The AWARE technique

Today we are going to talk about managing emotions and anxiety through the ACARA system. This technique is usually explained in the third session to anxious patients.

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1. THE AWARE ACRONYM

In your sessions, you need to establish a dialogue with your patients. Dr. Malbos suggests starting this session by asking a question: what is an acronym?

An acronym is a word made up of letters and each of its letters refers to a particular word. In our case, each of the letters is in fact a technique that you will teach to your patients.

2. A : ACCEPT THE ANXIETY

This is the key point of the whole therapy. Your patients must realize that anxiety is paradoxical. That is, the more they want to control the anxiety, the more it will increase. This is related to the fact that many of your patients are obsessed with the idea of control. They want to control themselves, control their emotions, control their anxiety, control others, control events…etc. But, as you already know, not everything is controllable and sometimes you have to let go. 

The point is that your patients need to understand that they can’t control their anxiety. And that the more they try to control it, the more it will increase. Your patients must make the choice to accept the anxiety. To accept the fact that their hands are sweaty, to accept the increase in their heart rate, telling themselves that the anxiety is there to protect them and that it’s not dangerous.

You have to let the anxiety come, let it be there and let it go. You can put your patients in a situation so that they assimilate this acceptance of anxiety. Tell them that they have to imagine themselves in the street with a young girl having a panic attack in front of them. What will your patients say to this young girl? Ask them. Many patients will probably say, “Calm down, everything is fine,” and they will be wrong! “Calm down” is an appeal to control, which should be avoided if you don’t want to make the situation worse. It is better to say to this girl, “I understand how you feel. Sit down if you want, I’ll stand by you. It’s going to be okay and it’s going to pass.”. This example of the young girl is exactly what patients need to do for themselves. 

ACCEPTABILITY VERSUS SUFFERING

If it rains today, will you be able to control the weather or will you accept the weather as it is? A person who is in resistance is going to brace himself, resist and will therefore suffer. Whereas a person who accepts the bad weather will enjoy his day with an umbrella on his head.

Another example of acceptability to avoid suffering is panic surfing. If anxiety was a six-foot Australian wave coming at you, would you stand up to it? No, if you care about your survival at all, you will dive under it and let it pass over your head.

3. C : WATCH YOUR ANXIETY

When your patients are anxious, they should measure their anxiety from 0 to 100. “A noisy subway station, sweaty hands, train doors closing behind me, the subway full of people, difficulty breathing: my anxiety level is at 60.” With these measurements, your patient will become aware that anxiety is always temporary. It rises, stagnates, and falls again.

4. A : ACT NORMALLY DESPITE THE ANXIETY

When the patient is anxious, he or she must continue to do what they were doing. Continue washing dishes at the sight of a spider, continue walking to an auditorium. Of course, your patient has the right to move slightly away from the sink or walk more slowly toward the crowd, but he or she should not stop what he or she was doing. Doing relaxation exercises to calm that anxiety is also taking action!

You can’t control your emotions and you can’t really control your thoughts. So ask your patients what is the one thing they can control? It’s behavior, in other words, gestures, actions. Even if your patients are anxious, if they want to keep moving towards the auditorium, physically, they can. Anxiety doesn’t cause as much chaos as they think it does.

ONE ACTION AT A TIME

There are two rules for your patients. The first is that when they are anxious, they should only do one thing at a time. This avoids distraction, which is not effective in the long run. When we drive, we only look at the road, we concentrate on each of our actions. We don’t talk to the passenger. Yes, it may calm the driver in the short term but not in the long term.

SLOW DOWN YOUR MOVEMENTS

When your patient is in an anxiety-provoking situation, ask them to slow down and break down their every move. Slowing down lowers anxiety and brings back calm. Conversely, rushing will make the anxiety worse.

5. R : REPEAT THE STEPS

Your patient simply needs to repeat the steps we just explained. They have to accept the anxiety, that is, not face it. The anxiety is not dangerous, it will pass, I just have to dive under the wave. They must then contemplate the anxiety. That is, measure it and finally realize that it is only temporary. Then they have to act on that anxiety. We only have control over our actions. By slowing them down and jerking them around, I don’t make my anxiety worse.

6. A : EXPECT THE BEST

This is the last letter of this ACARA technique. “Wait for the best” means that your patient should wait for the best. Since his catastrophic thoughts are not realistic (the plane is going to crash, the dog is going to bite me, I’m going to stay locked in the subway, I’m never going to get out of this elevator…etc.) they will never come true. Your patient can only expect the best, that is, what is realistic.

To make sure that your patients do not forget the ACARA method, Dr. Malbos advises them to write it down on a piece of paper and put it in their wallet. That way, if they get into a frightening situation and lose their nerve, they will always have this little card with them.

The AWARE method is often associated with slogan or  positiveself-instruction discover our article.

Discover Schultz relaxation 

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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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