Mindfulness Manual – Psious Professionals

Index Mindfulness Manual

Introduction to Mindfulness
Mindfulness for adults
1. Summary table for the use of Mindfulness different environments
2. Mindfulness protocol for adults
3. Audios
  1. Audio of the Conscious walk environment exercises
  2. Audio of the Spring – Summer environment exercises
Mindfulness for children
1. Mindfulness protocol for children
2. Audios
  1. Audio of Winter exercises
  2. Audio of Autumn exercises
  3. Audio of Summer exercises
  4. Audio of Spring exercises
Bibliography and appendix
1. Daily self-registration of meditations
2. Daily self-registration of concerns

1. Introduction to Mindfulness

Mindfulness is defined as the consciousness that emerges through paying attention on purpose, in the present moment, and without being critical, to the development of the moment-by-moment experience (Kabatt-Zinn, 2003, cited in Boettcher et al., 2014). However, it is more than a type of meditation, since it is considered a state of consciousness by nature (Shapiro, Carlson, Astin & Freedman, 2006) that involves consciously paying attention to the personal experience of “moment by moment”.

Through the use of meditation practices (both formal and informal), in combination with components of other therapies such as the cognitivebehavioral, intervention with mindfulness aims to help patients become more aware of problematic patterns of thinking, feelings, and action. In addition, it helps them develop a better acceptance relationship with their unwanted internal experiences (Morgan, Danitz, Roemer and Orsillo, 2016).

The concept of Mindfulness is essentially transdiagnostic (Boettcher et al., 2014), therefore, its use in the field of psychological therapy is justified from a broad theoretical framework in which it is considered that individuals with mental disorders share behavioral processes and specific cognitive factors that contribute to the development and maintenance of said disorders (Barlow et al., 2004 and Mansell et al., 2009, cited in Boettcher et al., 2014). These are processes such as selective attention both internal and external, avoidance of attention, interpretation biases, recurrent negative thoughts and avoidance and safety behaviors (Harvey, Watkins, Mansell, & Shafran, 2004, cited in Boettcher et al., 2014). Therefore, through the practice of Mindfulness it is not intended to treat specific aspects of a specific disorder, but to treat certain aspects common to different disorders.

2. Mindfulness for adults

2.1. Summary table for the use of Mindfulness different environments

MINDFULNESS EXCERSISES

NIVEL 1	NIVEL 2	NIVEL 3	NIVEL 4
Conscious walk	Body scan Spring Summer (without visual guide)	Under the sea (free)	Relaxation exercises in another treatment environment
Body scan Spring Summer (with visual guide)	Under the sea (with elements such as – bubbles, etc.)

The levels have been assigned based on:

Level 1: Practice in a specific environment with visual and auditory support elements.

Level 2: Practice with auditory support but not visual or vice versa. Thus, in specific environments, the visual guidance will have to be eliminated and in the free environments only the auditory exercises will have to be introduced.

Level 3: Practice in free environment without auditory or visual support.

Level 4: Practice in an anxiety situation, at first using the audios available for it, then concluding their practice without any external help.

2.2. Mindfulness protocol for adults

Mindfulness can be used as a central aspect of clinical intervention for the treatment of anxiety disorders (Mindfulness-based interventions). One of the most commonly used interventions in this context is the socalled Mindfulness-based stress reduction (MBSR) (Vøllestad, Sivertsen, Nielsen, 2011). Therefore, it must be the psychologist who decides how to apply the mindfulness technique through the tool of virtual reality (VR), especially according to the characteristics of each patient and the characteristics and particularities of the disorder in question.

Thus, the environments directed to the practice of mindfulness offered by Psious can be used as part of the program of cognitive-behavioral therapy for the treatment of certain anxiety disorders or can be used as a central tool to reduce the levels of anxiety, while the pillars of mindfulness are learned as a state of consciousness.

Having said that, a guideline about how to apply mindfulness through VR is proposed below. 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.

Description of treatment sessions

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

Recommended protocol for the second session

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 patient 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 therapist in the next session.

Put into practice the Mindfulness technique daily

SESSION 3

Recommended protocol for the third session

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 patient 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 therapist in the next session.

Perform mindfulness exercises daily.

SESSION 4

Recommended protocol for the fourth session

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 patient 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 therapist in the next session.

Perform mindfulness and relaxation exercises daily.

SESSION 5

Recommended protocol for the fifth session

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 patient write down on the dossier how he/she felt before and after performing the exercises, in order to discuss them with the therapist in the next session.

Perform mindfulness and relaxation exercises daily.

SESSION 6

Recommended protocol for the sixth session

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

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 patient write down on the dossier how he/she felt before and after performing the exercises, in order to discuss them with the therapist in the next session.

Perform mindfulness and relaxation exercises daily.

SESSION 7

Recommended protocol for the seventh session

Perform the exercise of mindfulness in the environment of relaxation under the sea (the patient alone, without the help of the psychologist).

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 patient write down on the dossier how he/she felt before and after performing the exercises, in order to discuss them with the therapist 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.

2.3. Audios

2.3.1. Audio of the Conscious walk environment exercises

Approximate length: 17 minutes.

In the following mindfulness exercise, we will clear our mind, letting concerns go, we will only focus on being here and now, in the present time, in our body and mind, and we will fix our attention on our goals, leaving distractions behind. Let’s pay attention to the exercise.

We will start by being present in our body, in this place, in the present moment. Let’s take two deep breaths.

Now, we will concentrate on our breathing. We concentrate on our nose, and feel the air going in and out through our nostrils. Notice how the air is dry and cool as you inhale, and moist and warmer as you exhale.

Over the course of the exercise, several elements will be shown on which you will have to focus your attention.

Now, we will concentrate on the leaves slowly falling from this tree.

Pick a leaf and follow its path until it reaches the ground. Focus your attention on the side-to- side movement of the leaf. Every time a leaf touches the ground we will try our best to become aware of the focus of our attention.

Have we let ourselves be influenced by our mental process? Were we completely involved in it? If any thought has drawn our attention, we congratulate ourselves for noticing our small distraction, and continue directing our attention towards the leaves movement. If we were paying attention to what we were doing, we also congratulate ourselves.

There is no failure when practicing mindfulness. It is an exercise that requires complete attention.

Exercise 2: Lemon tree

Do you see the lemons? Focus on them, focus on their color, shape, texture… Imagine you cut one in half and take a bite, imagine the acid 16 juice running through your mouth… Feel the salivation caused by this taste, focus your attention on your body reacting to this… are you salivating? If you are, this is a clear example on how a thought can alter our body. Therefore, we must learn to control our mind and direct our awareness and attention to here and now.

Exercise 3

We are approaching the river, and we will focus our attention on the broad range of sounds made by the water running down from the mountain ice. Let’s be aware of the different sounds that make up the flowing river: some higher, some lower, some closer, some farther… And if any thought comes to mind, let it go, like another drop following the river’s course.

Let us focus on here and now… forgetting everything else…

Now that we’ve walked away from the river, we take with us our awareness of the changes made in nature sounds. Let us hear, without judging or trying to understand what each sound means. Our attention is focused fully on listening, without judging or thinking.

We are now in front of a meadow full of flowers. We focus our attention in each and every flower and butterfly. …One by one… We become aware of their colors, shapes, movement. …If we detect a thought, concern, task coming to mind, we kindly let it go and choose another flower or butterfly, with our attention still focused on the meadow we have in front of us.

Pay attention to the new elements that appear, one by one, stay focused.

We look around us and become aware of all the elements that surround us. We look at them, we hear them… When a thought comes to mind, we let it go away, like the birds in the sky that come and go.

Let us focus on here and now… forgetting everything else…

Now, little by little, we become aware of ourselves. We draw our attention towards our body. We notice each part of our body that is in contact with the chair and the floor. We start from the top, feeling the 17 top of our back touching the chair, and we keep moving down… We go through the whole body, all the sensations… down to our feet. Pay attention to these sensations on your body, forget everything else.

Let us finish by focusing again on our breathing. We feel the air coming through the nostrils cool and dry, and leaving moist and warm through the mouth

We take our awareness to our abdomen, and notice it moving up and down as we breathe. We feel it moving up when we inhale, and moving down when we exhale.

Before we go, we think about how important it is to focus our attention in here and now.

2.3.1. Audio of the Spring – Summer environment exercises

Approximate length: 22 minutes

Introductory exercise – Mindfulness principles (Spring)

In the following exercise, we are going to practice different mindfulness exercises.

To do this, we should understand the basic elements of the mindset or attitude that will help us make progress: Mindfulness is the practice of full attention: try to be present during the next minutes.

The first.. is not to judge. Full attention is accomplished when we acknowledge how an impartial witness might view our own experience. We try to be conscious of the constant flux of judgemental thoughts in your mind, as well as our internal and external reactions and experiences, in order to leave them behind. It is important to acknowledge our tendency toward judgement of ourselves and others.

Limiting our thoughts, watching how these judgements and thoughts… come and go. We don’t have to act upon them, but we also do not ignore them, nor attach ourselves to them. Just watch and let them go. Remember: Don’t judge.

The second attitude to understand is the beginners mind. It is the mental state of being ready to see things as if it was for the first time, 18 and being open to new possibilities, in order to perceive the richness of the present moment. Remember: Beginner’s mind.

The last attitude is the acceptance. Acceptance means seeing things as they are in this present moment. Forgetting about the influence of the past and or the uncertainty of the future, to focus on the present. We will be open about what we feel and what we think, accepting it because it is there in the present moment. Remember: Acceptance.

Mindfulness exercises and on-nature meditation (Spring)

Now pay attention to this natural landscape. Inhale deeply, feeling how air comes in through your nose, and then exhale through your mouth. Focus your attention on the natural landscape that’s in front of you. Just observe it

While you walk, focus your attention in your surroundings, here and now. Look around at everything in the landscape. Try not to make judgments of any kind, or to compare it with another experience, or orm opinions of what you perceive. Try not to analyse what you see, try to avoid relating it to your personal tastes or specific memories. Just follow the path

Remember that you don’t need to expect anything from this exercise. Focus on perceiving the images and sounds of every moment, don’t try to interpret or judge them. Pay attention to the details of the landscape: the trees… the flowers… The animals…

If you notice that you get distracted and lose the state of full attention, try to identify what distracted you, and then, focus once more on the landscape that surrounds you… feeling the sensations that you have. In order to do this, concentrate on your breathing, continuing to focus on the landscape that surrounds you, only in the present moment.. here and now.

Let the your deep breathing… guide you back to the present moment. Feel completely calm, enjoy the landscape, and continue breathing…

Cascade of thoughts exercise (fire – Spring

Try to keep yourself calm… Observe the campfire that’s in front of you, noticing how the smoke blurs and rises… to the sky. Now, let’s imagine that this campfire is a way to see your thought process. It symbolizes how your thoughts are born, how they get to your mind… and how they leave. The smoke that blurs into the sky are a representation of your thoughts; after forming in the heart of this campfire, they rise like smoke and finally…. disappear. Picture this process taking place continuously in your mind.

In this moment… focus your attention farther out, behind the thoughts taking form, focusing on the fire and the smoke… but notice, that you’re outside of it, you’re just an observer. In this moment, take notice of the thoughts that come to your mind, even if you were not conscious of them before. Notice the inside of this campfire… your thoughts… how they appear, without judging them. They blend with the flames, flames that have different shapes, textures, and colours… This is how you have to look at your thoughts, some more intense, bigger…, some smaller, faster, and fleeting,… and others slower. But just watch them.

Whatever it is that comes to your mind, accept it in order to achieve the full consciousness state.

Identify what caught your attention. Don’t judge it. Accept it because it is there, and let it follow its path with the smoke. Keep watching the fire, not thinking about it. Just observe it, try not to get tangled in analysis or comparisons. Breath deeply to bring back your attention if you become distracted.

Now focus only on your breathing… don’t think about anything else..

Now, take notice of the path you have already completed, while you walk away from this part. Notice all the elements that you appreciate from this new perspective.

Focus on the sensations that you feel while watching it.. Do you feel cold? do you feel warm?

Remember these sensations. Now we are going to switch the landscape. Focus on the different changes that you can notice.

Conscious observation exercise and focus on sensations (desert -Summer)

Now we are going to walk through this desert while we do a conscious observation exercise. First… focus on an element that you see around you, a cloud, a pyramid, a palm tree… Let your attention be completely focused on this object. Just look at it, focus on its shape, its color… What body sensation do you feel? do you feel warm?… or cold?

Try to focus on the present moment, here and now. Notice how your mind is liberated from thoughts about the past and the future… How different you feel in the present moment, being completely conscious. Conscious observation, is a subtle meditation form, but powerful at the same time… Try it.

Now you’re walking through this desert landscape. A sunny and warm space… try to perceive all your body sensations. It is important to focus your vision forward during the walk through the desert. Try to be calm, With your attention focused on the landscape, on your path. Walking. You don’t need to go fast because you are not trying to go anywhere. Be present in every step you make, being conscious of where you are at every moment.

As you can see, you have a path to follow, a fixed path. This will allow your mind to guide you, allow you to rest because you will not have to think about which path to choose. You only have to focus on the path you are following. Remember that you are in the desert. Some temperatures may appear. Remember that you don’t have anywhere to go now, and that nothing important will happen on this path. You only have to focus on what you’re seeing. Let yourself go. If you become entangled in thought or distracted, focus on your breathing, and continue to bring your full attention to the elements of the landscape , the colors… the sensations… Remember: Let yourself pass by the desert. Try to keep calm, with your focus forward and your attention focused on the exercise. Don’t try to go to a certain place. focus on what you see, in the sensations that you feel. Do you feel warm? Your path continues. Focus your attention on the sensations that you perceive… Don’t focus on your footsteps. Now you will stop. 21 You stand still, feeling all the physical sensations that you can identify. Your breathing, your heartbeat, your muscles…

You stand still, feeling all the physical sensations that you can identify. Your breathing, your heartbeat, your muscles…

Final gratitude exercise (Summer)

We will conclude mindfulness with a gratitude exercise. Notice what you see from this place.

Take a deep breath and focus on three aspects of your life that you feel grateful for. Identify each of these elements with the three elements that appear in front of you.

Remember: Three things that you are grateful for. They do not need to be extraordinary things, they may be smaller things that give you a sense of fulfillment.

Mentally create a gratitude affirmation for each of the aspects that you’ve identified. Once you’ve thought about each affirmation, take a deep breath, focusing on the here and now. But with a small tweak: when inhaling focus on one of the affirmations that you thought, and when exhaling… share your positive sensations with the people that you have around you in your life. Remember: Inhale, focus all your attention on the affirmation that you thought. Exhale and share all your positive sensations with the people around you.

Simply, try to reflect the emotional sensations and the thoughts that you feel… this is your lived experience. Be grateful for what you have. Be conscious of all the gifts that life gives us, day after day, the ones that we rarely perceive. We stay conscious of the important things in life and also share our happiness with others day by day. Remember to live your mindfulness here and now.

3. Mindfulness for children

3.1. Mindfulness protocol for children

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 all of this, it must be the mental health 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.	Haber hablado con el menor sobre algún recuerdo agradable acontecido con alguien cercano, progenitores, un amigo, abuelos…
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 autoinstructions 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).

3.2. Audios

3.2.1. Audio of Winter exercises

Winter introduction

Approximate length: 4 min 30 seconds.

Hi, I welcome you to this exercise where you will have fun in a magical scene. You are going to travel, think that it will be a special trip where you cannot walk, or drive, nor bike, nor plane… you will be traveling with your breathing. You are going to “Tranquil land” where you will learn to be in calm, to relax, and use your happiness

We are going to do an exercise in which we will learn to be very attentive. While you are watching the landscape you will travel through, you will see colors, shapes, hear sounds, and I would like you to pay a lot of attention, I want you to listen to your breath while traveling, do we start?

I want you to pay attention in this breathing exercise.

I want you to sit, and be able to notice how your back is stuck as if you had put glue between your back and the back of your chair. Remember that you will have to keep your back straight so that the exercise goes well.

Is it okay if we start? Let’s start counting aloud 1 …, 2 …, 3 … (pause) Now we will join these three numbers with the breaths, let’s start…

Let’s breathe deeply. First, put your hand on your belly and note how it goes up and down while you breathe. Imagine as if you had to inflate a balloon, take air through your nose with all the strength you have, taking all the fresh air from the room where you are … now release the hot air, from inside your body, through the mouth, this air you do not need anymore. At the end of catching and releasing the air count 1.

Now we will concentrate on the sound that is heard, the wind, the trees, your breathing … and we will pay all our attention to that sound. We will notice that the more we focus on listening, the more attentive we will be, it is like a superpower!

You will see that the volume sounds very loud, but take it easy, when the time passes it will go down until it is completely silent. Keep it up as you look and explore the landscape you are in right now

We continue again, inspire the fresh air through your nose from the environment where we are now, with all the force until you cannot hold more air and … we hold it in and … we release it by the mouth, we count 2, then we start again and for the last time, we taaaaaaake all the fresh air through the nose that will renew us and give strength in our body, we release and expel it through the mouth, you already have used it and no longer need it, we count 3.

I want you to remember this exercise and during the trip we take, we do the breathing we have done here and no. If you get distracted or forget, do not worry, when you realize, just start breathing deeply again.

Shall we start our attention trip?

House

Approximate length: 4 minutes.

We are going to start our attention trip, for that, remember what I explained, breathe deeply, so that you can notice and learn with much more attention on this trip. I want you to not miss out on anything, it’s a magical trip where you have to go looking at everything you see and then tell me what you liked most.

We start with a deep breath, breathing deeply before continuing (here begins to walk). Remember that we have to do it naturally and try to listen to your breathing and how the sounds of your surroundings sound, with great attention and as if we were really there.

If you get distracted and your head starts spinning, it’s okay, very interesting things can happen at any time, but now, we have to focus on one thing, on traveling with ATTENTION. Think that if you get it, it’s a kind of superpower that we can develop little by little with practice. Refocus on the sound.

Remember that I do not force you to do anything, but simply following the sound, let your head follow the sound naturally and calmly. We will notice that the sound fades little by little … until it finally disappears.

Lighthouse

Approximate length: 1 minute 30 seconds.

Let’s take a deep breath before we continue.

Little by little we will begin to hear another sound, remember that you have to concentrate on that soft, delicate, and quiet sound, relaxing in the sound, but without letting your head get distracted. If many thoughts come to you, do not listen to them, let them go, it’s okay. Finally, the sound will go slowly loosening … You can do it!

We will take another deep breath before continuing (here begins to walk)

We reach the final part of the exercise, focus on the sound while you contemplate the movement of the aurora, those colored lights that appear in the sky. You have done very well, you have managed to forget many thoughts that distract you, congratulations!

Winter end

Approximate length: 1 minute 50 seconds.

We will finish the ATTENTION exercise, as we have started but this time we will do 5 deep breaths in the way I have taught you, remember, 5 times as the 5 fingers of your hand. Once you finish the 5 times, focus on how little by little the sound and the images go off. When the screen goes off, stay a moment with your eyes closed if you want …

Ah! and before I forget, today and this week you will test what we have practiced and learned. I want you to ask your daddies, brothers or family to give you a song, the one you like the best, close your eyes and keep listening to the song. I want you to hear everything, noise, tone, tune, lyrics of the song, when I finish I want you to remember: How many instruments have you heard? What did the lyrics of the song say? Why have you chosen this song? What is that you like most about it? Very good, you have done great! When you want, take off your glasses and open your eyes little by little.

3.2.2. Audio of Autumn exercises

Autumn introduction

Approximate length: 4 minutes 30 seconds.

You will do an exercise in which you will learn to feel pleasant emotions Do you know what it is to be happy and pleased? I want to see how you will feel while you practice a breathing exercise.

I want you to sit down, and make your back stick as if you’ve been glued between your back and the back of your chair. Remember that you will have to keep your back straight so that the exercise goes well.

Is it okay if we start? Let’s start counting aloud 1 …, 2 …, 3 … (pause) Now we will join these three numbers with the breaths, let’s start…

Let’s breathe deeply: First put your hand on your belly and note how it goes up and down while you breathe. Imagine as if you had to inflate a balloon, take air through your nose with all the strength you have, taking all the fresh air from the room where you are … now release the hot air, from inside your body, through the mouth, this air you do not need anymore. At the end of catching and releasing the air, count 1.

Now we will concentrate on the sound that is heard and we will pay all our attention to that sound. We will notice that the more we focus on listening, the more attentive we will be, it is like a superpower! You will see that the volume of sounds is very loud, but take it easy, when the time passes it will go down until it is completely silent. Keep it up as you look and explore the landscape you are in right now.

We continue again, inspire the fresh air through your nose from the environment where we are now, with all the force until you cannot hold more air and … we hold it in and … and we release it by the mouth, we count 2, and then we start again for the last time, we taaaaaaake all the fresh air through the nose that will renew us and give strength in our body, we release and expel it through the mouth, you already have used it and no longer need it, we count 3.

I want you to remember this exercise and during the trip we make, we do the breathing we have done here and now. If you get distracted or forget, do not worry, when you realize, just start breathing deeply again.

Would you like to start the Happiness trip?

Let’s start … Let’s see … Have you ever felt angry at any situation that has caused you anger, sadness …, an urge to scream? For example, they punished you, or you did not get a good grade, they bought you something you did not want, or something you do not want is happening to them and you want to erase it …

Now you are going to travel in a world that is not unpleasant, where everything you dream is possible, that sadness and anger will not travel with us, there are only pleasant things like joy, laughter, or calm.

Pinwheel

Approximate length: 2 min 20 seconds.

Shall we start the trip?

Remember to start with a deep breath to charge energy for the trip, as if you were putting gas into your ship.

If you get distracted and your head starts spinning, it’s okay, you can come up with very interesting things at any time, but now, you have to focus on one thing, on traveling with HAPPINESS. Think that if you get it, it’s a kind of superpower that you can develop little by little with practice. Refocus on the sound.

Remember that I do not force you to anything, but just follow the sound, let your head listen to the sound naturally and calmly. Note that the sound fades little by little … until it finally disappears. Then you will imagine all the good people in your life, your family, friends, teachers, pets … That you surely have many. Which ones are good with you, they love you and they show it to you? Which ones protect you and which do you have a good time with? It’s very easy, you’ll see!

Now you are going to look at the grinder in front of you, this grinder has the capacity to make bigger and stronger those pleasant feelings that you have and you are thinking and you can make them go around the world. You will look at it carefully, feeling that with every turn you make, those good feelings you have are growing little by little. Even if you want to send anyone who wants a positive feeling, who do you want? Come on, you’re doing it very well!

Projection of joy

Approximate length: 2 minutes 20 seconds.

Take a deep breath before continuing. Now that you have experienced this wonderful feeling a bit, you will do the same with the people with whom you may have fought sometimes or are afraid of you, either your friends, your teachers, someone from your family, or someone you have met… Even if you have argued because what was happening to you was unfair, such as a punishment, a change of plans or a very unfair situation that you are experiencing.

Now imagine the person you want. Imagine that you have that person in front of you and that you had a problem with it. You feel bad … pay attention to what you notice in the body when you think about this person and now imagine it in front of you, what do you note in your body? And what do you feel? You are going to reimagine yourself with this person and that you will feel that you are very happy, radiant, with a great joy.

Try to imagine and project this positive feeling now, it’s great! It’s like a superpower, in which you decide when and how you want to see things, and that shows and communicates what you feel, and that’s why you will now project the same joy and love that you feel towards your loved ones. Well done, that’s how it is done!!!

Autumn end

Approximate length: 4 minutes 10 seconds.

Take a deep breath before continuing.

You have reached the final part of the exercise, you are in an elevated area and you can see a sunset that inspires pleasant sensations inside you. Take this moment, you can only live it, here and now, with your super power you decide what to feel and who to imagine in your life, imagine happy people, smiling, a moment without sadness. Remember a time when someone helped you. People help each other and love each other as they are, without exception, an ideal and magical moment and now that you are in it use the superpower to the maximum now, feel as if all that energy of JOY surrounds everything you know, not only people but also plants and animals, everything is wrapped in that magical feeling of joy and love … Well done, congratulations!

You will finish the HAPPINESS exercise, just as you have started but this time we will do 5 deep breaths in the way that I have taught you. Remember, 5 times as the 5 fingers of your hand. Once you finish the 5 times, focus on how little by little the sound and the image go off. When the screen goes off, stay a moment with your eyes closed if you want …

I propose that you give three strong hugs to three people you want today, and accompanied by an “I love you” or a “Thank you”, I also propose that you write them on paper or make them a drawing to show them how much you love them and place it, without them noticing (whisper), in their pocket, their purse, under their pillow … let your imagination flow. When you have made your plan … take off your glasses and finish the exercise.

3.2.3. Audio of Summer exercises

Summer introduction

Approximate length: 4 minutes.

You will do an exercise in which you will learn to feel pleasant emotions. Do you know what it is to be with energy? I want to see how you feel while you practice a breathing exercise.

I want you to sit, and be able to notice how your back is stuck, as if you had put glue between your and the back of your chair. Remember that you will have to keep your back straight so that the exercise goes well.

Is it okay if we start? Let’s start counting aloud 1 …, 2 …, 3 … (pause) Now we will join these three numbers with the breaths, let’s start…

You will take a deep breath, take a breath through your nose with all the strength you have, taking all the fresh air from the room where you are. When you are taking aaaaaall the air and expelling it and releasing the hot air from your mouth from inside your body, count to 1. To do your breathing well, put your hand on your belly and note how it goes up and down. Now we will concentrate on the sound that is heard and we will pay all our attention to that sound. You will notice that the more you concentrate on listening, the more attention you give and the more energy you have, it is like a superpower!

You will see that the volume sounds very loud, but you do not have to worry, when you pass the time it will go down until it is completely silent. Keep it up as you look and explore the landscape you are in right now.

Continue again, inspire the fresh air of your environment through the nose with all the force until you can’t do it anymore and hold it inside and let it out through the mouth, count 2. Come back again and for a last time, taaaaaake all the fresh air by the nose that will renew and give strength in your body and release it and expel it through the mouth, count 3.

Very good! Continue like this for a while as you look and explore the landscape where you are right now.

I want you to remember this exercise and during the trip we make, we do the breathing we have just done here and now. If you get distracted or forget, do not worry. When you realize, just start breathing deeply again.

Shall we start our ENERGY trip?

Magical objects

Approximate length: 2 minutes 30 seconds.

Remember, start with a deep breath to charge energy for the trip, as if you were charging batteries to your ship. See where you are now, the plants, the animals, the sound that surrounds us …

If you get distracted and your head starts spinning, it’s okay, you can come up with very interesting things at any time, but now, you have to focus on one thing, on traveling with ENERGY. Think that if you get it, it’s a kind of superpower that you can develop little by little with practice. Refocus on the sound.

The place where you are NOW, has a very good thing; it is full of energy!!! As you know, there is good and positive energy on one side and there is also bad and negative energy on the other. Well, this place where you are being is made to absorb and eliminate the negative energy, don’t you think it’s cool?

If you look closely, there are things that float and move, these objects take and absorb a lot of energy to be able to float and when you look at them carefully you can fill yourself with their positive energy. This energy is in the trees, in the flowers, in the air, in the water, in all nature and now you have it all for you directly. YOU’LL TRY IT, OKAY? Now, you are going to focus on the magical object that you like the most about your surroundings, when you look at it fixedly, an energy force comes out that goes to you and recharges you with its magical energy, its vitality and its strength. Cool, enjoy!!!

Recharge energy

Approximate length: 3 minutes 10 seconds.

Take a deep breath before continuing. When you finish I want you to feel the strength and energy that is NOW inside you, you will feel that you have more heat and the energy of the sun that charges you and full of energy … Look around calmly and look at everything.

If you get distracted and your head starts spinning and getting distracted, it’s okay, you don’t have to worry, it’s normal, but you have to be alert because you lose energy when it happens

For example, when we put a new battery in a toy it is positively charged, that means it will last a lot, but if it does not work, the charge becomes negative, it does not work anymore.

After the example, you will return to the exercise, you will return to focus on the magical object that you have closer. Breathe, paying attention to how you do it, now you can ask yourself, is my energy positively or negatively charged?

Summer end

Approximate length: 2 minutes 10 seconds.

Take a deep breath before continuing. You are reaching the ruins of a very powerful ancient civilization, it is abandoned, but they still leave powerful jets of energy, only that we are close to this civilization, it gives us more life and more strength.

Here we are safe, breathe deeply and look at the last magical object … as you can see, jets of energy leave all the ruins, you feel very good, very free, as if you were about to fly, with full batteries, with lots of vitality. Enjoy this moment! You’ve done great, well done!

Finish the ENERGY exercise, just as you have started but this time you will do 5 deep breaths in the way I have taught you, remember 5 times as the 5 fingers of your hand. Once you finish the 5 times, focus on how little by little the sound and the image go off. When the screen goes off, stay a moment with your eyes closed if you want …

During today, identify in the morning, evening and at night how are you and the people of your house and your environment, and you are telling them how you see them and how you see yourself. For example, maybe you notice that in the morning you have a positive charge, but at night you have a negative charge because you feel tired … You can tell your mommies daddies which kind of energy charge they have, your friends, your teachers, etc. …

3.2.4. Audio of Spring exercises

Spring introduction

Approximate length: 4 minutes

Hi, I welcome you to this exercise where you will have fun in a magical scene. You are going travel, think that it will be a special trip where you cannot walk, or drive, nor bike, nor plane… you will be traveling with your breathing. You are going to “Tranquil land” where you will learn to be in calm, to relax.

You will do an exercise in which you will learn to feel a relaxation sensation in your head and in your body. Do you know what it is to be relaxed? I want to see how you feel while you practice a breathing exercise.

Is it okay if we start? Let’s start counting aloud 1 …, 2 …, 3 … (pause) Now we will join these three numbers with the breaths, let’s start…

Keep it up as you look and explore the landscape you are in right now..

We continue again, inspire the fresh air through your nose from the environment where we are now, with all the force until you cannot hold more air and … we hold it in and … we release it by the mouth, we count 2, and then we start again for the last time, we taaaaaaake all the fresh air in through the nose that will renew us and give strength in our body, we release and expel it through the mouth, you already have used it and no longer need it, we count 3.

Very good. Continue for a while, as you are looking at the landscape you are in right now.

I want you to remember this exercise and during the trip we make, we do the breathing we have done here and now, if you get distracted or forget do not worry, when you realize just start breathing deeply again.

Shall we start our RELAX trip?

Keep it like that as you are looking at the landscape you are in right now. It is a place where there are no worries or anything that makes you feel bad.

River

Approximate length: 1 minute 40 seconds.

Take a deep breath before continuing. If you get distracted and your head starts spinning and get distracted, it’s okay, we do not have to worry, we can come up with very interesting things at any time, but now, you have to focus on one thing, on traveling with relaxation, we have to be calm and refocus our attention on our RELAX trip.

Think that if you get it, it is a kind of superpower that we can develop little by little with practice. Refocus on the sound.

Look at the river and the movement of the water for a while, imagine that everything that worries you or that you do not like goes downstream. Continue with this exercise and at the same time start breathing slowly and deeply, paying attention to how you breathe. Little by little you realize that you are more relaxed and calm, with a very nice and pleasant feeling.

Great, keep going!!!!

Light of energy

Approximate length: 1 minute 40 seconds.

Take a deep breath before continuing

See where you are right now, the plants, the animals, the sound that surrounds us … Breathe normally and calmly … Now, pay attention to your body, and imagine that you give off a light of energy, a light that has appeared above you, this kind of light has the power to make everything that worries us or make you feel bad disappear, making us feel very calm and relaxed, a very good and pleasant feeling. This light begins to fall little by little, first by the head, then by the shoulders, then by the back and the chest, the belly, followed by the hips, the legs and in the end, by the feet.

Remember, breathe deeply, enjoy the moment … you are very comfortable and without tension …

Spring end

Approximate length: 2 minutes.

Take a deep breath before continuing. You are coming to the most relaxed area of this landscape, where you can see and observe everything you have around, from a higher part, where there are no nerves or tension, and you move and imagine it as if it were there below you, it does not affect you because you are in a very high part, where it cannot bother you or affect you at all. Enjoy this moment, notice how your body is so light that you can float and how your breathing is deeper and calmer.

Congratulations, you’ve done great!!!!!

We will finish the RELAX exercise, just as we started but this time we will do 5 deep breaths in the way I have taught you, remember, 5 times as the 5 fingers of your hand. Once you finish the 5 times, focus on how little by little the sound and the image go off. When the screen goes off, stay a moment with your eyes closed if you want …

I want you to close your eyes today and during the week and remember the exercise if discomfort appears or you think you need it. Imagine your virtual reality glasses, and that you are relaxed and traveling through this magical place.

When you’re ready, take off, little by little, the virtual reality glasses.

4. Bibliography and appendix

Bibliography

Boettcher, J., Aström, V., Pahlsson, D., Schenström, O., Andersson, G. & Carlbring, P. (2014). Internet-Based Mindfulness Treatment for Anxiety Disorders: A Randomized Controlled Trial. Behavior Therapy, 45(2), 241- 253. doi:10.1016/j.beth.2013.11.003

Delgado, L. C. (2009). Correlatos psicofisiológicos de mindfulness y la preocupación. Eficacia de un entrenamiento en habilidades mindfulness. (Gr. 1989-2009). Universidad de Granada. Granada.

Morgan, L. P. K., Danitz, S. B., Roemer, L. & Orsillo, S. M. (2016). Mindfulness approaches to psychological disorders. En Encyclopedia of mental health (pp. 148-155). San Diego, CA: Elsevier.

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

Shapiro, S. L., Carlson, L. E., Astin, J. A. & Freedman, B. (2006). Mechanisms of Mindfulness. Journal of Clinical Psychology, 62(3), 373- 386. Recuperado de: http://www.mindfulnessstudies.com/wp-content/ uploads/2014/01/2-Shapiro-M-echanismsOfMindfulness2006.pdf

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/2283876 36_Virtual_reality_and_other_experiential_therapies_for_combatrelated_posttraumatic_stress_disorder/links/00463518c81d4ac9d10000 00.pdf

Vøllestad, J., Sivertsen, B. y Nielsen, G.H. (2011). Mindfulness-based stress reduction for patients with anxiety disorders: Evaluation in a randomized controlled trial. Behaviour Research and Therapy, 49(4), 281-288. Recuperado de: http://www.sciencedirect.com/science/article/ pii/S0005796711000246

Zoogman, S., Goldberg, S. B., Hoyt, W. T., & Miller, L. (2015). Mindfulness Interventions with Youth: A Meta-Analysis. Mindfulness, 6(2), 290–302. https://doi.org/10.1007/s12671-013-0260-4

Appendix

4.1. Daily self-registration of meditations

	Monday	Tuesday	Wednesda y	Thursday	Friday	Saturday	Sunda y
Number of meditations and length
Attention level achieved (0- 10)
Subjective achievement sensation (0-10)
Generalizatio n to daily life (0-10)

4.2. Daily self-registration of concerns

Name: ……………………………………………….

Day:……………………..

Number of concerns periods (One mark per period)	Periods total (estimated)	Total duration (estimated)
		……… min.

Any more at night? Estimated number:………… Duration:…….……min.