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Relaxation Manual

Index Relaxation Manual

  1.  Anxiety, Relaxation and Virtual Reality
    1.  Exercises and Techniques
  2.  How to apply the relaxation techniques 
  3. Summary table of Relaxation Exercises and Environments
  4. Psious-based treatment Protocol 
  5. Bibliography
  6. Annexes 
    1. Jacobsons exercise recommendations
    2. Relaxation self-recording

1. Anxiety, relaxation and virtual reality

With Psious training in relaxation techniques is easy and fast thanks to Virtual Reality (VR), in a fe sessions, the patient ill be able to generalize the use of the techniques learned and apply them in their day to day.

Relaxation techniques useful for anxiety reduction. Useful for the treatment of Post-traumatic Stress Disorder (PTSD ), Generalized Anxiety Disorder (GAD), eating disorders, substance related disorders , addictive disorders and others. 

We recommend the following steps to have a successful training:

  1. Practice the techniques in relaxation environments
  1. Visual and audio support
  1. No audio
  1. Practice the techniques in the anxiogenic environment
    • Audio support
  1. Practice the techniques in the anxiogenic environment
    •  No audio

For more details on training, please refer to point 3 of the manual. The relaxation techniques and virtual environments offered by Psious are presented below.

1.1. Exercises and Techniques

Diaphragmatic Breathing

Its goal is to induce parasympathetic activation and promote a relaxed state, reducing stress and other symptoms caused by excessive activation.

Progressive Muscle Relaxation

Through the tension-relaxation cycle, Jacobsons technique teaches to control the voluntary musculature in order to reach a state of relaxation.

All the environments of Psious have two audios, in the relax section, that allow to put in practice both techniques.

2. 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 
  1. Diaphragmatic breathing:
  1. Breathing exercise in the meadow
  1. Breathing exercise under the sea
  1. Progressive muscular relaxation
  1. Jacobson relaxation exercise
  1. Free environments: relaxing natural spaces where the patient can practice every relaxation technique at the discretion of the psychologist (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. 
  • Jacobsons 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

3. Summary table of relaxation exercises and environments

LEVEL 1LEVEL 2LEVEL 3LEVEL 4
DIAPHRAGMATIC BREATHING
Breathing exercise under the sea and on the meadowIsland Under the sea (with/without audio)Relax exercises in an environment of another treatment
PROGRESSIVE MUSCLE RELAXATION 
Jacobson (with guide)
Island Under the sea (with audio)
Relax exercises in an environment of another treatment

The levels have been assigned according to the folloing criteria:

  • Level 1: Practice in a specific environment with image and audio support.
  • Level 2: Practice with only audio support or image support ( not both). Therefore, in the specific environments the visual guide should be removed and in the free environments only the audio exercises should be introduced..
  • Level 3: Practice in a free environment without audio and visual support.
  • Level 4: Practice in an anxiety-inducing situation, using the available sound recordings at first and conclude without any external help.

4. Psious-Based treatment protocol

Protocol for the application of VR relaxation techniques. Psychoeducation is included and combines VR relaxation in consultation ith your home practice. It is recommended that the psychologist adapt and implement relaxation strategies to each patients needs and to the program.

SESSION DESCRIPTION

SESIÓN 1: PSICOEDUCACIÓN Y DISCRIMINACIÓN MUSCULAR 

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(handsface-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 environment.
  • Audio ON.
  • 3D object.
  • Minimum-length inhalation and exhalation.

Homework:

  • Practicing Jacobsons exercise.
  • Filling in the relaxation self-recording ( Annexes).
  • Carrying out 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 Jacobsons 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.

Protocolo recomendado:

  • 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 sixth 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.

5. Bibliography 

Ansgar, C. & Walton, R. (2007). Muscle relaxation therapy for anxiety disorders: it works but how?. Journal of Anxiety Disorders, 21(3), 243-264. Recuperado de: http://www.sciencedirect.com.sire.ub.edu/science/article/pii/S0887618506001174 

Mazoni, G., Pagnini, F., Castelnuovo & G., Molinari, E. (2008). Relaxation training for anxiety: a ten-years systematic review with metaanalysis. BMC Psychiatry, june. Recuperado de: http://link.springer.com/article/10.1186/1471-244X-8-41/fulltext. html#copyrightInformation

Richard, D. & Lauterbach, D. (2007). Handbook of exposure therapies. San Diego, CA: Elsevier. 

Serrano, V., Baños, R. & Botella, C. (2016). Virtual reality and stimulation of touch and smell for inducing relaxation: A randomized controlled trial. Computers in Human Behavior, 55(A), 1-8. Recuperado de: http://ac.els-cdn.com.sire.ub.edu/S0747563215300856/1-s2.0-S0747563215300856- main.pdf?_tid=592d5014-e60b-11e5-9676-00000aacb35e&acdnat=1457537392_38be 8d967a7bf04c27d4b027990429b4

Spira, J.L., Pyne, J.M., Wiederhold, B., Wiederhold, M., Graap, K. & Rizzo, A. (2006). Virtual reality and other experiential therapies for combat-related posttraumatic stress disorder. Primary Psychiatry, 13(3), 58-64. Recuperado de: http://www.researchgate.net/profile/James_Spira/publication/228387636_Virtual_ reality_and_other_experiential_therapies_for_combat-related_posttraumatic_ stress_disorder/links/00463518c81d4ac9d1000000.pdf

6. Annexes

6.1. Jacobson’s exercise recommendations

  • Find a comfortable position. You can do the exercises sitting with your back straight or lying down..
  • Put your hand on your belly and feel how it inflates when breathing in and relaxes when breathing out.
  • To breathe in through your nose and to breathe out through your mouth.
  • If you follow a 3-2-3 cycle (breathing in for 3 seconds , holding air for 2 seconds, and breathing out for 3 seconds) you will be able to control your breathing rhythm.
  • Try to visualize the air going into and out of your lungs.
  • Remember you can carry out a breathing exercise whenever you want.

6.2. Relaxation selfrecording

Name:______________________________ Date:____________________

DateHourDegree of relaxation (0-100) BeforeDegree of relaxation (0-100) AfterUsed timeDifficulties or comments