Gray’s neurobiological model

Psychoeducation is done during the first group therapy session and consists of explaining the patterns of anxiety for patients who are phobic, have OCD, or have generalized anxiety disorders. The models help explain the causes and mechanisms of anxiety, the goal is to get patients to understand what is going on in their brains. Ignorance leads to fear. In group therapy, it is important to establish a dialogue with your patients and to set up an exchange, giving patients the opportunity to participate as often as possible. In this article, we will look at Gray’s neurobiological mode and its implication in anxiety, phobias and OCDs.

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1. THE FIRST STEP: THE SITUATION

According to Gray’s model the first step is the situation. This is the time for the first question to be asked of patients: “Give me a situation that scares you?” (patient answers).

When you are in this situation … (stated by candidates) that you consider threatening, you make a primary assessment of the danger present in the situation. Continue the dialogue:”When you are faced with dangers… (listed according to the fears stated) what do you pay attention to ?” Patients will pay attention to the elements present in the situation, generally related to the danger. For example, the ventilation grids in the elevator for patients suffering from claustrophobia, the expression of the hostess and the exits for aviophobes etc..

This primary evaluation is possible thanks to a functional entity of the brain: BIS (Behavioral Inhibition Systeme) It is this system in the brain that will provoke anxiety, an increase in vigilance, and it is this entity that will provoke a secretion of adrenalin at the level of the suprarenal medulos, these are glands situated above the kidneys. This adrenaline will cause symptoms, make them talk about their symptoms:” What are your symptoms ? ”(patients answers) everything you described to me: increased sweating, heart rate, muscle tone etc… 

2. THE REALIZATION OF THE FFS ACTION

Once the situation has been assessed, according to Gray’s model, the patient carries out an action called Fight or Fly System (FFS). He will have two choices: either he fights and stays in the situation, or he will choose flight to avoid the situation. New question to ask: “What do you do?” (patients answers).

Most of them usually avoid the situation. Some may say that they have confronted the situation, but forcing themselves to do so is not helpful in therapy because it will reinforce the conditioning and cause bad memories. 

Anxiety exists in all people and all mammals and is the result of millions of years of evolution. : “What do you think anxiety is for?” (patients answers)

Anxiety was created by evolution to protect itself, it is a mechanism of protection of the individual. Anxiety was present in human beings 20 000 or 30 000 years ago. New question: ”Where your ancestors lived ?” (patients answers) Our ancestors lived in hostile environments, to survive they needed a system that allowed them to react quickly to dangers and this system is anxiety. It is thanks to anxiety that our species has been able to live until now. Anxiety serves to protect us. Take the symptoms your patients mentioned earlier, for example, if the symptoms are increased heart rate:“ Why does your heart beat fast?” (patients answers)

The heart speeds up to bring more oxygen and sugar into the body because it needs it, if we take the survival model of the ancestors, the increase in heart rate served in case of a fight with a bear to give the body superhuman energy. The symptoms caused by anxiety are therefore preparations for action.

3. AN EXAMPLE ON ANXIETY

New question : “Give me an example in which anxiety saved a life?” (patients answers) Angela Cavalo is an American who lived in the 80s. She saved her son’s life by lifting a Chevrolet Impala. Her son was repairing it, had set up trestles allowing him to be under the car. The trestles gave way and began crushing her son. Angela realized the situation, did her primary assessment, her heart beat very fast, she started to sweat. Angela lifted the car and saved her son. Anxiety gave her superhuman strength that saved her son.

Discover Beck’s cognitive model, and the Barlow’s cognitive model  

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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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