Category: Uncategorized

Attention training

The Distraction environment is similar to a game. It is set in the sea and the patient will have to capture different marine creatures according to the indications of the game itself. To capture them, the patient will have to place a white dot on top of the creature and wait for a circle to be generated around the point. 

By capturing the indicated creatures, the patient will earn rewards. Specifically, he/she can add points, level up and change the scene. When the patient makes mistakes (to catch other species than those mentioned, marine mines or drums) there will be penalties, for example, to end with the dot-dash multiplier or reducing the level status bar. Repeatedly making mistakes will prevent the status bar from filling up, which will prevent leveling up. 

This environment will not require supervision of a healthcare professional to activate events or configuration variables. The patient will discover how to play on his/her own. 

The goal of this environment is immersion, interactivity and focused attention. The user must be alert at all times to the indicators to know which type of fish or animal has to be focused on at that time.

Small elevator

This environment, unlike “Big Elevator”, allows the option of getting in the elevator and going to another floor but in a smaller space. In addition, this time there is not the control variable option, so the healthcare professional will have to completely guide the exposure. The reason for this change is increasing the level of difficulty , since the patient will have less control over the situation, hence being forced to cope with anxiety.

EVENTS

• Emergency stop
  When the button is pressed, a temporary fault occurs inside the elevator.
  
• Finish
  The elevator stops, the doors open, and the patient exits the elevator.
  
• Go to another floor
  The elevator moves to another floor.
  
• Go to elevator
  The patient enters the elevator.

Basement and small room

In this scenario, the patient has to get in the elevator and ride to the basement, which consists in a room whose size can be modified by the therapist. This environment is even harder, so it is recommended to use it when optimal results have been obtained in the previous ones.

The scene starts on the floor in which the patient gets in the lift. Once inside, it will get down to the basement. The patient will then leave and start walking a corridor until reaching the room in which the exercise will take place. The therapist will be able to modify the size of the room in order to design a gradual exposition.

EVENTS

• Go to the first floor
  By pressing this button the patient goes from the basement to the first floor.
  
• Walk
  The patient starts walking / stops.
  
• Open Door
  The basement door opens or closes.
  
• Go to room:
  By pressing this button the patient goes from the first floor to the basement.
  
• Size room
  Allows room size to be modified based on the slider.

Magnetic resonance imaging (MRI) scan

This environment is devised to deal with discomfort and claustrophobia associated with magnetic resonance imaging. The level of difficulty is high in this environment and it is divided up into three stages (hierarchal from lower to higher difficulty). In the first stage, the patient is located in a waiting room where they will listen to information given on a television screen. Anticipatory anxiety and psychoeducation can be worked on in this environment.

In the second stage, the patient will enter a room to get changed, the room is small and has no windows, and serves as exposure in a small closed space.

Lastly, in the third stage they will go to the magnetic resonance room, here they will be able to work on a diversity of hierarchy items: be present in the room while the technician speaks to them, lie down on the treatment bed, both partially and wholly enter the machine, and adjust the volume from low to high. 

VARIABLES SETTINGS 

• Body parts
  Corresponding to the part of the body that will be scanned: leg, trunk, limb. 
• Television
  This variable implies that the TV in the waiting room is on or off.
• Sanitary mask
  You can choose whether or not the people around you will have a mask.

EVENTS

• Zone 1
  The patient will be in the waiting room, he will see how several avatars approach the reception desk. Then you must go to the changer.
• Zone 2
  The patient will be in the changing room and after an informative session that he will hear from a loudspeaker, he will go to the resonance room.
• Zone 3
  The doctor’s avatar will tell us some directions before we lie down in the resonance cabin. The patient should lie down to maintain the immersion and look towards the indication that will appear on the ceiling, to become lying in the environment.
• Zone 4
  The patient will enter the cabin and undergo the resonance process, the noise will depend on the configuration slider. At the end of the process the patient will leave the cabin and the avatar the doctor will inform us that the session has ended.

• Noise volume
  The noise generated from the magnetic resonance machine can be adjusted in this slider. Do remember to use the platform volume (up down) as a further hierarchy exposure setting.

Large elevator

The patient is located in a room and must get into the lift. Initially, these two spaces have people, although the presence or absence of people can be regulated using the configuration button “Number of people”. Specifically, you can choose that there is no one in the elevator, that there are few people (3 people), or that there are many people (7 people).

SETTINGS VARIABLES

• Number of people You can choose between Nobody, Medium and Maximum.

• Sanitary mask
  You can choose whether or not the people around you will have a mask.

EVENTS

The sequence of events will always follow the order presented in the diagram below:

• Start breakdown: when the button is pressed, the elevator will stop.

• Finish breakdown: when the button is pressed, the elevator will work again. 

• Exit elevator : the elevator stops, the doors open and leaves the elevator.

• Move elevator: the doors close and the elevator changes floors.

• Open elevator: the elevator doors are opened.

What is a panic attack?

When our organism faces an exterior situation or a corporal sensation, that we consider as dangerous, our brain orders a sign (catastrophic thought) to the ANS that immediately hyper accelerates (physiological response). 

The ANS has as one of its priority missions to prepare our organism to confront potentially dangerous or difficult situations. It’s a genetically recorded survival function. It prepares our organism to fight or to run away, and the changes that we notice in our body aim to qualify us. 

The ANS is formed by two subsystems, the Sympathetic Nervous System (S.N.S) and the Parasympathetic Nervous System (P.N.S). Both are complementary and antagonists. The S.N.S. activates the organism and the P.N.S. restrains it. For it, a response of anxiety or panic cannot last for too long (a few minutes) because as soon as the SNS accelerates, the PNS stops it.  

When the brain sends its message to the ANS, this one activates the SNS giving an order to the adrenal glands that inject adrenaline and noradrenaline into the blood. These substances act as chemical messengers accelerating our organism. This is why we notice so many different sensations; it activates itself all at once, not by parts. Remember that at the same time, the PNS does its work by restraining the activation, and certain substances that neutralize the adrenaline and the noradrenaline appear, stopping the attack from lasting for too long. 

In this sense, anxiety isn’t dangerous, nothing will happen to you just by being anxious: nevertheless, it’s uncomfortable. 

Once the system has returned to normality, we can feel very tired, have head or back ache, and other sensations too. It’s common. This is due to our organism consuming a lot of energy, we have tensed muscles and this type of sensations can appear.

Hyperventilation:

In a significant proportion of people with panic, another physiological phenomenon that complicates everything appears: hyperventilation. 

As part of the physiological response, the respiratory pace hastens involuntarily to send extra oxygen to the whole organism that, if we remember, prepares us to run away or to fight. 

As this does not happen during a panic attack, we enter a state of hyperventilation: There is much more oxygen than what we need and what we use, and at the same time the level of carbon dioxide diminishes. This increases the alkalinity level of the blood (Ph) and arterial pressure descends, causing sensations such as weakness, throbs, tachycardia, pain in the precordium, dizziness, blurry vision, sensation of unreality, lack of air sensation, suffocation, dry mouth, stomachache, inflexibility, muscular pain, trembling and cramps. 

In some cases, the involuntary hyperventilation is increased by another voluntary one. Since one of the effects of the hyperventilation is to paradoxically notice suffocation (in spite of the fact that the hyperventilation is the opposite sensation), the person tries to breathe more, or more deeply, which worsens even more the situation. 

Here you have a table with the majority of the physical changes that we notice in panic, and its explanation produced by the hyperventilation of the ANS:

Physical changes of the panic and its explanation

Feelings fears	Catastrophic interpretation	Real explanation
Tachycardia	Heart attack	The heart pumps harder and faster to send blood to vital areas
Loss of sensitivity, pallor, cold	Infarction, stroke, paralysis, brain tumor	The blood is concentrated in the viscera, leaving the peripheral areas with a minor irrigation
Drowning, shortness of breath. Hyperventilation	Choking	Increase of Oxygen in the blood (state against the choke)
Dizziness	Fainting, fading	Lowering of blood pressure produced by hyperventilation.
Pain in the chest, arms, prick.	Heart attack	Abnormal pattern of breathing (keep lungs too full), muscle tension in the area, prolonged incorrect postures
Heat, sweat, hot flashes	Disease	Increased body temperature in vital areas. The body puts into operation the cooling system (sweat glands).
Dry mouth, nausea, stomach sensations	Disease	Decreased activation of the digestive system
feeling that light annoys, spots in the vision	Go crazy, stroke	The pupils enlarge and dilate to increase peripheral vision
Tremors, pricks, cramps	Disease, infarction, insanity	Excessive muscle tension