Self-affirmation: communication technique

Today, we are going to discuss an essential element of cognitive-behavioral therapy applied and enhanced by virtual reality: assertiveness. Which of your patients will be concerned by this type of technique? It is mainly patients who suffer from social phobias. So often, those who have difficulty speaking in public, those who are afraid to express themselves, those who are afraid to say “no” or those who do not dare to assert their point of view.

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1. COGNITIVE-BEHAVIORAL THERAPY

Today, we are going to discuss an essential element of cognitive-behavioral therapy applied and enhanced by virtual reality: assertiveness.

Which of your patients will be concerned by this type of technique? It is mainly patients who suffer from social phobias. So often, those who have difficulty speaking in public, those who are afraid to express themselves, those who are afraid to say “no” or those who do not dare to assert their point of view. It is really important to distinguish between introspective and shy people, because being introspective is not a pathology at all. Shyness is a normal personality trait that should not be corrected because it is simply not a disease. Where you need to intervene is when the person is suffering from the psychological pain of social phobia.

2. PSYCHOLOGICAL DISTRESS FROM SOCIAL PHOBIA

This psychological suffering of social phobia is precisely that the person is afraid of being badly judged by others, is afraid that they will be found stupid, idiotic, ugly, badly made up etc… The person is therefore suffering and as a result will have difficulty expressing themselves. Their self-confidence in terms of communication being very low, they will tend to say “yes” to everything. This person will not be able to express his desires or his needs.

3. HELPING YOUR PATIENT TO REDUCE HIS SUFFERING BY FINDING A BALANCE

To help your patient, you can offer him many tools present in cognitive-behavioral therapy associated with virtual reality. One of the major tools for social phobia is “self-affirmation”. 

What is self-affirmation? Well, it’s a balance in expression and communication. It’s about helping your patient express their needs, but without overwhelming others. The goal is not for him to express himself aggressively or to assert himself by crushing others, but to assert his needs while listening to the needs of others. To sum up; help him find the balance in communication. 

We are going to cover three different parts of self-affirmation so that you can teach your patients this technique in the most comprehensive way possible. In this article, we will detail the basics of this technique so that you have a good foundation. You are then free to add other elements or to improvise.  

4.COMMUNICATION TECHNIQUES

Non-verbal aspect of communication

- Hand to mouth expression

The first thing that is important are the communication techniques or in other words: how to communicate your point of view, your thoughts, your ideas. There are two aspects to distinguish: the non-verbal and the verbal aspect.

The non-verbal aspect concerns the expression of the body. You must tell your patient that when he expresses himself, he must think of using his hands, because they will help him to get the words out. Don’t hesitate to do things the “Italian way” and get your ideas out using your hands. Help your patient, for example, with the virtual reality environment in a lecture hall to coordinate hands and words. As the session progresses, your patient will become better at coordinating this expression.

- Mimics

Facial expression, the mimicry, is the second important thing that we will discuss with you and that we advise you to discuss with your patient.
It is good for the patient to listen to the conversation that is going on and to vary their expressions. If, for example, he hears funny things, it is important that there is a mimicry with joy. Or that when a good news is expressed to him, that a smile appears, that the eyebrows move and that the cheeks are in movement. It must be congruent. That is, completely in harmony with the conversation. Obviously, you should not smile if you are announcing a death or at a funeral. In these situations, one should expect the patient to make facial expressions that evoke a feeling of sadness. Facial expression is a very important part of communication.

- Distance

Another important element in non-verbal communication is distance. When you speak in front of a person, you need to keep a distance of about 1 or 2 meters so as not to be too aggressive. If your patient stands too close, he will appear brutal and on the contrary, too far away, he will appear distant and cold. Maintaining a good distance is therefore essential for good communication.

- Body control

For social phobics or even for the youngest of your patients, making speeches, getting on the board, giving an interview or expressing themselves in professional meetings is a big problem. It is up to you, in particular, to accompany them in learning to control their body. Your patient should not be slouching or stooping in these situations. They should let their body express itself by maintaining a relatively upright but relaxed position. 

- The eye contact

The eyes are also important. The patient must be able to look at the other person, but again with a certain balance. The idea is to tell your patient that he is looking at the other person but, of course, without staring either. You look at the other person for about 90% of the time. It is important that the patient does not look away from the other person, but rather that he looks at the person in front of him/her in a tempered way.

Aspect of the communication

Let’s move on to the verbal part of the communication technique. How should your patient express himself in a business meeting, in a classroom, in an evening party, so that the communication of his needs and ideas can be properly conveyed ? 

- Curiosity and interest

The first thing to advise your patient is to be curious and interested. This means that in a conversation, your patient really needs to listen to the person in progress to properly introduce a topic and show curiosity. He needs to make the other person feel interested, for example, by first asking questions. Social phobics often don’t know what to say or to do. To fight this, just tell them to start by asking very very simple and banal questions. They can practice asking these questions with you, but also and especially in front of virtual reality avatars with C2Care environments. Typical questions are: what did you do this weekend? what did you plan for your vacations? what movie did you watch recently? 

- Listening

Then, apart from curiosity and interest, it is important to listen. Listen carefully to what is being said in order to gather information that will be useful for the conversation. If he has listened well to his interlocutor, who, for example, appreciates tapestries or sports, he will be able to ask appropriate questions: why do you like to do tapestries? what do you like about surfing? Good listening skills will enable your patient to pick up on elements mentioned by the interlocutor and then to discuss a subject of interest to him. 

- Introducing a topic

Besides knowing how to listen, it is important to know how to introduce a subject when you have ideas. Having ideas is good, but it is just as interesting to take the time to observe your interlocutor. The patient has listened to him, the patient has asked him questions, but he can also observe how the other person is acting because this can give him clues to the questions your patient may ask. For example, if he sees that the person is wearing a cap with the effigy of the OM (the Marseille soccer team), he will be able to bounce on this element and thus ask questions: “I see that you have a cap of the OM. Tell me, what do you like so much about this team? What did you think of their last game against PSG?

The fact of observing the interlocutor attentively already allows the patient to have a lot of questions to ask and to introduce a conversation. Social phobics find it difficult to introduce a conversation, but observing the person they are talking to (clothes, handbag, watch, etc.) will help them to start a conversation.

Dr. Malbos tells us an interesting story: in the hospital cafeteria, he met a young lady wearing a pink watch, pink make-up and a pink T-shirt. Dr. Malbos went to meet her and commented on her outfit, which then led to a discussion. 

- Giving compliments

The other way through observation is to give compliments. This is an excellent way for a social phobic to start a conversation or to introduce a subject. Be careful, you must tell the patient that he must not flatter, because the goal is not to lie, but on the contrary to share his positive thoughts. Observation is therefore very important. If, for example, the person is well-dressed, your patient can compliment the outfit. “That skirt with that jacket, it’s really elegant”, “Your tie is really nice, you must have chosen it carefully”. Obviously, this is going to be a good way to introduce a topic. Moreover, from a psychological point of view, everyone likes compliments. This compliment will touch the positive thinking and the ego of the interlocutor, making him more willing to start a conversation. It is therefore an excellent way for social phobics to start an exchange. Complimenting is a great way to maintain or introduce a conversation.

Overcoming a blockage

Once your patient has all of these elements, he will probably ask you the following question: How do I find a topic? When I am in front of people in a meeting or even in a bar, I don’t know what to say. I get stressed, my hands get sweaty, I get stuck, I can’t think of anything to say. 

Well, at that point, you can advise your patient to go to news sites the day before the meeting or bar date. Have them check out what’s going on in the world and select articles on interesting topics such as unusual, funny, scientific news…etc. The idea is that he can read them and learn them. Even if he wants to learn them by heart, it’s not a big deal, it’s even recommended. In fact, when he is very anxious, he will not remember the articles he has read. The fact that he learns them by heart or at least reads them with great attention will help him, the next day, to throw them into a conversation. 

Introducing current topics

But how do you introduce these topics of current interest? The patient can’t just say “I saw some funny kangaroos in Australia”, it won’t work, people won’t pay attention to him. The patient must introduce the subject with a question. Your patient could, for example, say: did you see all those kangaroos in Australia? or: have you ever seen kangaroos in Australia? 

Inevitably, the interlocutor will appreciate this question which shows that he is interested and will therefore answer. “No, no, I have never seen any. What happened with those kangaroos in Australia?”. This is where the patient will be able to introduce the subject. 

Laughter and smiles are important. If your patient hears a joke during the evening, of course, laughing is important. These news and current affairs topics of conversation will need to be said with a smile, so avoid having a cold face. The patient will be able to practice expressing this news with something that is a bit warm, a friendly expression. 

If in the conversation your patient has to face a disagreement, he should not hesitate to concede. Assertiveness is not about being aggressive, it is also about understanding that sometimes you are wrong and therefore making concessions. 

We have just seen together, thanks to Dr Malbos, the non-verbal and verbal techniques. Combined together, these techniques are an excellent ally for your patient and his affirmation. They can be practiced in virtual reality and then, once your patient is ready, in real life. 

Do you need further information or have any specific questions ?

FAQ

Virtual reality (VR) is an innovative technology that enables patients to be exposed to immersive and controlled environments, facilitating the management of numerous psychological and psychiatric disorders. Its use in mental health offers several advantages:
  • Gradual and Controlled Exposure: VR allows patients to confront anxiety-inducing situations in a secure environment, gradually adjusting the intensity of stimuli to promote habituation and emotional regulation.
  • Realistic and Reproducible Environments: Unlike traditional techniques, VR provides immersive scenarios that can be consistently reproduced, ensuring a coherent and effective approach.
  • Increased Patient Engagement: The interactive and immersive nature of VR enhances treatment adherence and motivates patients to continue their therapy.
  • Personalized Treatment: Virtual environments can be adapted to meet the specific needs of each patient.
  • Versatile Applications: VR is used to treat anxiety disorders (phobias, post-traumatic stress disorder, obsessive-compulsive disorders), addictions, mood disorders, and even cognitive remediation.
The use of virtual reality in healthcare is not new! It has been studied and utilized for over 30 years in the medical and psychological fields. As early as the 1990s, researchers began exploring its potential for treating anxiety disorders, particularly phobias and post-traumatic stress disorder. Since then, numerous scientific studies have confirmed its effectiveness in addressing various psychiatric, neurological, and cognitive disorders.
Today, VR is widely integrated into therapeutic and medical practices, with clinically validated protocols. It is used in hospitals, clinics, and psychologists' offices worldwide to provide patients with innovative, effective, and safe treatments.
To use virtual reality, one must immerse themselves in a virtual environment. There are several ways to achieve this.
In the past, the CAVE system (Cave Automatic Virtual Environment), a 3D setup consisting of multiple screen walls, was the primary method used. This system allowed users to be fully immersed in the virtual world, with their movements detected in real-time. However, this technology was expensive and not widely accessible.
Since around 2016, with the introduction of virtual reality headsets like the Oculus Rift and HTC Vive, VR has become much more accessible. These headsets immerse users in virtual reality through an enclosed screen that projects digital images. The user's head movements are tracked, enabling them to look around and interact with the environment as they would in the real world.
Today, VR headsets are wireless and standalone, providing maximum comfort and ease of use without requiring external sensors or cables.
A virtual environment is an immersive digital simulation created through virtual reality. It allows users to navigate in a 3D space that accurately replicates everyday situations or specific contexts.
In mental health, these environments are designed to help individuals gradually face certain situations, manage their emotions, or enhance cognitive skills. By interacting with these virtual spaces, patients can engage in meaningful experiences tailored to their needs.
You need to equip yourself with a virtual reality headset. Our software is compatible with Meta Quest 2, 3, and 3S. 
You will then only need an internet connection. 
Numerous studies confirm that virtual reality is safe to use. However, some restrictions are in place to protect users from potential adverse effects.
For instance, individuals with epilepsy and pregnant women should avoid this type of therapy.
As with any immersive technology, prolonged use may cause visual fatigue or mild discomfort, particularly for those sensitive to motion sickness. Therefore, it is recommended to take regular breaks and adjust session durations according to individual needs.
Virtual environments are designed to be gradual and controlled, minimizing the risk of excessive anxiety. Most users quickly adapt to immersion and experience the benefits of this innovative approach from the first sessions.
Anxiety disorders and phobias can be effectively treated using virtual reality. Patients are gradually and progressively exposed to anxiety-inducing situations in various environments while remaining in a safe space. This process helps develop a sense of habituation, ultimately reducing or even eliminating anxiety over time.
Behavioral and substance addictions can also be addressed through virtual reality. By incorporating synthetic stimuli into the environments that trigger craving responses, patients struggling with addiction can work on their cravings to diminish the urge to consume.
Additionally, multiple environments—such as bars, casinos, and social settings—enable cognitive work on dysfunctional beliefs associated with specific temptation scenarios.
Regarding eating disorders, virtual reality software helps target key etiological factors, such as body dysmorphia, allocentric lock (a tendency to focus on others rather than oneself), and food cravings.
Currently, our TERV (Virtual Reality Exposure Therapy) solutions include multiple software programs designed to address critical psychiatric, psychological, and neuropsychological determinants such as relaxation, cognitive stimulation, behavioral activation, and social skills training.
Reminiscence therapy is also a major therapeutic tool in treating depression. By allowing patients to relive sensations linked to past pleasurable activities (such as sports, driving, or traveling), virtual reality stimulates hypoactive brain areas, enhancing therapeutic success. VR serves as an excellent mediator for reigniting engagement in enjoyable activities.
Moreover, cognitive stimulation for elderly individuals is another area where virtual reality proves beneficial. By leveraging technology to make stimulation activities more engaging and accessible, patients and nursing home residents can improve executive functions and memory through specially designed applications.
Today, virtual reality in mental health care is advancing rapidly. Researchers, clinicians, and developers continue to explore new therapeutic targets to offer innovative and effective treatment solutions in the near future.
VR can be used by all healthcare professionals assisting patients with anxiety, phobias, post-traumatic stress disorders, addictions, or other psychological challenges.
It is particularly beneficial for psychologists, psychiatrists, neuropsychologists, specialized nurses, as well as psychomotor therapists, physiotherapists, dietitians, sophrologists, and hypnotherapists. With a wide range of immersive environments, VR enhances therapeutic approaches and provides innovative tools to improve patient care.
Healthcare providers incorporating virtual reality exposure therapy (VRET) expand their range of treatment options. VRET is a well-established therapeutic technique with scientific validation from cognitive-behavioral therapy research.
  • Professional Differentiation: Integrating VR into practice allows therapists to stand out from traditional treatment options.
  • Scientific Validation: VRET is backed by extensive research, reinforcing its credibility as an effective treatment method.
  • Improved Patient Engagement: The interactive nature of VR fosters greater patient involvement in therapy.
  • Time-Saving: VR provides direct access to various exposure environments without needing external logistics.

One of the considerable advantages of virtual reality is that it is effective on a wide spectrum of populations. Existing data from the literature on the subject shows us that it is entirely possible to expose a wide age group to virtual reality, with real therapeutic benefits.

The studies attest, in fact, to excellent feasibility and significant results; particularly in adults, in the treatment of anxiety disorders (including school phobia), autism, addictions, eating disorders, neuropsychological disorders, psychotic disorders and mood disorders.

The results are identical for adolescents with a significant added value concerning therapeutic engagement where virtual reality promotes adolescents' interest in their therapy.

Among elderly subjects, study results encourage the use of virtual reality with the aim of working on cognitive stimulation, on behavioral disorders but also on anxiety.

One of the major advantages of virtual reality is its effectiveness across a broad spectrum of the population. Existing literature on the subject shows that virtual reality can be used with individuals of various age groups, providing significant therapeutic benefits.
Studies confirm excellent feasibility and significant results, particularly among adults in the treatment of anxiety disorders (including school phobia), autism, addictions, eating disorders, neuropsychological disorders, psychotic disorders, and mood disorders.
The results are equally promising for adolescents, with a notable advantage in terms of therapeutic engagement, as virtual reality enhances their interest and participation in treatment.
For older adults, research supports the use of virtual reality to improve cognitive stimulation, behavioral disorders, and anxiety management.
However, people with epilepsy and pregnant individuals are not advised to undergo this type of therapy.
Yes, all our environments are grouped within a single application.
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