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.



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.



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.  




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.


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.



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.



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 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.



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? 



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? 



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. 



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. 



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.



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. 



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. 




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