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A usabilidade e aceitabilidade da terapia de exposição através da realidade virtual do medo de falar em público: estudo de caso único
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Abstract(s)
A glosofobia ou medo de falar em público é uma especificação da Perturbação de Ansiedade Social (PAS). A Terapia Cognitivo-Comportamental tem-se mostrado eficaz no tratamento da PAS através da Terapia de Exposição (TE). A TE pode ser realizada através de três modalidades: in vivo, na imaginação e através da Realidade Virtual (RV). A TE em RV, é considerada como uma modalidade intermédia entre a exposição por imaginação e a exposição in vivo. Diversos estudos têm mostrado a eficácia da TE aplicada através de RV na redução da glosofobia. Estes estudos recorreram, contudo, a softwares e/ou hardware dispendiosos e pouco acessíveis que não permitiam a aplicação generalizada em contexto clínico. Hoje em dia, estão disponíveis, no mercado, software e hardware de RV muito acessíveis que podem ser utilizados em qualquer ambiente clínico apenas com recurso a um smartphone. Objetivo: O presente estudo teve como objetivo avaliar, através de um desing de caso único, a usabilidade e aceitabilidade de um programa de Terapia de Exposição, aplicado com recurso a um programa de software livre de RV e equipamento acessível a qualquer psicólogo clínico, na redução do medo de falar em público. Método: Foram seguidas as guidelines do artigo de Tate e colaboradores (2016) como design de caso único do tipo AB. Foi avaliado o medo de falar em público, o medo da avaliação negativa, a ansiedade e evitamento em situações de desempenho e interação social, antes e depois da aplicação da TE; a usabilidade e aceitabilidade depois das sessões; e a ansiedade, a frequência cardíaca, os pensamentos e o senso de presença durante a aplicação da exposição. Resultados: As pontuações das escalas de autorrelato do medo de falar em público e da ansiedade e evitamento tiveram uma redução significativa. Já a medida do medo de avaliação negativa teve redução, porém não foi significativa. O nível de ansiedade foi reduzido nos itens da hierarquia de exposição e a participante obteve um bom nível de senso de presença. Já o escore do Questionário de Usabilidade e Aceitabilidade (SUS) foi considerado bom e aceitável, de acordo com o artigo de Bangor e Miller (2009). Conclusões: O estudo teve uma boa eficácia na intervenção na RV, porém, por ser um estudo de caso único, não é generalizável e adequado para comprovar a eficácia com precisão. Com isso, estudos futuros são necessários, principalmente com uma amostra maior.
Glosophobia or fear of public speaking is a specification of Social Anxiety Disorder. The Cognitive-Behavioral Therapy has been shown to be effective in the treatment of Social Anxiety Disorder through Exposure Therapy (ET). ET can be performed through three modalities: in vivo, imaginal and through Virtual Reality (VR). ET in VR is considered as an intermediate modality between imaginal and in vivo exposures. Several studies have shown the effectiveness of ET applied through VR in reducing glosophobia. These studies, however, used expensive and inaccessible software and / or hardware that did not allow general application in a clinical context. Today, however, very affordable VR software and hardware are available on the market that can be used in any clinical setting when combined with a smartphone. Objective: The present study aimed to evaluate, through a single case design, the usability and acceptability of an Exposure Therapy program, applied using a free VR software program and equipment accessible to any clinical psychologist, in order to reduce the fear of public speaking. Method: The guidelines of the article by Tate and collaborators (2016) were followed as a single case design of type AB. Fear of public speaking, fear of negative evaluation, anxiety and avoidance in situations of performance and social interaction, before and after the application of ET were evaluated; usability and acceptability after sessions; and anxiety, heart rate, thoughts and sense of presence during exposure. Results: The scores of the self-report scales for fear of public speaking and anxiety and avoidance had a significant reduction. The measure of fear of negative evaluation was reduced, however, not significantly. The level of anxiety was reduced in the items of the exposure hierarchy and the participant obtained a good sense of presence level. The score of the Usability and Acceptability Questionnaire (SUS) was considered good and acceptable, according to the article by Bangor and Miller (2009). Conclusions: The study had a good effectiveness in the intervention in VR, however, as it was a single case study, it was not generalizable and adequate to prove the effectiveness with precision. Thus, future studies are needed, especially with a larger sample.
Glosophobia or fear of public speaking is a specification of Social Anxiety Disorder. The Cognitive-Behavioral Therapy has been shown to be effective in the treatment of Social Anxiety Disorder through Exposure Therapy (ET). ET can be performed through three modalities: in vivo, imaginal and through Virtual Reality (VR). ET in VR is considered as an intermediate modality between imaginal and in vivo exposures. Several studies have shown the effectiveness of ET applied through VR in reducing glosophobia. These studies, however, used expensive and inaccessible software and / or hardware that did not allow general application in a clinical context. Today, however, very affordable VR software and hardware are available on the market that can be used in any clinical setting when combined with a smartphone. Objective: The present study aimed to evaluate, through a single case design, the usability and acceptability of an Exposure Therapy program, applied using a free VR software program and equipment accessible to any clinical psychologist, in order to reduce the fear of public speaking. Method: The guidelines of the article by Tate and collaborators (2016) were followed as a single case design of type AB. Fear of public speaking, fear of negative evaluation, anxiety and avoidance in situations of performance and social interaction, before and after the application of ET were evaluated; usability and acceptability after sessions; and anxiety, heart rate, thoughts and sense of presence during exposure. Results: The scores of the self-report scales for fear of public speaking and anxiety and avoidance had a significant reduction. The measure of fear of negative evaluation was reduced, however, not significantly. The level of anxiety was reduced in the items of the exposure hierarchy and the participant obtained a good sense of presence level. The score of the Usability and Acceptability Questionnaire (SUS) was considered good and acceptable, according to the article by Bangor and Miller (2009). Conclusions: The study had a good effectiveness in the intervention in VR, however, as it was a single case study, it was not generalizable and adequate to prove the effectiveness with precision. Thus, future studies are needed, especially with a larger sample.
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Keywords
Ansiedade social Terapia de exposição Realidade virtual Medo de falar em público Caso único