Chapman, L. K., & DeLapp, R. C. (2013). Nine session treatment of a blood–injection–injury phobia with manualized cognitive behavioral therapy: An adult case example. Clinical Case Studies. Retrieved October 26, 2014, from http://ccs.sagepub.com/content/ early/2013/10/28/1534650113509304
Marks, I. M. (1988). Blood-injury phobia: A review. American Journal of Psychiatry, 145, 1207- 13.
Marks, I. M. y Mathews, A. M. (1979). Case histories and shorter communications. Brief stan- dard self-rating for phobic patients. Behaviour Research and Therapy, 30, 425-434.
Mas, M. B., Jiménez, A. M. L., & San Gregorio, M. Á. P. (2010). Blood-injection Phobia Inventory (BIPI): Development, reliability and validity.[Inventario de fobia a la sangre (BIPI): Desarrollo, fiabilidad y validez]. Anales de Psicología/Annals of Psychology, 26(1), 58-71.
Wiederhold, B.K., Mendoza, M., Nakatani, T. Bulinger, A.H. & Wiederhold, M.D. (2005). VR for blood-injection-injury phobia. Annual Review of CyberTherapy and Telemedicine, 3, 109-116.
Wolf, J.J. & Symons, F.J. (2013). An evaluation of multi-component exposure treatment of needle phobia in an adult with autism and intellectual disability. Journal of Applied Research in Intellectual Disabilities, 26(4), 344-348.
Ritz, T.M., Meuret, A.E. & ALvord, M.K. (2014). Blood-injection injury-phobia. In Grossman, L. & Walfish, S. (Ed.): Translating psychological research into practice (pp. 295-301). New York, NY, US: Springer Publishing Co, 609.
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.
At the waiting room:
You are attending a blood extraction on your own. Do you think you would have felt better if someone had come with you?
What does the person getting out of the extraction room cause in you? Does he/she make you more nervous? Or does he/she soothe you?
Do you think the extraction is going to hurt?
How do you think the person sitting next to you feels? Is he/she nervous or calm?
How do you feel about that personʼs state?
At the extraction room:
How many years of experience do you think this nurse has?
Does this nurse make you feel safe?
When you are ready, look at the needle which the extraction will be performed with.
Look at the bloodstained cotton over the small table.
At Magnetic Resonance Imaging:
What do you expect about this diagnostic test?
How much time do you think has passed?
How do you feel about being in such a small place?
Are you worried about not being able to move during the procedure?
“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.”
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.
SESSION 1: PSYCHOEDUCATION + APPLIED TENSION
Information about blood phobia is provided (origin, maintenance and biphasic anxiety response).
Treatment techniques that will be used throughout the protocol are presented and justified: exposure to Virtual and Augmented Reality environments, applied tension technique.
Elaboration of an exhibition hierarchy.
Introduction and practice of the applied tension technique.
HOMEWORK Practice of the applied tension technique and filling out the associated self-recording (see Annex 6.1).
SESSION 2-3: APPLIED TENSION
The technique of applied tension continues.
Familiarization accompanied by Psious platform. The patient learns how to use the VR headphones and navigate within virtual environments.
HOMEWORK Daily practice of applied tension and Jacobson’s progressive muscle relaxation. The self-records of applied tension (see annex 6.1) and relaxation (see annex 6.2) are completed.
SESSION 4: RV EXHIBITION TRADITIONAL TECHNIQUES
From the fourth session on , the gradual and systematic exposure to virtual environments begins. Throughout the exposure sessions, according to the characteristics of each patient, the VR is combined by the applied tension and progressive muscle relaxation techniques.
The patient is exposed to:
A waiting room as a companion.
An extraction room as a companion.
HOMEWORK Self-exposure to stimuli related to a feared situation. Applied tension and progressive muscle relaxation practice.
SESSION 5: EXHIBITION RV + TRADITIONAL TECHNIQUES
Homework review
The patient is exposed to:
The waiting room + interoceptive exposure elements.
“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 Objectives
Evaluate the presence and comorbidity of other emotional disorders, in particular specific phobias, other anxiety and emotional disorders.
Evaluate anxiety associated with components: intensity, frequency, characteristics…
Set the feared stimulative settings for the patient and define to what extent. Exposure hierarchy development.
Measure the presence of distorted thoughts.
Some useful instruments for Fear of Blood and Needles
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:
Open or semi-structured interview
Structured interview: ADIS-IV
Behavioral approach test/behavior avoidance (in vivo or with Virtual Reality)
SELF-REPORTS
Fear Questionnaire (FQ-BI, Marks y Mathews, 1979)
Blood-injection Phobia Inventory (BIPI, Mas, Jiménez & San Gregorio, 2010)
Psious Self-Reports for the elaboration of the hierarchy (annexes)
Exposure Hierarchy development with Psious Environments
Once we have received the evaluation information we can then proceed to develop the hierarchy exposure. To do this, in addition to using the data obtained during the initial evaluation, we can carry out a series of questions, (For example, what level of discomfort, on a scale of 0 to 100, does a blood extraction have generated? What level of discomfort, on a scale of 0 to 100, would lead you to take a blood test? Is there something that makes you feel even more uncomfortable?) all geared at the planning of the intervention via the Virtual Reality.
Hierarchy example
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.
The fear of blood is a phobia classified on current mental disorders diagnosis systems as a specific Blood-Injection-Injury type of phobia (BII). Some sort of fear towards blood is common and, in fact, it is considered that the amount of people that experience this fear may exceed 10%. Yet recent studies point out that about 2-3% of the population suffers from BII phobia.
This data is significant; not only because of its prevalence, but also due to the negative consequences that blood phobia can have on the quality of life of those who suffer from it. These people tend to avoid medical interventions that are key to health or pregnancies, as well as quit on graduate school (e.g. medical school, nursing school), or avoid visiting hospitalized relatives, and so on.
Blood phobia, unlike the rest of phobias, is characterized by a biphasic anxiety response. That is to say, even though during the first seconds of exposure to the feared stimulus an elevated physiological activity takes place (tachycardia, palpitations, sweating, etc.), immediately followed by a rapid drop (blood pressure drops, cardiac rhythm can drop to between 35 to 40 beats per minute, etc). This can lead to dizziness, pallor, and, sometimes, even fainting.
In addition to the fear of fainting, among the most common fears are: the possibility of losing control, having a panic attack, fear of making a fool of oneself, or fear that the needle will break and stay inside the body. The feeling of disgust when seeing stimuli related to blood is also common.
In regard to the treatment of blood phobia, it is not usually recommended to use relaxation techniques during the exposure to the feared situation (though these are useful during the first phase of the biphasic response). On the contrary, it is considered more adequate to use Applied Tension techniques, with the aim of balancing out the physiological drop and so preventing fainting.
In the last few years, Virtual Reality (VR) and Augmented Reality (AR) have shown great clinical efficiency in the treatment of specific phobias. These technologies provide the ideal context to play the situations feared by the patient , in a controlled safe way. In the case of blood phobia, for instance, these technologies allow for blood analysis to be carried out any day of the year, without prior appointment, and offer the chance to set the parameters that are considered suitable and without even leaving the practice.
I’m at the airport boarding gate, very Good day and I don’t have many people around me. I go to look at the panels to find my flight number.
As there is hardly anyone at the boarding gate, I calmly look out the window to see the planes that are leaving, and also I see that today it is very sunny today.
I am at the boarding gate from the airport, it is a clear night and I don’t have many people around me. I go to look at the panels to find my flight number.
I am at the airport gate, it is a stormy night and there are quite a few people around me. I go to look at the panels to find my flight number.
I move around the room, which is quite crowded, until I find a chair to sit in.spending.
Aftera while at the gate, seeing that the night is very clear, I listen to the boarding call and leave the hall, which is quite empty.
I am at the airport gate, the day is very rainy and I do not have many people around me. I turn to look at the panels to find my flight number.
I left him plenty of people there at the gate, and looked out the window to watch the planes come out, and also see that the night is clear.
I’m in the airport gate, it is a very good day and I have a lot of people around me. I go to look at the panels to find my flight number.
As there is hardly anyone at the gate, I calmly look out the window to see the planes that are leaving, and also I see that the day is very rainy.
I am moving around the room, which is almost empty, until I find a chair to sit.
After spending some time at the gate, watching the good day he does, I hear the boarding call and left the room, which is quite crowded.
I’m in the airport gate, the day is very rainy and there are many people around me. I go to look at the panels to look for my flight number.
After sitting for a while at the gate, seeing how it is raining tonight, I listen to the boarding call and leave the room, which is quite crowded.
I separate myself from the crowd of people at the gate, and I look out the window to see the planes that are leaving, and also I see that the night is very rainy.
After being awhile at the gate, seeing how rainy it is today day, I listen to the boarding call and I leave the room, which is quite crowded.
I separate myself from the crowd of people at the boarding gate, and I look out the window to see the planes that are leaving, and also I see that today it is very sunny.
After spending a while at the gate, seeing how it is raining tonight, I hear the boarding call and leave the hall, which is quite empty.
I am at the boarding gate of the airport, it is a stormy night and I don’t have many people around me or. I turn to look at the panels to find my flight number.
I left him plenty of people there at the gate, and looked out the window to watch the planes come out, and also see that the day is very rainy.
as not there is hardly anyone at the gate, I calmly look out the window to see the planes that are leaving, and also I see that the night is very clear.
After spending a while at the gate, seeing that the night is very clear, I listen to the boarding call and leave the room, which is quite crowded.
As there is hardly anyone at the gate, I calmly look out the window to see the planes that are leaving, and also I see that the night is very rainy.
After spending some time at the gate, seeing how rainy it is today, I hear the boarding call and leave the hall, which is quite empty.
I am at the gate of the airport, it is a clear night and there are many people around me. I go to look at the panels to look for my flight number.
After sitting for a while at the boarding gate, seeing the fine day it is, I listen to the boarding call and leave the room, which is quite empty.
Self-report Hierarchy Psious Environments: Plane
ITEM
LEVEL OF DISCOMFORT (0-100)
I am inside the plane, sitting in the window and with few people around me. Suddenly, while I see out of the window that it is a very good day, the stewardesses begin to give the safety instructions and the plane is moving down the runway.
The plane I am sitting in is quite empty, and I am sitting in the front, in the hallway. Through the windows I can see that the weather is very good, and suddenly the captain announces that we have arrived at our destination and that we are going to land. Just then, the landing begins.
Upon entering the plane, I sat in the middle of two more passengers, and listened to the storm that is today. Although there are quite a few people, nobody says anything, and after we get on the runway, the plane starts accelerating for takeoff.
I find myself inside the plane, sitting in the window and with many people around me. Suddenly, while I see out the window that the day is very rainy, the hostesses begin to give the safety instructions and the plane is moving down the runway.
On the plane I am on there are many people, I sit in the middle of two passengers. In addition to the sound of the plane, I hear how it is raining outside, and suddenly a ding is heard.
I am in the middle of a normal flight, and from my seat behind the plane I can see the number of people there. I also see that there is a storm, and suddenly I hear a boy who says he makes some anxious comment regarding the fact of flying.
I find myself inside the plane, sitting in the window and with many people around me. Suddenly, as I see through the window that it is a very good day, the stewardesses begin to give the security instructions and the plane is moving down the runway.
I am sitting in the window, so I see that it is very sunny. There are a lot of people and I hear how a boy comments that he is afraid to fly, and then the pilot reports that we are going to take off. The engines are heard, the plane accelerates and we take off.
I am sitting in the middle of the plane, in the hall. It is night and I hear how much it rains. Also, there are many people, and a boy says that he is very afraid to travel by plane, and that he is anxious. Suddenly, the plane begins to move a lot, there are many turbulences.
I have entered the plane and I have sat in the corridor, and through the window I can see how the night is very dark and it is raining a lot. Suddenly, the stewardesses begin to give the safety instructions and the plane moves down the runway.
Although I am sitting in the middle of two passengers, I see out the window that the day is very rainy. There are many people on the plane, and then the pilot announces that we are already arriving and proceeds to start landing.
I am sitting in the window and near the wing, so I see that it is very sunny. There are enough people but nobody says anything, and then the pilot reports that we are going to take off. The engines are heard, the plane accelerates andoff
We are already in the air, and from my window seat I can see a very clear sky. The flight is quite normal, there are no incidents but there are many people on the plane.
From my seat at the end of the plane I can see that there are not many people, and although I hear the flight it is still quiet. Suddenly, I start to notice some turbulence, but it doesn’t last long.
I’m in my seat, in the hallway, and in the back of the plane. It is a very good day, and the plane is quite full. When we head to the runway for takeoff, I hear a boy saying that he is afraid of taking off. Just then, takeoff begins.
Sitting in the window seat, I can see how the night is very dark because it rains a lot. The plane is quite full, and when the commander announces that we are going to start landing, I hear someone comment that the moment of landing creates a lot of anxiety.
I am in the middle of a flight that at the moment is very normal, although through the window I can see that there is a storm. Since there are not many people, the atmosphere is quite calm.
I am on a plane with few people, sitting in the hallway. I hear how someone comments that it is a very good day, but then another person says that he is nervous about traveling by plane. Suddenly, I hear a kind of ding.
I am on a plane with few people, in the middle of a fairly calm flight. Through the window of my seat I can see that it is a very good day. Suddenly, I hear how a boy says that he is afraid of landing, that it is dangerous.
There are few people on the flight I am on, and I see from my window that the weather is good. Everything is fine until suddenly the plane moves a lot, there is a lot of turbulence.
While I’m in the middle of a fairly normal flight, looking out the window on a good day today, a ding is suddenly heard, but since there are few passengers it seems nobody pays attention to him.
I’m sitting towards the end of the plane, which is quite empty, and through the window I can see that today is a very good day. Suddenly I hear how a boy near me comments that he is afraid of landing, and just then the pilot announces that we have arrived and starts landing.
I am sitting in the middle of the plane, next to a window, from what I see there is good weather. The flight is quite normal, but suddenly there is some turbulence.
I am sitting in the window seat, avoiding looking at how much it is raining tonight. On the plane there are quite a few people, and in the distance I hear someone talk about the anxiety caused by traveling by plane. Suddenly a ding is heard near me.
Psycho-educational dossier on flight phobia
The phobia of flying is classified, in the current diagnostic systems of mental disorders, as a specific phobia of situational type. It is an intense and persistent fear that is considered excessive or irrational and that is usually triggered by anticipation or having to face a flying situation.
Nowadays, the phobia of flying is very widespread among the population, which can range in experience from a slight discomfort at the moment of flying, to a real terror at the idea of getting on a plane, which makes it impossible to make this type of trip. In fact, according to recent American data, 10% of people have an intense fear of
flying and avoid doing so, while nearly 15% fly with considerable discomfort; those with phobia may account for 2.6 to 3.5% of the adult population.
Among the most common fears are the possibility of an accident (and therefore death), the feeling of being locked in a very small place, the instability of the plane itself, the height at which one flies, or even losing control (e.g. experiencing a panic attack during flight). To deal with this situation, defence and avoidance strategies are often adopted.
It is important to highlight that among the variables that affect the intensity of the fear are: size and type of aircraft, the appearance of turbulence, aircraft noise, atmospheric conditions, time of day, season, delays and the reason for them, location of the seat, time of take-off and landing, duration of the flight, the company of a trusted person and a long etc.
Exposure techniques (combined with techniques such as relaxation or cognitive restructuring) have shown the highest success rate in treating flight phobia. In spite of this, in this phobia it is difficult to carry out systematic live exposure, both because of economic aspects and because of the difficulty of grading situations, some of which depend on factors outside the healthcare professional .
In this context, Virtual Reality is a particularly suitable tool. Firstly, live exposure is too complex and costly in terms of time, money and effort, and a repetition of the exposure is rarely possible. Furthermore, it is not possible to make a graduated live exhibition as flying is an all/nothing dichotomous decision. In these cases, imaginative exposure is often used, although this treatment may not be very effective, as there are great differences in the capacity for imagination. Secondly, in Virtual Reality exposure the healthcare professional can control the different parameters of the flight such as its duration, weather conditions, turbulence, etc. These characteristics, among others, make flying phobia an ideal candidate for exposure therapy using the Psious.
Relaxation self- assessment
Name: ______________________
Date: _______________________
Date
Time
Degree of relaxation (0-100)
Before
Degree of relaxation (0-100)
After
Time spent
Difficulties or Commentsrios
Negative thoughts self-assessment
Name: ______________________
Date: _______________________
Date
Time
Activity being performed
Thoughts
Anxiety level (0-10)
Grade belief (0-10)
[ DISCLAIMER: This document has been automatically translated using Google Translate. ]
Bornas Agustí, F., Tortella-Feliu, M., García de la Banda García, G., Fullana Rivas, M., & Llabrés, J. (1999). Validación factorial del cuestionario de miedo a volar. Análisis y Modificación de Conducta.
Botella, C., Osma, J., García-Palacios, A., Quero, S. & Baños, R.M. (2004). Treatment of Flying Phobia using Virtual Reality: Data from a 1-Year Follow-up using a Multiple Baseline Design. Clinical Psychology & Psychotherapy, 11(5), 311-323.
Bretón-López, J., Tortella-Feliu, M., Del Amo, A. R., Baños, R., Llabrés, J., Gelabert, J. M., & Botella, C. (2015). Patients’ preferences regarding three computer based exposure treatments for fear of flying. Behavioral Psychology/ Psicologia Conductual.
Da Costa, R.T., Sardinha, A. & Nardi, A.E. (2008). Virtual reality exposure in the treatment of fear of flying. Aviation, Space, and Environmental Medicine, 79(9), 899-903.
Haug, T., Brenne, L., Johnsen, D. H., Brentzen, D., Götestam, K. G., & Hughdal, K. (1987). A three systems analysis of fear of flying: A comparison of a consonant versus a non-consonant treatment method. Behaviour Research and Therapy, 25, 187-194. doi:10.1016/0005-7967(87)90045-3
Hirsch, J.A. (2012). Virtual reality exposure therapy and hypnosis for flying phobia in a treatment resistant patient: A case report. American Journal of Clinical Hypnosis, 55(2), 168-173.
Tortella-Feliu, M., Botella, C., Llabrés, J., Bretón-López, J. M., del Amo, A. R., Baños, R. M., & Gelabert, J. M. (2011). Virtual reality versus computer-aided exposure treatments for fear of flying. Behavior Modification. https://doi.org/10.1177/0145445510390801
Wallach, H.S. & Bar-Zvi, M. (2007). Virtual-reality-assisted treatment of flight phobia. Israel Journal of Psychiatry and Related Sciences, 44(1), 29-32.
Wiederhold, B.K., Jang, D.P., Gervirtz, R.G., Kim, S.I., Kim, I.Y. & Wiederhold, M.D. (2002). The Treatment of Fear of Flying: A Controlled Study of Imaginal and Virtual Reality Graded Exposure Therapy. IEEE Transactions on Information Technology in Biomedicine, 6(3), 218-223.
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 suggestions for flying environments:
Waiting at home, or in the taxi
Today you are going to catch a flight to (choose a city). The plane leaves at 6 a.m., but we should be at the boarding gate by 11.15 a.m. Also, we have to go through the security controls… It is now 10 a.m., and the taxi will come pick you up in 5 minutes.
Would you want to watch the weather news before we leave home?
They just said that it is rainy. Does that make you more anxious? Can you tell me why?
You have to be aware that, even though it is raining, the taxi is still going to come pick you up to take you to the airport.
You are going to catch a plane by yourself. When was the last time you flew alone?
At the Gate area, or during the flight
Now we are going to watch the planes taking off through the window. In a while you are going to be inside one of those planes.
What does the person beside you/in front of you evoke in you?
Now we are going to look at the displays where the boarding gates are indicated.
Do you think your mate is nervous?
Would you ask the lady sitting next to you for help if you felt an increase in your levels of anxiety?
It’s been a while since you last saw a flight attendant in the aisle. Does that make you feel more insecure?
(In the middle of a turbulence) Would you like to call the flight attendant in a moment like this?
“All the information contained in this section is for guidance only. Psious environments are 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.”
Example of intervention Fear of flying
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.
SESSION 1: PSYCHOEDUCATION
Information about flying phobia is provided (origin, upkeep and appearance of the triple system cognitive, physiological and motor).
Information about the functioning and safety of planes.
Treatment techniques that will be used throughout the protocolare explained (emphasizing the exposure to the Virtual Reality environments).
HOMEWORK Hand out of the Psychoeducation file (see appendix).
SESSION 2- 3: RELAXATION
The patient learns and practices two types of relaxation techniques: controlled breathing and Jacobson’s progressive muscular relaxation.
Familiarization with the Psious platform. The patient learns to use the VR helmets and navigate inside the virtual scenes.
HOMEWORK Daily practice of relaxation techniques. The self-registers of relaxation and negative thoughts are completed (see appendix)
SESSION 4: COGNITIVE RESTRUCTURING
Revision and adjustment of the patients negative thoughts.
Cognitive restructuring for each of the negative thoughts. Two kinds of cognitive therapy may be used: the one proposed by Beck or the one belonging to Ellis.
HOMEWORK Daily practice of relaxation techniques. The self-registers of relaxation and negative thoughts are completed (see appendix)
SESSION 5: VR EXPOSURE + TRADITIONAL TECHNIQUES
As of the fifth session of treatment the gradual and systematic exposure to the virtual environments begins. Throughout all exposure sessions, VR is combined with techniques of relaxation and cognitive restructuring.
The patient is exposed to:
Patients house on a sunny day (the news is on TV).
Taxi ride on a sunny day (the news is on the radio).
Boarding gate on a sunny day.
HOMEWORK Daily practice of the relaxation techniques and tasks of self-exposure to stimulus related to planes.
SESSION 6: VR EXPOSURE + TRADITIONAL TECHNIQUES
Homework review.
The patient is exposed to:
Taxi ride on a sunny day
Boarding gate on a sunny day. The display with the flight schedule is shown, also the window with planes taking off and landing.
Plane take-off on a sunny day.
HOMEWORK Daily practice of relaxation techniques and tasks of self-exposure to stimulus related to planes.
SESSION 7: VR EXPOSURE + TRADITIONAL TECHNIQUES
Homework review.
The patient is exposed to:
Boarding gate on a sunny day and with comments from other passengers. The screen with the flight schedule and the window with planes taking off and landing are observed.
Plane take-off on a sunny day.
Flight situation. Elements of internal sense exposure are introduced.
HOMEWORK Daily practice of relaxation techniques and self-exposure tasks to stimuli related to planes.
SESSION 8: VR EXPOSURE + TRADITIONAL TECHNIQUES
Homework review.
The patient is exposed to:
Plane take-off on a sunny day. Turn on comments.
Flight situation and short turbulence. Internal sense exposure.
Landing.
HOMEWORK Daily practice of relaxation techniques and self-exposure tasks to stimulus related to planes.
SESSION 9 VR EXPOSURE + TRADITIONAL TECHNIQUES
As of the ninth session of treatment the exposure is re-started to the virtual environments but with a higher level of difficulty. Like in the rest of the exposure it is used in combination with relaxation and cognitive restructuring.
The patient is exposed to:
At home on a rainy day (the news is on TV).
Taxi ride on a rainy day (the news is on the radio).
Boarding gate on a rainy day.
HOMEWORK Daily practice of relaxation techniques and self-exposure tasks to stimulus related to planes.
SESSION 10 VR EXPOSURE + TRADITIONAL TECHNIQUES
The patient is exposed to:
Taxi ride on a rainy day with the radio on. Elements of internal sense exposure are introduced.
Boarding gate on a rainy day. The screen with the flight schedule and window with planes landing and taking off is observed.
Plane take-off on a rainy day.
HOMEWORK Daily practice of relaxation techniques and self-exposure tasks related to planes.
SESSION 11 VR EXPOSURE + TRADITIONAL TECHNIQUES
Homework revision.
The patient is exposed to:
Boarding gate on a rainy day. Elements of internal sense exposure are introduced.
Plane take-off on a rainy day. Elements of internal sense exposure are introduced.
Flight situation on a rainy day with comments. Elements of internal sens exposure are introduced.
HOMEWORK Daily practice of relaxation techniques and self-exposure tasks to stimulus related to planes.
SESSION 12 VR EXPOSURE + TRADITIONAL TECHNIQUES
Homework review
The patient is exposed to:
Plane take-off on a rainy day. Turbulence appears.
Flight situation on a rainy day with turbulence. Elements of internal sense exposure plus comments
Landing on a rainy day with turbulence.
HOMEWORK Daily practice of relaxation techniques and tasks of self-exposure to flight-related stimuli.
SESSION 13: VR EXPOSURE + TRADITIONAL TECHNIQUES
The therapeutic process is evaluated and future self-exposure tasks are programmed, as well as booster sessions.
“All the information contained in this section is for guidance only. Psious environments are supporting tools that must be used by the healthcare professional within an evaluation and intervention process designed according to the characteristics and needs of the user.
Also remember that you have the General Clinical Guide in which you have more information on how to adapt psychological intervention techniques (exposure, systematic desensitization, cognitive restructuring, chip economy…) to Psious environments.”
Fear of Flying
Evaluation Objectives
Evaluate the presence and comorbidity of other emotional disorders, in particular specific phobias, other anxiety and emotional disorders.
Set the feared stimulative settings for the patient and define to what extent. Exposure hierarchy development.
Measure the presence of distorted thoughts.
Some useful instruments for fear of flying
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:
Open or semi-structured interview
Structured interview: ADIS-IV
Behavioral approach test/behavior avoidance (in vivo or with virtual reality).
SELF-REPORTING
Cuestionario de Miedo a Volar/Fear of Flying Questionnaire/Questionari de por de volar (CMV-II/FFQ-II/QPV-II, Bornas et al. 1999).
Fear of flying Scale (FFS, Haug et al., 1987).
Psious Self-Reports for the elaboration of the hierarchy (annexes).
Exposure Hierarchy development with Psious environments
Once we have received the evaluation information we can then proceed to develop the hierarchy exposure. To do this, in addition to using the data obtained during the initial evaluation, we can carry out a series of questions, (For example, what level of discomfort, on a scale of 0 to 100, does flight generate? What level of discomfort, on a scale of 0 to 100, would lead you to take a plane? Is there something that makes you feel even more uncomfortable?) all geared at the planning of the intervention via the virtual reality.
