telephone rings	Fear of public speaking	Office, medium, easy	Office, medium, easy
Be explaining a project to a lot of work colleagues and someone comes in interrupting the meeting	Fear of public speaking	Office, maximum, easy	Distraction (person comes in)
Be in an auditorium alone, preparing a talk that you are going to give in a few minutes	Fear of public speaking	Auditorium, none, easy	No Event
Have a meeting with several colleagues and when you finish your talk they make a critical remark	Fear of public speaking	Office, maximum, difficult	Negative remark

SESSION 3 

• Review the previous session achievements and establish objectives for the session: in a meeting with work colleagues who are not very interested, a mobile telephone rings and a negative remark is made. 

• Gradual and systematic exposure to the virtual reality environments. Cognitive restructuring, if applicable. 

• Show clinical advances, through reports on the platform, to the patient. 

HOMEWORK
Concealed exposure at home reviewing the process followed in consultation with the imagination + live exposure preparing a talk (although later they do not say it). 

ITEM	ENVIRONMENT	CONFIGURATION	EVENT
Be about to give a talk in a room that is not very big with few people and the public applauds you	Fear of public speaking	Audience, few, easy	Applause
Be in a meeting with quite a lot of colleagues who are not interested, and then another person comes in and interrupts	Fear of public speaking	Office, maximum, difficult	Distraction (person comes in)
Be giving a talk with few people and one of the audience asks you a question that seems easy to answer	Fear of public speaking	Audience, minimum, easy	Easy question
Be in a meeting with work colleagues who do not show much interest. A mobile telephone rings and they make a negative remark	Fear of public speaking	Office, maximum, difficult	Distraction (telephone) + negative remark

SESSION 4

• Review previous session achievements and establish objectives for the session: prepare a talk that is going to be given shortly and will be seen on television. 

• Gradual and systematic exposure in the virtual reality environments. Cognitive restructuring, if applicable. 

• Show clinical advances, through reports on the platform, to the patient. 

HOMEWORK
Live exhibition doing some meeting at work + covert exposure at home, reviewing the process followed in consultation by imagination.

ITEM	ENVIRONMENT	CONFIGURATION	EVENT
Be giving a talk with quite a lot of people and hear a mobile telephone ring	Fear of public speaking	Audience, medium, easy	Distraction (mobile)
Be in a conference room with a lot of people and see that they are not paying much attention	Fear of public speaking	Audience, maximum, difficult	No event
Be preparing a talk that is going to be broadcast on television	Fear of public speaking	Broadcast conference, none, easy	No event

SESSION 5

• Review previous session achievements and establish objectives for the session: Be giving a conference that is going to be broadcast on television and the audience is paying attention. 

• Gradual and systematic exposure in the virtual reality environments. Cognitive restructuring, if applicable. 

• Repeat each one of the exercises twice.

• Show clinical advances, through reports on the platform, to the patient.

HOMEWORK
Concealed exposure at home, reviewing the objectives of the sessions and the process followed in consultation.

ITEM	ENVIRONMENT	CONFIGURATION	EVENT
After answering an easy question from a member of the audience at the conference today, see that there are people talking amongst themselves	Fear of public speaking	Audience, medium, difficult	Difficult question + people talking
Be giving a talk in an auditorium full of people, and also see that they are not paying much attention, hear a yawn from the audience	Fear of public speaking	Auditorium, maximum, difficult	Distraction (yawn)
Be giving a talk that is being broadcast on television and see that the audience is paying attention	Fear of public speaking	Broadcast conference, medium, difficult	Go to the stage and then no event

SESSION 6 

• Review previous session achievements and establish objectives for the session: Give a conference that is broadcast on TV and a listener asks a difficult question. 

• Gradual and systematic exposure in the virtual reality environments. Cognitive restructuring, if applicable.

• Repeat each one of the exercises twice.

• Show clinical advances, through reports on the platform, to the patient.

HOMEWORK
Imaginal exposure at home reviewing the process following the consultation.

ITEM	ENVIRONMENT	CONFIGURATION	EVENT
Be in a room full of people giving a talk, see that the audience is not showing much interest and that one of them leaves the room	Fear of public speaking	Audience, maximum, difficult	Person leaves
Be giving a talk in a room full of people, with the lights down and television cameras and hear laughing in the background	Fear of public speaking	Broadcast conference, many, easy	Difficult question
Be giving a talk in a room full of people, with the lights down and television cameras and hear laughing in the background	Fear of public speaking	Broadcast conference, many, easy	Distraction (laughs)
Be holding a conference that is going to be broadcast on television and a person from the audience asks you a question that is difficult to answer	Fear of public speaking	Broadcast conference, maximum, difficult	Difficult question

Evaluation

“All the information contained in this section is for guidance only. Psious environments are therapy supporting tools that must be used by the healthcare professional within an evaluation and intervention process designed according to the characteristics and needs of the user. 

Also remember that you have the General Clinical Guide in which you have more information on how to adapt psychological intervention techniques (exposure, systematic desensitization, cognitive restructuring, chip economy…) to Psious environments.”

Evaluation fear of public speaking

Objectives of evaluation

• To evaluate the presence and comorbidity of other emotional disorders, especially social phobia, anxiety disorders or other phobias

• To evaluate anxiety associated with components: speaking in front of an audience, whether in a formal way (such as an oral presentation in an academic environment) or more informal (such as making a toast at a birthday party), being the centre of attention in a social situation, receiving a potential negative evaluation from an audience. 

• To define configurations of stimulated fears by the patient and in what degree. Creation of hierarchy of exposure. 

• To evaluate the presence of distorted thoughts: being embarrassed in a social situation, being criticised for everything they say, not being capable of coordinating their thoughts, not knowing how to behave themselves in an appropriate way…

Some useful instruments for the evaluation of fear of public speaking

Bearing in mind the objectives for evaluation we will list some tools and instruments that can be useful for obtaining information relevant to the characteristics of your user. Remember that a good definition of objectives, characterisation of the patient and plan for intervention are important for therapeutic efficiency and efficacy, as well as for the satisfaction of your patients. In the bibliography, you will find articles in which the characteristics of the instruments proposed are reviewed below.

• Open or semi-structured interview

• Structured interview: Interview for Anxiety Disorders according to the DSM-IV 

• Observation and self-observation (with self-report):
  • Behavioural approximation test live and/or through virtual reality
  • List of Appropriate Behaviours at the Beginning and End of a Talk 
  • Scale of Qualification of Social Performance 

SELF-REPORTS

• State Speech Anxiety Inventory (SSAI)

• Self-Statement During Public Speaking Scale (SSPSS) 

• Speech Anxiety Thoughts Inventory (SATI) 

• Personal Report of Confidence as a Speaker (PRCS) 

• Psious self-reports for the creation of the hierarchy  

Creation of the hierarchy of exposure to Psious’s environments

Once we have the information from the evaluation we can proceed to create the hierarchy of exposure. For this, as well as using the data obtained through the initial assessment, we can ask a series of questions (e.g. What level of discomfort, on a scale of 0 to 100, does holding a conversation with a group of four people give you? What level of discomfort, on a scale of 0 to 100, does having to make an oral presentation for 10 minutes give you?, Do you think that there is something that could make you feel even more discomfort?…) directed at planning the intervention through virtual reality. 

Below there is a series of items that can be used to create a suitable hierarchy for treating fear of public speaking with Psious. It must be borne in mind that we might be able to ask the patient about the anxiety that these items create, and after that, start grading the different elements of the hierarchy.

• Being in an auditorium alone preparing for a presentation that will be given in a few minutes (environment of fear of public speaking, auditorium).

• Having a job interview (environment of fear of public speaking, office).

• Presenting a new project to a small group of work colleagues (environment of fear of public speaking, office).

• Giving a talk that will be broadcast on television and seeing that the audience is listening attentively (environment of fear of public speaking, Broadcast conference).

• Giving a talk in an auditorium full of people (environment of fear of public speaking, auditorium).

• To be giving a conference and hear laughter from the audience (environment of fear of public speaking, audience).

• In a work meeting a colleague makes a critical remark to you (environment of fear of public speaking, office).

Bibliography

• Chapman, L. K., & DeLapp, R. C. (2013). Nine session treatment of a blood–injection–injury phobia with manualized cognitive behavioral therapy: An adult case example. Clinical Case Studies. Retrieved October 26, 2014, from http://ccs.sagepub.com/content/ early/2013/10/28/1534650113509304

• Marks, I. M. (1988). Blood-injury phobia: A review. American Journal of Psychiatry, 145, 1207- 13.
  
• Marks, I. M. y Mathews, A. M. (1979). Case histories and shorter communications. Brief stan- dard self-rating for phobic patients. Behaviour Research and Therapy, 30, 425-434.
  
• Mas, M. B., Jiménez, A. M. L., & San Gregorio, M. Á. P. (2010). Blood-injection Phobia Inventory (BIPI): Development, reliability and validity.[Inventario de fobia a la sangre (BIPI): Desarrollo, fiabilidad y validez]. Anales de Psicología/Annals of Psychology, 26(1), 58-71.

• Wiederhold, B.K., Mendoza, M., Nakatani, T. Bulinger, A.H. & Wiederhold, M.D. (2005). VR for blood-injection-injury phobia. Annual Review of CyberTherapy and Telemedicine, 3, 109-116.

• Wolf, J.J. & Symons, F.J. (2013). An evaluation of multi-component exposure treatment of needle phobia in an adult with autism and intellectual disability. Journal of Applied Research in Intellectual Disabilities, 26(4), 344-348.

• Ritz, T.M., Meuret, A.E. & ALvord, M.K. (2014). Blood-injection injury-phobia. In Grossman, L. & Walfish, S. (Ed.): Translating psychological research into practice (pp. 295-301). New York, NY, US: Springer Publishing Co, 609.