Tag: Diversity

Terrace of a bar

La Terraza is located on a boulevard of an international and tourist city where we find avatars strolling, various shops and a bar with a terrace where our patient and their accompanying avatar will be seated.

On the table the patient will find a newspaper where they can read a headline related to cannabis or rave. To the left of our patient there is a television on, where advertising related to parties will appear from time to time. In front of the patient’s point of view, there is another client (smoker avatar), also consuming tobacco depending on the selected configuration variable. Other avatars are in the walking area, highlighting among these a couple, a passerby and a character with an “appearance” of substance use / sale. Finally, the commercial premises around the bar and visible by the patient will be a souvenir and a store selling objects related to cannabis. These businesses will also display less or more paraphernalia related to substances depending on the selected configuration variable.

VARIABLES SETTINGS

The configuration variables will allow modifying the environment to suit each patient and each phase, be it the evaluation or the treatment phase. For this, you will have the same configuration variables available, explained below:

• Gender
  Choose between a male or female body. A neutral body is selected by default.

• Skin tone
  Choose the skin tone that best represents your patient to enhance the feeling of immersion.

• Companion

The accompanying variable will allow us to configure which character accompanies our patient and carries the substance incitement.

• Paraphernalia
  Little / Medium / A lot

The paraphernalia variable will make it possible to configure the presence of a smaller or greater number of stimuli related to alcohol, tobacco and cannabis. By selecting little, there will be few stimuli and they will be related to low alcohol and tobacco, being largely contextual cues for the consumption impulse (Traylor et al. 2011). Only in the high configuration will contextual and proximal signals appear (Traylor et al. 2011), for the craving of the three substances. The items of paraphernalia that appear at each level of the configuration variable are listed below in table form.

ENVIRONMENT	LITTLE	MEDIUM	A LOT
Our Table	Non-alcoholic beverages (Soft Drinks)	Water for patient, Beer for our companion	The drinks are beers.
Newspaper cover on the table	Cover: CANNABIS: Legalization or Persecution? and a photo with one finger up (Green) and one finger down (Red)	Cover: ¿CANNABIS: “The bill for legalization of cannabis passes the first camera” a photo of cannabis plantation.	Cover: Climate change, mid-story announcement about a macro Rave party
Character at the table in front (Smoker)	Smoking and packet of tobacco on the table	He smokes a cigar and has a shisha on the table	He smokes a cigar and has a shisha on the table
Television	Every X appears advertising about beach party	Every X appears advertising about Techno music	Every X appears advertising about a macro-party / Rave
Seed shop	The blind is down (Closed)	Same as above	Same as above but the blind goes up when the scene takes X time.
Souvenir shop	The souvenir has clothes with words about Turkey, Romania, Portugal, Spain…	To this is added clothes of Bob Marley and Homer Simpson smoking a joint	Same as the previous

• Sanitary mask
  You can choose whether or not the people around you will have a mask.

EVENTS

TYPE OF ADDICTION

This event configures the type of incitement to consumption that the accompanying avatar will make to the patient. This event is combined with the short or long prompt event. For example, to trigger a conversation that involves declining invitations to drink alcohol, the therapist will choose the Alcohol option.

1. Alcohol: If alcohol is chosen, the accompanying avatar will ask or propose to drink something to the patient …
2. Tobacco:  If tobacco is chosen, they will offer or ask for a cigarette…
3. Cannabis: If cannabis is chosen, the offer will revolve around this substance.

INCITEMENT

This event will initiate a conversation between the accompanying avatar and the patient. There will be two options: short and long, and they will be conditioned on the initial question that the accompanying avatar will launch, to the type of addiction event (alcohol / tobacco / cannabis).

1. SHORT

In short conversation, the therapeutic objective is to work on negative assertiveness, rejecting a proposal for consumption. When asked by the accompanying avatar, answers will appear corresponding to passive (one option), aggressive (one option) and assertive (two options) communicative style. In this way the event can be used to:

A.1. Assess (assess the patient’s communicative style)

A.2. Intervene (work with the patient to change to a more assertive style)

2. LONG

In the long conversation, the therapeutic objective is to work on negative assertiveness by rejecting a consumption proposal and being consistent with the rejection, despite the insistence of the accompanying avatar. Responses will appear corresponding to the communicative style passive (one option), aggressive (one option) and assertive (two options). In this way the environment will serve to:

B.1. Evaluate (determine the patient’s communicative style). This option is the same as in the short conversation event.

B.2. Intervene (work with the patient on negative and positive assertiveness). In the conversation the accompanying avatar will incite consumption. The patient can only reject consumption (passive, assertive or aggressive communicative style). The accompanying avatar will insist on the consumption before which the patient must reaffirm himself in the rejection on this occasion through negative assertiveness. The accompanying avatar will initiate the personal criticism of the patient which will allow working with a second reaffirmation of the rejection by the patient (assertive). Finally, a response of support / claudication will appear from the accompanying avatar, to which the patient can show gratitude (positive assertiveness). At that point the conversation will end. 

In order to stimulate conversations, so that they are not linear, they are not always repeated the same and the use of the selection of assertive options is reinforced, a system of positive reinforcement is established on the behavior of the patient when he chooses assertive responses: 

1. Patient: select passive option: 
   1. 70% of the occasions will appear AI insistence
   2. 20% of the occasions will appear critical AI
   3. 10% of the occasions will appear AI support

2. Patient: select aggressive option 
   1. 20% of the occasions will appear AI insistence
   2. 70% of the times Sometimes critical AI will appear
   3. 10% of the times support AI will appear

3. Patient: select assertive option: 
   1. 40% of the times will appear AI insistence
   2. 30% of the times will appear critical AI
   3. 30% of the times will appear AI support

EMOTIONAL CRAVING TYPE

The emotional craving event consists of 6 variables, each of them related to one of the basic emotions (fear-anxiety, disgust-boredom , anger, joy, sadness and surprise). 

Once the event is selected, the patient will receive a text message from Alex, on his mobile which is located on the table. The text, which can be read in a sandwich, will send you information with the selected emotional charge. In addition to reading the message, the accompanying avatar will make comments aloud to promote emotional activation.

• ANXIETY
  A calendar notification appears on my mobile to go to the movies (it comes out as a pop-up and warns that there are 20 minutes left)… 10 seconds later a message from a friend (Alex) comes in saying that he will be late, please let’s hope.
  
  The accompanying avatar, to whom the message has also reached, tells me worried: We don’t make it to the cinema, we will miss the beginning of the film, what happened to him? Will it be OK?

• ANGER
  The person we are meeting with sends a last minute message and tells us that he will not come: Enter a text message from my friend (Alex) to my mobile phone and to that of my companion avatar. “Hey, I’m not coming in the end. See you!. 
  
  My accompanying avatar says angrily @: “I can’t believe it, it’s always the same. Has he planted us again? And do you still want to stay? That’s good for you! “

• BOREDOM
  A calendar notification appears on my mobile to go to the movies (it comes out as a pop-up and advises that there are 60 minutes left) and it is still too early.
  
  Our accompanying avatar tells us bored @ about ten seconds after the mobile reminder: “Wow, there’s still an hour left, what do we do?”

• JOY
  The person I have met, my friend (Alex) tells us, via text message to his mobile phone, that he is arriving and that he really wants to see us. 
  
  My accompanying avatar says very content @: “How nice, have you seen? It’s coming: We’re going to have a great time!

• SURPRISE
  A text message arrives to the patient and to the accompanying avatar of a friend (Alex): “Party at home tonight! 
  
  Will you sign up?” The accompanying avatar says surprised: “Great, later we went to the parties at Alex’s house”

• SADNESS
  The text message is about the misfortune of a close person, Alex: A text message arrives to the patient and the accompanying avatar of a friend: “Confirmed, Alex’s cancer is incurable”
  
  (Alex): “Confirmed…, I have been confirmed to have terminal cancer. I can not believe it. What a disgusting life! ”. The accompanying avatar is visibly affected, he leaves the mobile on the table and looks at me very sad and with tears in his eyes. Very sad, she sobs: “what a disaster!”

     Note: Once the events are finished, you will return to the starting scene.

EMOTIONAL CRAVING

Play the emotional craving based on the selection of the previous event.

Public bathroom

This scene can be very useful for interventions for Obsessive-Compulsive Disorders, more specifically contamination-hygiene type in public toilets. This virtual environment wants the subject to confront his/her appellant thoughts and at the same time be capable of accustoming the anxiety that they produce in him/her and of extinguishing the ritualized neutralizing behaviors and thoughts.

The scene begins at the door of a public toilet. The patient will enter the toilet, and he/she will be able to confront anxiogenic situations inside the toilet cubicle. Finally the avatar will be placed opposite the sink, where he/she will be able to confront obsessions and prevent the use of compulsions and/or neutralizing thoughts. 

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.

• Difficulty
  Easy / Difficult
  Control if the avatar touches certain elements like the faucet, the soap or the hand dryer, or they’re just simply next to him/her. 

• Dirty
  Clean / Dirty

• Toilet type
  Female / Male
  Choose the gender of the people in the environment.

• Sanitary mask
  You can choose whether or not the people around you will have a mask.

ACTION EVENTS

• Open entrance door
  The door opens and the avatar is situated in the toilet.

• Open WC cubicle door
  The door opens and the avatar enters in the toilet cubicle.

• Touch the wall (standing inside the cubicle)
  The avatar touches the wall with his/her left hand.

• Lower the toilet lid
  The avatar lowers the lid to sit on the toilet.

• Flush the toilet
  The avatar touches the button to flush the toilet. 

• Touch the wall (sitting on the toilet)
  The avatar touches the wall while sitting on the toilet.  

• Grab paper
  Grabs paper and throws it in the trash.

• Touch the toilet brush
  The avatar touches the brush on his/her left.

• Wash hands
  Depending on the difficulty settings that you’ve chosen, the avatar will wash its hands touching (difficult) or not (easy) the elements (soap, faucet, etc.).

POSITION EVENTS

• From the outside until sitting on the toilet
  The avatar stands outside the toilet, opens the door, appears in front of the toilet cubicle, opens the door, enters the toilet cubicle, lowers the toilet lid to sit on it and finally sits on the toilet.

• From sitting until washing hands
  The avatar appears sitting on the toilet, grabs paper, stands in front of the toilet, flushes the toilet and washes his/ her hands.

• Complete sequence
  The avatar is placed outside the toilet, opens the door, appears in front of the toilet cubicle, lowers the toilet lid to sit on it, sits on it, grabs paper, stands in front of the toilet, flushes the toilet, stands in front of the sink and washes his/her hands.

POSITION OF THE AVATAR

• Outside bathroom
• Inside bathroom
• Standing inside the toilet cubicle
• Sitting on the toilet
• In front of the sink

University

In this case, when the scene begins the patient appears in the hallway of a university. The students that appear speaking will be between 18 and 30 years. This will allow you to intervene with exam anxiety with young people and adults who present this same problem. When entering the classroom the patient will be able to see a projector in the background and the organization of the desks will be the one that you can see in universities.

Since this environment is intended for adults, it can also be used to work in other, non-strictly university situations, such as, for example, entrance and public exams.

SCENES

SETTINGS VARIABLES

AVATAR

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.

ATTENDANCE

Alone / A few students / A lot of students
Depending on the option we select, the type and the amount of ambient sound will change. 

With this configuration variable, you can regulate the levels of anxiety and distractors. In general, more people and more noise, lead to more difficulty.

Difficulty

Easy 

• Easier questions
• Relaxed students
• Calm and friendly teacher

Hard

• Difficult questions
• Anxious students
• Serious and controlling teacher

The easy configuration can be used in the early stages of the intervention, where you are seeking anxiety reduction in an environment that does not generate excessively high levels of anxiety.

Exam subject

Psychology
“Psychoeducation about test anxiety and social anxiety”

Natural Sciences and Biology
“Autoimmunity and Immunopathology”

History and Law
“The Spanish Constitution”

Each one of these exams will consist of 10 questions, most of them true / false type.

Duration

Short / Long
This last variable is related to the duration of the test. If we choose “short” the test will last only five minutes, while if we choose “long”, the test will be about twenty minutes.

EVENTS

• Teacher appears
  At the beginning of the session, the environment is the hallway of the high school/university, and an intelligible murmur is heard among the students who are waiting. When the event is activated, the teacher appears at one end of the hallway. As he approaches, he greets the patient with a gesture and invites the students to come into the classroom. Right after that, he proceeds to enter into the classroom and at the same time the murmur decreases until it reaches a normal level.  

• Enter classroom
  Once this event is triggered, a fade to black will occur and the patient will appear seated at the classroom table, ready to perform the exam.

Once in the classroom, the teacher will be waiting for the test to begin. The students will be reviewing or waiting for the test to begin, so the general murmur will be low and unintelligible. 

• Start exam
  When this event is activated, the test will be performed. The general murmur that could be heard is almost completely eliminated, and in the tablet placed on the desk in front of the patient will appear the first question of the test. This question will have two possible interactive answers, so to answer the question the patient should use visual control in the same way that he/she used it when entering the test classroom.

After the patient has selected one of the two available answers, the next question will appear, and the patient should follow the same interactive procedure to answer. When choosing one of the options, the third question will appear, and so on up to completing the ten questions.

In addition to the questions of the test and the corresponding answers, on the tablet will appear, at all times, the remaining time to finish the test. The time in question will depend on the configuration of the difficulty variable.

Throughout the development of the test, in case of having selected that there are people present, some students will finish their test announcing it aloud to the teacher (they will not move from their place). Depending on the difficulty level selected, there will be more or fewer students completing the test.

Once the test time expires, it will automatically be passed to the test completion event, described below. 

• Finish exam
  By activating this event, the teacher will finish the test with a fade to black. The teacher will reappear in the hallway with the tablet visible, being able to see the test result on the screen. At this point, the general murmur among the students in the hallway will again be intelligible.

School

At the beginning of this scene, the patient is in the hall of a high school, so the people that appear are teenagers (between 14 and 17 years). Therefore, this environment will be suitable for adolescents of this age who are anxious about performing a test. When entering the classroom, the patient will sit at one of the multiple tables and will be ready to begin the test.

SCENES

SETTINGS VARIABLES

AVATAR

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.

Attendance

Alone / A few students / A lot of students
Depending on the option we select, the type and the amount of ambient sound will change. 

With this configuration variable, you can regulate the levels of anxiety and distractors. In general, more people and more noise, lead to more difficulty.

Difficulty

Easy 

• Easier questions
• Relaxed students
• Calm and friendly teacher

Hard

• Difficult questions
• Anxious students
• Serious and controlling teacher

The easy configuration can be used in the early stages of the intervention, where you are seeking anxiety reduction in an environment that does not generate excessively high levels of anxiety.

Exam subject

Psychology
“Psychoeducation about test anxiety and social anxiety”

Natural Sciences and Biology
“The cell”

History and Law
“The recent Spain”

Each one of these exams will consist of 10 questions, most of them true / false type.

Duration

Short / Long
This last variable is related to the duration of the test. If we choose “short” the test will last only five minutes, while if we choose “long”, the test will be about twenty minutes.

EVENTS

• Teacher appears
  At the beginning of the session, the environment is the hallway of the high school/university, and an intelligible murmur is heard among the students who are waiting. When the event is activated, the teacher appears at one end of the hallway. As he approaches, he greets the patient with a gesture and invites the students to come into the classroom. Right after that, he proceeds to enter into the classroom and at the same time the murmur decreases until it reaches a normal level.  

• Enter classroom
  Once this event is triggered, a fade to black will occur and the patient will appear seated at the classroom table, ready to perform the exam.

Once in the classroom, the teacher will be waiting for the test to begin. The students will be reviewing or waiting for the test to begin, so the general murmur will be low and unintelligible. 

• Start exam
  When this event is activated, the test will be performed. The general murmur that could be heard is almost completely eliminated, and in the tablet placed on the desk in front of the patient will appear the first question of the test. This question will have two possible interactive answers, so to answer the question the patient should use visual control in the same way that he/she used it when entering the test classroom.

After the patient has selected one of the two available answers, the next question will appear, and the patient should follow the same interactive procedure to answer. When choosing one of the options, the third question will appear, and so on up to completing the ten questions.

In addition to the questions of the test and the corresponding answers, on the tablet will appear, at all times, the remaining time to finish the test. The time in question will depend on the configuration of the difficulty variable.

Throughout the development of the test, in case of having selected that there are people present, some students will finish their test announcing it aloud to the teacher (they will not move from their place). Depending on the difficulty level selected, there will be more or fewer students completing the test.

Once the test time expires, it will automatically be passed to the test completion event, described below. 

• Finish exam
  By activating this event, the teacher will finish the test with a fade to black. The teacher will reappear in the hallway with the tablet visible, being able to see the test result on the screen. At this point, the general murmur among the students in the hallway will again be intelligible.

Family health

They are giving the weather broadcast on the television. The weatherman is talking about the heavy rains that are taking place, and talks about the dangers; he also explains recommendations and safety precautions to keep in mind due to the storm (as for example, to not take the car if it can be avoided). At the end, he speaks of a car crash that has taken place and about its victims.
The situation allows to work with the patient for example, on the excessive fear that something bad will happen to a loved one

These scenes have no configuration variables. In addition, each scene, as in the other environments, has the possibility of practicing relaxation exercises in the section Relax.

VARIABLES SETTINGS

The configuration variables will allow modifying the environment to suit each patient and each phase, be it the evaluation or the treatment phase. For this, you will have the same configuration variables available, explained below:

• Gender
  Choose between a male or female body. A neutral body is selected by default.

• Skin tone
  Choose the skin tone that best represents your patient to enhance the feeling of immersion.

Babies’ health

The is a televised debate about babies care. Topics like what to eat and how, aspects of sleep and illness (with data of hospitalized children for example) are discussed.
While the patient is watching the debate program, child’s sobs are heard through the intercom which is on the coffee table (from issuing normal sounds until it begins to mourn with increasing intensity).
It is specially indicated for patients whose main worrying is that something bad may occur to their children.

These scenes have no configuration variables. In addition, each scene, as in the other environments, has the possibility of practicing relaxation exercises in the section Relax.

VARIABLES SETTINGS

The configuration variables will allow modifying the environment to suit each patient and each phase, be it the evaluation or the treatment phase. For this, you will have the same configuration variables available, explained below:

• Gender
  Choose between a male or female body. A neutral body is selected by default.

• Skin tone
  Choose the skin tone that best represents your patient to enhance the feeling of immersion.

Thinking about getting sick

In this case, it is also watching an informative discussion, but this time is about disease risk. At the beginning they will talk about heart attacks (high blood pressure, habits, stress, genetic factors, age, symptoms…). And later they will discuss cancer. Note that, from the beginning, the patient will have medical results, on the coffee table, plus a bottle of pills.
This scene is specially indicated to work on the overestimation of probability of a negative event may occur. And also to treat excessive worrying for health matters.

These scenes have no configuration variables. In addition, each scene, as in the other environments, has the possibility of practicing relaxation exercises in the section Relax.

SETTINGS VARIABLES

The configuration variables will allow modifying the environment to suit each patient and each phase, be it the evaluation or the treatment phase. For this, you will have the same configuration variables available, explained below:

• Gender
  Choose between a male or female body. A neutral body is selected by default.

• Skin tone
  Choose the skin tone that best represents your patient to enhance the feeling of immersion.

Children’s health

This scene is designed to work on the anxiety that gives some people the fact of leaving their children’s care to others. It is playing a debate program about supervision and children’s care. They talk about issues such as leaving them with a babysitter or relatives, several accidents, school trips, etc. Note that in the patient’s visual field there are elements such as a ball, which makes assume he or she has a son or a daughter. Whilst the patient is listening to the debate, a message from the school on the voicemail is received requesting an urgent callback.

These scenes have no configuration variables. In addition, each scene, as in the other environments, has the possibility of practicing relaxation exercises in the section Relax.

VARIABLES SETTINGS

The configuration variables will allow modifying the environment to suit each patient and each phase, be it the evaluation or the treatment phase. For this, you will have the same configuration variables available, explained below:

• Gender
  Choose between a male or female body. A neutral body is selected by default.

• Skin tone
  Choose the skin tone that best represents your patient to enhance the feeling of immersion.

Auditorium

The same as in the audience, when launching this environment, the patient finds themselves seated, and until the “go to stage” event is activated the patient will remain in this position. Even so, differently to the audience, this time the patient is sitting on seats looking at the stage, where they can see a lobby. Once on the stage they are placed in front of this lobby, and as in the previous environment, the patient can make a short personal presentation and, afterwards, make a report on a previously prepared topic.

SETTINGS VARIABLES

• Amount of People
  • None 
  • Low (room practically empty)
  • Medium (room almost full of people)
  • Full (room completely full) 

• 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.

• Difficulty
  • Easy (audience that listens attentively and with approval)
  • Hard (audience that is more distracted or disinterested)

EVENTS

• Go to the stage
  The patient goes onto the stage and is placed behind a table to start the presentation.

• Positive question
  One listener from the public asks a question that is easy for the patient to answer. The healthcare professional can choose between a series of questions of this type, for example, if they can explain part of the presentation again.

• Negative question
  In this case, one person from the audience asks a question that is more complicated to answer, something that could make the patient become nervous. The healthcare professional can choose from a series of questions of this type, for example, if they think that their proposal will work, or if they can highlight the weak points of their presentation.

• Therapist positive feedback
  When the healthcare professional selects this event, one of the audience starts to speak although nothing is heard. Therefore, this button allows the healthcare professional to make a positive remark to the patient about their involvement but by introducing themselves into the virtual environment, so that the patient finds they are even more immersed in that environment.

• Therapist negative feedback
  This event develops in exactly the same way as the previous setting, but it is reserved for the healthcare professional to make a more critical or negative remark about the patient’s involvement.

• Applause
  The audience applauds the speaker.

• Spectator leaves room
  One person gets up and leaves the room.

• Distraction
  Choice of a series of distractions: yawning, mobile phone, telephone vibration, laughter, coughing.

APPENDIX

List of positive questions

1. It’s evident that you are passionate about what you’ve explained. Where did the interest come from?
2. I’ve attended similar conferences before on the same topic but I’ve never been as enthusiastic about it as today. Do you recommend any author or some reading related to what you told us today?
3. What’s been the biggest obstacles you’ve had to overcome when preparing the subject?
4. You’ve approached the matter in a very innovative way. You’ve also explained it very clearly and concisely, is this your first time giving this conference?
5. Thank you very much for your presentation, it was fascinating. I would like to ask you though, what would you highlight from everything that you just explained?
6. Are you satisfied with the results of your presentation? Could you talk a bit more on the argument that you’ve exposed?
7. Do you think you could come back another day to repeat the presentation in front of a larger audience?
8. Could you give an example by placing it in a different context?
9. Excuse me, I didn’t understand your last point, could you explain it again?
10. These results are promising, what impact do you think it may have in the future?
11. Will you make another presentation during these upcoming weeks? I’d like to attend.
12. What do you think is the scope or limit of what you have just described?

List of negative questions

1. Could you highlight the strengths and weaknesses of your proposal?
2. What resources are available for you to implement your plan?
3. I don’t quite understand the last thing you explain. Could you give another example?
4. What difficulties do you think may arise in the future?
5. It started off so well, but the delivery of the findings isn’t as clear. Could you please summarize them again, briefly?
6. Do you think the results that you’ve shown are realistic?
7. Do you think that your proposal will work? The current situation doesn’t seem to be the most suitable.
8. Can you prove what you just said? In my opinion, your argument shows some weaknesses.
9. “You have made some very interesting proposals, although some of them are a little bit too daring. Have you thought about how you’ll proceed?”
10. Are you sure that this information comes from reliable sources?
11. Don’t you think that your point of view has certain limitations? How did you choose your presentation’s approach?
12. Some of your conclusions seem outdated. Are you aware of the latest trends on this matter?