Month: July 2020

Diaphragmatic breathing underwater in the ocean

In this environment, the patient will be at the under the sea, surrounded by a water area, which will help induce the desired state of relaxation.

SETTINGS VARIABLES

• Introduction
  This will be reproduced when the exercise starts. It is recommended that in the first session the optional introduction is activated so that the patient understands the importance of correct breathing and the methodology of the exercise.

• Visual reference
  The patient can also select his favorite 3D object in order to carry out the breathing exercises:
  • Seahorse
  • Jellyfish
  • Pufferfish

• Music
  Allows you to perform the exercises with background music. Note that in the default option this option is activated.

• Inhale/exhale duration
  Adjust the duration of the exercise by clicking on Exhalation or Inhalation from 3 to 12 seconds.

• Audio guide
  Allows you to choose whether the audio guide is a female or male voice.

EVENTS

• Inhale/exhale duration
  Adjust the duration of the exercise by clicking on Exhalation or Inhalation from 3 to 12 seconds.

Diaphragmatic breathing in a meadow

In this environment, the patient will be in the middle of a meadow, surrounded by a natural setting, which will help induce the desired state of relaxation.

SETTINGS VARIABLES

• Visual reference
  The patient can also select his favorite 3D object in order to carry out the breathing exercises:
  • Ball
  • Lotus flower
  • Owl

• Music
  Allows you to perform the exercises with background music. Note that in the default option this option is activated.

• Inhale/exhale duration
  Adjust the duration of the exercise by clicking on Exhalation or Inhalation from 3 to 12 seconds.

• Audio guide
  Allows to select if the voice in the audio guide is from a male or a female.

• Introduction
  Plays an introduction at the beginning of the scene.

EVENTS

• Inhale/exhale duration
  Adjust the duration of the exercise by clicking on Exhalation or Inhalation from 3 to 12 seconds.

Emotional regulation

This environment is formed by two different scenarios, connected to each other through a virtual tour accompanied by a series of meditation exercises. It comes to two environments that correspond to a different season of the year: spring and summer; each one with representative elements that are used to work the patient’s full and conscious attention and the sensations induced by the environment. 

It will begin with an aerial view of spring, where the patient will hear through audio the principles of Mindfulness that will be worked on later through the practice of mindfulness. When the patient is already walking on the path of the meadow, he will be asked to focus only on the natural landscape and the elements that comprise it, without falling into value judgments and simply observing them, in addition to concentrating on their breathing and in the here and now.

When arriving in front of a fire, the following exercise will take place: The Cascade of Thoughts. It will consist in becoming aware of the thought flow, focusing attention on the movement of fire, which this torrent symbolizes. At the end of this exercise, the camera will move away from the ground again, to ask the patient to observe the landscape from the new perspective and focus on the sensations experienced.

At this time there will be a change of environment: the patient will be in summer. This landscape will correspond to a desert, in which the patient will have to observe each of the new elements and focus on the sensations that the new environment produces at each moment while carrying out an exercise of conscious observation.

Next, the patient will begin a journey through the desert and will be instructed to let himself be carried by it, attending to the sensations and breathing. Finally, the avatar will stop and three 3D elements will appear that will help the patient to perform the final gratitude exercise.

SETTINGS VARIABLES

• Audio guide
  Allows you to choose whether the audio guide is a female, male or none voice.

Mindfulness for children

Consists of a virtual environment with guided activities that take place in different scenarios, each of them set in a different season of the year. These are meditations that work 4 different aspects in a generic way (attention, joy, energy and relaxation), and are applicable to any child between 6 and 12 years that at some point needs to work any of these aspects. The goal is to bring the patient to the desired state in a fun and entertaining way.  

SCENERY

• Winter (4 exercises aimed at working on attention)
• Autumn (4 exercises aimed at working on joy)
• Summer (4 exercises aimed at working on energy)
• Spring (4 exercises aimed at working on relaxation)

All the exercises will be guided through an audio-guide, so during its execution the intervention of the healthcare professional will not be necessary during the playback of an event.

It is important to bear in mind that it is not necessary to go through all the stations/exercises, but that the healthcare professional can choose which exercises to carry out through the events. Also, it should be noted that the audio guides of the introduction part of each station are practically the same (with the exception of certain specifications on the aspects to be treated in each station: attention, joy, etc.). This will allow each block of 4 exercises (each station) to be able to reproduce independently of the others.

Finally, in the visualization window of the tool suite, messages will appear indicating when it is being executed and when each exercise has finished, so that the healthcare professional can know it without having to ask the patient.

WINTER

This scenario is aimed at working on attention, specifically to train the patient to focus attention on the present moment. It is set in a snowy landscape, with mountains and trees covered in white, where you hear a sound similar to the wind of the mountains or the rocking of the trees.

EVENTS

• Winter introduction 

Here, the audio-guide welcomes the patient and explains the first instructions to follow. Specifically, it is explained that he is going to start a trip to “relaxiland”, a place where he will navigate through his breathing and in which he will do an exercise aimed to learn to be very attentive to everything that surrounds us (colors, sounds, shapes, etc.). To do this, first and foremost, the patient is asked to keep their back straight (attached to the back of the chair) and is taught to breathe deeply, inhaling air through the nose and exhaling through the mouth. Afterwards, the patient is invited to concentrate on the different sounds of the environment (the noise of the wind, the trees, their own breathing…) while looking and exploring the landscape in which they are, while still doing the breathing. Finally, they are asked to remember this exercise and continue to practice breathing during the trip they will do next.

• House 

In this exercise of attention, before anything else, the audio-guide reminds the patient that during this trip he must breathe deeply to facilitate that he can focus and learn with much more attention. The patient begins to move around the landscape and stops in front of a wooden house with smoke coming out of the chimney. In the background, there is a sound that the patient should pay attention to and concentrate as much as possible, trying to follow the sound in a calm and natural way. The sound will fade out little by little until disappearing.

• Lighthouse 

At the beginning of this exercise, the patient will be asked to take a deep breath before continuing. Here they will start walking and move forward through the scene until they reach an illuminated lighthouse from where a sound is emitted. The audio guide will ask the patient to concentrate on that soft and quiet sound, trying to keep his head from becoming distracted. At the end of the exercise, the sound will slowly fade until it disappears. Later, while reaching the end of the exercise, the audio guide will ask the patient to concentrate on the sound that is heard, while contemplating the aurora borealis in the sky. Finally, the patient is positively reinforced by how well he has done and because he was able to get rid of distracting thoughts.

• Winter end 

This exercise of attention will end on a hill in this winter scene. The patient will be asked to take 5 deep breaths and after that, he will notice how little by little both the sound and the image are fading. At the end of the exercise, and before removing the glasses, the audio guide will ask the patient during that day and that week to exercise at home what he has learned through this exercise of attention. In order to do that, they should ask a relative to put a song they like, close their eyes, and listen carefully as much as possible (noise, tone, timbre, instruments, lyrics…).

AUTUMN

The purpose of this scenario is to work with joy, encouraging empathy and experiencing pleasant emotions. It is set in a landscape of warm colors, where one can hear in the background the noise of the elements of the environment (trees, water, etc.).

EVENTS

• Autumn introduction 

Here the audio-guide welcomes the patient and explains the first instructions to follow. Specifically, it is explained that he is going to start a trip to “relaxiland”, a place where he will navigate through his breathing and in which he will do an exercise aimed to learn how to experience pleasant emotions, to be happy and cheerful. In order to do this, before anything else, the patient is asked to keep their back straight (attached to the back of the chair) and taught to breathe deeply, inhaling air through the nose and exhaling through the mouth. Afterward, the patient is invited to concentrate on the sound that is heard. He is asked to continue practicing their breath while looking and exploring the landscape in which he is. The patient is asked to remember this exercise and continue to practice breathing during the next trip. Finally, the patient is asked if he has ever been angry at any situation that caused him anger or sadness (e.g. for having been punished, because someone bought him something he did not want …). Then, it is indicated to him that now he is going to travel to a world in which there are no unpleasant things, but only pleasant ones like joy, laughter and calm.

• Pinwheel  

In this exercise, first of all, the need to start with a deep breath to “charge oneself with energy” for the trip is remembered. Then, the patient is asked to concentrate and follow the sound that is heard naturally and calmly. Afterward, the audio guide will ask the patient to imagine all the good people in his life who love him (family, friends…) and to look at the pinwheel in front of him. He is told that with each turn that pinwheel has the ability to make it bigger and spread all over the world the beautiful feelings caused by those people. At that moment, he should look at the pinwheel carefully, feeling that with each turn it makes, those good feelings he has are growing little by little, and he can even send to anyone he loves some of that positive feeling. Finally, the task performed by the patient is reinforced.

• Projection of joy 

Next, he will be asked to do the same as in the pinwheel exercise, but now thinking about the people with whom he has ever fought or argued or of whom he is afraid (some friend, teacher…). Then, he is asked to think of one of those people, anyone he wants, and to imagine that he has them in front of him; He is asked what he feels, what is he noticing in his body. Afterward, he must imagine that he is with that person and that he feels happy, with great joy, as if he had the “superpower” to see and experience things as he wants and whenever he wants.

• Autumn end 

In this exercise, before anything else, the patient will be asked to take a deep breath before continuing with the final exercise. The patient is now in a very high part of the landscape, a place where he can contemplate a sunset capable of generating very pleasant sensations. He can imagine many people smiling because at this moment there is no place for sadness. Then the patient is asked to imagine all those feelings of joy and love enveloping everything (people he knows, plants, animals…). Finally, the patient will be asked to take 5 deep breaths and after that, he will notice how little by little both the sound and the image are fading. At the end of the exercise, and before removing the glasses, the audio guide will ask the patient during that day to try to put into practice what he has learned through this exercise of projection of joy and love. For this, he must give three very strong hugs and say “I love you so much” or “thank you” to three people of his choosing. He is also asked to write a letter or make a drawing to these people and hide it “secretly” somewhere they can find it (in the bag, under the pillow…

SUMMER

This scenario is aimed at working on energy. It is set in a desert with palm trees, camels, horses, etc.

EVENTS

• Summer introduction 

Here the audio-guide welcomes the patient and explains the first instructions to follow. Specifically, it is explained that he is going to start a trip to “relaxiland”, a place where he will navigate through his breathing and in which he will do an exercise to learn to activate his energy. To do this, before anything else, the patient is asked to keep their back straight (attached to the back of the chair) and taught to breathe deeply, inhaling air through the nose and exhaling through the mouth. Afterward, the patient is invited to concentrate on the sound that is heard. He is asked to continue practicing the breaths while looking and exploring the landscape in which he is. Finally, the patient is asked to remember this exercise and continue to practice breathing during the trip he will do next.

• Magical objects 

In this exercise, the patient will be asked to take a deep breath to charge himself with energy before continuing and to observe everything surrounding him (sound, animals…). Subsequently, the patient is indicated that right now he is in a place full of positive energy, capable of eliminating the negative energy. The patient has around him a series of floating “magical” objects of different shapes (stars, rounds…) loaded with positive energy. It is explained that if one looks at them carefully, one can fill oneself with all this energy, strength and vitality that the objects will transmit to oneself. The audio-guide will ask him to look at the floating object that he likes the most and imagine how the energy and strength that it radiates is directed towards him and fills him with vitality.

• Recharge energy 

In this exercise, the patient is asked to take a deep breath before continuing. Afterward, he is instructed to feel the strength and energy that is now inside him. The audio guide reminds him that, although nothing happens if he is distracted during the task, he will have to be alert, because if that happens he will lose energy. Finally, the patient is asked to focus on the floating object that is closest to him, breathing and paying close attention to how he breathes, while looking at what kind of energy (positive or negative) he is feeling in his body in that precise instant.

• Summer end 

In this exercise, the patient will be asked to take a deep breath before continuing. In this activity, the patient finds himself in the middle of the ruins of an ancient abandoned civilization, which radiate a lot of positive energy. The patient is asked to take a deep breath, feeling how much energy comes to him, feeling free, light and full of vitality. Afterward, the patient will be asked to take 5 deep breaths and then notice how little by little both the sound and the image are fading. At the end of the exercise, and before removing the glasses, the audio-guide will ask the patient to try to identify during the day what kind of energy (positive or negative) he or she is feeling (his parents, his friends…). 

SPRING

This scenario takes place in a green landscape full of nature. By means of a walk through the representative elements of this environment, we will work full and conscious attention to enhance the patient’s ability to self-regulate their state of calm and relaxation. During the tour of this scenario, one can perform different exercises to work on relaxation. Each of them will be represented on the platform in the form of events:

EVENTS

• Spring introduction

Here the audio-guide welcomes the patient and explains the first instructions to follow. Specifically, it is explained that he is going to start a trip to “relaxiland”, a place where he will navigate through his breathing and in which he will do an exercise to learn to be calm and relax. In order to do this, before anything else, the patient is asked to keep their back straight (attached to the back of the chair) and taught to breathe deeply, inhaling air through the nose and exhaling through the mouth. Afterward, the patient is invited to concentrate on the sound that is heard. He is asked to continue practicing his breath while looking and exploring the landscape in which he is. Finally, the patient is asked to remember this exercise and continue to practice breathing during the trip he will do next.

• River 

In this exercise, the patient will be asked to take a deep breath before continuing. He will be reminded that if he is distracted at some point, nothing happens, but it will be very important that he tries to focus his attention on this relaxation exercise. At that time, the patient is on a bridge above a river. The exercise will consist of observing the river and the movement of the water during a while, imagining that everything that worries him or does not like goes downstream, dragged by the water. He should perform this exercise while continuing to breathe slowly and deeply, promoting a pleasant feeling of calm and relaxation. 

• Light of energy 

In this exercise, the patient will be asked to take a deep breath before continuing and to observe everything surrounding him (sound, nature…). At that time, the patient is in front of a fire where he will be asked to pay attention to his body and imagine that a light capable of eliminating any concern is moving through the interior of his body, starting with the head and descending little by little on the rest of his body (shoulders, back, chest, etc.) until reaching the feet. In this way, the patient is expected to experience a pleasant sensation of calm and tension-free.

• Spring end 

The patient will be asked to take a deep breath before continuing. This exercise will end in the highest and most relaxed part of this landscape. The audio guide will explain to the patient that from that high point nothing at all can affect him or bother him, promoting a sense of calm and lightness. Subsequently, he must perform 5 deep breaths and notice how little by little both the sound and the image are fading. At the end of the exercise, and before removing the glasses, the patient will be asked throughout that day and week to try to close his eyes and remember that exercise if he experiences discomfort at some time.

Attentional focus

At first, the patient is immersed in a virtual environment in which everything looks pink. Likewise, you can move from one exercise to another (Introduction, Leaves, Lemon tree…) or repeat them by selecting the specific event.

From the beginning, the patient will be instructed to concentrate on the present and on his own breathing, leaving behind any kind of distractions. 

First, the patient will be asked to observe a tree that is in the same place as him. Specifically, he must look at the leaves slowly falling from the tree, in which he may focus his attention, following the path of these until they reach the ground. If the patient is distracted or is surprised by some thought or concern, he will have to choose another leaf and continue with the process. Therefore, this exercise aims for the patient to put aside their concerns and learn to redirect the automatic and intrusive thoughts.

At the end of this exercise, the avatar will move a few steps and a lemon tree will appear in front of him. In this case, the patient is shown the existing physical and mental connection, through an exercise in which he will have to focus his attention on a lemon and imagine its taste when he bites it. 

Then, the avatar will move again through the meadow until reaching a bridge, where he will stop to watch the river while the third exercise takes place. The patient will have to keep their eyes on the environment, both in what he sees, and in what he hears, but without judging these stimuli, while watching the flow of the river. This exercise is based on the concept of Vipassana meditation, central to mindfulness, which refers to techniques of internal noise reduction to distance oneself from thoughts that cause a state of alertness. It is about realizing the thoughts and feelings that are presented to us, but without reacting to them or judging them. 

Simply paying attention to what arises, waiting passively for it to dissipate, and returning again to what was being done or continuing with what is next (Spira et al., 2006). In the same way as in the exercise of the leaves, the patient will be instructed that if any thought arises to let it go with the course of the river and redirect their attention.

Finally, the patient arrives at a meadow, which is a wider environment with more stimuli (flowers, butterflies, etc.). This increase in stimuli will help to train the patient’s ability to focus their attention on themselves, and to simply concentrate on the “here and now”. In this way, the exercise allows improving the focus of attention to concentrate in the present moment, which is known as the Zen absorption technique (Spira et al., 2006).

Through the audio, the patient will be instructed to concentrate on each of the flowers and butterflies, to observe them carefully. If interrupted by some thought or concern, they should refocus their attention on another element of the meadow.

Once it has finished, new elements will slowly appear in the landscape and in the patient’s visual field, such as trees, a mill, birds, small falling leaves, etc. They will be asked to look around and become aware of all the surrounding elements, and to listen carefully to the sounds. The goal is to focus on the here and now.

Little by little, it will get darker, and the landscape will disappear before the eyes of the patient. At this time, the audio will give indications that they should focus on themselves this time, on their own body and sensations instead of their surroundings. To finish, the patient should focus on their own breathing and reflect on the importance of the here and now.

SETTINGS VARIABLES

• Audio guide
  Allows you to choose whether the audio guide is a female, male or none voice.

REFERENCES

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.

Body scanning

In this environment, the patient will find himself in the middle of a relaxing meadow where he will be able to practice the body scan, one of the most important techniques in relaxation programs based on Mindfulness. It consists of mentally going through all the parts of one’s body so that a full consciousness develops. Through this exercise, the patient will notice the tensions and pains that are in their body so they can correct them. 

This environment can also be used to perform a Relaxation by induction within the program of Jacobson’s progressive relaxation, with a mental path through the body, but with the difference that one does not practice the part of voluntary tension and relaxation of the muscles.

To start the exercise, the healthcare professional should select the Play button and an audio will be played with instructions on the parts of the body to focus attention on. In addition, the patient will be able to observe that both in the human figure and in his own avatar, a light will appear illuminating the part of the body to which attention is directed.