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Relax – 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.”

How to apply the relaxation techniques  

Psious has 5 environments that allow working on the diaphragmatic breathing and progressive muscle relaxation: 

  1. Specific Environments
    Especially designed to practice different exercises 
    • Diaphragmatic breathing
      • Breathing exercise in the meadow.
      • Breathing exercise under the sea.
    • Progressive muscular relaxation
      • Jacobson relaxation exercise
  1. Free Environments
    Relaxing natural spaces where the patient can practice every relaxation technique at the discretion of the healthcare professional (Island and Under the Sea).

The specific environments are especially convenient to begin with the relaxation practice, since the visual support eases the learning process. As the learning progresses, it is recommended to progressively remove both the visual and the audio support available, in addition to generalizing it to the free environments or the ones corresponding to a specific treatment. Therefore, we suggest the following training sequence for every technique:

  1. Specific environment practice: with visual and audio support.
    • Breathing exercises: 3D elements and audio. 
    • Jacobson’s exercise: virtual coach and audio
  1. Specific environment practice: no visual or audio support either.
  1. Free environment practice:
    • Audio instructions (diaphragmatic breathing and progressive muscular relaxation) might be used first.
    • No audio instructions
  1. In the case of relaxation techniques being trained in the context of a specific disorder treatment, the next step would be the generalization of such techniques into the corresponding environment. For instance, in the case of agoraphobia, relaxation should be performed in such virtual environment in order to apply the learnt techniques
    • With the audio guide
    • No audio instructions

Psious-Based treatment protocol

Protocol for the application of VR relaxation techniques. Psychoeducation is included and combines VR relaxation in consultation with your home practice. It is recommended that the healthcare professional adapt and implement relaxation strategies to each patient’s needs and to the program.

SESSION DESCRIPTION
SESSION 1: PSYCHOEDUCATION AND MUSCULAR TENSION DETECTION 

Before starting the exercise:

  • Exercises to be used throughout the treatment and their benefits are explained. 
  • Explain the proven effectiveness of relaxation techniques through virtual reality. .

RECOMMENDED PROTOCOL

  • Introduction to Jacobson relaxation technique: foundations and procedure.
  • Practice using the Jacobsons exercise virtual environment (muscular discrimination):
  • Audio instructions and virtual coach ON
  • Optional intro ON.
  • Performance by muscle groups(hands-face-neck-body-legs-final).
  • Discuss with the patient how he or she felt during the exercise. 
  • Comentar con el paciente cómo se ha sentido durante el ejercicio.

HOMEWORK

  • Handing over psychoeducation bibliographic support.
  • Carrying out a tension-relaxation cycle before going to sleep.
  • Filling in the relaxation self-recording ( Annexes).
SESSION 2: JACOBSON’S  EXERCISE AND DIAPHRAGMATIC PRAGMATIC BREATHING

Before starting the exercise:

  • Review of homework and previous session.

RECOMMENDED PROTOCOL

  • Practice using the Jacobsons exercise virtual environment (muscular discrimination):
  •  Audio and virtual coach ON. 
  • Complete
  • Explaining the foundations of diaphragmatic breathing.
  • Practice diaphragmatic breathing in any of the specific virtual environments.
  • Audio ON.
  • 3D object.
  • Minimum-length inhalation and exhalation.

HOMEWORK

  • Practicing Jacobson’s exercise.
  • Filling in the relaxation self-recording ( Annexes).
  • Carrying out a 10-breath cycle before going to sleep.
SESSION 3: JACOBSON’S EXERCISE AND DIAPHRAGMATIC BREATHING

Before starting the exercise:

  • Review of homework and previous session. 

RECOMMENDED PROTOCOL

  • Practice using Jacobson’s exercise VR:
  • Complete.
  • Virtual coach OFF.
  • Diaphragmatic breathing training in a VR-specific environment.
  • Audio ON. 
  • 3D object.
  • Long-length inhalation and exhalation.

HOMEWORK

  • Carrying out a 10 -breath cycle before going to sleep.
  • Practicing Jacobson¡s exercise. 
  • The patient should write down the way he felt before and after practicing relaxation exercises in order to talk about it in the following session.
  • Whenever the patient feels anxious , he must stop and practice a 5 -breath cycle before carrying on with activity.
SESSION 4 : PROGRESSIVE MUSCULAR RELAXATION AND DIAPHRAGMATIC BREATHING 

Before starting the exercise:

  • Review of homework and previous session.

RECOMMENDED PROTOCOL

  • Diaphragmatic breathing practice in the free environment the patient prefers : Audio ON
  • Practicing the progressive muscular relaxation exercise in the the patient prefers free environment: Audio ON 

HOMEWORK

  • Carrying out a 10 -breath cycle before going to sleep. 
  • Whenever the patient is feeling anxious, he must stop and practice a 5 -breath cycle before carrying on with activity.
  • Practicing Jacobson s exercise.
  • The patient should write down the way he felt before and after practicing breathing exercises in order to talk about it in the following session. 
SESSION 5 : PROGRESSIVE MUSCULAR RELAXATION AND DIAPHRAGMATIC BREATHING

Before starting the exercise:

  • Review of homework and previous session .

RECOMMENDED PROTOCOL

  • Diaphragmatic breathing practice in the free environment the patient prefers : Audio OFF
  • Practicing the progressive muscular relaxation exercise in the free environment the patient prefers : Audio OFF

HOMEWORK

  • Whenever the patient is feeling anxious , he must stop and practice a 5 -breath cycle before carrying on with activity.
  • Practicing Jacobson’s exercise.
  • Carrying out 10-breath cycle before going to sleep.
  • The patient should write down the way he felt before and after practicing breathing exercises in order to talk about it in the following session…
SESSION 6 : RELAPSE PREVENTION

RECOMMENDED PROTOCOL FOR THE FINAL SESSION

  • Review of skills and techniques acquired throughout the treatment .
  • The training in relaxation techniques is concluded : reflections about the practice, conclusions , how to apply what has been learned in daily life.
  • Evaluation of the therapeutic process.
  • Future relaxation tasks are agreed in order to keep up with the results.