Clinical case: a private nurse handicaped in her work by acrophobia

Although I specialize in the treatment of teenagers, I report here the recent and more generic case of Misses X who is a private nurse near Marseille in the south of France. She came to see me for an acrophobia that made her waste hours everyday, in particular because of the presence on her daily journey of a catwalk. In addition to this impact on her work time, this phobia did not allow her to take advantage of the region, the “Calanque” these typical peaked massifs that plunge into the sea. For this patient, I therefore set up a treatment which lasted 6 sessions, 5 of which involved virtual reality exposure, the sessions being each spaced about ten days apart.

In general, I use the software from the company C2care, and for this specific case, the module dedicated to acrophobia. The first session is dedicated to understanding phobia, and a first overview of relaxation techniques (cardiac coherence). In the second session, I start a first exhibition. I start first only with the summary and the fixed thumbnails which present some of the points of view in the 3d scene so that the patient becomes familiar with : the different floors, the bridge between two buildings … Then we start to enter the first building in order that she familiarizes herself with the interface. The exhibition and those that follow last around thirty minutes, for sessions lasting a total of 45 minutes.

During each exposure, I monitor that the anxiety level does not exceed 20-30% and I adapt the exposure so that this is the case. This first involves carrying out a mini-questionnaire at the beginning of the session to validate that the patient does not start the session with significant stress due to his day. I also check that the inter-session exercises have been done (relaxation exercises because it would be dangerous to let the patient expose himself to his phobias alone) Once these validations have been made, I define with the patient the “program” of his exposure. The goal is to do enough in terms of exposure while not going beyond its capabilities. It is also important to give the patient the feeling that he is in control of the level of difficulty he chooses (even if in reality I orientate according to what I know from the previous sessions). If I realize that the exposure is too strong, I can go back to the thumbnails of the summary to resume a simpler thread.

A very effective way to give patients confidence to support them virtually. Is to tell them, as practitioner that we are present in the scene virtually with them. I sometimes take the hand of patients in the real world (especially for the youngest) and tell them “I hold your hand, I am here, with you, I accompany you” to comfort them in the fact that I am present with them.

To measure the patient’s anxiety level and adapt the difficulty, my indicators are visual and verbal. I watch the expression on the lower face, the tension in the shoulders, the way the hands are clenched or not at the controllers, whether the patient is sweating or not. Besides the simple observation of the rib cage, of the breath, I sometimes use a device that allows me to measure the level of oxygen saturation and therefore if the patient is breathing properly or not (ideally I would like to have more biofeedback, in particular with a heart rate measurement).

Each session is concluded with a time of relaxation, close to what is done in hypnosis, in order to ensure that the patient leaves “well”, proud of himself with the feeling of having passed a stage. This moment is key to ensure that the patient has “come back” and to avoid a possible “anxious raptus”. To add to this feeling of well-being and reconnection, I often offer a glass of cool water on the way out.

To come back to the specific case of this patient, we have not officially decided at the end of the 6 sessions of the end of treatment. We agreed that she would contact me again if necessary. I have since received an email and a photo of her in the creeks telling me that she considered her healing to be “miraculous”, her quality of life being of better quality. This testifies to the success of the method implemented on this case of acrophobia.

Although I specialize in the treatment of teenagers, I report here the recent and more generic case of Misses X who is a private nurse near Marseille in the south of France. She came to see me for an acrophobia that made her waste hours everyday, in particular because of the presence on her daily journey of a catwalk. In addition to this impact on her work time, this phobia did not allow her to take advantage of the region, the “Calanque” these typical peaked massifs that plunge into the sea. For this patient, I therefore set up a treatment which lasted 6 sessions, 5 of which involved virtual reality exposure, the sessions being each spaced about ten days apart.

In general, I use the software from the company C2care, and for this specific case, the module dedicated to acrophobia. The first session is dedicated to understanding phobia, and a first overview of relaxation techniques (cardiac coherence). In the second session, I start a first exhibition. I start first only with the summary and the fixed thumbnails which present some of the points of view in the 3d scene so that the patient becomes familiar with : the different floors, the bridge between two buildings … Then we start to enter the first building in order that she familiarizes herself with the interface. The exhibition and those that follow last around thirty minutes, for sessions lasting a total of 45 minutes.

During each exposure, I monitor that the anxiety level does not exceed 20-30% and I adapt the exposure so that this is the case. This first involves carrying out a mini-questionnaire at the beginning of the session to validate that the patient does not start the session with significant stress due to his day. I also check that the inter-session exercises have been done (relaxation exercises because it would be dangerous to let the patient expose himself to his phobias alone) Once these validations have been made, I define with the patient the “program” of his exposure. The goal is to do enough in terms of exposure while not going beyond its capabilities. It is also important to give the patient the feeling that he is in control of the level of difficulty he chooses (even if in reality I orientate according to what I know from the previous sessions). If I realize that the exposure is too strong, I can go back to the thumbnails of the summary to resume a simpler thread.

A very effective way to give patients confidence to support them virtually. Is to tell them, as practitioner that we are present in the scene virtually with them. I sometimes take the hand of patients in the real world (especially for the youngest) and tell them “I hold your hand, I am here, with you, I accompany you” to comfort them in the fact that I am present with them.

To measure the patient’s anxiety level and adapt the difficulty, my indicators are visual and verbal. I watch the expression on the lower face, the tension in the shoulders, the way the hands are clenched or not at the controllers, whether the patient is sweating or not. Besides the simple observation of the rib cage, of the breath, I sometimes use a device that allows me to measure the level of oxygen saturation and therefore if the patient is breathing properly or not (ideally I would like to have more biofeedback, in particular with a heart rate measurement).

Each session is concluded with a time of relaxation, close to what is done in hypnosis, in order to ensure that the patient leaves “well”, proud of himself with the feeling of having passed a stage. This moment is key to ensure that the patient has “come back” and to avoid a possible “anxious raptus”. To add to this feeling of well-being and reconnection, I often offer a glass of cool water on the way out.

To come back to the specific case of this patient, we have not officially decided at the end of the 6 sessions of the end of treatment. We agreed that she would contact me again if necessary. I have since received an email and a photo of her in the creeks telling me that she considered her healing to be “miraculous”, her quality of life being of better quality. This testifies to the success of the method implemented on this case of acrophobia.

Although I specialize in the treatment of teenagers, I report here the recent and more generic case of Misses X who is a private nurse near Marseille in the south of France. She came to see me for an acrophobia that made her waste hours everyday, in particular because of the presence on her daily journey of a catwalk. In addition to this impact on her work time, this phobia did not allow her to take advantage of the region, the “Calanque” these typical peaked massifs that plunge into the sea. For this patient, I therefore set up a treatment which lasted 6 sessions, 5 of which involved virtual reality exposure, the sessions being each spaced about ten days apart.

In general, I use the software from the company C2care, and for this specific case, the module dedicated to acrophobia. The first session is dedicated to understanding phobia, and a first overview of relaxation techniques (cardiac coherence). In the second session, I start a first exhibition. I start first only with the summary and the fixed thumbnails which present some of the points of view in the 3d scene so that the patient becomes familiar with : the different floors, the bridge between two buildings … Then we start to enter the first building in order that she familiarizes herself with the interface. The exhibition and those that follow last around thirty minutes, for sessions lasting a total of 45 minutes.

During each exposure, I monitor that the anxiety level does not exceed 20-30% and I adapt the exposure so that this is the case. This first involves carrying out a mini-questionnaire at the beginning of the session to validate that the patient does not start the session with significant stress due to his day. I also check that the inter-session exercises have been done (relaxation exercises because it would be dangerous to let the patient expose himself to his phobias alone) Once these validations have been made, I define with the patient the “program” of his exposure. The goal is to do enough in terms of exposure while not going beyond its capabilities. It is also important to give the patient the feeling that he is in control of the level of difficulty he chooses (even if in reality I orientate according to what I know from the previous sessions). If I realize that the exposure is too strong, I can go back to the thumbnails of the summary to resume a simpler thread.

A very effective way to give patients confidence to support them virtually. Is to tell them, as practitioner that we are present in the scene virtually with them. I sometimes take the hand of patients in the real world (especially for the youngest) and tell them “I hold your hand, I am here, with you, I accompany you” to comfort them in the fact that I am present with them.

To measure the patient’s anxiety level and adapt the difficulty, my indicators are visual and verbal. I watch the expression on the lower face, the tension in the shoulders, the way the hands are clenched or not at the controllers, whether the patient is sweating or not. Besides the simple observation of the rib cage, of the breath, I sometimes use a device that allows me to measure the level of oxygen saturation and therefore if the patient is breathing properly or not (ideally I would like to have more biofeedback, in particular with a heart rate measurement).

Each session is concluded with a time of relaxation, close to what is done in hypnosis, in order to ensure that the patient leaves “well”, proud of himself with the feeling of having passed a stage. This moment is key to ensure that the patient has “come back” and to avoid a possible “anxious raptus”. To add to this feeling of well-being and reconnection, I often offer a glass of cool water on the way out.

To come back to the specific case of this patient, we have not officially decided at the end of the 6 sessions of the end of treatment. We agreed that she would contact me again if necessary. I have since received an email and a photo of her in the creeks telling me that she considered her healing to be “miraculous”, her quality of life being of better quality. This testifies to the success of the method implemented on this case of acrophobia.

Although I specialize in the treatment of teenagers, I report here the recent and more generic case of Misses X who is a private nurse near Marseille in the south of France. She came to see me for an acrophobia that made her waste hours everyday, in particular because of the presence on her daily journey of a catwalk. In addition to this impact on her work time, this phobia did not allow her to take advantage of the region, the “Calanque” these typical peaked massifs that plunge into the sea. For this patient, I therefore set up a treatment which lasted 6 sessions, 5 of which involved virtual reality exposure, the sessions being each spaced about ten days apart.

In general, I use the software from the company C2care, and for this specific case, the module dedicated to acrophobia. The first session is dedicated to understanding phobia, and a first overview of relaxation techniques (cardiac coherence). In the second session, I start a first exhibition. I start first only with the summary and the fixed thumbnails which present some of the points of view in the 3d scene so that the patient becomes familiar with : the different floors, the bridge between two buildings … Then we start to enter the first building in order that she familiarizes herself with the interface. The exhibition and those that follow last around thirty minutes, for sessions lasting a total of 45 minutes.

During each exposure, I monitor that the anxiety level does not exceed 20-30% and I adapt the exposure so that this is the case. This first involves carrying out a mini-questionnaire at the beginning of the session to validate that the patient does not start the session with significant stress due to his day. I also check that the inter-session exercises have been done (relaxation exercises because it would be dangerous to let the patient expose himself to his phobias alone) Once these validations have been made, I define with the patient the “program” of his exposure. The goal is to do enough in terms of exposure while not going beyond its capabilities. It is also important to give the patient the feeling that he is in control of the level of difficulty he chooses (even if in reality I orientate according to what I know from the previous sessions). If I realize that the exposure is too strong, I can go back to the thumbnails of the summary to resume a simpler thread.

A very effective way to give patients confidence to support them virtually. Is to tell them, as practitioner that we are present in the scene virtually with them. I sometimes take the hand of patients in the real world (especially for the youngest) and tell them “I hold your hand, I am here, with you, I accompany you” to comfort them in the fact that I am present with them.

To measure the patient’s anxiety level and adapt the difficulty, my indicators are visual and verbal. I watch the expression on the lower face, the tension in the shoulders, the way the hands are clenched or not at the controllers, whether the patient is sweating or not. Besides the simple observation of the rib cage, of the breath, I sometimes use a device that allows me to measure the level of oxygen saturation and therefore if the patient is breathing properly or not (ideally I would like to have more biofeedback, in particular with a heart rate measurement).

Each session is concluded with a time of relaxation, close to what is done in hypnosis, in order to ensure that the patient leaves “well”, proud of himself with the feeling of having passed a stage. This moment is key to ensure that the patient has “come back” and to avoid a possible “anxious raptus”. To add to this feeling of well-being and reconnection, I often offer a glass of cool water on the way out.

To come back to the specific case of this patient, we have not officially decided at the end of the 6 sessions of the end of treatment. We agreed that she would contact me again if necessary. I have since received an email and a photo of her in the creeks telling me that she considered her healing to be “miraculous”, her quality of life being of better quality. This testifies to the success of the method implemented on this case of acrophobia.

Doctor Violaine Gubler

Child psychiatrist (Child, Adolescent, Young Adult up to 25 years) Specialized in the management of Attention Deficit Hyperactivity Disorder (ADD / HD) and Eating Disorders Neurofeedback Cognitive Remediation Neuro-nutrition





                    	

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