Mindfulness – Intervention Protocol

Intervention proposal

“All the information contained in this section is for guidance only. Psious environments are therapy supporting tools that must be used by the healthcare professional within an evaluation and intervention process designed according to the characteristics and needs of the user.

Also remember that you have the General Clinical Guide in which you have more information on how to adapt psychological intervention techniques (exposure, systematic desensitization, cognitive restructuring, chip economy…) to Psious environments.”

Mindfulness for adults

All the information contained in this section is for guidance only. Psious environments are therapeutic tools that must be used by the healthcare professional within a process of evaluation and intervention designed according to the characteristics and needs of the user.

An orientation protocol is proposed below on how to apply mindfulness through VR. This protocol includes psychoeducation and written instructions on how to apply mindfulness to daily life and its duration is eight weeks with a weekly session.

SESSION 1

The patient is offered information about the exercises he is going to perform, and is informed about the benefits of its practice.

Brief introduction to Mindfulness.

The proven effectiveness of Mindfulness through VR is explained.

Recommended protocol for the first session

Perform the virtual tour of the Conscious Walk environment so that the patient becomes familiar with the tool, only until the first exercise.

Perform the diaphragmatic breathing exercise or progressive muscle relaxation in a virtual environment of relaxation.

Discuss with the patient how they felt during the exercise and after it.

HOMEWORK

Mindfulness of routine activity.

SESSION 2

Perform the virtual tour of the Conscious Walk until completing the first two exercises.

Practice of diaphragmatic breathing or progressive muscle relaxation in a virtual environment of relaxation.

Discuss with the patient how they felt during the exercise and after it.

Body exploration (body scan).

HOMEWORK

It is recommended that the patients write down on the dossier how they have felt before and after performing the exercises (self-registration of relaxation/meditation), in order to discuss them with the healthcare professional in the next session.
Put into practice the Mindfulness technique daily

SESSION 3

Perform the complete virtual tour of Conscious Walk (using the stop option whenever is necessary).

Practice of diaphragmatic breathing or progressive muscle relaxation in a virtual environment of relaxation.

Discuss with the patient how they felt during the exercise and after it

Body exploration (body scan).

Discuss the relaxation/meditation self-registration chart with the patient in order to solve any difficulties that may arise when practicing the exercises.

HOMEWORK

It is recommended that the patients write down on the dossier how they have felt before and after performing the exercises (self-registration of relaxation/meditation), in order to discuss them with the healthcare professional in the next session.
Perform mindfulness exercises daily.

SESSION 4

Perform the partial virtual tour of the Spring Summer environment only until Spring is completed.

Practice of diaphragmatic breathing or progressive muscle relaxation in a virtual environment of Relaxation.

Discuss with the patient how they felt during the exercise and after it.

Body exploration (body scan).

Discuss the relaxation/meditation self-registration with the patient in order to solve any difficulties that may arise when practicing the exercises.

HOMEWORK

It is recommended that the patients write down on the dossier how they have felt before and after performing the exercises (self-registration of relaxation/meditation), in order to discuss them with the healthcare professional in the next session.
Perform mindfulness and relaxation exercises daily.

SESSION 5

Perform the complete virtual tour of Spring Summer.

Practice of diaphragmatic breathing or progressive muscle relaxation in a virtual environment of Relaxation.

Discuss with the patient how they felt during the exercise and after it.

Body exploration (body scan).

Discuss with the patient the self-registration of relaxation/meditation in order to solve any difficulties that may arise when practicing the exercises.

HOMEWORK

It is recommended that the patients write down on the dossier how they have felt before and after performing the exercises (self-registration of relaxation/meditation), in order to discuss them with the healthcare professional in the next session.
Perform mindfulness and relaxation exercises daily.

SESSION 6

Perform the mindfulness exercise in the relaxation environment Under the sea guided by the healthcare professional.

Practice of diaphragmatic breathing or progressive muscle relaxation in the same environment.

Discuss with the patient how they felt during the exercise and after it.

Body exploration (body scan).

Discuss with the patient the self-registration of relaxation/meditation in order to solve any difficulties that may arise when practicing the exercises.

HOMEWORK

It is recommended that the patients write down on the dossier how they have felt before and after performing the exercises (self-registration of relaxation/meditation), in order to discuss them with the healthcare professional in the next session.
Perform mindfulness and relaxation exercises daily.

SESSION 7

Perform the exercise of mindfulness in the environment of relaxation Under the Sea (the patient alone, without the help of the healthcare professional).

Practice of diaphragmatic breathing or progressive muscle relaxation in the same environment.

Discuss with the patient how they felt during the exercise and after it.

Body exploration (body scan).

Discuss with the patient the self-registration of relaxation/meditation in order to solve any difficulties that may arise when practicing the exercises.

HOMEWORK

It is recommended that the patients write down on the dossier how they have felt before and after performing the exercises (self-registration of relaxation/meditation), in order to discuss them with the healthcare professional in the next session.
Perform mindfulness and relaxation exercises daily.

SESSION 8

Body exploration (body scan).

The initiation into mindfulness is concluded: reflections on the practice, conclusions, how to apply what was learned into daily life.

The therapeutic process is evaluated and future relaxation and meditation tasks are programmed.

Mindfulness for children

Proposal of psychological intervention for children based on Mindfulness and Virtual Reality.

Mindfulness can be used as a tool in the intervention for the treatment of different difficulties linked to mental health or to improve abilities and capacities in individuals with no psychopathology. Currently, there is still little empirical validity about the use of Mindfulness in children and adolescents. According to Zoogman et al (2015), “mindfulness seems to be a promising intervention modality for young people. Although to date most of the studies on mindfulness with young people generally involve healthy participants recruited in schools, the findings of this metaanalysis suggest that future research could focus on young people in clinical settings and on the symptoms of psychopathology”. Because of all of this, it must be the healthcare professional who decides how to apply the mindfulness technique through the tool that constitutes virtual reality (VR). We recommend the decision process to be carried out according to the characteristics of each patient and the therapeutic objective established from the evaluation.

In what follows, there is an illustrative protocol about how to apply mindfulness through VR in minors. This protocol includes each of the VR environments, with their pertinent therapeutic objectives and the considerations to be taken into account before using them. A closed intervention protocol has not been established, thus leaving the selection, the order of presentation, number of repetitions, etc. of each one of the possible mindfulness activities applied by VR in children from 6 to 12 years old in the hands of the health worker.

Description of treatment sessions

Intervention general dynamic

Information is offered to the patient about the exercises they are going to perform and about the benefits of their practice. Each activity has specific objectives; it is advisable to explain them to the patient before performing them.

Perform participant modeling of abdominal breathing exercises (see audios in section 8 of the manual), prior to launching the setting (especially in the first sessions). In the following ones, only a brief reminder will be necessary.

At the beginning of the intervention, in order to familiarize the child with the virtual environment, it is recommended to activate this environment (playing the general viewing window, without activating any event yet) so that the child can explore freely and observe what is around (in this case, he will appear at the beginning of the Winter scenario). This will favor that he can ask us questions, that we ask what he sees, how he feels, etc. Once this part of the environment has been explored, the desired event will be activated according to the therapeutic objective. In the beginning, it is recommended that the sessions be initiated by the introductory activity of the station intended to work on and that the desired exercise (event) of the corresponding station is subsequently performed (activated). For example, starting with the Winter introduction and then moving on to the House or Lighthouse activity, without having to follow a chronological order.

Use the stated objectives as a reference and remember that the same activity can be repeated several times to favor training.

Finish activities with the breathing exercise and with the programming of homework, by means of some example and/or preparation of activity.

WINTER ENVIRONMENT	ATTENTION EXERCISES – ATTENTION FOCUSING
Objective	Previous preparation
Winter introduction	Focus on the breath and sounds of the environment	Modeling abdominal breathing. Introduction to attention, what it is, how we use it, etc.
House	Pay visual and auditory attention to the environment, divert attention from thoughts and direct it towards the activity: Visual: attention to the smoke of the house. Auditory: attention to sound (especially music and wind).	Tell the patient that after the exercise he will talk about what he has seen (smoke from the house, stars, snow, animals…).
Lighthouse	Changing the focus of attention from one sound to another: from the music to the sound “little sparkles” effect. Change of the focus of attention from a sound to an image (the aurora borealis).	Indicate that there will be different sounds and that he has to pay attention and detect the changes!
Winter end	Five cycles of abdominal breathing. Preparation of activities for home	Prepare a song to listen to with the patient to train in consultation what is proposed to do with him during the week: listen to a song and change the focus of attention from instruments, to notes, to the lyrics of the song, etc. Work after the VR session.

AUTUMN ENVIRONMENT	EXERCISES OF JOY – GENERATION OF NICE EMOTIONS
Objective	Previous preparation
Autumn introduction	Focus on the breath and sounds of the environment.	Having talked with the child about a pleasant memory that happened with someone close to them, parents, a friend, grandparents …
Pinwheel	Focus attention on the sound and movement of the pinwheel, as well as on the “memory” of the loved ones the child has in their life. Activate, manage and amplify pleasant emotions.	Having talked with the child about a pleasant memory that happened with someone close, parents, a friend, grandparents …
Projection of joy	Focus attention on physical discomfort as a result of emotional distress caused by a discussion, a problem with a family member or partner, etc. Train the ability to generate pleasant emotions in relation to an unpleasant situation. Avoid/manage the appearance of aggressive thoughts towards that person.	Having talked with the child about some unpleasant memory that happened recently with someone close to him (parents, friends, grandparents…).
Autumn end	Generation of pleasant emotions through the memory of lived situations in which he has felt joy, affection Five cycles of abdominal breathing. Preparation of activities for home.	Talk about some pleasant past experience or about one that the patient would like to live, in which he has laughed out loud, there have been affectionate hugs… At the end of the VR session, prepare one or several notes with secret messages for family, friends or any other loved one.

SUMMER ENVIRONMENT	EXERCISES OF ENERGY – IDENTIFICATION AND MANAGEMENT OF EMOTIONAL STATES
Objective	Previous preparation
Summer introduction	Focus on the breath and sounds of the environment.	Modeling abdominal breathing. Introduction to what are the emotional states.
Magical objects	Attention focus. Imagery and visualization to favor activation.	Work control of thoracic and clavicular breathing to promote activation. Choose, with the child, a superhero position that he will put into practice in order to “recharge energy” within the VR environment.
Recharge energy	Identification of emotional states (positive and negative energy)	Talk with the child about the emotional states, about the fact that us feeling one way or another makes us feel “strong” or “weak”, with or without “energy” (e.g.: “Joy loads us the batteries…, sadness unloads us … “). Play with nonverbal behavior to reflect postures with energy and without energy
Summer end	Detection of own and other’s emotional states (parents, siblings, teachers…). Five cycles of abdominal breathing. Preparation of activities for home.	Talking about how being in certain places makes us feel good, (e.g.: “In which places do you feel very good?”; “What things, objects, activities of those sites help you to charge the batteries”?; “Look at the surroundings, at the ruins and imagine how the energy flows towards you and loads your batteries …”). Work on what kind of bodily sensations tell us that we are “charged” or “discharged” of energy. Help the child to recognize them.

SPRING ENVIRONMENT	EXERCISES OF RELAXATION – CONTROL OF ACTIVATION
Objective	Previous preparation
Spring introduction	Focus on the breath and sounds of the environment	Modeling abdominal breathing. Introduction to what it is to relax …
River	Management of emotional cognitive discomfort. Let go of unpleasant thoughts.	Talk about thoughts and how they may be related to the emotional state. Explain how the management of thoughts can help regulate emotions.
Light of energy	Visualization and muscle relaxation exercise.	Muscle relaxation modeling. Make some kind of body screening by imagery-visualization (imagine a “light” that runs through the body) to detect the discomfort and “letting it go”.
Spring end	Promote a state of relaxation through autogenous auto instructions of relaxation, height, and lightness… Five cycles of abdominal breathing. Preparation of activities for home.	Discuss how we can generate sensations of heat, lightness, heaviness, etc., in our own body. For example, do an exercise (modeling) of how your hand can become light as a feather (autogenic training).