Test anxiety has been defined as the emotional, physiological and behavioral responses that occur around the potential consequences of negative evaluations or a future test or exam (Zeidner, 1998)
Spielberg and Vagg (1995) have described test anxiety as an element of general anxiety which is composed of processes of cognitive attention that interfere with performance in academic situations or tests. Like Sapp, Durand and Farrel (1995) who consider it as a case of general anxiety disorder related to being tested. Studies about the start, prevalence and incidence indicate that the start of the problem may be very early (7 years), although the major manifestations occur in adolescence, Von Der Embse, N., Barterian, J., & Segool, N. (2013) estimate that between 10 and 40% of the child/adolescent population may suffer from it. Other studies indicate a high incidence, around 48%, on the university access (Kavakci, O., Semiz, M., Kartal, A., Dikici, A., & Kugu, N., 2014).
Systematic desensitization (SD) through exposure is shown to be effective itself to reduce test anxiety (Hembree, 1988) in addition to having a positive effect on academic results and a decrease in overall anxiety and trait status.
The therapeutic approaches that combine SD with cognitive restructuring and study techniques are the ones that show a greater reduction of anxiety before the test (Talbot, 2016).
The virtual reality environments are capable of generating the anxious response that appears because of the test to be able to perform the gradual exposure. In addition, virtual reality is equally effective as exposure by imagination and achieves a greater reduction of avoidance behaviors than exposure by imagination (Gutiérrez-Maldonado, Alsina, Carvallo, Letosa & Magallón, 2007). This may be because virtual reality allows a greater generalization of the coping response learned.
Psious environments allow you to use different techniques of psychological intervention: exposure, cognitive restructuring, systematic desensitization, training in social skills…, use those that are more appropriate to the characteristics of your patient and build on those with greater empirical support to get better results.
Somatic Symptom Disorder (SSD) includes the diagnosis of somatic symptom disorder, illness anxiety disorder, conversion disorder (functional neurological symptom disorder), psychological factors affecting other medical conditions, factitious disorder and other related disorders. It is important to note that some other mental disorders may initially manifest with primarily somatic symptoms (e.g., major depressive disorder, panic disorder). Such diagnoses may account for the somatic symptoms, or they may occur alongside one of the somatic symptoms and related disorders. (adapted from APA, 2013).
Somatic symptom disorder (SSD) is characterized by an extreme focus on physical symptoms — such as pain or fatigue — that causes major emotional distress and problems functioning. The patient may or may not have another diagnosed medical condition associated with these symptoms, but the person’s reaction to the symptoms is excessive. People diagnosed with IAD strongly believe they have a serious or life-threatening illness despite having no, or only mild, symptoms. Yet IAD patients’ concerns are to them very real. Even if they go to doctors and no illnesses are found, they are generally not reassured, or they only do it for a short time, and their obsessive worry continues. IAD can also trigger worries in people who do have a physical illness that they are sicker than they really are. The disorder is not about the presence or absence of illness, but the psychological reaction (adapted from Mayo and Cleveland Clinics).
Cognitive Behavior Therapy (CBT) is the best established treatment for a variety of somatoform disorders, with some benefit also demonstrated for a consultation letter to the primary care physician ( Kroenke, K., 2007).
Psious’ “Somatic and Related” therapeutic area tools were grouped to help therapists on somatic symptoms assessment and treatment, especially for somatic symptoms and illness anxiety disorders. These tools can help for somatic symptomatology treatment using CBT evidence-based techniques: exposure and response prevention (Hedman, E., et al 2016 ), relaxation training and cognitive–behavioral therapy (Bauer, M.,et al 2014), Mindfulness (Fjorback, L. O.,et al 2013, Hedman, E., et al 2016 ).
The fifth version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V), replaces the old term of social phobia with Social Anxiety Disorder. This modification represents a change in the conceptualization of the disorder, in which it is understood that the condition exists in a variety of social settings.
Virtual Reality (VR) is a beneficial tool for the treatment of Social Phobia, as it exposes the patient to social interactions, cognitive restructuring, social skills training and allows to train the patient on relaxation techniques. Moreover, the virtual exposure can be applied in an anxiogenic or unfavorable situation (seated, noisy, mid-conversation, etc), which is useful to design the exposure to the patient’s needs.
With Psious training in relaxation techniques is easy and fast thanks to Virtual Reality (VR), in a few sessions, the patient will be able to generalize the use of the techniques learned and apply them in their day to day.
Relaxation techniques useful for anxiety reduction. Useful for the treatment of Post-traumatic Stress Disorder (PTSD ), Generalized Anxiety Disorder (GAD), eating disorders, substance related disorders , addictive disorders and others.
We recommend the following steps to have a successful training:
Exercises and Techniques
Diaphragmatic BreathingIts goal is to induce parasympathetic activation and promote a relaxed state, reducing stress and other symptoms caused by excessive activation.
Progressive Muscle RelaxationThrough the tension-relaxation cycle, Jacobson’s technique teaches to control the voluntary musculature in order to reach a state of relaxation.
All the environments of Psious have two audios, in the relax section, that allow to put in practice both techniques.
Mindfulness is defined as the consciousness that emerges through paying attention on purpose, in the present moment, and without being critical, to the development of the moment-by-moment experience (Kabat-Zinn, 2003, cited in Boettcher et al., 2014). However, it is more than a type of meditation, since it is considered a state of consciousness by nature (Shapiro, Carlson, Astin & Freedman, 2006) that involves consciously paying attention to the personal experience of “moment by moment”.
Through the use of meditation practices (both formal and informal), in combination with components of other therapies such as the cognitive behavioral intervention with mindfulness aims to help patients become more aware of problematic patterns of thinking, feelings, and action. In addition, it helps them develop a better acceptance relationship with their unwanted internal experiences (Morgan, Danitz, Roemer and Orsillo, 2016).
The concept of Mindfulness is essentially transdiagnostic (Boettcher et al., 2014), therefore, its use in the field of psychological therapy is justified from a broad theoretical framework in which it is considered that individuals with mental disorders share behavioral processes and specific cognitive factors that contribute to the development and maintenance of said disorders (Barlow et al., 2004 and Mansell et al., 2009, cited in Boettcher et al., 2014). These are processes such as selective attention both internal and external, avoidance of attention, interpretation biases, recurrent negative thoughts and avoidance and safety behaviors (Harvey, Watkins, Mansell, & Shafran, 2004, cited in Boettcher et al., 2014). Therefore, through the practice of Mindfulness it is not intended to treat specific aspects of a specific disorder, but to treat certain aspects common to different disorders.
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 quitting 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.
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 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 the creation of a relaxing mood. 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 therapist can carry out exposure to the patient’s worrying in two different environments: a house and subway.
This Psious Virtual Reality environment (VR) will assist you in the intervention and evaluation of children and adults who are showing signs of fear of darkness and or storms. With the help of the events and the environment settings provided in the platform each environment can be adapted to the therapeutic procedure requirements.
For example, a behavioral approach test or alike, can be carried out (Orgilés, Méndez y Espada, 2005) or the psychological intervention through procedures that have demonstrated stronger observational, in this instance multicomponent programs (systematic desensitization, exposure, modelling, token economy approach, parents training…). Amongst them, one worthy of mention is that of Mikulas y Coffman (1989) and the “emotive performances technique” ( EPT) by Méndez (1986) that suggested using EPT as an alternative to emotive imagery by Lazarus y Abramovitz (1979). Furthermore, an environment can be used to carry out gradual exposure, psychoeducation, cognitive reconstruction, relaxation…
Lastly, let’s focus on the advantages that VR brings to this type of intervention and denote that VR has already demonstrated to be very effective as a treatment in phobias (Capafons, J.I, 2001). With respect to darkness phobia in children, as already indicated, multicomponent programs have shown greater effectiveness than other intervention techniques. For example, in the emotive performances technique counterconditioning components are clearly combined (a child being introduced to a game should be sufficiently attractive to offset the effects of the feared stimulus) with other operant conditioning techniques, not only the strengthening of approach behaviors to the phobic stimulus, but also the elimination of possible conduct behaviors that parents or adults involved in the treatment could apply.The control that the therapist acquires in addition to the gradual process that patients undergoes, on the one hand, facilitates the transition from the simulated environment to the real environment, delivering greater levels of accuracy, and on the other hand, due to the fact that this type of coaching encourages acceptance of the intervention. Thereby, favoring the coaching of parents through observation during the visit and lastly, allowing us to easily “gamify” the intervention.
When it comes to storm phobias, VR provides the solution to solving one of the major drawbacks to in vivo exposure: unpredictability and the lack of frequency. Exposures in Psious can be exposed to patients systemically and the levels of anxiety can be adjusted accordingly to the degree of: night or day, amount of light, intensity of rain or storms.
Ultimately, it combines your knowledge with the tools that you are provided with by Psious, thus enhancing user experiences and achieving better results.
Virtual Reality (VR) is a less complex, cheaper alternative to in vivo exposure for 2.2. Going to the airport 2.3. Boarding Gate 2.4. The Plane the treatment of flying phobia. This technology does not require a high imagination capacity on the patient as the case of the typical exposure techniques. Also, the exposure can be modified to the patients needs when using VR, as the therapist can control different parameters such as duration of the flight, weather conditions, people on the flight,etc.
Many studies demonstrate the efficiency of VR as a treatment for specific phobias. A systematic review about the use of VR as a treatment of flying phobia showed that Cognitive Behavioral Therapy (CBT) combined with relaxation techniques and VR exposure is effective for the treatment of flying phobia (Costa et al. 2008). Also, a study by Botella (2004), demonstrated the efficiency of VR as the only line of treatment for flying phobia at short and long term.