This is a scenario aimed at the treatment of anticipatory anxiety, which is an essential component of flight phobia. In this scene, the patient is at home and is about to leave on a trip and must wait for the taxi that will take him to the airport.
SETTINGS VARIABLES
Time Day / Night
Weather Clear/ Rainy
EVENTS
TV weather report News about the weather forecast are shown on TV. The news vary according to the weather conditions previously selected.
TV crash report News about a plane accident are shown on TV.
Taxi arrives Upon enabling this setting, the taxi driver arrives to pick up the patient and make their way to the airport.
Thunders Activates the sound of thunder outside the house.
The highway virtual environment displays a three-lane road with straight sections and curves. In this environment, the healthcare professional can manipulate specific variables in order to design a personalized exposure hierarchy for each patient.
SETTINGS VARIABLES
Cars in road None / Full
Passengers None / Full
Patient position Driver / Passenger
Time Day / Night
Weather Clear/ Rainy
EVENTS
Turn left
Turn right
Accelerate To regulate the speed of the car. The speedometer will respond according to the selected speed changes. If the vehicle is travelling at the maximum speed (5/5) on the left lane and returns to the center lane, the speed will be reduced to 4 to avoid colliding with the vehicle ahead.
Distraction
Telephone: the driver receives a call.
Passenger: a passenger distracts the driver with his mobile.
Radio: the co-pilot plays loud music.
Type Road: Tunnel / Bridge / Highway (Please note that these are infinite stages, so the selected stage will go on until another option is selected.)
Curve Straight / Mixed / Curves
Accident Displays a broken car on the right side of the road.
Broken engine Causes the car to slow down and an error signal appears on the car’s controls.
This route reproduces a car journey through a city. Includes clinically relevant elements such as straight streets, corners, traffic signs, stop lights and cars moving through the streets.
SETTINGS VARIABLES
Number of cars Regulates if the car ride takes place with or without cars on the road. Choose among three traffic flow options: none, minimum, medium and maximum.
Number of passengers:
Minimum (only the driver)
Medium (driver and front passenger)
Maximum (with passengers in the back seat)
Seat It changes the avatar position (driver/passenger).
Time Day / Night
Weather Clear/ Rainy
EVENTS
Speed The speed can be increased and decreased with a slider control.
Circuit Choose between two different routes: Track 1 (less anxiogenic. With straight roads and few curves and intersections) and Track 2 (fewer straight distances, constantly turning corners, cars coming from both ways).
Horn Reproduces the sound of a horn.
Hard brake The driver suddenly hits the brakes.
Ambulance An ambulance with its siren turned on can be heard. The car stops at a traffic light and the ambulance crosses in front.
Enable traffic jam The driver is stuck in traffic.
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.
This virtual reality (VR) environment aims to create an ideal environment to apply the exposure technique to cockroaches. In this environment, the patient is seated and can observe a terrarium on the table in front of him.
SETTINGS VARIABLES
Number of cockroaches Allows regulating the amount of cockroaches from a minimum to a maximum (6 cockroaches).
Zone of exposition You can choose if cockroaches are on the table or inside the terrarium.
Cockroach size Choose between three sizes: small, medium and large.
EVENTS
Cockroach noise A noise is heard and the cockroach will start moving from side to side.
Near distance Position the cockroaches at a close distance from the patient.
Medium distance Position the cockroaches at an average distance from the patient.
Far distance Position the cockroaches at a far distance from the patient.
Cockroach in hand When this event is activated, cockroaches will approach and begin to walk above the avatar’s hand.
Move finger The avatar starts to move a finger. This option aims to enhance the immersion of the patient through a rhythmic movement that you will have to perform at the same time, thus facilitating the identification of the hand you are seeing as your own.
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 environment simulates a restaurant where the patient can eat various menu options (hypocaloric/diuretic/standard/hypercaloric), alone or accompanied, as required by the situation. The healthcare professional will select the menu option the patient should be eating. In this environment, we mainly intend to work the anxiety towards certain foods, awareness on how good eating habits can prevent a subsequent purge/compensation, and not isolation during meals.
Exposure Therapy To reduce the anxiety caused by certain “forbidden” foods (usually, hypercaloric foods).
Exposure with Response Prevention (EPR) To be exposed to certain stimuli (food), which usually precede binge eating and/or compensatory behaviors (e.g., purge) with the aim of preventing the occurrence of such behaviors. The procedure consists of exposing the patient to foods that usually act as a trigger for binge eating. When the patient feels that he/she has broken the diet and wishes to vomit, we will try for him/her to focus on what his/her feelings and what he/she thinks, with the aim of being able to analyze and restructure it together with the therapist during the session. The aim is for the subject to verify he/she can control himself/herself and notice how anxiety, guilt, etc., can be reduced without the need to compensate (e.g., vomiting). These exposures can also work as behavioral tests through which the patient can test whether or not his/her irrational fears regarding the consequences of not compensating are met (e.g., put on a lot of weight, fat accumulation on a certain part of his/her body at once, etc.) (Saldaña, Tomás & Bachs, 1997).
CONFIGURATION VARIABLES
Companion This variable will allow choosing whether the patient eats alone or accompanied and, in that case, whether the companion is male or female. This variable should be taken into account during the exposure based on whether the patient is more or less stressed when eating alone or with a companion, and whether he/she is worried when eating with a person of the same sex (e.g., because he/she tends to compare himself/herself with them) or of the opposite sex (e.g., for fear of feeling judged):
None: The patient appears eating alone, without any companion at his/her table and with no people on the tables surrounding him/her
Female: The patient eats while accompanied by another avatar (a woman). Also, there are people eating on the tables near them.
Male: The patient eats while accompanied by another avatar (a man). Also, there are people eating on the tables near them.
Conversation In the case of the “Accompanied” configuration, the healthcare professional may choose the kind of conversation the patient’s companion will provide during the experience. It is important to keep in mind that this conversation will not be activated if there is no food on the table. In fact, it will not consist of a conversation per se (there will be no exchange), but only the companion will issue sentences/comments. However, the idea is to simulate a real situation in which a conversation takes place during a meal. The subject of said conversation may be:
None: In this option, the companion will not make any comments and will remain silent.
Neutral: In this modality, the companion will issue phrases regarding a neutral subject, such as the movies (going to the movies, favorite movies, upcoming releases…).
Bad: In this case, the companion will issue phrases related to physical appearance, food, social events where eating while with a group of people is included, etc. That is, subjects that often cause anxiety (or discomfort) to this type of patients.
EVENTS
Choose menu In this events, will appear the following menu options for the patient to take:
Hypocaloric: Menu consisting of foods with a low fat content: Water + grilled chicken breast together with a salad + natural yogurt.
Diuretic: Menu consisting of foods that help the elimination of liquid (urine), often eaten by people who wish to lose weight: Green tea + salad (lettuce, beet, and carrot) + Fruit (kiwi).
Standard: A normal diet’s menu: Water + Steamed vegetables + Omelette with tomato slices + Natural yogurt.
Hypercaloric: Menu including foods with higher fat content: 1 soft drink (Coca-Cola) + Hamburger with French fries + Pie.
View menu The patient (and the companion, if also present) will have a menu in their hands with different menu options. However, the healthcare professional will be the one to choose the patient’s menu, by selecting the event described below.
The healthcare professional can make the avatar (patient) hold the menu in his/her hands for as long as he/she wants. When the healthcare professional wants the avatar to start eating, he/she must select the kind of menu to which he/she wishes to expose the patient from the “Menu” event.
Once the menu option is selected, the menu will automatically disappear and the first course of the chosen menu option will be displayed. Once the patient finishes the dish, the second course will appear (if there is one), and finally the dessert
Once the configuration/event variables have been selected and the patient has the corresponding course in front of him/her, he/she should pretend to eat the food by staring at the dish until the little circle that appears on the goggles is completed. Each time the patient stares at the dish, the avatar will ingest a portion of the food, until the food is finished (approximately, 7-10 bites). However, if the patient takes too long to perform this action, the system will automatically simulate a mouthful intake after approximately 30 seconds. The drinking action can also be activated by looking at the glass with the goggles. When finishing each course, the avatar will leave the cutlery on the plate. When the full menu is finished, the scene will return to its initial state, and the option to choose another menu will be available
In order for the healthcare professional to receive a more accurate feedback of the patient’s behavior during the experience, some signs will appear on the platform viewer notifying him/her of each time the patient ingests a portion of food, whether the patient has decided to eat it voluntarily, or if the system has automatically simulated the intake after 30 seconds, etc. The different signs (feedbacks) that will appear will be the following ones:
Initial state: Informs that the avatar is at the table, without the menu or the food, still in “standby mode”
Showing menu: Informs that the avatar (patient) is looking at the menu
Changing menu: A brief fade to black will be shown on the goggles at that moment, and immediately after it, the menu selected by the therapist will appear.
Menu [kind of menu] – [course]: Signals the kind of menu and the specific course the avatar (patient) is eating. Example, “Hypercaloric menu-Hamburger”
Eating portion [number] of [number], voluntarily: Informs that the patient is currently taking a bite and what bite number it is (for example, 3 of 8 would inform the patient is eating the third bite of a total of 8 bites in which the course can be eaten), and also that he/she has voluntarily decided to eat it (it has been the patient who, using the goggles, has deliberately selected the action of eating that bite).
Eating portion [number] of [number], automatically: Informs that the patient is currently taking a bite and what bite number it is (for example, 3 of 8 would inform the patient is eating the third bite of a total of 8 bites in which the course can be eaten), but that the bite has not been voluntary (i.e., that 30 seconds have passed without the patient deciding to take a bite, and the system has performed the action automatically).
Menu [kind of menu] – Drinking: Informs that the patient has directed the goggles towards the drink to take a sip at that moment.
Finished course: Informs that the patient has finished the dish he/she was eating at that time.
Changing course: When the patient has finished a dish, a brief fade to black is shown on the goggles, and the next course of the menu will appear immediately afterwards.
Menu [kind of menu] – Completed: Informs the patient has just finished eating the full menu (after eating the dessert). Example, “Hypercaloric menu – Completed”.
If the healthcare professional wants to expose the patient to the plate but not to eat it (that is, to watch the plate), it is sufficient for the patient to place the pointer of the viewer outside the plate (e.g. on the table) and, keeping your head in that position, lower your gaze to the plate (only with your eyes, otherwise you would place the pointer again on top of the food and the intake would begin).
REFERENCES
Saldaña, C., Bach, L., & Tomás, I. (1997). Técnicas de intervención en los trastornos del comportamiento alimentario – Dialnet. Aniedad y Estrés, 3(2–3), 319–337.
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.
