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.
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.
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.
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.
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.
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.
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
It’s the most common fear. There’s a very widespread, and enormously pernicious myth, among the general population and even among some mental health professionals, and probably you also share it. This myth is to think that anxiety provokes heart failures. This is completely false!
In order for a cardiac arrest to be produced, it has to be influenced by a series of genetic organic variables, way of living and even age and gender. A person can suffer some type of heart attack if he/she has several of these characteristics: some serious base injury in the heart or the surrounding arteries, a high excess of oily acids in blood, inadequate diet and/or overweight, sedentary life without any physical activity, excessive consumption of alcohol and tobacco or other drugs, family background, problematic age and being a man. The stress is a last variable that combined with the previous ones increases the risk. Now, it must be clear that the stress on its own does not cause heart attacks.A person, in the middle of the most terrible of panic attacks, is not going to suffer any type of heart attack if they don’t bring together a good number of the enumerated characteristics, and, even this way, the probability would still be low.
A very common physiological phenomenon that causes panic attacks is to notice a sudden raise in the cardiac rate. The heart is designed to rise and to go down at a sharp pace when the body needs it. Just imagine the beating of an athlete’s heart in the middle of a competition. When we feel anxious, our heart speeds up to send more blood and oxygen to the tissues and muscles because, if you remember, your organism prepares itself to run or to fight.] Unlike what everybody thinks, the constant rise of the heart rate that a person with panic could notice, more than damaging the heart what it does is training it to be stronger. Next time you feel your heart beating very fast, just remember your training session just started!
In some people, the most out-standing fear is to lose control of their mind or to become crazy. This belief appears as a result of experiencing many rare sensations without a logical explanation, such as vision anomalies (blurry vision, seeing small lights, sensation of unreality), very intensive thoughts, or a strong escape feeling.
All these organic phenomena have one punctual explanation on the basis of the ANS activation as an adaptive response of the species.
The most worrying sensations are the ones related to visual fields, who make you perceive reality in a distorted way. (“as if I wasn’t myself”). When we suffer a strong anxiety response, our organism thinks we’re in a dangerous situation, we can be attacked by a predator and we have to decide in little time if we’re going to run away or fight. In order to see our enemy more clearly, our pupils dilate abnormally, which gives us a much greater view, but at the same time it can cause those visual peculiarities, due to the over-dilated pupil which isn’t used to the environmental light.
When a person thinks they’re about to lose their mind, they think “something will break” inside their brains, and from that moment onwards, they’ll become mentally ill or schizophrenic. Schizophrenia and all psychosis normally appear in early ages: adolescence and early adulthood. They don’t appear out of the blue, they follow a progressive worsening process, which the patient isn’t aware of, reaching deliriums and hallucinations, such as hearing and seeing things that don’t exist. Normally those patients have family history, and even though it isn’t totally clear, it is thought to be a genetic-based disorder.
In clinical psychology, there’s an important difference between emotional problems and psychotic disorders. We all suffer emotional problems to a greater or lesser extent, such as depression, phobias, panic or sexual problems. Psychotic problems are illnesses, and fortunately only suffered by a few people.
A psychotic disorder is NEVER a branch of an emotional problem. Psychosis isn’t the end of a phobia; emotional problems and psychosis have different origins and evolutions. They are similar paths, but they don’t overlap each other. The same way that having a cold could turn into a flu, but would never be cancer. This can be applied to psychology: anxiety problems like panic could get worse and become a more serious panic, but would never turn out into a psychosis.
Other people think that they will lose control temporarily and that they will behave violently, ridiculously or in an extravagant way and that this could even endanger other people or even themselves by shouting, or throwing themselves to the ground, break objects, attack others or jump out the window. These thoughts are strengthened by the decontrol sensation of a person suffering a panic attack. Nevertheless, this lack-of-control sensation is more of a subjective sensation rather than a reality. There’s not a single documented case in which it has happened during a panic attack. Worst case scenario, a person would escape from the situation where they suffered the attack by “securing themselves”. This is something that the patient must do consciously and voluntarily.
In your next panic attack, don’t worry, stay calm, your muscles will do what you tell them to do!
When someone’s suffered several panic attacks, it’s quite common to develop another fear apart from the central fears. It’s what we call “scared of fears” or being scared of suffering a new panic attack. The real fear is thinking that panic or anxiety won’t stop and that they’ll go on forever. Other people fear that the attack will never end.
This is a good moment to remind some concepts that you probably already know about anxiety. Panic happens due to bad experiences, it’s the result of inadequate learning. If you use the precise methodology, that inadequate learning will disappear. It doesn’t have to do with opinion, it’s an immutable psychological law.
On the other hand, it also takes up panic physiology knowledge. Remember that the Autonomic Nervous System is designed to work at a high intensity, but in short periods of time. Also remember that the Sympathetic Nervous System hyperactivates itself together with the Parasympathetic which controls and restrains it. A panic attack, without using control techniques, only lasts a few minutes.
Next time you think you’re not going to overcome a problem, or that you’ll be stuck in panic, just remember that that’s not prone to happen!
