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Generalized Anxiety Disorder – Appendix

Appendix

Scenes audio

PERSONAJEWorrying about infantsWorrying about childrenWorrying about family membersWorrying about health
Character 1 (PJ1)PresenterPresenterPresenterPresenter
Character 2 (PJ2) TertullianTertullianTertullian
Character 3 (PJ3)TertullianTertullianTertullian
Worrying about infants

PJ1: Let’s start the debate on caring for babies. We’ll start by trying what a baby can and can’t eat, if that’s okay with you.

PJ2: I was looking forward to this topic, since it is something that parents worry about and sometimes they do not know if they do the right thing or not regarding the care of their children, it could be worrying in some cases due to the Intake of inappropriate food at that stage, what do you think? 

PJ3: I think the same, during this stage, you have to take into account the things that you can eat and those that cannot, look at the portions and times of the day, and well then… and things like clothing, to avoid us Put 30 washing machines if I spit something out lol.

PJ2: man, you don’t need to be so alarmed either! It doesn’t matter to put extra washing machines, it’s normal when you have babies. 

Pj3: Ya… ya… well, but the milk stains keep bothering… and they smell really bad! 

PJ1: Okay, enough, let’s start the debate in a serious and correct way, let’s not focus on the spots… Haha. So what do you think they can and can’t eat?

PJ2: I understand that the typical, breast milk or bottle, some soup… baby food… some vegetables would also be fine, right?

PJ3: Man, if you are a newborn, only milk and to be able to be maternal, and in the event that you cannot give breast milk for any reason, you should use a bottle.

PJ1: Besides, it is not advisable to give them anything other than milk since they are very small.

PJ2: Ah well, I thought we were talking about older babies…

PJ1: Nono, in this case we focus on “small” babies, to put it in some way, almost newborns… And in the case of the bottle, especially so that our Spectators do not panic, make sure that the baby suckles properly, and that no air enters the bottle itself.

PJ3: Yes, for the latter, you have to see that the baby is well inclined and that’s it.

PJ2: And the final burp? Do you have to do it yes or no? I always hope that it does Haha.

PJ3: God… Haha I wish they didn’t, but well at least that way you make sure everything is fine.

PJ1: It is not obligatory, do not confuse the spectators Haha, but hey, they feel better after having blown the air.

PJ3: Well, typical, right? You put it on the shoulder and ale!

PJ2: Neither ¨and ale… ¨ is to pat him gently and wait for him to release it. (pause).

PJ1: We have just received a report to Production on the number of babies who need to be hospitalized for causes such as a common cold and the truth that so far this year, the number is alarming, 764 babies have been hospitalized.

PJ2: My goodness, to think that something as common as a cold can seriously affect a baby… is that of course being so small… They have low defenses and are vulnerable to any virus, however dangerous it is for us. .

PJ3: Pff, a friend of mine, had her baby hospitalized for 3 days just because of this… her fever started to rise dramatically, and you know, a baby’s health is very fragile.

PJ1: It is better to be attentive to any symptoms that our baby may show, even if it is almost negligible, it is better to be attentive at the moment, and if necessary, go to the hospital immediately.

PJ3: Also think that a cold, in a baby, although for us it is almost harmless, for them they can be a trigger for more serious diseases, and as you have said, we must be vigilant for any symptoms and treat them immediately . Well… And the fact that after 3 months they need a routine now? They already want to put them to work, eh. Haha. 

PJ2: Poor things, imagine, no man, it refers to a series of habits, schedules that they already do with us, work… that they go to sleep at certain times and also wake up at certain times… come on, establish a schedule. it goes that… 

PJ3: It was a joke! Haha.

PJ1: Our viewers will be happy… Aha. Well, look, a relative of mine who has a baby says that good grows and grows and grows and increases weight a lot, even bending it.

PJ2: That is rather normal, the truth is that babies are expected to gain weight continuously.

PJ3: What was it?, tripling the weight in the first five months?

PJ2: No no!, they doubled in the first five months.

PJ1: And in the quadruple year?

PJ2: Nooo… One year it has to triple, oh, and another thing, we don’t need to weigh the baby every day, it doesn’t make any difference, every 5 days it would be more recommended.

PJ3: Well, but sometimes it does not excite, nose, see if a gram or something has risen, just like looking at how much they measure Haha, it’s fun! Haha.

PJ1: But… I don’t understand, why isn’t it good to weigh it every day?

PJ2: Let’s see… it is not that it is not good or bad to weigh him, it is clear that it will not affect what he weighs, but simply, you subject the baby to a situation that can cause slight stress without any type of base, what can make us excited?, it is clear that yes, but well

PJ1: I’ll tell my family then, and how they should grow eh…

PJ3: And how do they sleep! Dear me, who could sleep so many hours! what a life huh!

PJ2: Well, do you know how many hours of sleep are necessary?

PJ1: Totally, more than 14 or 15 hours! 

PJ2: Well yes, and especially during the first year, they are essential since for 50% of the time you are asleep, your brain remains active!

PJ3: Sounds familiar to me, I read this the other day, the baby secretes growth hormone!

PJ2: Exactly, therefore it helps you grow.

PJ1: And well, they only have two phases of sleep, and we 4!

PJ2: Haha Now!, and many parents are scared because the baby kicks or grimaces or similar things, and no!, we all do that, what happens is that the baby can enter this phase of sleep directly!

PJ3: Sure, and we have to overcome 3 to enter this, how curious how we work huh…

PJ1: another interesting point is that there is no need to be alarmed if the baby only sleeps during the day.

PJ3: Will you have jet lag, right? Haha

PJ2: More or less, you could say yes.

PJ1: Haha yes, it is like us when we return from a trip that we need a few days to adapt to our schedules, because they the same, little by little they will get used to the day and night cycle, they will identify it, and without realizing it they will adopt hours of night like hours of sleep and hours of being awake, like daytime.

PJ2: It is normal, it takes a while to adapt, no baby is the same as another, just like us, it just takes time to adapt, that’s all!  

PJ3: I keep saying that I wish I slept the same hours as them… Let’s see if I grow more like this! Haha

PJ1: Well, let’s end this debate today! I hope our viewers have been entertained and have been able to learn more about caring for babies, it seems that they will never cease to amaze us!

PJ2: Thanks for joining us!

PJ1: Thanks!

PJ3: Thanks and see you soon!

(End of scene)

Worrying about children

PJ1: Today, we are going to discuss a somewhat controversial debate, how our children go to school, learn, study, or when we leave them in care, whether from family, friends or known.

PJ2: Let’s start with the family members, it is clear that within the range of people we have at our disposal and who are available to take care of our children, they would be our parents and in the event that they cannot, a babysitter… someone they know.

PJ3: For me, in the case of leaving them with someone when they are not at school, the ideal would be to leave them with the grandparents, right?

PJ2: I totally agree, although… sometimes a babysitter comes out more, that there are very misguided grandparents!

PJ1: good, but you also have to take into account that you don’t know a babysitter, or well, if it is familiar, yes.

Yaya, but hey, we always hear stories of a child who has come home from being with a babysitter with a bump, or who had not taken the cold pills, and even in some cases, that the same babysitter decides to leave. from home just when the parents leave and return home just when they return…

PJ3: It would not be the first case, of course, but hey, you also have to trust a little. My daughter came back with a bump the other day!, and note that she was with her grandparents, but anyway… they are things that happen, everyone can be confused for a moment.

PJ1: It seems that children at this age are rubber, notice that if some of us feel like they would break something, instead they hit each other and continue. Haha. Well, we are also going to count some positive points, that we do not want the audience to drop! Haha

PJ2: You are right Haha, positive points, knowing that they are well, it is not necessary to make a call to know how they are and even talk to them, although they also have to learn to be without us. We can also make sure that if they have a task, they do it with the babysitter or the family member, which also helps the discipline and order of the child. Don’t you think?

PJ3: Well, but you can also play, right? They also have to have fun because they are something for children.

PJ2: Of course, that is not disputed by anyone, it is simply that well, grandparents or babysitter can also help educate in a certain way.PJ1: Totally agree, but let’s not forget that we shouldn’t do as some parents do and say, either! to! responsibility for grandparents. We must never forget that the responsibility is ours, and that we commit ourselves to take care of them and educate them from the first moment.

PJ2: Very well said, that there is everyone out there… the education of children is very important… That is why you have to take into account who you leave them with… and more knowing that of home accidents that may occur.

PJ3: Relax! If, as we have said before, children at this age are rubber, the worst thing that could happen is that they break an arm or a leg at most, that can happen to anyone and it has a very easy solution, at hospital in a moment, and like new in a few weeks! Besides then I would get many signatures on the plaster huh! Haha

PJ1: Well, well, we are not going to laugh at the serious things that could happen to a child… What about school?

PJ2: This is a very wide field in which you could see from the education they receive to how they behave so much in class with teachers, with classmates, on field trips…

PJ3: Now that you mention this about field trips, a niece of mine, he went the other day on an excursion with his school and they went to see some ruins and he really enjoyed it. When he returned he wanted to know more about the history of that place.

PJ1: Well, you know that… I’ll tell you about it, I once escaped from the group on an excursion and went to explore on my own, the truth was that at times I was a little worried, but that feeling of freedom… well… time.

PJ2: But then did you meet the group again?

PJ1: Yes, well, I found them… It turns out that they had been looking for a long time and the teachers were worried, luckily that my mother did not find out anything, but… scared poor poor haha.

PJ3: Who was going to say it, you did a little indiana jones from what I see…

PJ1: Going back to the previous topic again, are babysitters safe?

PJ2: I would say that yes, sometimes I have hired one and everything has been impeccable, although well, it is better to keep an eye also, conducting a previous interview is key to know more or less how the person with whom we are going to leave our kids.

PJ3: I share your opinion, although I continue to recommend that children can be left with someone in the family better than with someone outside. Because of the simple fact of the family bond, the attention that can be paid, the things that can be talked about… etc. Although I also have to admit that sometimes, it is almost better to leave children with a babysitter than with what type of family member. Haha. 

PJ1: You are not right!

PJ2: You are right with this about the relatives, although… imagine doing interviews with your relatives too Haha, that would be funny.

PJ1: Well, we have run out of time, we have finished the debate, thank you very much to our viewers and our collaborators!

PJ2: Thanks!

PJ3: Thanks everyone!

(End of scene)

Worrying about family members

PJ1: Welcome to the weather news, where we will inform you about the weather forecast, how it will evolve, how the traffic is at the moment and some tips to avoid dangers both in the road like home.

We started, as you can see today, the rain predominates and with force, registering rain records per square meter in some points. It has been a long time since you saw a quantity of water as it is, some will think that due to the drought that we were suffering, some fields are doing well with this rain, but quite the opposite, since so much water at once, can be harmful .

We have just received a report from our satellite in which it is expected that the rain will increase during the day today and will also spread in the coming days. Due to the problems that this time can pose, we are going to give some tips that may be useful to you.

It is advisable not to take the car today, since the visibility conditions are minimal due to heavy rain, especially if you are in the city, remember to keep the safety distance. 

For easier identification and for other vehicles to see us, it is necessary to activate both front and rear fog lamps, only if necessary, although it should also be noted that it would be better not to have to reach that point, and that if at any In this case, it would be advisable to stop the vehicle in a safe place, and wait for the storm to stop or its intensity to drop a little. 

Above all, take care not to park where it can cause a traffic jam and where a large amount of water can pass, pay special attention to the latter since if you are in one of these points where there may be a large influx of water, if in any case If the storm were to spout, the current could grow from one moment to the next, dragging the vehicle. If they can use public transportation, this way, the flow on the highway will be more continuous and there won’t be so many traffic jams or problems. 

We have just been informed that in the city center there have been several accidents due to the rain and the malfunctioning of some traffic lights because of it, there are no confirmed fatalities at the moment, but we are aware that there are at least 7 people who are being rushed to the hospital urgently.

The accident happened just a few minutes ago, when a bus and two passenger cars collided at an intersection. This has made the situation in the city a bit chaotic especially at this point. Fire services are already working to expedite the collection of materials released during the collision, and the police are guiding traffic in the best possible way. 

The latter inform us that the situation is a bit complicated due to the number of people who are on the road and the storm that is currently falling. It doesn’t seem like a good day to get around. 

As we have informed you before, it is better that you do not take the car today, and if you do not have more options, please wait for the rain to decrease a little intensity and not so much traffic. Also keep in mind that it is safer to go on main and illuminated roads and the city itself, than to use secondary roads, the latter are much less safe than the former due to poor visibility and lack of lighting at some points. 

We must also inform you of several more precautions that you should take into account: First of all, do not use the phone at all if you are driving, it is very dangerous and can be easily distracted and cause an accident and more with the weather conditions of a day like today. 

Avoid isolated trees, especially if no building is taller than this, as it can be dangerous. Also avoid the ordered alignments of these, since if by any chance, a tree fell, the domino effect could occur. 

They also avoid leaning on cars due to their metal components, as well as antennas, cranes, metal fences, both tram and train rails. Any type of insulated metal structure. 

Because we anticipate that the weather will not improve, we repeat that it is not advisable to use the car while the situation remains the same. Some of the safe places where they can take refuge in case the storm gets worse are: The interior of buildings with steel structures, buildings with lightning rods, in the case of being in the car and having to stop due to lack of visibility, We must make sure that the car is completely closed in terms of doors and windows. If you are at home, be sure to keep both doors and windows closed to prevent drafts, especially if you hear thunder.

Also remember, for those who are at home, unplug the electronic devices to protect them against a possible voltage surge or that they cause electric shocks. 

So far this year the number of road accidents and fatalities and serious injuries has increased by 13% compared to last year, so please, if you have to take the car, circulate with great caution and if you can avoid it, better . 

“Comment” We have just received more information about the accident that occurred between two passenger cars and a bus, the driver of one of the passenger cars is in critical condition and fears for his life due to the injuries suffered in the collision, it should be noted that the accident occurred just as he was leaving work to go to his home. 

Let’s hope that he gets out of danger as soon as possible. We would also like to say that you please use caution when driving home with your vehicle when leaving work, as it is the most complicated time and with the highest traffic density, and in turn that more accidents occur. If you see that the situation on the road it’s complicated as a day like today, better to wait a little and be late, than not to arrive.

This has been all for today, Thank you very much and stay tuned if there is any news regarding the weather forecast.

(End of scene)

Worrying about health

PJ1: Hello and welcome once again to our informative discussion about risky diseases. Today’s show will cover diseases like cancer, blood pressure and heart attacks. caused by stress and Alzheimer’s. We are pleased to have our doctor specialized in this kind of more severe diseases who will be able to provide us with technical information about them. Welcome.

PJ2: Delighted to be here with you and to be able to give more information about these diseases to our viewers. 

PJ3: Also welcome.

PJ1: We will start by talking about the problems that can trigger high blood pressure and heart attacks. First of all, we must bear in mind that heart attacks are one of the main causes of death in western countries, especially in the population. aged 40 to 50 who are especially sensitive to this, an estimated 48% of people who have ever had a heart attack are more likely to have it again, and 34% of these attacks are fatal .

PJ2: Well, one of the main causes of high blood pressure, although they are not specifically determined, are unhealthy habits, sensitivity to sodium, excessive alcohol consumption, the use of oral contraceptives and a very sedentary lifestyle, for example. .

PJ3: It is solved then doing sports for what I see given the symptoms that it has exposed.

PJ2: not entirely, since it is useless to do sports if we do not also modify the other habits that can harm us in this regard. It can help to some extent, but not in a complete way.

PJ1: I understand that there are some causes of high blood pressure that cannot be changed, right? That is, they are genetic.

PJ2: Exactly, there are some causes, such as sex, which of course are not modifiable, it must be borne in mind that men are more predisposed to hypertension than women until they reach the age of menopause, from of that stage, we would say that the probabilities of suffering this pathology are equal. This is due to the fact that women are endowed with hormones that protect them during their childbearing years, estrogens, and therefore they have less risk of cardiovascular diseases, until they stop secreting them. We have to take into account that the percentages are very disparate during the fertile age, being in men twice as likely that these will happen, coming to equate with women as we have said around 50 years.

PJ3: Interesting, and is only the sex of a person the non-modifiable cause?

PJ1: I understand no, wait for the doctor to tell us.

PJ2: We must bear in mind that genetic factors also influence this type of pathology, if for any case we have evidence that a first-degree relative has suffered these, it is twice as likely that we may suffer from this type of pathology.

PJ1: What about heart attacks? because an age is coming when you have to be careful with these things and control it very well… since as I mentioned at the beginning, the chances of suffering one increase considerably once we pass the threshold of 45 years.

PJ3: Well… a cousin of mine suffered one recently due to stress, we constantly told him that he had to relax a little and take things more calmly, he ignored us and until it happened… Luckily, he is already recovered, although he feels very tired and has to go to therapy.

PJ2: Explained in a technical but simple way, most of these are caused by a clot that blocks one of the coronary arteries, which carry blood and oxygen to the heart. If the blood flow blocks the heart, it suffers from lack of oxygen and the heart cells die. These clots are normally made up of cholesterol and other cells that cause the plug.

PJ3: Look, my cousin, the one I mentioned a moment ago, had cholesterol above 200!

PJ2: You have to control that very well, especially with the intake of what type of food, and more at certain ages.

PJ1: I understand that a heart attack only occurs in extreme stress situations, right?

PJ2: Well, let me tell you that you are wrong, and at the same time, they can be given both in stressful situations, when we are resting or sleeping, during a sudden and intense exercise… etc, in any type of situation.

PJ3: So the last events that have happened with footballers is this, right? a very high intensity exercise from the first moment.

PJ2: Exactly, and this is one of the reasons why athletes should always be taught to warm up before going out to play to minimize this physical intensity curve. They are not common cases… It is clear, since we are talking about elite athletes whose job is to make this type of effort frequently, we have seen that as we get older, there are more probabilities, but that does not exempt us from being able to suffer one while young and even in top shape.

PJ1: Let us remind our spectators that if in any case they feel symptoms such as a part of the body falling asleep or they feel pain in this part, they should call the emergency services very quickly.

PJ2: We should also clarify that at the age of one or those at greater risk of suffering these attacks, it is recommended to have regular check-ups to check blood pressure, cholesterol level, and if any symptoms have occurred.

PJ1: Lastly, we will treat cancer, a big problem that is a constant struggle for a large number of people. At a congress on pathology in Texas, a new chemotherapy treatment was presented, which made 31% more cancer remit. breast.

PJ3: To my truth, I am quite concerned about this issue, since more and more people around me or acquaintances of these are suffering from it.

PJ2: If the truth is a disgrace, the increase of this type of cancer among the population, but luckily, great advances are being made on how to treat it. As you mentioned, at the last congress held on this pathology, a new treatment was presented that manages to make cancer remit in 31%. One of the problems that we always find with these new drugs is that as they are new and of great technological advance, their price is in line with these, we must bear in mind that the vial of this new drug costs up to 5 times more than the one that is used until now.

PJ3: It is a big problem that better and more effective treatment cannot be accessed due to prices.

PJ1: Totally agree.

PJ2: The great advantage of this new drug is that it allows it to better reach tumor cells and, in turn, increases its dose by 16%. Fortunately, it is already being used in metastatic breast tumors.

PJ1: That’s great news!

PJ3: Now you should be able to see if this same drug could be applied to different primary cancers.

PJ2: From what we know about the application to different cancers, it is being used and with good results in pancreatic cancer for example, although there is still a long way to go.

PJ1: Perfect, I hope that this information that we have provided has been useful to you, what better, than to finish with this great news about the advances that are being achieved in the field.

PJ2: I totally agree, thank you very much for joining us!

PJ3: Thanks everyone!

(End of scene)

Worrying about work

PJ2: Let’s see what time it is…? We are just running out of time… and we just need to stop so that we are late…

PJ1: Uff, again we are going to be late because of the subway, last week I was already twice late… my boss is going to kill me.

PJ2: Well, I don’t think your boss is going to tell you anything either, you can’t control the subway in any way, if for some reason it stops like today and we’re late… well, look. We cannot do anything about it.

PJ1: Yes, you can say if, as you said, it is not my problem that the subway does not work well, take the subway earlier, in case something like this happens that you are not late.

PJ2: I understand, it seems more than I think that you make it up than anything else really… Well, I once had a boss who almost controlled with a stopwatch the time we entered and the time we left work.

PJ1: Really? (surprised)

PJ2: Yes, totally real, and what’s more, if we did fewer hours than the established ones, we would deduct it from our salary…

PJ1: Really?, I don’t think so… but then if you do more hours, would I also pay you?

PJ2: Go! Haha, if you did less discounted but if you did more… nothing at all.

PJ1: Anyway, with a dropper from what I see.

PJ2: Well, yes, luckily, I already found another job, the only thing I have to do now is take the subway, and this because I miss so much and am late for work… it’s a problem…

PJ1: Well, I’m glad you’re better now, Will see if it starts now! that we should already be at work!

PJ2: Pfff is that it has been standing for a while, it is not very normal… what if we walk? is that I don’t know what to do, once again… I’m late.

PJ1: Nono, we had better wait, the typical thing that you go down to walk has already happened to me… and it just starts.

PJ2: I hope you’re right…

(End of scene)

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

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Generalized Anxiety Disorder – Bibliography

Bibliography


  • 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
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Generalized Anxiety Disorder – Intervention Protocol

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.”

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.
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Generalized Anxiety Disorder – Evaluation Protocol

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.”

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.

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Generalized anxiety and Virtual Reality

Generalized anxiety
and virtual reality

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. 

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Fear of public speaking – Appendix

Appendix

Preparation for an oral presentation in public
  • 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
ITEMLEVEL 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 
ITEMLEVEL 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
ITEMLEVEL 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. ]

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Fear of public speaking – Bibliography

Bibliography


  • Anderson, P.L., Price, M., Edwards, S.M., Obasaju, M.A., Mayowa, A., Schmertz, S.K., Zimand, E. & Calamaras, M.R. (2013). Virtual reality exposure therapy for social anxiety disorder: A randomized controlled trial.
  • Journal of Consulting and Clinical Psychology, 81(5), 751.760. Bados López, A. (2006). Fobias específicas.
  • Bados, A. (2009). Miedo a hablar en público: naturaleza, evaluación y tratamiento. Barcelona: Publicacions i Edicions de la Universitat de Barcelona.
  • Cho, Y., Smits, J.A.J. y Telch, M.J. (2004). The Speech Anxiety Thoughts Inventory: Scale development and preliminary psychometric data. Behaviour Research and Therapy, 42, 13-25. 
  • Fawcett, S.B. y Miller, L.K. (1975) Training public-speaking behavior: An experimental analysis and social validation. Journal of Applied Behavior Analysis, 8, 125-135.
  • Fydrich, T., Chambless, D.L., Perry, K.J., Buergener, F. y Beazley, M.B. (1998). Behavioral assessment of social performance: A rating scale for social phobia. Behaviour Research and Therapy, 36, 995-1010.
  • Gega, L., White, R., Clarke, T., Turner, R. & Fowler, D. (2013). Virtual environments using video capture for social phobia with psychosis. Cyberpsychology, Behavior, and Social Networking, 16(6), 473-479
  • Hofmann, S.G. y DiBartolo, P.M. (2000). An instrument to assess self statements during public speaking: Scale development and preliminary psychometric properties. Behavior Therapy, 31, 499-515. 
  • Lamb, D.H. (1972) The Speech Anxiety Inventory: Preliminary test manual for Form X. Normal, IL: Illinois State University. 
  • Moldovan, R. & David, D. (2014). One session treatment of cognitive and behavioral therapy and virtual reality for social and specific phobias. Preliminary results from a randomized clinical trial. Journal of EvidenceBased Psychotherapies, 14(1), 67-83.
  • Paul, G.L. (1966) Insight vs. desensitization in psychotherapy. Stanford, California: Stanford University Press. 
  • Safir, M.P., Wallach, H.S. & Bar-Zvi, M. (2012). Virtual reality cognitive behavior therapy for public speaking anxiety: One-year follow-Up. Behavior Modification, 36(2), 235-246.
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Public speaking – Recommendations

Recommendations for use

To increase the sense of immersion in Virtual Reality, you can include comments, questions or ideas in the session so the experience will seem more realistic to your patient. 

Some examples can be:

  • These are your bosses/teachers/interviewers… You have to give a talk/do an oral exam/ do an interview…
  • What did the woman in front suggest to you? What do you think that she thinks of you? 
  • If you had to have a second meeting with one of them alone, who would you prefer it to be? Who makes you most nervous?
  • What impression do you think that you have given them with your proposal? 
  • Now you have to ask them a favour. Whose face are you going to look at while you do it? 
  • Of those that are listening to you, who do you think has the most power within the company? 
  • A man in the audience just raised his hand. What type of question do you think he is going to ask you? Do you think that he will embarrass you with his question?  
  • With which of those would you speak after the conference?
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Fear of public speaking – Intervention Protocol

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.”

SESSION 1
  • Inform the patient about the fear of public speaking (causes, symptoms, prevalence…). 
  • Present and justify the techniques that will be used throughout the treatment: exposure to virtual reality and live exposure.
  • Creation of a hierarchy of exposure and exposure to items on the 20-30 USA’s hierarchy (example). 
  • Begin hierarchy of exposition with an item from the 30 USAs. The main objective will be to familiarise the patient with virtual reality and the dynamics of work. 
ITEM ENVIRONMENTCONFIGURATIONEVENT
Be in the office alone, preparing the meeting that you will shortly have with some colleaguesFear of speaking in publicOffice, none, easyNo Event
Be in a meeting with one colleague and they are listening attentively to you Fear of speaking in publicOffice, minimum, easyNo Event
Be alone in a conference room, preparing a talk that you will give in a few minutes Fear of speaking in publicAudience, none, easyNo Event
Be in a meeting with few colleagues and when speaking they give you positive feedback Fear of speaking in publicOffice, medium, easyPositive remark 
They ask you to give an example of something that you have explained in a job interview  Fear of speaking in publicOffice, minimum, easyNeutral remark
SESSION 2
  • Review the previous session achievements and establish objectives for the session: You are speaking in a meeting with several work colleagues and you receive a negative remark. 
  • After the second session of treatment, it is recommended to start the gradual and systematic exposure to the virtual reality environments. Cognitive restructuring, if applicable.  
  • Show clinical advances, through reports on the platform, to the patient. 

HOMEWORK
Live exposure by preparing some type of talk as if later they would have to present it in a meeting, and also they can practice this talk with a very close person.

ITEM ENVIRONMENTCONFIGURATIONEVENT
Be in a meeting with few colleagues and while you are talking a mobile telephone rings Fear of public speakingOffice, medium, easyOffice, medium, easy
Be explaining a project to a lot of work colleagues and someone comes in interrupting the meeting Fear of public speakingOffice, maximum, easyDistraction (person comes in)
Be in an auditorium alone, preparing a talk that you are going to give in a few minutes Fear of public speakingAuditorium, none, easyNo Event 
Have a meeting with several colleagues and when you finish your talk they make a critical remark Fear of public speakingOffice, maximum, difficultNegative remark
SESSION 3 
  • Review the previous session achievements and establish objectives for the session: in a meeting with work colleagues who are not very interested, a mobile telephone rings and a negative remark is made. 
  • Gradual and systematic exposure to the virtual reality environments. Cognitive restructuring, if applicable. 
  • Show clinical advances, through reports on the platform, to the patient. 

HOMEWORK
Concealed exposure at home reviewing the process followed in consultation with the imagination + live exposure preparing a talk (although later they do not say it). 

ITEM ENVIRONMENTCONFIGURATIONEVENT
Be about to give a talk in a room that is not very big with few people and the public applauds you Fear of public speaking Audience, few, easyApplause 
Be in a meeting with quite a lot of colleagues who are not interested, and then another person comes in and interrupts Fear of public speaking Office, maximum, difficult Distraction (person comes in) 
Be giving a talk with few people and one of the audience asks you a question that seems easy to answer  Fear of public speaking Audience, minimum, easyEasy question
Be in a meeting with work colleagues who do not show much interest. A mobile telephone rings and they make a negative remark  Fear of public speaking Office, maximum, difficultDistraction (telephone) + negative remark
SESSION 4
  • Review previous session achievements and establish objectives for the session: prepare a talk that is going to be given shortly and will be seen on television. 
  • Gradual and systematic exposure in the virtual reality environments. Cognitive restructuring, if applicable. 
  • Show clinical advances, through reports on the platform, to the patient. 

HOMEWORK
Live exhibition doing some meeting at work + covert exposure at home, reviewing the process followed in consultation by imagination.

ITEM ENVIRONMENTCONFIGURATIONEVENT
Be giving a talk with quite a lot of people and hear a mobile telephone ringFear of public speakingAudience, medium, easyDistraction (mobile)
Be in a conference room with a lot of people and see that they are not paying much attention Fear of public speakingAudience, maximum, difficult No event
Be preparing a talk that is going to be broadcast on televisionFear of public speakingBroadcast conference, none, easyNo event 
SESSION 5
  • Review previous session achievements and establish objectives for the session: Be giving a conference that is going to be broadcast on television and the audience is paying attention. 
  • Gradual and systematic exposure in the virtual reality environments. Cognitive restructuring, if applicable. 
  • Repeat each one of the exercises twice.
  • Show clinical advances, through reports on the platform, to the patient.

HOMEWORK
Concealed exposure at home, reviewing the objectives of the sessions and the process followed in consultation.

ITEM ENVIRONMENTCONFIGURATIONEVENT
After answering an easy question from a member of the audience at the conference today, see that there are people talking amongst themselves Fear of public speakingAudience, medium, difficultDifficult question + people talking
Be giving a talk in an auditorium full of people, and also see that they are not paying much attention, hear a yawn from the audience Fear of public speakingAuditorium, maximum, difficultDistraction (yawn)
Be giving a talk that is being broadcast on television and see that the audience is paying attention Fear of public speakingBroadcast conference, medium, difficultGo to the stage and then no event
SESSION 6 
  • Review previous session achievements and establish objectives for the session: Give a conference that is broadcast on TV and a listener asks a difficult question. 
  • Gradual and systematic exposure in the virtual reality environments. Cognitive restructuring, if applicable.
  • Repeat each one of the exercises twice.
  • Show clinical advances, through reports on the platform, to the patient.

HOMEWORK
Imaginal exposure at home reviewing the process following the consultation.

ITEM ENVIRONMENTCONFIGURATIONEVENT
Be in a room full of people giving a talk, see that the audience is not showing much interest and that one of them leaves the roomFear of public speakingAudience, maximum, difficult Person leaves
Be giving a talk in a room full of people, with the lights down and television cameras and hear laughing in the background Fear of public speakingBroadcast conference, many, easyDifficult question
Be giving a talk in a room full of people, with the lights down and television cameras and hear laughing in the backgroundFear of public speakingBroadcast conference, many, easyDistraction (laughs)
Be holding a conference that is going to be broadcast on television and a person from the audience asks you a question that is difficult to answer Fear of public speakingBroadcast conference, maximum, difficultDifficult question
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Fear of public speaking – Evaluation Protocol

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.”

Evaluation fear of public speaking

Objectives of evaluation
  • To evaluate the presence and comorbidity of other emotional disorders, especially social phobia, anxiety disorders or other phobias
  • To evaluate anxiety associated with components: speaking in front of an audience, whether in a formal way (such as an oral presentation in an academic environment) or more informal (such as making a toast at a birthday party), being the centre of attention in a social situation, receiving a potential negative evaluation from an audience. 
  • To define configurations of stimulated fears by the patient and in what degree. Creation of hierarchy of exposure. 
  • To evaluate the presence of distorted thoughts: being embarrassed in a social situation, being criticised for everything they say, not being capable of coordinating their thoughts, not knowing how to behave themselves in an appropriate way…
Some useful instruments for the evaluation of fear of public speaking

Bearing in mind the objectives for evaluation we will list some tools and instruments that can be useful for obtaining information relevant to the characteristics of your user. Remember that a good definition of objectives, characterisation of the patient and plan for intervention are important for therapeutic efficiency and efficacy, as well as for the satisfaction of your patients. In the bibliography, you will find articles in which the characteristics of the instruments proposed are reviewed below.

  • Open or semi-structured interview
  • Structured interview: Interview for Anxiety Disorders according to the DSM-IV 
  • Observation and self-observation (with self-report):
    • Behavioural approximation test live and/or through virtual reality
    • List of Appropriate Behaviours at the Beginning and End of a Talk 
    • Scale of Qualification of Social Performance 
SELF-REPORTS
  • State Speech Anxiety Inventory (SSAI)
  • Self-Statement During Public Speaking Scale (SSPSS) 
  • Speech Anxiety Thoughts Inventory (SATI) 
  • Personal Report of Confidence as a Speaker (PRCS) 
  • Psious self-reports for the creation of the hierarchy  
Creation of the hierarchy of exposure to Psious’s environments

Once we have the information from the evaluation we can proceed to create the hierarchy of exposure. For this, as well as using the data obtained through the initial assessment, we can ask a series of questions (e.g. What level of discomfort, on a scale of 0 to 100, does holding a conversation with a group of four people give you? What level of discomfort, on a scale of 0 to 100, does having to make an oral presentation for 10 minutes give you?, Do you think that there is something that could make you feel even more discomfort?…) directed at planning the intervention through virtual reality. 

Below there is a series of items that can be used to create a suitable hierarchy for treating fear of public speaking with Psious. It must be borne in mind that we might be able to ask the patient about the anxiety that these items create, and after that, start grading the different elements of the hierarchy.

  • Being in an auditorium alone preparing for a presentation that will be given in a few minutes (environment of fear of public speaking, auditorium).
  • Having a job interview (environment of fear of public speaking, office).
  • Presenting a new project to a small group of work colleagues (environment of fear of public speaking, office).
  • Giving a talk that will be broadcast on television and seeing that the audience is listening attentively (environment of fear of public speaking, Broadcast conference).
  • Giving a talk in an auditorium full of people (environment of fear of public speaking, auditorium).
  • To be giving a conference and hear laughter from the audience (environment of fear of public speaking, audience).
  • In a work meeting a colleague makes a critical remark to you (environment of fear of public speaking, office).