Psious Professionals

Evaluation

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

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

PTSD Evaluation

In this section we propose different strategies and tools on how to evaluate PTSD, as a previous step to using the EMDR technique. 

OBJECTIVES

• Evaluating the presence and comorbidity with other emotional disorders.
• Evaluating the presence of re-experimentation, avoidance and activation increase.
• Defining anxiogenic stimuli configurations and in what grade. 
• Evaluating presence of distorted thoughts.

Useful tools for the Posttraumatic stress disorder (PTSD) evaluation. 

Considering the evaluation objectives, we will enumerate some of the tools that can be useful to obtain relevant information about the characteristics of your user. Remember that good objectives definitions, patient characterization and planification of the intervention are important for therapeutic efficiency and  effectiveness just like the user satisfaction. In the bibliography you will find articles where you can revise the characteristics of the proposed tools. 

OPEN OR SEMI-STRUCTURED INTERVIEW 

1. Structured interview ADIS-IV
2. CAPS-DX interview
3. Scale (TOP-8)
4. “Índice Global de Duke DGRP”

SELF-REPORTS

1. The Impact of Event Scale – Revised (IES-R) 
2. MMPI PTSD Subscale
3. PTSD Symptom Scale (PSS)
4. Child PTSD Symptom Scale (CPSS)
5. Traumatic Events Questionnaire (TEQ)
6. Davidson Trauma Scale (DTS).
7. Mississippi Scale for Combat-Related
8. The critical war zone experiences (CWE) scale

Stress & trauma,
and virtual reality

Trauma and Stress-related disorders include disorders in which exposure to a traumatic or stressful event is listed explicitly as a diagnostic criterion. These include reactive attachment disorder, disinhibited social engagement disorder, posttraumatic stress disor­der (PTSD), acute stress disorder, and adjustment disorders (APA, 1994). 

Posttraumatic stress disorder (PTSD) is a psychiatric disorder that can occur in people who have experienced or witnessed a traumatic event such as a natural disaster, a serious accident, a terrorist act, war/combat, rape or other violent personal assault. People with PTSD have intense, disturbing thoughts and feelings related to their experience that last long after the traumatic event has ended. They may relive the event through flashbacks or nightmares; they may feel sadness, fear or anger; and they may feel detached or estranged from other people. People with PTSD may avoid situations or people that remind them of the traumatic event, and they may have strong negative reactions to something as ordinary as a loud noise or an accidental touch. A diagnosis of PTSD requires exposure to an upsetting traumatic event. However, exposure could be indirect rather than first hand. For example, PTSD could occur in an individual learning about the violent death of a close family. It can also occur as a result of repeated exposure to horrible details of trauma such as police officers exposed to details of child abuse cases (adapted from: https://www.psychiatry.org/patients-families/ptsd/what-is-ptsd). 

A World Health Organization study found a lifetime prevalence of PTSD in upper-middle income and lower-middle income countries of 2.3 and 2.1 percent respectively (Koenen KC et al., 2017 ). 

Virtual Reality (VR) was proposed over two decades ago (Rothbaum et al., 1995) as a potentially useful tool to assist in the activation of the fear structure given its ability to present customizable visual, auditory, tactile, or olfactory stimuli. VR-based improvements to emotional engagement could overcome barriers in activation of the fear structure, such as avoidance (Foa, Huppert, & Cahill, 2006) and improved clinical outcomes. Studies of VR exposure (VRE) therapy for PTSD have repeatedly demonstrated reductions in PTSD symptoms following treatment (Difede et al., 2007, 2014; Reger et al., 2011; Rizzo, Difede, Rothbaum, & Reger, 2010; Rothbaum, Hodges, Ready, Graap, & Alarcon, 2001; Rothbaum et al., 2014).

This manual describes different Psious tools designed  to help healthcare professionals on assessment and treatment in general and work related-stress and post-traumatic stress disorder. 

Appendix

Conversations: Patient response options and companion avatar dialogs.

https://docs.google.com/spreadsheets/d/1WuBHNleWMoBvJfSnH-WlrqRogyA-U8O07cSD7fPq6B0/edit#gid=0

Dialog reference:

https://docs.google.com/spreadsheets/d/1WuBHNleWqMoBvJf0SDU8O07cSD7fPq6B2 # gid = 0 Please

Note the following for dialogue references:

• The color red represents the accompanying phrases.
• The blue color represents the phrases that the user can say.

Communication styles to decline consumption: Options that the patient can choose from

https://docs.google.com/spreadsheets/d/1WuBHNleWMoBvJfSnH-WlrqRogyA-U8O07cSD7fPq6B0/edit#gid=1565071000

[ DISCLAIMER: This document has been automatically translated using Google Translate. ]

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Recommendations for use

It is always interesting and positive to try to complement the Virtual Reality experience with comments, questions or indications to make it easier for the patient to get into the situation and feel a greater immersion in the environment. 

Some examples could be: “Imagine that these are your friends, with whom you usually consume or have used in the past”… “How do you feel when you see them?” “What do you think they think of you?” “Which one do you feel most uncomfortable with and why?” “Which one generates more impulse of consumption?” “Which one do you trust or give you more security?” “Do they make you nervous?” etc.

At the same time, it is highly recommended to try to keep the patient in the same body position as the protagonist of the scene (in this case, sitting at the classroom desk).

In the same way, it can be useful to add any element of the scene or the context where the events take place. In this case, preparing some air freshener, incense…, with a smell similar to the substance (tobacco, cannabis, beer…), having a bottle and / or a can that the patient can touch…, can help make the immersion more effective and provide the patient with the sensations and emotions of the environment. In these environments, the use of tactile, olfactory and gustatory stimulation complementary to virtual reality will be of special importance.

It is also recommended that during the conversations between patient and avatars within the virtual environment, the patient says aloud the answer he is selecting to communicate with the avatar with whom he is interacting.

Finally, remember that in Psious you have a wide variety of environments with which you can complement the work in relation to substance-related disorder. We present some examples below:

[ DISCLAIMER: This document has been automatically translated using Google Translate. ]