Bados, A. (2005). Trastorno de ansiedad generalizada. Recuperado de la web del depósito digital de la Universidad de Barcelona: http:// diposit.ub.edu/dspace/bitstream/2445/357/1/116.pdf
Bastida de Miguel, A.M. (2012). Tratamiento cognitivo-conductual aplicado a un caso de insomnio severo comórbido con ansiedad generalizada. Revista de Psiquiatría, 16(3), 2-36. Recuperado de http://www.psiquiatria.com/revistas/index.php/psiquiatriacom/ article/viewFile/1395/1266/
Brown, T.A., O’Leary, T.A. y Barlow, D.H. (2001). Generalized Anxiety Disorder. En D.H. Barlow (Ed.), Clinical Handbook of Psychological Disorders: A Step-by-Step Treatment Manual (pp. 154-208). Nueva York: The Guilford Press.
Chorpita, B.F., Tracey, S.A., Brown, T.A., Collica, T.J. y Barlow, D.H. (1997). Assessment of worry in children and adolescents: An adaptation of the Penn State Worry Questionnaire. Behaviour Research and Therapy, 35, 569-581.
Dilbaz, N., Cavus, S.Y. y Darcin, A.E. (2011). Treatment resistant Generalized Anxiety Disorder. En S. Selek (Ed.), Different views of Anxiety Disorders (pp. 219-232). Rijeka: InTech.
Dugas, M., Savard, P., Gaudet, A., Turcotte, J., Laugesen, N., Robichaud, M., Francis, K. y Koerner, N. (2007). Can the components of a cognitive model predict the severity of generalized anxiety disorder? Behavior Therapy, 38, 169-178.
Gorini, A., Pallavicini, F., Algeri, D., Repetto, C., Gaggioli, A. y Riva, G. (2010). Virtual Reality in the treatment of Generalized Anxiety Disorders. En B.K. Wiederhold, G. Riva y S.I. Kim (Eds.), Annual Review of Cybertherapy and Telemedicine (pp. 39-43). Amsterdam: IOS Press. Wittchen, H.U. y Hoyer, J. (2001). Generalized Anxiety Disorder: nature and course. Journal of Clinical Psychiatry, 62(11), 15-19. Recuperado de http://psychologie.tu-dresden.de/i2/klinische/mitarbeiter/ publikationen/hoyer/Pdf/504.pdf
Meyer, T.J., Miller, M.L., Metzger, R.L. y Borkovec, T.D. (1990). Development and validation of the Penn State Worry Questionnaire. Behaviour Research and Therapy, 28, 487-495.
Spitzer, R.L,, Kroenke, K., Williams, J.B.W. y Löwe, B. (2006). A brief measure for assessing Generalized Anxiety Disorder. Archives of Internal Medicine, 166, 1092-1097.
Tallis, F., Davey, G.C.L. y Bond, A. (1994). The Worry Domains Questionnaire. En G.C.L. Davey y F. Tallis (Eds.),Worrying: Perspectives in theory, assessment and treatment (pp. 285-297). Nueva York: Wiley.
Wittchen, H.U. (2002). Generalized Anxiety Disorder: prevalence, burden, and cost to society. Depression and Anxiety, 16(4), 162-171. doi: 10.1002/da.10065
In these environments, the healthcare professional plays a very important role, as by specific comments you may enhance the patient ’s sense of presence, thus strengthening the subjective feeling that they are in the virtual environment.
It is therefore important to use real elements of everyday life of the patient in order to build a story as close as possible to reality, as this will help the virtual environment to be more significant from the patient’s viewpoint and can generate an emotional attachment.
For example, you can set the scene and explain to the patient that they are at home watching a programme.
For the “Babies health” scene, before reproducing the debate, the healthcare professional can ask the patient to imagine that he or she has just put the baby to sleep and that the intercom is on the coffee table with him or her activated to be aware of the baby. With this, the patient whose concern is that something wrong may happen to their children, will start building an emotional bond from the beginning, associating the simulation to real life. So once the patient realizes they are talking about babies on the television, his or her reaction will probably be stronger.
For the “childrens’ health” scene, it is also recommendable to create an emotional bond by making the patient pay attention to the elements of the scene indicating that a child lives in that house (a toy, a ball…).
As for the “family health” scene, as in the television they are giving the weather forecast and talking about heavy rains, it may be of interest to previously indicate to the patient that it is the time when his or her partner comes home from work, coming by car, etc. Therefore, you will expose them to the concern that something bad happens to a loved one.
For the “thinking about getting sick” , the importance lies in making the patient notice what is on the table: a medical report and a bottle of pills . This will make the patient react more strongly when they hear talk about a disease- for example cancer- on television.
Finally, in the “thoughts about work” scene, the healthcare professional can tell the patient he or she is going to take the subway to go to work (or to go to an important event…), so he or she must be punctual.
En estos entornos el profesional de la salud juega un papel muy importante ya que mediante comentarios específicos, podrá mejorar el sentido de presencia y la sensación subjetiva de que se encuentra en el entorno virtual.
Para ello, es importante utilizar elementos reales de la vida cotidiana del paciente con el fin de poder construir una historia lo más cercana a la realidad posible, ya que eso contribuirá a que el entorno virtual sea significativo desde su punto de vista y se pueda generar un vínculo emocional.
Por ejemplo, puede explicar al paciente que está en casa viendo un programa de televisión.
Para la escena “Salud del bebé”, antes de reproducir el debate en la TV, el profesional de la salud puede pedirle al paciente que imagine que acaba de poner a dormir a su bebé y que el intercomunicador está en la mesa de café con él o ella activado para estar atento. Con ello, el paciente con preocupaciones relacionadas con que algo malo les pueda pasar a sus hijos, comenzará a activarse desde el principio de la escena, trabajando en la simulación aspectos de su vida real
Para la escena “Salut infantil”, también es recomendable fomentar al activación haciendo que el paciente preste atención a los elementos de la escena que indican que en esa casa vive un niño (un juguete, una pelota…
En la escena “salud familiar”, el paciente verá la previsión meteorológica en la televisión, indicando ésta que habrá mal tiempo y fuertes lluvias. Es recomendable indicar al paciente, previamente al lanzamiento de la escena, que es la hora en la que su pareja llega del trabajo , que viene en coche, etc. El objetivo será activar la preocupación de que algo malo le pase a un ser querido.
Para el “pensamientos sobre la enfermedad”, será relevante hacer que el/la paciente se fije en los objetos que hay sobre la mesa: un informe médico y un frasco de pastillas. Eso hará que el/la paciente reaccione con más intensidad cuando escuche hablar de una enfermedad -por ejemplo cáncer- en la televisión.
Finalmente, en la escena de “pensamientos sobre el trabajo”, el profesional sanitario puede decirle al paciente que va a tomar el metro para ir a trabajar (o para ir a un evento importante…), por lo que debe ser puntual.
“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.”
In the following lines, a treatment protocol using Psious virtual environments is offered as an example.
However, it is noteworthy that this tool should accommodate the cognitive behavioural therapeutic framework used by the healthcare professional, and combine it with techniques such as cognitive restructuring, training in problem solving and worry exposure. It must adapt to the needs and particularities of the patient. On the other hand, for training in relaxation techniques, Psious has specific environments that will facilitate their learning.
The suggested protocol is an adaptation of the intervention protocol of Brown, O’Leary and Barlow (2001) for GAD. Our proposal has a total of ten sessions instead of the 13 of the original, as VR facilitates the therapeutic process compared to the imagination (Both in the exposure and learning relaxation techniques), so the treatment’s duration is reduced.
Treatment session description
SESSION 1 PSYCHOEDUCATION
Information relating to GAD is given ( origin, maintenance and demonstration in the triple system: cognitive, physiological and conductual).
The role and origin of anxiety and worries are explained.
General information about treatment (for example importance of self-Assessment and homework).
Treatment techniques to be used are explained (emphasizing exposure by Virtual Reality).
HOMEWORK The patient must perform a self-assessment of daily levels of worry and mood using the self-records provided (Annexes 5.1).
SESSION 2 INTRODUCTION TO RELAXATION
Discuss self-reports with the patient, as well as what was commented about anxiety on the first session.
Physiological aspects of anxiety and GAD’s maintenance factors are explained.
Familiarization with Psious platform.
HOMEWORK Self-Assessment daily levels of worrying and mood through self-reports provided (Annexes 5.1.).
SESSION 3 RELAXATION
Discuss self-reports with the patient, possible questions are resolved.
The patient learns and practises two types of relaxation techniques: diaphragmatic breathing and progressive muscle relaxation. (to do this, specific relaxation environments can be used for the training with the available audio).
HOMEWORK
Daily practise of relaxation techniques and self-reports (Annexes 5.1 and 5.4).
SESSION 4 INTRODUCTION TO THE COGNITION’S ROLE
Discuss self-reports with the patient, possible questions are resolved.
Introduction to cognition’s role in persistent anxiety (for example, automatic thoughts) and cognitive distortions.
Explain how to use cognitive self- assessment form (annexes 5.2).
It starts to work on automatic thoughts using a VR set in the home environment and go writing down these thoughts.
Practise of relaxation techniques in a relaxation environment with the available audio.
HOMEWORK Daily practise of relaxation techniques and self-reports (Annexes 5.1, 5.2. and 5.4).
SESSION 5 EXPLORATION OF THE COGNITIVE DISTORTIONS
Discuss self-reports with the patient, possible questions are resolved.
Cognitive distortions in GAD are discussed and strategies to counter them are offered (alternative thinkings).
Overestimation of probabilities is explained.
Explain what catastrophizing is.
Exposure to the house scene playing the indicated debate on TV ( depending on the characteristics of the patient).
During the exposure, the patient must verbalize his or her thoughts aloud, so it would be possible to explore these distortions.
Practise relaxation techniques in a relaxation environment with the available audio.
HOMEWORK Daily practise of relaxation techniques and self-reports (Annexes 5.1, 5.2. and 5.4).
SESSION 6 INTRODUCTION TO WORRY EXPOSURE
Discuss self-reports with the patient, possible questions are resolved.
It is explained what worry exposure is and a hierarchy of exposure is done.
Gradual and systematic worry exposure begins in virtual environments. Throughout all sessions of exposure, Virtual Reality is combined with techniques such as diaphragmatic breathing and progressive muscle relaxation when the therapist deems it necessary.
Practise relaxation techniques in a relaxation environment with the available audio.
HOMEWORK Daily practise of relaxation techniques, self-reports and daily worry exposure (Annexes 5.1, 5.2, 5.3 and 5.4).
SESSION 7 VR EXPOSURE
Discuss self-reports with the patient, possible questions are resolved.
Worry exposure on the house environments playing the audio.
Practise relaxation techniques in a relaxation environment with no audio.
HOMEWORK Daily practise of relaxation techniques, self-reports and daily worry exposure (Annexes 5.1, 5.2, 5. 3 and 5.4).
SESSION 8 RELAXATION AND WORRYING PREVENTION
Discuss self-reports with the patient, possible questions are resolved.
It is explained what it is the prevention of worrying conducts. A list of worries with strategies to prevent them is elaborated.
Exposure to the VR environment of the house or the subway. The patient must propose strategies to prevent the worries in situ.
Practise relaxation techniques in a relaxation environment with no audio.
HOMEWORK Daily practise of relaxation techniques, self – reports and daily worry exposure ( Annexes 5.1, 5.2, 5.3 and 5.4) and the prevention of worrying conducts must be applied.
SESSION 9 TIME MANAGEMENT AND PROBLEM SOLVING
Discuss self-reports with the patient, possible questions are resolved.
Time management and problem solving are discussed.
Exposure to the subway virtual environment to implement what has been said in the previous point.
Practise relaxation techniques in the same exposure environment.
HOMEWORK Daily practise of relaxation techniques, self – reports and daily worry exposure ( Annexes 5.1, 5.2, 5.3 and 5.4) and the prevention of worrying conducts must be applied.
SESSION 10 REVISION OF SKILLS AND TECHNIQUES
Discuss the last session and self-reports with the patient, possible questions are resolved.
Skills and learned techniques during the treatment are discussed.
The therapeutic process is evaluated. Future tasks of self-exposure and reinforcement sessions are scheduled.
“Toda la información contenida en este apartado es de carácter orientativo. Los entornos de Psious son herramientas de apoyo terapéutico que deben ser utilizadas por el profesional de la salud dentro de un proceso de evaluación e intervención diseñado según las características y necesidades del usuario.
Recuerda además que dispones de la Guía Clínica General en la que tienes más información sobre cómo adaptar las técnicas de intervención psicológica (exposición, desensibilización sistemática, reestructuración cognitiva, economía de fichas…) a los entornos de Psious.”
A continuación y a modo de ejemplo, se presenta un protocolo de tratamiento sugerido utilizando los entornos virtuales disponibles en la plataforma de Psious.
Sin embargo, cabe mencionar que esta herramienta debe acomodarse al marco terapéutico cognitivo-conductual utilizado por el profesional de la salud, combinándolo así con técnicas como la reestructuración cognitiva, el entrenamiento en resolución de problemas y la exposición a las preocupaciones. Asimismo, debe adaptarse a las necesidades de cada paciente. Por otro lado, para la parte de entrenamiento en técnicas de relajación, Psious cuenta con otros entornos específicos que facilitarán su aprendizaje.
El protocolo sugerido es una adaptación del protocolo de intervención de Brown, O’Leary y Barlow (2001) para el TAG. La propuesta de Psious cuenta con 10 sesiones en total (en lugar de 13 en el original), ya que la RV facilita el proceso terapéutico en comparación con la imaginación (tanto en la exposición como en el aprendizaje de técnicas de relajación).
Descripción de las sesiones de tratamiento
SESIÓN 1 PSICOEDUCACIÓN
Se presenta información referente al TAG (origen, mantenimiento y manifestación en el triple sistema cognitivo, fisiológico y conductual).
Se explica el papel y origen de la ansiedad y las preocupaciones.
Se ofrece información general acerca del tratamiento (por ejemplo, importancia de la autoevaluación y las tareas para casa).
Se explican las técnicas de tratamiento que se utilizarán (enfatizando la exposición mediante Realidad Virtual)
TAREAS PARA CASA El paciente debe realizar la auto-evaluación de los niveles diarios de preocupación y el estado de ánimo mediante los auto-registros proporcionados (Anexos 5.1).
SESIÓN 2 INTRODUCCIÓN A LA RELAJACIÓN
Se comenta la técnica de autoevaluación y los autorregistros, así como lo relativo a la ansiedad comentado en la primera sesión.
Se explica el aspecto fisiológico de la ansiedad y los factores de mantenimiento del TAG.
Familiarización con la plataforma Psious.
TAREAS PARA CASA El paciente debe realizar la auto-evaluación de los niveles diarios de preocupación y el estado de ánimo mediante los auto-registros proporcionados (Anexos 5.1).
SESIÓN 3 RELAJACIÓN
Se comentan los autorregistros de autoevaluación y se resuelven posibles dudas.
El paciente aprende y practica dos tipos de técnicas de relajación: respiración diafragmática y relajación muscular progresiva. Para ello, se pueden utilizar los entornos virtuales específicos de relajación con el audio disponible.
TAREAS PARA CASA
El paciente debe practicar las técnicas aprendidas de relajación y exposición diaria a la preocupación.
Y completar los auto-registros (Anexos 5.1, 5.2, 5.3 y 5.4).
SESIÓN 4 INTRODUCCIÓN AL PAPEL DE LA COGNICIÓN
Se comentan los autorregistros y las técnicas de relajación y se resuelven posibles dudas.
Introducción al papel de las cogniciones en la ansiedad persistente (ej. pensamientos automáticos) y de las distorsiones cognitivas.
Se comenta cómo utilizar el formulario de auto-evaluación cognitiva (Anexo 5.2.).
Se empieza a trabajar en los pensamientos automáticos utilizando el entorno de RV ambientado en casa e ir anotando dichos pensamientos.
Se practican las técnicas de relajación en los entornos de relajación con audio.
TAREAS PARA CASA
El paciente debe practicar las técnicas aprendidas de relajación y exposición diaria a la preocupación.
Y completar los auto-registros (Anexos 5.1, 5.2, 5.3 y 5.4).
SESIÓN 5 EXPLORACIÓN DE LAS DISTORSIONES COGNITIVAS
Se comenta la sesión anterior, los autorregistros y se resuelven posibles dudas.
Se comentan las distorsiones cognitivas en el TAG y se ofrecen estrategias para contrarrestarlas (alternativas de pensamiento).
Se explica la sobreestimación de las probabilidades.
Se explica qué es la catastrofización.
Se realiza la exposición a la escena de la casa con reproducción del debate televisivo que se desee (en función de las características del paciente).
Durante la exposición, el paciente debe verbalizar sus pensamientos en voz alta, lo que permitirá explorar dichas distorsiones.
Se practican las técnicas de relajación en el entorno virtual de exposición con la ayuda del audio disponible en el apartado Relax.
TAREAS PARA CASA
El paciente debe practicar las técnicas aprendidas de relajación y exposición diaria a la preocupación.
Y completar los auto-registros (Anexos 5.1, 5.2, 5.3 y 5.4).
SESIÓN 6 INTRODUCCIÓN A LA EXPOSICIÓN A LAS PREOCUPACIONES
Se comenta la sesión anterior, los autorregistros y se resuelven posibles dudas.
Se explica qué es la exposición a las preocupaciones y se elabora una jerarquía de exposición.
Se inicia la exposición gradual y sistemática a las preocupaciones dentro de los ambientes virtuales. A lo largo de todas las sesiones de exposición, la RV se combina con las técnicas de relajación muscular progresiva y respiración diafragmática cuando se crea conveniente.
Se practican las técnicas de relajación en el entorno virtual de exposición con la ayuda del audio disponible.
TAREAS PARA CASA
El paciente debe practicar las técnicas aprendidas de relajación y exposición diaria a la preocupación.
Y completar los auto-registros (Anexos 5.1, 5.2, 5.3 y 5.4).
SESIÓN 7 EXPOSICIÓN RV
Se comenta la sesión anterior, los autorregistros y se resuelven posibles dudas.
Exposición a la preocupación con el entorno de RV de la casa reproduciendo el audio (correspondiente a las escena que se desee).
Se practican las técnicas de relajación en el entorno virtual de exposición sin ayuda del audio.
TAREAS PARA CASA
El paciente debe practicar las técnicas aprendidas de relajación y exposición diaria a la preocupación.
Y completar los auto-registros (Anexos 5.1, 5.2, 5.3 y 5.4).
SESIÓN 8 RELAJACIÓN Y PREVENCIÓN DE LA PREOCUPACIÓN
Se comenta la sesión anterior, los autorregistros y se resuelven posibles dudas.
Se explica en qué consiste la prevención de la conducta de preocupación. Se elabora una lista de preocupaciones y de estrategias de prevención de dicha conducta.
Exposición al entorno de realidad virtual de la casa y/o del metro. El paciente debe proponer estrategias de prevención de la conducta de preocupación in situ.
Se practican las técnicas de relajación en el entorno virtual de exposición sin ayuda del audio.
TAREAS PARA CASA
El paciente debe practicar las técnicas aprendidas de relajación y exposición diaria a la preocupación.
Y completar los auto-registros (Anexos 5.1, 5.2, 5.3 y 5.4).
SESIÓN 9 GESTIÓN DEL TIEMPO Y RESOLUCIÓN DE PROBLEMAS
Se comenta la sesión anterior, los autorregistros y se resuelven posibles dudas.
Se comentan estrategias de gestión del tiempo y/o solución de problemas.
Exposición al entorno virtual del metro para poner en práctica lo comentado en el punto anterior.
Se practican las técnicas de relajación en el mismo entorno virtual de exposición.
TAREAS PARA CASA
El paciente debe practicar las técnicas aprendidas de relajación y exposición diaria a la preocupación.
Y completar los auto-registros (Anexos 5.1, 5.2,5.3 y 5.4). Además, se debe poner en práctica la prevención de conductas de preocupación, así como las técnicas de gestión del tiempo y/o resolución de problemas.
SESIÓN 10 REVISIÓN DE HABILIDADES Y TÉCNICAS
Se comenta la sesión anterior, los autorregistros y se resuelven posibles dudas.
Se comentan las habilidades y técnicas aprendidas a lo largo del tratamiento.
Se evalúa el proceso terapéutico y los avances realizados. Se programan futuras tareas de auto-exposición y sesiones de refuerzo.
“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.”
Generalized Anxiety assessment
Evaluation Objectives
Evaluate the presence and comorbidity of other anxiety and emotional disorders.
Evaluate the anxiety parameters: intensity, frequency, characteristics…
Measure the presence of distorted thoughts and dysfunctional beliefs.
Some useful instruments for Generalized Anxiety
Taking the evaluation objectives into account let’s proceed onto listing some tools and devices that can be useful in gathering relevant information on the user characteristics. Always remember good goal setting, patient characterization and intervention planning are important in effective and efficient therapies, as that of your patients’ satisfaction. The following are the articles you will find in the bibliography where you can refer to the proposed tool characterization:
Structured interview: ADIS-IV
Behavioral approach test/behavior avoidance (in vivo or with virtual reality)
Assessing thoughts while running virtual environments
SELF-REPORTS
Generalized Anxiety Disorder-7 Scale; (GAD-7; Spitzer et al., 2006).
Questionnaire sur le Inquiétude et l’Anxiété; Worry and Anxiety Questionnaire, (WAQ; Dugas et al., 2001).
Penn State Worry Questionnaire, (PSWQ; Meyer et al., 1990).
Penn State Worry Questionnaire for Children, (PSWQ-C; Chorpita et al., 1997).
Worry Domains Questionnaire, WDQ; (Tallis et al., 1994)
A proposal for a treatment protocol that includes the Psious tool is described below. It is recommended to combine virtual reality with traditional techniques, such as relaxation or cognitive restructuring.
“Toda la información contenida en este apartado es de carácter orientativo. Los entornos de Psious son herramientas de apoyo terapéutico que deben ser utilizadas por el profesional de la salud dentro de un proceso de evaluación e intervención diseñado según las características y necesidades del usuario.
Recuerda además que dispones de la Guía Clínica General en la que tienes más información sobre cómo adaptar las técnicas de intervención psicológica (exposición, desensibilización sistemática, reestructuración cognitiva, economía de fichas…) a los entornos de Psious.”
Evaluación de la Ansiedad Generalizada
Objetivos de evaluación
Evaluar presencia y comorbilidad de otros trastornos emocionales.
Evaluar ansiedad asociada a componentes: intensidad, frecuencia, características…
Evaluar la presencia de pensamientos distorsionados y creencias disfuncionales.
Algunos instrumentos útiles para la evaluación de la Ansiedad Generalizada
Teniendo en cuenta los objetivos de evaluación pasamos a enumerar algunas herramientas que pueden serte útiles para obtener información relevante sobre las características de tu usuario. Recuerda que una buena definición de objetivos, caracterización del paciente y planificación de la intervención son importantes para la eficiencia y eficacia terapéutica, así como para la satisfacción de tu usuario. En la bibliografía encontrarás los artículos en los que revisar las características de los instrumentos propuestos a continuación:
Entrevista estructurada: ADIS-IV
Test de aproximación/ evitación conductual (en vivo o mediante realidad virtual.
Evaluación de los pensamientos mientras se ejecutan los entornos virtuales.
AUTO-INFORMES
Escala del Trastorno de Ansiedad Generalizada – 7 (Generalized Anxiety Disorder-7 Scale; GAD-7; Spitzer et al., 2006).
Cuestionario de Preocupación y Ansiedad (Questionnaire sur le Inquiétude et l’Anxiété; Worry and Anxiety Questionnaire, WAQ; Dugas et al., 2001).
Inventario de Preocupación del Estado de Pensilvania (Penn State Worry Questionnaire, PSWQ; Meyer et al., 1990).
Inventario de Preocupación del Estado de Pensilvania para Niños (Penn State Worry Questionnaire for Children, PSWQ-C; Chorpita et al., 1997).
Cuestionario de Áreas de Preocupación (Worry Domains Questionnaire, WDQ; Tallis et al., 1994).
A continuación se describe una propuesta de protocolo de intervención que incluye las herramientas de Psious. Se recomienda combinar la Realidad Virtual con técnicas tradicionales.
The main objective in the treatment of generalized anxiety disorder (GAD) is to get the complete and prolonged remission of symptoms, as well as the restoration of the operational level of presymptomatic (Dilbaz, Cavus Y Darcin, 2011). However, not all patients respond well to the treatment of choice: Cognitive Behavioural Therapy, which can be combined with training on relaxation techniques and/or pharmacological treatment.
Research conducted about this topic shows that treatment with Virtual Reality (VR) is a good alternative for people with GAD (Gorini & Riva, 2008). Mainly because it eases the learning process as well as creates a relaxing mood. This is particularly complicated in people with chronically raised voltage as in the case of this disorder.
Moreover, Psious virtual environments specially designed for the treatment of GAD, are very useful as the healthcare professional can carry out exposure to the patient’s worrying in two different environments: a house and subway.
El objetivo principal del tratamiento para el Trastorno de Ansiedad Generalizada (TAG) es conseguir la remisión completa y prolongada de los síntomas, así como la restauración del nivel de funcionamiento presintomático (Dilbaz, Cavus Y Darcin, 2011). Sin embargo, no todos los pacientes responden al tratamiento que se emplea habitualmente: la terapia cognitivo-conductual. Usualmente, esta terapia se combina con entrenamiento en técnicas de relajación y/o tratamiento farmacológico.
El tratamiento aplicando la Realidad Virtual (RV) resulta ser una buena alternativa para los pacientes con TAG, sobre todo por lo que respecta a la relajación, ya que facilita el aprendizaje y el proceso de relajación, lo cual es particularmente complicado en personas con una tensión crónicamente elevada como en el caso de este trastorno.
Psious cuenta con dos entornos virtuales especialmente diseñados para el tratamiento del TAG: una casa y el metro. Usando estos entornos, se podrá llevar a cabo la terapia de exposición con el fin de conseguir una remisión en la sintomatología provocada por el TAG.
If there is nothing insisted upon, select a general topic for their presentation. Choose a topic that they have a good command of and that interests them.
Summarize the previous topic, focusing on some aspect of it. For this, bear in mind, on one hand, the interests, attitudes and knowledge of the audience and, on the other, the occasion (reason for the meeting in public, moment in which they will speak, available time).
Determine the objective that they want to achieve with their presentation (informing, persuading, making the audience think, calling to action, entertaining).
Make a short preliminary outline that includes basic ideas and points on the topic and that serves as a guide to searching for information on the topic.
Collect pertinent information. Possible material to be collected may include examples, explanations, demonstrations, analogies, numeric data, quotes, testimonies, graphics and visual aids.
Make an outline of the body of the presentation in which the ideas to be presented can be organised coherently. It should contain the simple numbering of the main ideas about which they want to speak (no more than 4-5) and, under each of these, the secondary ideas that are going to be developed. They can also include essential information (examples, statistics, quotes), the time assigned to each main idea and the moment in which they will use each audio-visual aid, if there are any.
If they want more information than that given by the outline, they can prepare some numbered notes written on only one side of paper in which they can briefly develop the ideas to present. However, if they use a lot of notes, these can be difficult to manage and they run the risk of looking more at the notes than the audience or ending up reading the presentation.
Anticipate possible questions, objections or interruptions and prepare appropriate responses.
If it is the case, prepare a limited number of audio-visual aids to support or clarify their presentation. These aids should be easily understood, clearly visible and/or audible and preferably graphic in nature. As technology can fail, be prepared to do the presentation without them.
Prepare the introduction and check that it is clearly connected to the body of the presentation. The introduction should follow: a) earning the attention of the audience and motivating them for the presentation; and b) informing them of the topic of the presentation, the main points that it will cover. The introduction should be short and not cover more than 5-10% of the available time.
Prepare the conclusion and check that it is clearly connected to the body of the presentation. A presentation can be concluded by: a) reaffirming its main points; b) making a short summary of the main ideas presented; and c), if it is the case, prompting to carry out a specific action. The conclusion should not take up more than 10% of the available time.
It is useful to make a short mental essay on the introduction, main points and conclusion. If they are a beginner, frightened or usually have problems managing time, it is advisable to do a real rehearsal alone or in front of some collaborators. Think that the real presentation usually lasts around 10-20% longer than the private rehearsal.
Self-Report Hierarchy Environments Psious Office
ITEM
LEVEL OF DISCOMFORT (0-100)
After exposing a project in a small work group, one of my colleagues makes a comment, asking me to give him an example of what I have just explained.
I am in the office alone, preparing the presentation that I am going to do in a few minutes.
I am in the office with a couple of colleagues. We have a meeting so I have to explain the progress I have made on the job during the week.
While I’m explaining a work project to a group of a few colleagues, a Skype call comes into one of the computers.
I am in a meeting in the office with a small group of colleagues, and when I explain how the project we are working on is progressing, it seems that they do not pay much attention to me, they are distracted.
I find myself in an office room doing a job interview, and when I’m done explaining a little why I’m interested in the offer, the interviewer makes a nice comment.
I am in a meeting with a colleague, and while I am speaking another colleague enters and interrupts the meeting.
While I’m explaining a work project to a group of few people, a mobile phone rings.
I meet a couple of colleagues in the office, and I have to explain the objectives of a project that we are going to have to develop. I see that they listen to me carefully and share my opinions.
I am in a meeting with a small group of colleagues, and after talking to them about a project, one of them makes an unpleasant comment about my presentation.
While I’m explaining a work project to a group of quite a few colleagues, a mobile phone rings.
I am in an office room about to do a job interview. As I tell him things, I see that the interviewer does not seem very interested in what I explain.
While I’m in the middle of a meeting with a coworker, a Skype call comes in on a computer.
I am in an office room because I have a job interview. When I explain my professional career to the interviewer, I see that he listens to me carefully and that he listens to what I present.
After explaining my career path in a job interview, the interviewer makes a critical comment about my exposure.
While I am explaining a work project to a large group of colleagues, someone enters interrupting the meeting.
When I’m doing a job interview, the interviewer’s mobile starts ringing.
When I am in a meeting with a co-worker, I realize that he is not very attentive to what I am explaining, but rather he is distracted.
I am in the office and we have a meeting with quite a few colleagues. When it is my turn to speak, I see that everyone is listening carefully.
While I’m explaining a work project to a few colleagues, a Skype call comes into one of the computers.
While I am in a meeting with quite a few colleagues, after making my explanation, I get a nice comment.
I find myself in a meeting with quite a few colleagues, and I have the feeling that when I’m speaking they don’t listen to me too much, they don’t show much interest.
While I am explaining a work project to a small group of people, someone enters interrupting the meeting.
I have a meeting with a co-worker, and after explaining my proposal, he tells me that we will discuss it again in another meeting.
Auto-Report Hierarchy Environments Psious Auditorio and Concert
ITEM
LEVEL OF DISCOMFORT (0-100)
I am giving a lecture in an auditorium with few people, and I see that look very attentive to what I’m explaining.
I am going to give a talk that will be broadcast on television and therefore there are a series of cameras in front of me. I am talking and I can see that there are many people and that everyone listens to me carefully.
I am sitting in the seats of the auditorium before the public that comes to see the conference I do today enter.
While I am giving my presentation in a room with a lot of people, I see how a person gets up and leaves the room.
I’m doing a presentation in a completely crowded auditorium, and I can see the lack of interest on the faces of the attendees.
I’m about to start a concert in a crowded auditorium, the lights are off, and even though I focus on the cameras that focus on me, I hear the audience applaud me.
I am giving a conference in an auditorium, the lights are off and the television cameras are focusing on me, and one of the attendees asks me a question that seems quite difficult to me.
I am on stage about to give a lecture, and the small audience present applauds me.
I am in front of an atrium as I am going to give a lecture; I can see that the room is quite full.
I am giving a conference in a room with few people, and while I am talking you can see how there are people in the audience who are talking to each other instead of listening to me.
I am giving a talk that will be broadcast on television, and although the light is off, I can see that there are quite a few attendees and that they do not listen to me too closely.
I am in front of an atrium, about to give a lecture, and I see that there are not many people.
I am on a stage rehearsing the presentation that I am going to do today, taking advantage of the fact that there is still nobody in the audience.
While I am giving a talk in a fully packed auditorium, a person in the audience asks me a question that seems quite difficult to me.
I’m in a fairly empty auditorium, with the lights off and cameras in focus, and I’m giving a talk. As I speak, I hear a yawn in the audience.
While I am giving a conference in a crowded room, I notice how the public does not have much interest in what I explain, and, at some point, I hear people laughing.
I am in front of an atrium, there are television cameras in front of me, and although the lights are off, I see that there are quite a few people when I am about to start my presentation.
I am in a fairly crowded auditorium, I go up on stage to start my lecture and the audience applauds me.
I’m in an auditorium room, giving a lecture in front of few people, and one of the listeners asks me a question that seems easy to answer.
From the auditorium stage, I can see that the room is fully booked when I go to start my lecture.
I find myself giving a conference in a room with few people, and when I speak I can see how they don’t pay too much attention to what I say.
In today’s conference there are a lot of people, but as I speak I can see how there are people who speak to each other instead of listening to me.
I am making a presentation in a totally full room, and I can see how everyone seems to be attentive to what I am explaining.
I am lecturing in a fully packed auditorium. Although the lights are off, I can see how the audience seems interested in what I’m explaining.
I am giving a presentation in a crowded room, and while I speak one of the attendees begins to cough.
I am in an auditorium room, giving a conference in front of few people, and one of the listeners asks me a question that seems difficult to answer.
I am in the center of the stage of the auditorium, I can see that the room is completely full, and just before starting, the audience applauds me.
When I am giving a presentation in a totally full room, one of the people in the audience gets up from his seat and leaves. I find myself giving a conference in a fairly full room, and I see that the whole audience seems interested in what I am telling them. .
While I am giving a talk in a fully packed auditorium, a person in the audience asks me a question that seems easy to answer.
As I give my presentation in a fairly crowded room, there are people in the room talking to each other.
I am giving a talk in a fairly crowded auditorium. Even though the lights are off, I can see that as I speak one of the attendees gets up from his seat and leaves the room.
As I speak in today’s presentation, I see that the room is quite full, but that the public is not very interested in what I explain.
While I’m giving a talk in a crowded auditorium, someone’s cell phone rings.
I find myself in an auditorium giving a presentation to quite a few people, and one of them asks me a difficult question to answer.
As I lecture in a fully packed auditorium, I can see how the audience doesn’t seem very interested in what I’m saying, and besides, I hear someone yawn.
When I am giving a talk in a crowded room, one of them gets up and leaves the room.
I am in a room with very few people giving a talk, and I can hear how a mobile phone starts to vibrate.
I find myself in an auditorium giving a presentation to quite a few people, and one of them asks me an easy question to answer.
While I’m giving a talk in a fairly crowded auditorium, I can hear someone yawning.
I am giving a conference in a room full of people, and while I am talking I hear a phone vibrating in the distance.
I am in an auditorium giving a lecture. The lights are off and there are cameras in focus, and at one point an assistant asks me a question that I find difficult to answer.
Self-Report Hierarchy Psious Settings Audience
ITEM
LEVEL OF DISCOMFORT (0-100)
I am giving a talk in a room that is practically empty. I can see how the attendees react, and it seems that they are not very interested in what I am explaining.
I am in the conference room, which is empty, preparing the talk that I am going to give in a few minutes.
I am giving a talk and there are many attendees, and I can see how they listen to me attentively.
I am in a conference room where there are quite a few people, and I hear laughter as I speak.
I am giving a talk in a room that is practically empty.
After making an intervention during the talk that I am giving today, the little attending public begins to applaud me.
I am giving a talk in a room that is practically empty. As I speak, I can see how the attendees react, and they seem to be listening carefully.
I am lecturing in a fairly crowded room. As I speak, the sound of a mobile phone is heard.
I am giving a conference in a room that is quite full.
I am giving a conference, and as I speak I notice how the public is not very interested in what I say. In addition, one of the assistants gets up and leaves the room.
I am in a fairly crowded room, and at the end of the conference that I have given the public begins to applaud me.
While I am giving a talk in a practically empty room, one of the assistants asks me a somewhat difficult question to answer.
While I am giving a talk in a crowded room, I can see how they are not interested in what I am hearing, and even a yawn is heard.
I am in a conference room where there are not many people, and although I cannot see who it is, I hear someone laugh while I am talking.
I am giving a talk and there are quite a few people in the room, and suddenly the vibration of a mobile phone is heard.
While I am giving a conference in a room with few assistants, one of them asks me a question, which seems easy to answer.
I find myself giving a lecture in a room full of everything. As I speak, I can see that attendees are listening intently.
I am giving a conference, and the room is quite full. At one point, one of the attendees asks me a question that I find difficult to answer.
Today I give an important conference, and the room is quite full. As I speak, I have the feeling that the public is not very interested in what I say.
While I am speaking at the conference that I give today, the few assistants that there are begin to speak among themselves.
While I am giving a conference in a room with many attendees, one of them asks me a question, which seems easy to answer.
I am in a fully-packed conference room, I am giving a talk, and at one point I hear a laugh from the audience.
I am giving a talk, and there are not many attendees in the room. Still, as I speak I hear a yawn.
I find myself giving a talk in a fairly crowded room. I can see how attendees react, and it seems that they are not too interested in what I am explaining.
The room where I am giving a conference today is completely full, and while I speak one of the assistants gets up and leaves the room.
While I am giving a talk in a fully packed room, one of the attendees asks me a somewhat difficult question to answer.
At the end of today’s presentation, all the audience in the room, which is full, begins to applaud me.
As I speak at the conference I am giving today, it seems that the attendees are paying attention, but then a yawn is heard.
I am giving a talk in a room that is totally full.
While I am giving a talk in a fairly crowded room, one of the attendees asks me a somewhat difficult question to answer.
I am speaking in front of a fully packed room, and as I speak I can hear how attendees are speaking to each other.
I’m doing a presentation in front of a room full of people, and then one of the attendees asks me a fairly simple question.
I find myself giving a talk, and as I speak I can see that the audience in the room (which is quite full), starts talking to each other.
[ DISCLAIMER: This document has been automatically translated using Google Translate. ]
