Psious Professionals

Appendix

Economy Contingency table

PSYCHOBOT TOKENS

Self-report Hierarchy home (children)
Darkness Psious 

ITEM	LEVEL OF DISCOMFORT (0-100)
You are in the living room at home and, with the help of Psychobot , you can explore the different areas. You teleport to the dining room where there is less light and your mission is to find where the tallest vase is and which is closest to the ceiling. What level of difficulty do you think that mission has?
After you have teleported into the hallway, you see that it is quite dark. Your mission is to stay in this area for at least a minute… How difficult do you think this activity is?
With Psychobot you have moved super fast to the hallway bathroom, great! Now your mission is to explore this area that has very little light. Do you find it easier or more difficult than the others?
You are in the hall. You see the entrance to the bathroom, with the bathtub and the shower curtain half open. Although there was little light when you teleported, there is now a little more. How long can you stay here for a mission?
When you are in the room, which is very dark, you ask the Psychobot for help and he tells you that you are doing very well. How do you have your energy level?
After teleporting with your Psychobot friend, you have reached the hallway. Since there is enough light now, you can see the attic door and everything in the hallway. Do you find it a very complicated mission?
You are in the living room of your house with all the lights on, it is night and the moon shines a lot. Suddenly, a Psychobot appears, and explains that you have a super power to teleport, and that you are going to have to explore all the areas of your house to get points. Are you afraid of this new adventure?
When you and the Psychobot have already arrived in the room, you lie down on the bed and you only see the moon through the window because it is very dark. Do you think this mission is very difficult?
You and Psychobot have teleported super fast from the bathroom hallway to the living room, and there is a little light there. Your mission now is to explore the room as long as you want, do you find it easy or difficult?
You have a super important mission: teleport to the loft hallway, which has just a little bit of light, and be there for two minutes. Do you dare with this super mission?
You are with a Psychobot in the dining room of your house where there is a lot of light, and suddenly you teleport super fast to the room, which is very dark. What difficulty would you put on this mission?
Now your mission is to teleport from the room, which is very dark, to the living room, which is very bright, and your mission is to explore the area, does this seem easy to you?
Now you are going to be a super explorer! With the help of Psychobot, go to the dark room, and try to discover everything in it. Then, if you are very adventurous, lie down for a minute in bed. What do you want to accomplish this mission?
You’ve reached the bathroom hallway in no time thanks to your superpower! There you can see the bathroom door and what is inside, because now it seems that there is enough light. What you have to do is explore the area. Do you find it an easy mission or more difficult than others?
With your superpower you have teleported from the living room to the dining room in just a second, great! Now you have to use another super power, be very brave and explore the area as long as you can, even if it is a bit darker. Do you dare or do you think it is very difficult?
You just got to the hallway that leads to the loft, and you see it’s very dark. Can you explore the area to see what you find in it?
Now your mission is to teleport from the hallway that leads to the loft to the one that leads to the bathroom. On your way you can see how, although there is not much light, it seems that there is a little more each time. Do you think this is very difficult?
You are in the dark room, and suddenly you and the Psychobot teleport to thein a second dining room. How does it make you feel to go from a place without light to another that has much more?

Self-report Hierarchy home (Kids)
Darkness and Storms Psious 

ITEM	LEVEL OF DISCOMFORT (0-100)
After reaching the dark room, you lie down on the bed. Nothing is heard, everything is calm because the weather is good. How long could you stay here?
You are in the living room at home and your mission, with the help of Psychobot, is to explore the different areas. You teleport to the dining room where there is less light and you can see lots of lightning and hear thunder. Your mission is to find where the tallest vase is and which is closest to the ceiling. What level of difficulty do you think that mission has?
After teleporting into the loft hallway, which is quite dark, you have a very important mission. You have to be very brave and look for where the window is, look through it and see the great storm that is tonight. Don’t be scared by lightning and thunder, think you have the help of Psychobot!
You are in the living room with your friend Psychobot, and the lights are all on. Through the window you only see that it is night, and you don’t hear any noise from outside either. Does it seem like an easier or more difficult mission than the previous ones?
When you are in the dark room, where you can hear it raining a lot, you ask Psychobot for help and he tells you that you are doing very well. How do you feel to hear this?
You are in the hallway of the bathroom, which is not very very dark. Now you are going to have to look out the window to see what the weather is like; after doing it, you see that the night is dark but it doesn’t rain, you only see the very big and bright moon in front of you, are you very afraid?
You have teleported very quickly to the dining room, and you see that the light there is not very strong. After exploring the area, your mission this time is to look out the window and see how it rains. What degree of difficulty do you think this mission has?
You are in the living room of your house with all the lights on, it is night and the moon shines a lot. Suddenly, a Psychobot appears, and explains that you have a super power to teleport, and that you are going to have to explore all the areas of your house to get points. What would you say your energy level is?
When you and the Psychobot have already arrived in the dark room, you lie on the bed and see many rays through the window. Do you think this mission is very difficult?
Now your mission is to teleport from the room, which is very dark, to the living room, which has a lot of light, and your mission is to look at the weather through the window. What do you want to do on this mission?
You and Psychobot have teleported super fast from the bathroom hallway to the living room, and there is a little light there but you hear a lot of thunder. Your mission now is to explore the room as long as you want. How difficult do you think this activity is?
After you have teleported into the hallway, you see that it is dark and that it is raining heavily. Your mission is to stay in this area for a minute, do you dare to do this activity?
You are in the dining room and it is dark, but you have to be brave and look out the window. Your mission is to approach this window and look and listen to the lightning and thunder that there is tonight. What degree of difficulty would you put on it?
You have reached the room in just a moment, great! Still, as soon as you get there you can see out the window that there is a big storm tonight, is this scary?
After you’ve teleported into the attic hallway, your mission is to find where the window is. After you have explored the entire hallway and found it, you have to look through it and see that it is raining. Are you afraid of this new adventure?
With Psychobot cobot you have moved super fast to the bathroom hallway, great! Now, your mission is to explore this area that has very little light, and you will have to dare to look out the window and see how it rains. Do you think this mission is easier or more difficult than the others?
You are lying on the bed in the room, which is very dark. Psychobot is with you, and when you look out the window you can see that it is raining. How calm would you say you feel?
With your superpower you have teleported from the living room to the dining room in just a second, great! Now you have to use another super power, be very brave and explore the area as long as you can, even if it is a bit darker and you are hearing how it rains. Do you dare to explore the area?
You have reached the loft hallway super fast, and you see that it is quite dark. Still, you are very brave and you explore the area, and through the window you can see that it is not bad weather and that the moon shines a lot. How difficult do you think this mission is?
You just got to the room, and you can only see the moon shine through the window because it’s so dark. Are you afraid or are you calm?

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

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Bibliography

• Antony, M.M., Craske, M.G. y Barlow, D.H. (2006). Mastering your fears and phobias: Client workbook (2a ed.). Londres Oxford University Press.

• Arrindell, W. A. Dimensional structure and psychopathology correlates of the fear survey schedule (FSS-III) in a phobic population: A factorial definition of agoraphobia, Behaviour Research and Therapy, Volume 18, Issue 4, 1980, Pages 229-242, ISSN 0005-7967 

• Brown, T. A., DiNardo, P. A., & Barlow, D. H. (1994). Anxiety disorders interview schedule for DSM-IV (ADIS-IV), adult version. Albany (NY): Graywind Publications Inc.http://www.libreriaolejnik.com/ventana. php?codig=31669

• Carrobles, J.A. (1986). Cuestionario de Temores de Wope y Lang, FSS-III-122. En J.A.I. Carrobles, P. Bartolomé, P.T. Costa y T del Ser. La práctica de la terapia de conducta: Valencia: Promolibro. 

• Craske, M.G., Antony, M.M. y Barlow, D.H. (2006). Mastering your fears and phobias: Therapist guide (2a ed.). Londres: Oxford University Press.

• Gutiérrez, C. et al.(2012): Características psicométricas del inventario de Miedos de Ollendick. CUaDERNos HisPaNoaMERiCaNos DE PsiCología, Vol 12 No 1, 85-93  

• Mikulas, W. L. y Coffman, M. G. (1989). Home-based treatment of children’s fear of the dark. En C.E. Schaefer y J.M. Briesmeister (Eds.), Handbook of parent training (pp. 179-202). Nueva York: John Wiley and Sons. 

• Matesanz, L. (2006): Datos para la adaptación castellana de la Escala de Temores (FSS). Análisis y Modificación de Conducta. Vol. 32, Nº 144. 

• Méndez, X. , Orgilés, A. y Espada, J.P. (2003). Escenificaciones emotivas para la fobia a la oscuridad: un ensayo controlado. International Journal of Clinical and Health Psychology. ISSN 1697-2600 2004, Vol. 4, No 3, pp. 505-520 

• Méndez, X., Orgilés, A. y Rosa, A. I. (2005). Los tratamientos psicológicos en la fobia a la oscuridad: Una revisión cuantitativa. Anales de psicología. Vol. 21, no 1 (junio), 73-82 

• Muris, P., Merckelbach, H., Ollendick, T. H., King, N. J., & Bogie, N. (2001). Children’s nighttime fears: Parent-child ratings of frequency, content, origins, coping behaviors and severity. Behaviour Research and Therapy, 39(1), 13-28. doi: 10.1016/S0005-7967(99)00155-2

• Lazarus, A. y Abramovitz, A. (1979). The use of “emotive imagery” in the treatment of children’s phobias. En H.J. Eysenck (Ed.), Experimentos en terapia de conducta: experimentación con niños (vol. 3) (pp. 37-45). Madrid: Fundamentos

• Olivares, J., Y Méndez, F.X. (2001).Técnicas de modificación de conducta. Madrid: Biblioteca Nueva.

• Ollendick, T. H. (1979). Fear reduction techniques with children. En M. Hersen, R. M. Eisler y P. M. Miller (Eds.), Progress in behavior modification: Vol. 8 (pp. 127-168). Nueva York: Academic Press. 

• Ollendick, T. H. (1983). Reliability and validity of the revised fear survey schedule for children (FSSC-R), Behaviour Research and Therapy, VolumeZ21, Issue 6, 1983, Pages 685-692, ISSN 0005-7967.

• Orgilés, A., Méndez, X. , y Espada, J.P. (2005)Tratamiento de la fobia a la oscuridad mediante entrenamiento a padres. Psicothema. Psicothema 2005. Vol. 17, no 1, pp. 9-14 

• Sardinero, E., Pedreira J.L. y Muñiz J.: El cuestionario CBCL de Achenbach: Adaptación española y aplicaciones clínico-epidemiológicas: http://www.copmadrid.org/webcopm/publicaciones/clinica/1997/Vol8/Arti3. Htm

• Silverman, W.K, M, Albano, A.M y Sandín, B (2003): ADIS-IV: Entrevista para el diagnóstico de los trastornos de ansiedad en niños según el DSM IV : entrevista para el niño = (anxiety disorders interview schedule for DSM-IV: child version : child interview schedule). Ed. Klinik, 2003. España

Intervention proposal

“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.”

An example of the Fear intervention to darkness in children 

Example protocol designed to be applied on a biweekly or weekly basis, made up of 8 to 12 sessions, lasting 30-45 minutes. A follow-up in 3 to 6 months is recommended. 

SESSION 1

• On introducing the virtual reality, show a neutral environment such as an island or underwater in the sea.

• The objective in the opening session is to create a game where the child feels relaxed and is willing to participate. Explain to the child that he is going to meet Psicobot, the teleportation who he/she can use for help when needed, be shown the rooms in the house which they can visit, and gain tokens for exploring the house, which the child can exchange for prizes at the end of the session (in the case of using token economy)…

• When using the token economy, clarify the operating rules before starting the virtual session. Get the child to interact with the environment and collect tokens easily and exchange the tokens for prizes (in the case of using token economy) at the end of the session.  

ITEM	ENVIRONMENT	CONFIGURATION	EVENT
Virtual Reality Presentation	Underwater in the sea	Fish: maximum
Training Zone	Fear of darkness and storms	Cotherapist: Activated Points: easy. Climate: Clear spells	Introduction Teleportation (on child’s request)  Help (on child’s request)
In the living room	Fear of darkness and storms	Cotherapist: Activated Points: easy. Climate: Clear spells	Introduction Teleportation (on child’s request) Help (on child’s request)
In the hall-attic zone	Fear of darkness and storms	Cotherapist: Activated Points: easy. Climate: Clear spells	Teleportation (on child’s request) Help (on child’s request)
In the bedroom	Fear of darkness and storms	Cotherapist: Activated Points: easy. Climate: Clear spells	Introduction Teleportation (on child’s request)  Help (on child’s request)
Lying down on bed	Fear of darkness and storms	Cotherapist: Activated Points: easy. Climate: Clear spells	Introduction Teleportation (on child’s request)  Help (on child’s request) Lying down on bed (on child’s request)
In the Living room area and dimming the light	Fear of darkness and storms	Cotherapist: Activated Points: easy. Climate: Clear spells	Introduction Teleportation (on child’s request) Help (on child’s request)  Ambient light)

SESSION 2

• Review achievements from the last session and the objectives set in the session: Continue exploring the house to gain tokens and carry out missions with levels of less lighting. 

• To favor confrontation and, in particular in the case of implementing emotive performances techniques, games (counterconditioning) could be introduced in the individual spaces. For example, count the number of vases there there are in the living room (5), the number of pictures on the wall in the training zone and in the living room (7)…count the windows in the house, find the contingency/tokens table (bedroom wall) where you can take note of the tokens obtained. 

• If you use gradual exposure, playing games or distracting is not recommended, use the tokens as a confrontational reinforcement and repetition as a strategy in promoting the bedroom and end to the conditioned galvanic response sensor. As and from the second session in treatment, introducing the systematic and gradual exposure to the distinct spaces in the house is recommendable. In function with the minor’s progress, reduce the light intensity progressively. 

• Use cognitive reconstruction, if necessary. 

• Remember you have been given TOKENS, set up a token economy, if need be, so that confrontational behavior can be positively reinforced. In the beginning, exchanging tokens for prizes is recommendable at the end of the session.

HOMEWORK

Programme activities to be carried out with the parents and the minor between sessions. These activities should be similar to the ones carried out by the healthcare professional via VR. For example, when it’s night-time, using enough lighting, go through the individual rooms in the house, and play teleportation, looking for a specific toy that has been previously hidden by the parents.

If you are using the token economy, using tokens at home is also recommendable: for finding toys and exploring the rooms. Teach the parents never to force the child to do something he/she does not want to do. Whether scenes such as those which are used in gradual exposure are applied, it would also be a good idea for the parents to be present for the sessions so they can see how the coping develops during the VR sessions.  

ITEM	ENVIRONMENT	CONFIGURATION	EVENT
Training zone	Fear of darkness and storms	Cotherapist: Activated Points: easy. Climate: Mild	Introduction Teleportation (on child’s request) Help (on child’s request)
In the hall-attic area	Fear of darkness and storms	Cotherapist: Activated Points: easy. Climate: Mild	Teleportation (on child’s request) Help (on child’s request)  Ambient light 75%
In the bedroom	Fear of darkness and storms	Cotherapist: Activated Points: easy. Climate: Mild	Teleportation (on child’s request) Help (on child’s request) Ambient light 75%
Lying down on the bed	Fear of darkness and storms	Cotherapist: Activated Points: easy. Climate: Mild	Teleportation (on child’s request) Help (on child’s request) Lying down on bed (on child’s request) Ambient light 75%

SESSION 3 TO SESSION N

• Review achievements from the last session, go over the activities done at home and objectives set in the last session: Continue exploring the house to gain tokens and carry out missions.

• Emotive performance techniques/Gradual and systematic exposure to the distinct spaces in the house. In function with the minor’s progress, gradual light intensity reduction. REMEMBER BY SETTING THE TOKENS CONFIGURATION SETTINGS (Easy, Medium, Difficult) YOU WILL IN TURN INCREASE THE TIME SPENT IN GAINING TOKENS. 

• Cognitive reconstruction, if necessary.

• To favor confrontation and, in particular in the case of implementing emotive performances techniques, games (counterconditioning) could be introduced in the individual spaces. Be creative by offering a variety of games, get the child to make suggestions…

• If you use gradual exposure playing games or distracting the child will not be necessary, use the tokens system as a confrontational reinforcement and repetition as a strategy in promoting the bedroom and end the conditioned response. 

• If you have used a token economy, within the last 2-3 sessions schedule a fading to the token economy: the exchanging of tokens for prizes becomes further apart and reinforcement becomes more social, from the environment itself (child’s autonomy) and self-administered.

HOMEWORK 
When based on the emotive performance technique, continue with the kitchen, which will not be accessible, will also be visible from the zones described above, starting at the training zone. 

FINAL SESSION

Review achievements and objectives set from the previous session. Lie down on bed with the light turned off (to proceed use rain and even storms if needed).

• Systematic and Gradual exposure/Emotive performances techniques to distinct spaces in the house. ”Tokens” configuration settings in difficult mode and lights offs. Cognitive reconstruction, and proceed.

• If you have used environment tokens to carry out a token economy, make sure it has been completely withdrawn: behaviors are maintained from natural and social effort and not from exchanging tokens.

• Arrange a follow-up within 3, 6 months.

ITEM	ENVIRONMENT	CONFIGURATION	EVENT
Training zone	Fear of darkness and storms	Cotherapist: Activated Points: Difficult. Climate: Storms	Introduction Teleportation (on child’s request) Help (on child’s request)
Living room	Fear of darkness and storms	Cotherapist: Activated Points: Difficult. Climate: Storms	Teleportation (on child’s request) Help (on child’s request) Ambient Light 25-0%
In the hall-bathroom zone	Fear of darkness and storms	Cotherapist: Activated Points: Difficult. Climate: Storms	Introduction  Teleportation (on child’s request) Help (on child’s request)
In the hall-attic zone	Fear of darkness and storms	Cotherapist: Activated Points: Difficult. Climate: Storms	Teleportation (on child’s request) Help (on child’s request) Ambient Light 25-0%
In the bedroom	Fear of darkness and storms	Cotherapist: Activated Points: Difficult. Climate: Storms	Teleportation (on child’s request)  Help (on child’s request) Ambient Light 25-0%
Lying down on the bed	Fear of darkness and storms	Cotherapist: Activated Points: Difficult. Climate: Storms	Teleportation (on child’s request) Help (on child’s request) Lying down on bed (on child’s request) Ambient Light 25-0%

PLEASE REFER TO OUR CLINICAL GUIDE ON OBSERVATIONAL EVIDENCE THERAPEUTIC PROCEDURES AND HOW TO ADAPT THE INTERVENTION TO VIRTUAL REALITY ENVIRONMENTS WITH PSIOUS

An example of Fear Intervention to storms in adults  

Example protocol designed to be applied on a biweekly or weekly basis, made up of 6 to 8 sessions, lasting 30- 45 minutes. A follow-up in 3 to 6 months is recommended.

SESSION 1

• Inform the patient about fear of storms (Causes, symptoms, prevalence…)

• Present and show sufficient grounds for the techniques that are used overtime in the treatment: virtual reality exposure and exposure in vivo…

• Exposure hierarchy development and hierarchy item exposure development from 20-30 USA’s.

• Start exposure hierarchy with an item close to USA’s 30. The main objective is to familiarize the patient with the virtual reality and the working dynamics. 

ITEM	ENVIRONMENT	CONFIGURATION	EVENT
Training zone. In the dining room	Fear of darkness and storms	Cotherapist: deactivated Points: easy. Climate: Clear spells	Teleportation (on adult’s request)
In the living room without light turned on	Fear of darkness and storms	Cotherapist: deactivated Points: easy. Climate: Clear spells	Teleportation (on adult’s
Hall-attic without light turned on	Fear of darkness and storms	Cotherapist: deactivated Points: easy. Climate: Clear spells	Teleportation (on adult’s
In the bedroom at night without light turned on	Fear of darkness and storms	Cotherapist: deactivated Points: easy. Climate: Clear spells	Teleportation (on adult’s request)
Lying down on the bed at night	Fear of darkness and storms	Cotherapist: deactivated Points: easy. Climate: Clear spells	Lying down on bed (on adult’s request)

SESSION 2

• Review achievements and objectives set from the previous session: reduce light in the environments and increase rain intensity.

• From the second treatment session, it is recommended to start systematic and gradual exposure in light of virtual reality environments. Cognitive reconstruction, if applicable. 

• Show clinical progress to the patient, using the reports provided in the platform. Reveal clinical progress to the patient, using the reports provided in the platform.

HOMEWORK
Covert and/or assisted exposure by computer to the sound of rain (light-moderate) with heavy overcast imaging. Foster in vivo exposure.

ITEM	ENVIRONMENT	CONFIGURATION	EVENT
In the living room with dim light and raining.	Fear of darkness and storms	Cotherapist: deactivated Points: easy. Climate: rain	Teleportation (on adult’s request) Ambient light 50% Rain intensity 30%
Hall-attic zone with dim light and raining	Fear of darkness and storms	Cotherapist: deactivated Points: easy. Climate: rain	Teleportation (on adult’s request) Ambient light 50% Rain intensity 30%
Bedroom with dim light and raining	Fear of darkness and storms	Cotherapist: deactivated Points: easy. Climate: rain	Teleportation (on adult’s request) Ambient light 50% Rain intensity 30%
Lying down on bed with dim light and raining	Fear of darkness and storms	Cotherapist: deactivated Points: easy. Climate: rain	Lying down on bed (on adult’s request) Ambient light 50% Rain intensity 30%
In the living room with dim light and raining	Fear of darkness and storms	Cotherapist: deactivated Points: easy. Climate: rain	Teleportation (on adult’s request) Ambient light 50% Rain intensity 50%
Hall-attic zone with dim light and raining	Fear of darkness and storms	Cotherapist: deactivated Points: easy. Climate: rain	Teleportation (on adult’s request) Ambient light 50% Rain intensity 50%
Bedroom with dim light and raining	Fear of darkness and storms	Cotherapist: deactivated Points: easy. Climate: rain	Teleportation (on adult’s request) Ambient light 50% Rain intensity 50%
Lying down on bed with dim light and raining	Fear of darkness and storms	Cotherapist: deactivated Points: easy. Climate: rain	Lying down on bed (on adult’s request) Ambient light 50% Rain intensity 50%

SESSION 3

• Review achievements and objectives set from the previous session: reduce light in the environments and increase rain/storm intensity.

• Systematic and gradual exposure in light of virtual reality environments. Cognitive reconstruction, if applicable.

• Show clinical progress to the patient, using the reports provided in the platform.

HOMEWORK
Covert and/or computer-assisted exposure to the sound of rain (light-moderate) with heavy overcast imaging. 

ITEM	ENVIRONMENT	CONFIGURATION	EVENT
Training zone with dim light and moderate rain	Fear of darkness and storms	Cotherapist: deactivated Points: easy. Climate: Storms	Teleportation (on adult’s request) Ambient light 50% Rain intensity 30%
Hall-bathroom zone with dim light and moderate rain	Fear of darkness and storms	Cotherapist: deactivated Points: easy. Climate: Storms	Teleportation (on adult’s request) Ambient light 50% Rain intensity 30%
Bedroom with dim light and moderate rain	Fear of darkness and storms	Cotherapist: deactivated Points: easy. Climate: Storms	Teleportation (on adult’s request) Ambient light 50% Rain intensity 30%
Lying down on bed with dim light and heavy rain	Fear of darkness and storms	Cotherapist: deactivated Points: easy. Climate: Storms	Lying down on bed (on adult’s request) Ambient light 50% Rain intensity 30%
In the living room with dim light and heavy rain	Fear of darkness and storms	Cotherapist: deactivated Points: easy. Climate: Storms	Teleportation (on adult’s request) Ambient light 50% Rain intensity 70%
Hall-attic with dim light and heavy rain	Fear of darkness and storms	Cotherapist: deactivated Points: easy. Climate: Storms	Teleportation (on adult’s request) Ambient light 50% Rain intensity 30%
Bedroom with dim light and heavy rain	Fear of darkness and storms	Cotherapist: deactivated Points: easy. Climate: Storms	Teleportation (on adult’s request) Ambient light 50% Rain intensity 70%
Lying down in bed with dim light and heavy rain	Fear of darkness and storms	Cotherapist: deactivated Points: easy. Climate: Storms	Lying down on bed (on adult’s request) Ambient light 50% Rain intensity 70%

SESSION 4

• Review achievements and objectives set from the previous session: reduce light in the environments and increase rain/storm intensity (intense). 

• Systematic and gradual exposure in light of virtual reality environments. Cognitive reconstruction, and proceed.

• Repeat each exercise twice.

• Reveal clinical progress to the patient, using the reports provided in the platform.

HOMEWORK
Covert and/or assisted exposure by computer to the sound of rain (light-moderate) with heavy overcast imaging. Foster in vivo exposure.

ITEM	ENVIRONMENT	CONFIGURATION	EVENT
Training zone with light rain and storms	Fear of darkness and storms	Cotherapist: deactivated Points: easy. Climate: Storms	Teleportation (on adult’s request) Ambient light 50% Rain intensity 80%
Living room with dim light and scant storms	Fear of darkness and storms	Cotherapist: deactivated Points: easy. Climate: Storms	Teleportation (on adult’s request) Ambient light 25% Rain intensity 80%
Hall-attic zone with dim light and scant storms	Fear of darkness and storms	Cotherapist: deactivated Points: easy. Climate: Storms	Teleportation (on adult’s request) Ambient light 25% Rain intensity 80%
Bedroom with dim light and scant storms	Fear of darkness and storms	Cotherapist: deactivated Points: easy. Climate: Storms	Teleportation (on adult’s request)  Ambient light 25% Rain intensity 80%
Lying down on the bed with dim light and scant storms	Fear of darkness and storms	Cotherapist: deactivated Points: easy. Climate: Storms	Lying down on bed Ambient light 50% Rain intensity 80%

SESSION 5

• Review achievements and objectives set from the previous session: reduce light in the environments and increase rain/storm intensity (very intense).  

• Systematic and gradual exposure in light of virtual reality environments. Cognitive reconstruction, and proceed.

• Repeat each exercise twice.

• Reveal clinical progress to the patient, using the reports provided in the platform.

HOMEWORK
Covert and / or computer-assisted exposure to the sound of light-moderate rain) and images of very cloudy skies. Promote live exhibition.

ITEM	ENVIRONMENT	CONFIGURATION	EVENT
Training zone with dim light and very intense storms	Fear of darkness and storms	Cotherapist: deactivated Points: easy. Climate: Storms	Teleportation (on adult’s request) Ambient light 25-0% Rain intensity 90%-100
Living room with dim light and very intense storms	Fear of darkness and storms	Cotherapist: deactivated Points: easy. Climate: Storms	Teleportation (on adult’s request) Ambient light 25-0% Rain intensity 90%
Hall-attic with dim light and very intense storms	Fear of darkness and storms	Cotherapist: deactivated Points: easy. Climate: Storms	TTeleportation (on adult’s request)  Ambient light 25-0% Rain intensity 90%-100
Hall-bathroom with dim light and very intense storms	Fear of darkness and storms	Cotherapist: deactivated Points: easy. Climate: Storms	Teleportation (on adult’s request) Ambient light 25-0% Rain intensity 90%-100
Bedroom with dim light and very intense storms	Fear of darkness and storms	Cotherapist: deactivated Points: easy. Climate: Storms	Teleportation (on adult’s request) Ambient light 25-0% Rain intensity 90%-100
Lying down on bed with dim light and very intense rain	Fear of darkness and storms	Cotherapist: deactivated Points: easy. Climate: Storms	Lying down on bed Ambient light 25-0% Rain intensity 90%-100

SESSIONS 6 & 7

• Review achievements from previous session and set objectives for current session: generalization and overlearning.

• Systematic and gradual exposure in light of virtual reality environments. Cognitive reconstruction, and proceed. 

• Repeat each exercise twice, in function with levels of discomfort.

• Reveal clinical progress to the patient, using the reports provided in the platform.

• Foster in vivo exposure and set follow-up at 3-6 months. 

ITEM	ENVIRONMENT	CONFIGURATION	EVENT
At home watching television and it’s raining. One family member is not at home	Generalized Anxiety	Concerns about family	Reproduce
At home, just on way to do some errands. TV weather forecast warns of storms	Fear of flying	At home: daytime, rain	Forecast
Driving in the city at night in a storm.	Fear of driving	City: night, rain, maximum, driving, minimum	Circuit 1
Driving on the road at night in a storm	Fear of driving	Road, night, rain, driver, show, hide.	Highway, Medium speed,Bends
Taking a taxi by day in a storm	Fear of flying	On the way to the airport: day, rain.	Weather forecast on radio
At the airport, going to travel in bad weather	Fear of flying	Boarding area:day, rain, maximum	Window, Boarding call
Traveling on a plane in bad weather	Fear of flying	Plane:maximum day, rain, window,middle,off
Traveling on a plane in bad weather	Fear of flying	Plane:maximum, storm,- day window, behind,off	Taxi, Landing
Traveling on a plane in bad weather	Fear of flying	Plane: maximum, storm,day window, behind,off	Flight, Take-off, Light,Turbulences

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.”

Fear of darkness and storms evaluation

Evaluation Objectives

• Evaluate the presence and comorbidity of other emotional disorders, in particular anxiety from separation, night terrors, sleep alterations, other phobias…

Evaluate anxiety associated with dimensions

• DARKNESS
  • Personal safety (eg. rapture, robbers)
  • Loss or separation (eg. in children, for example with their parents)
  • Nightmares
  • Imaginary creatures 
  • Darkness 

• STORMS
  • Personal safety/damage
  • Intense sounds

• Set the feared stimulative settings for the patient and define to what extent. Exposure hierarchy development, assess if there is only fear of darkness or storms or both collectively.
  
• Measure the presence of distorted thoughts: monsters, robbers, lightning coming through the windows… In the case of MRI, especially those associated with suffocation, possible damage caused by the machine and fear of losing control.

Some useful instruments for fear of darkness and/or storms evaluation (children and adults) 

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:

Child evaluation

• OPEN INTERVIEWS
  • Structured interview: ADIS-IV:C (Children)
  • Interview with one or both parents: education background, coping with fear…
  • Natural observation procedures for parents (similar to Orgilés proposal, Méndez y Espada, 2005): Register of Behavior to Darkness and Register at Bedtime. 
  • Artificial observation procedures for parents (based on Orgilés, Méndez y Espada, 2005): behavioral approach test to darkness and darkness tolerance test.
  • Fear level thermometer for children applicable to the observation procedures.
  • Bedtime register (BD)
• SELF-REPORTING
  • General diagnosis examination questionnaire for parents: e.g CBCL.
  • General questionnaire of fears for children: e.g FSSC-R
  • Fear of Darkness assessment scale (EMO)
• ELECTROMYOGRAPHY BIOFEEDBACK
  Set the baseline in a neutral environment. 

Evaluation in Adults

• STRUCTURED INTERVIEW: ADIS-IV
• BEHAVIORAL APPROACH TEST/BEHAVIOR AVOIDANCE
  (in vivo or with Virtual Reality)
• SELF-REPORTING
  • Fear Survey Schedule FSS-III (Fear Survey Schedule) 
• ELECTROMYOGRAPHY BIOFEEDBACK
  Set the baseline in a neutral environment. 

Exposure Hierarchy development with
Psious Environments

Once we have received the evaluation information we can then proceed to develop the hierarchy exposure. To do this, in addition to using the data obtained during the initial evaluation, we can carry out a series of questions, (e.g What level of discomfort is generated, on a scale of 0 to 100, when left alone without any light in the living room? What level of discomfort is generated, on a scale of 0 to 100, when left alone without any light in this bedroom? Can you think of anything else that would generate even more discomfort?…) all geared at the planning of the intervention via Virtual Reality.