In this case the patient represents being crouched. You can see the pigeons eating around him very close to him.
Duration: 29 ”
Difficulty: High
[ DISCLAIMER: This document has been automatically translated using Google Translate. ]
The environment shows a hand stroking a cat. At first it bites sometimes, but without force. Then it is allowed to caress calmly under the chin and on the head.
Duration: 1’50”
Difficulty: High
[ DISCLAIMER: This document has been automatically translated using Google Translate. ]
ESTE DOCUMENTO HA SIDO TRADUCIDO DEL ESPAÑOL MEDIANTE GOOGLE TRANSLATE Y NECESITA SER TRADUCIDO POR UN TRADUCTOR PROFESIONAL
Index Manual Fear of Animals
1. Animal phobia: virtual reality and augmented reality
The treatment of choice for animal phobia is based on the use of exposure techniques, whose success rate is around 90%. However, sometimes it can be difficult to carry out these sessions due to the difficulty of controlling insect reactions, creating specific situations, getting certain species, etc. Furthermore, most patients refuse to perform live exposure tasks and may even drop out of treatment. It is precisely for this reason that Virtual Reality (VR) and Augmented Reality (RA) are good alternatives for the treatment of this phobia. These technologies help facilitate patient adherence to treatment and allow the therapist to have control over different variables during exposure.
In addition to this advantage, AR is a technology that combines the real world with digital objects, making it easy to show three-dimensional objects superimposed on real situations. This facilitates the construction of systematic, gradual and adapted exposition sessions to the needs of each one.
This is why the abundant research in this regard has confirmed the therapeutic efficacy of both RV and RA in the treatment of this type of phobias (García-Palacios et al, 2001), as well as the wide range of advantages that make them preferable. to traditional techniques (Miloff et al, 2016).
2. Psychological evaluation / intervention protocol
All the information contained in this section is for guidance only. Psious environments are therapeutic tools that must be used by the healthcare professional within an evaluation and intervention process designed according to the characteristics and needs of the user. Also remember that you have the General Clinical Guide in which you have more information on how to adapt psychological intervention techniques (exposure, systematic desensitization, cognitive restructuring, token economy …) to Psious settings.
2.1 Evaluation Fear of animals
2.1.1 Evaluation objectives
2.1.2 Some useful instruments for the evaluation of Fear of animals
Taking into account the evaluation objectives, we will list some tools and instruments that may be useful to obtain relevant information about the characteristics of your user. Remember that a good definition of objectives, characterization of the patient and planning of the intervention are important for the efficiency and therapeutic efficacy, as well as for the satisfaction of your patients. In the bibliography you will find the articles in which to review the characteristics of the instruments proposed below.
For a complete evaluation of the problem, a combination of the following instruments will be used:
2.1 .3 Elaboration of the exposure hierarchy with Psious environments:
Once we have the evaluation information we can proceed to elaborate the exposure hierarchy. For this, in addition to using the data obtained during the initial assessment, we can ask a series of questions (eg, what level of discomfort, on a scale of 0 to 100, does it generate to see a small spider? What level of discomfort , on a scale of 0 to 100, would it generate you to have a cockroach walking by your hand? Do you think there is something that can generate even greater discomfort? …) aimed at planning the intervention using virtual reality.
Below are a number of items that could be used to create an appropriate hierarchy for dealing with animal fear with Psious. It should be borne in mind that we could ask the patient about the anxiety that these items generate, and from this, graduate the different elements of the hierarchy.
2.2 Treatment in a single session by Öst
More A treatment protocol using Psious is provided below. The suggested protocol is based on the guidelines for single session treatment proposed by Öst (1989), which is currently one of the recommended treatments for specific phobias. It is an intensive exhibition, the duration of which is usually between one and three hours. The main objective is to confront the patient to the phobic situation in a controlled way, allowing him to see that the feared consequences do not happen.
An alternative is to carry out several sessions in which the total treatment time does not exceed three hours, so it is proposed to distribute it in six sessions. In addition, for its long-term effectiveness, it is recommended that the patient continue with techniques of self-exposure to the feared situations once the treatment ends.
Exposure using RV and / or RA is normally combined with traditional techniques, such as cognitive restructuring and modeling techniques.
To apply the Öst single-session technique, patients must meet the following characteristics: present a phobia not associated with other pathologies, be motivated enough to tolerate a high level of anxiety for long periods of time, and not obtain positive consequences derived of phobia. Furthermore, the technique will not be used in patients with physical illnesses such as heart disease.
It is a prolonged exposure, with no possibility of escape and which is generally graduated through the use of aids and closer approximations to the feared element. Each step in the hierarchy continues until anxiety levels are reduced by at least 50% from their highest value, or when the patient’s negative thoughts are modified.
Next, an adaptation of this treatment of a single session is proposed to the resources available on the Psious platform. This intensive session is designed to last approximately two hours. To begin with, the patient must be informed of the objective: to approach by a small step towards the insect, with the subsequent maintenance of said approach, which will ultimately lead to a decrease in anxiety (Gunnar Götestam and Hokstad, 2002).
Each session will begin with the exhibition using virtual reality, with the presence of spiders or cockroaches depending on the patient’s phobia. First, you will start with the insect in question inside the terrarium. Little by little, the distance between them will be reduced (always indicating the patient before). Afterwards, the patient should be asked if he feels prepared to be exposed to the animal outside the terrarium. When the patient feels ready, then this will be done. Little by little, the insect will get closer and closer to the patient, always indicating previously. Finally, through the corresponding menu, the virtual insect will be placed on top of the avatar’s hands. As a last step, it is recommended to use the augmented reality environment so that the hands are those of the patient. In this case, you can first touch the insect with an object and then proceed to contact with your hands. The final objective for the patient will be to be able to catch the insect without suffering anxiety.
2.3 Example of intervention in Fear of spiders
SESSION 1
Psychoeducation: Inform the patient about fear of animals (Causes, symptoms, prevalence …).
The main objective will be to familiarize the patient with virtual reality and work dynamics.
| Item | USA’s | Environment | Configuration | Event |
| Being at a table having a terrarium over | 20 | rooms withspiders, | minimal terrarium, small | Maximum distance |
| See a very small spider in a terrarium | 30 | rooms withspiders, | minimal terrarium, small | Maximum distance |
| See a few small spiders inside of a terrarium | 40 | Room with spiders | maximum, terrarium, small | Maximum distance |
SESSION 2
Homework
Live exhibition before an empty terrarium or with a small insect.
| Item | USA’s | Environment | Setting | Event |
| See a medium spider inside a terrarium | 45 | Room with spiders | minimum, terrarium, medium | Maximum distance |
| See some large spider inside the terrarium and that moves | 50 | Room with spiders | minimum, terrarium, large | Disorder |
| See a medium spider in a terrarium quite close | 55 | Room with spiders | minimum, terrarium, medium Medium | distance |
| See enough large spiders inside a terrarium | 60 | Room with spiders | maximum, terrarium, large | Maximum distance |
SESSION 3
Homework
Live exhibition looking at an empty terrarium or with a couple of insects + covert exhibition at home reviewing the session through the imagination.
| Item | USA’s | Environment | Configuration | Event |
| View some small spiders to the other side of the table | 60 | room withchandeliers, | minimal table, small | maximum distance |
| that a few large spiders you begin to move much while in a terrarium | 65 | room withspiders, | maximum terrarium, large | disorder |
| See a small group of mediumsized spiders to the other side of the table | 65 | room withchandeliers, | minimal table medium | maximum distance |
| See some large spider to the other side of the table | 70 | room withchandeliers, | minimal table, large | maximum distance |
SESSION 4
Homeworks
Exhibition covertly through imagination
| Item | USA’s | Environment | Configuration | Event |
| Standfront of a small spider does not move | 70 | Augmented Reality: Spiders | small, low | |
| See some spider medium halfway between the end of the table and your hands | 75 | roomspiders | minimum, table, mediumMedium | distance |
| Have a small number of medium moving | 80 | spidersRoom withspiders | medium, medium, walk |
SESSION 5
Homework
Exhibition in imagination reviewing the objectives discussed in consultation.
| Item | USA’s | Environment | Setting | Event |
| Having a few spiders nearby and not moving | 80 | Augmented Reality: | Large, medium | |
| spiders See how many medium spiders approach you | 85 | Augmented Reality:spiders | Large, maximum, walking | |
| Having a large group of spiders moving ahead of you | 90 | Room with spiders | maximum, table, medium | Reduce distance |
SESSION 6
Homework
Covert exposition, reviewing the process followed in the session at home.
| Item | USA’s | Environment | Setting | Event |
| Having a medium-sized spider walking by your hand | 85 | Video: Spider | ||
| Having enough spiders in front, a loud noise is heard and they begin to move | 90 | Room with spiders | maximum, table, large | Minimum distance + Disorder |
| See in front of you a large group of large spiders that move | 95 | Augmented Reality:spiders | Large, maximum, walk | |
| Have many large spiders nearby and walk by your hand | 100 | Room with spiders | maximum, table, large | Minimum distance + Walk by hand |
3. Recommendations for use
It is important to accompany the presentation with comments, questions or indications so that the patient is more in position and experiences the exhibition in a more realistic way.
Some examples for fear of animals
4. Recommended bibliography
Bados, A. (2005). Specific phobias. Barcelona. University of Barcelona.
Bottle, C., Breton-López. J., Quero, S., Baños, RM, García-Palacios, A., Zaragoza, I. and Alcañiz, M. (2011). Treating cockroach phobia using a serious game on a mobile phone and augmented reality exposure: a single case study. Computers in Human Behavior, 27, 217-227.
Botella, CM, Juan, MC, Baños, RM, Alcañiz, M., Guillén, V. and Rey, B. (2005) Mixing Realities? An Application of Augmented Reality for the Treatment of Cockroach Phobia. Cyberpsychology and Behavior, 8 (2), 162-171.
Brown, TA, Di Nardo, PA & Barlow, DH (1994). Anxity Disorders Interview Schedule for DSM-IV (ADIS-IV). San Antonio: The Psychological Corporation.
García-Palacios, A., Hoffman, HG, Kwong See, S., Tsai, A. and Botella, C. (2001) Redefining Therapeutic Success with virtual reality exposure therapy. Cyberpsychology & Behavior, 4, 341-348
Gunnar Götestam, K. and Hokstad, A. (2002). Single-session treatment of Arachnophobia in a group through Active Rotating Exposure. The European Journal of Psychiatry, 16 (3), 133-138.
Juan, MC, Alcañiz, M., Montserrat, C., Baños, RM and Guerrero, B. (2005). Using augmented reality to treat phobias. IEEE Computer Graphics and Applications, 25 (6), 31-37.
Miloff, A., Lindner, P., Hamilton, W., Reuterskiöld, L., Andersson, G., & Carlbring, P. (2016). Single-session gamified virtual reality exposure therapy for spider phobia vs. traditional exposure therapy: study protocol for a randomized controlled non-inferiority trial. Trials, 17 (1), 60. https://doi.org/10.1186/s13063-016-1171-1
Öst, LG (1989). One-session treatment for specific phobias. Behavior Research and Therapy, 27, 1-7.
Sosa, CD, Capafóns, JI, Conesa-Peraleja, MD, Martorell, MC, Silva, F. and Navarro, AM (1993). Inventory of fears. In F. Silva and C. Martorell (dirs.), Assessment of childhood and youth personality (vol. 3, pp. 101-124). Madrid: MEPSA
Wolpe, J. and Lang, P. (1977). Manual for the Fear Survey Schedule. San Diego, CA: Educational and Industrial Testing Services.
6. Annexes
6.1 Self-report hierarchy Augmented Reality spiders / cockroaches Psious environments
* The self-report only talks about cockroaches, but it is applicable to the RA of spiders (both environments work exactly the same)
| Item | Level discomfort (0-100) |
| Above the table there are some roaches. I can see that they are moving and that they are quite large. | |
| There are a few roaches, neither too big nor too small, that are static on the table. | |
| I have a small roach in front of me, and it does not move. | |
| There are a few roaches, not too large. not too small, they are walking on the table | |
| I have a small cockroach in front of me that is moving | |
| I have a cockroach in front, which is not too big but not too small, and that does not move | |
| I can see many cockroaches that move and they are quite small | |
| I have some roaches in front, they are rather small and they do not move | |
| I can see many roaches in front of me. I see that they do not move but that they are medium, neither too small nor too big. | |
| In front of me I can see a very large cockroach that moves from one side to the other. | |
| I can see many cockroaches that do not move and that are quite small. | |
| I have some cockroaches moving in front, and they are rather small | |
| I have a cockroach in front, which is not too big but not too small, and it is moving | |
| I have a large group of large cockroaches in front. Still, they don’t move too much. | |
| I can see a lot of roaches in front of me. I see that they move but they are medium, neither too small nor too big. | |
| In front of me I can see a very large cockroach that does not move. | |
| On the table there are some cockroaches. I can see that they do not move and that they are quite large | |
| I have in front of me a large group of large cockroaches that move all over the table |
6.2 Self report hierarchy room spiders / cockroaches Psious environments
* In the self report we only talk about spiders, but it is applicable to the environment of cockroaches (both environments work exactly the same)
| Item | Level discomfort (0-100) |
| I have a small group of large spiders on the other side of the table, and suddenly a noise is heard that makes the spiders move a lot | |
| I am faced with a table, and I can see that there is some very small spider moving around there | |
| In the terrarium on top of the table I can see that there are many rather medium-sized spiders, they are not small but not very large | |
| Halfway between the end of the table and my hands there is a small group of spiders that are quite big and they move | |
| I have a couple of small spiders very close to my hands | |
| I am looking at a terrarium and I can see that there are a lot of very small spiders | |
| There are a small number of very large spiders on the table, but they are quite far from my hands. | |
| There are many medium spiders on the table, and they move until they are at a medium distance between my hands and the end of the table. | |
| I am in a room, with a terrarium in front. In it I can see that there are a couple of very large spiders that move. | |
| I have my hands resting on the table, and I can see how a small spider begins to move through them. | |
| When I have many large spiders near me, there is a loud noise and spiders move from side to side | |
| I am at a table and I can see that there are a lot of very small spiders | |
| I am sitting in a chair and at the table in front I can see that there are a couple of very large spiders that move | |
| There are a small number of medium sized spiders on the table, but they are quite far from my hands.myself in | |
| I findfront of a terrarium, and I can see that there is some very small spider inside. | |
| While sitting in a chair I see that there is some medium sized spider above the table. | |
| There are many, many fairly small spiders on the table, but they are quite far from my hands. | |
| I am with my hands resting on the table, and I see how some spider, neither too big nor too small, moves quite close to me. | |
| I have my hands resting on the table, and I can see how many small spiders start to move around them | |
| On the table I can see that there are many, many medium-sized spiders, they are not small but they are not very large either. | |
| I have many large spiders very close, and they start to walk by my hand | |
| While sitting in a chair I see the terrarium in front of me, and in it there is some medium spider. | |
| Halfway between the end of the table and my hands there is a large group of spiders that are quite large and move. | |
| I have a pair of medium spiders very close, and they start to walk by my hand | |
| I am in a room, and on the table there are many spiders that are very large | |
| I am with my hands resting on the table, and I see how many spiders, neither very large nor very small, move quite close to me | |
| I’m in a room, and in the terrarium there on the table there are many spiders that are very large | |
| there are some small spiders near me, and begin to move much when a loud noise heard in the room | |
| have a pa r of large spiders very close, and they start to walk by my hand | |
| There are a small number of quite small spiders on the table, but they are quite far from my hands | |
| As I am looking at the table, I see like a large group of spiders, which are quite large, they move very close to my hands | |
| I have many small spiders very close to my hands | |
| On the table there are some small spiders, and although they are not at the end of the table, they are not touching my hands | |
| On the table there are quite a few spiders small, and although they are not at the end of the table, they are also not touching my hands | |
| There are some medium-sized spider on the table, and they move until they are at a medium distance between my hands and the end of the table | |
| I have many spiders very large quite far from my hands | |
| While I’m looking at the table, I see a small group of spiders, which are quite large, they move very close to my hands | |
| There are many medium-sized spiders near my hands, and they start walking around one of them | |
| There are a large number of ara Medium-sized nails on the table, but they are quite far from my hands |
6.3 Self-report hierarchy environment Fear of Dogs
| Item | Level discomfort (0-100) |
| I see a dog in the distance sitting muzzled next to its owner and tied on a leash | |
| In the distance I see to a dog sitting, muzzleless next to its owner and on a leash | |
| I can see in the distance a dog with a muzzle sitting on a leash, somewhat separated from its owner | |
| In the distance I see a dog without a muzzle, sitting and separated from its owner but tied on a leash | |
| I see a dog sitting with a muzzle in the distance, without a leash but next to its owner | |
| I see a dog sitting in the distance, without a muzzle, next to its owner and without a leash | |
| I can see a dog with a muzzle in the distance , sitting, without a leash and a little far from its owner | |
| I observe a dog without a muzzle, sitting, without a leash and a little far from its owner | |
| I observe a dog in the distance standing with a muzzle next to its owner and tied on a leash | |
| A in the distance I see a dog standing, muzzleless next to its owner and on a leash | |
| I can see in the distance a dog with a muzzle standing on a leash, somewhat separated from its owner | |
| In the distance I see a dog without a muzzle, standing and separated from its owner but tied on a leash | |
| I see in the distance a dog with a muzzle standing , without a leash but next to its owner | |
| I see a dog standing in the distance, without a muzzle, next to its owner and without a leash | |
| I can see in the distance a dog with a muzzle, standing, without a leash and a little away from its owner | |
| I see far away a dog without a muzzle, standing, without a leash and a little far from its owner | |
| In the distance I see a dog sitting, without a muzzle next to its owner and tied on a leash and barking | |
| In the distance I see a dog without a muzzle and barking, sitting and separated from its owner but tied on a leash | |
| I observe in the distance a sitting dog, without a muzzle, next to its owner and without a leash and barking | |
| I observe far a dog without a muzzle, sitting, without a leash and a little away from its owner and barking | |
| In the distance I see a dog standing, muzzleless next to its owner, on a leash and barking | |
| A l or far I see a dog without a muzzle and barking, standing and separated from its owner but tied on a leash | |
| I see in the distance a dog standing, without a muzzle, next to its owner, without a leash and barking | |
| I see far a dog without a muzzle, standing, off leash, slightly away from its owner and barking | |
| I observe a medium-distance dog sitting muzzled next to its owner and tied on a leash | |
| At a medium distance I see a dog sitting, muzzled next to its owner and tied on a leash | |
| I can see at a medium distance a dog with a muzzle sitting on a leash, somewhat separated from its owner | |
| At a medium distance I observe a dog without a muzzle, sitting and separated from its owner but tied on a leash | |
| I observe at a medium distance a dog sitting with a muzzle, without a leash but next to its owner | |
| I observe at a medium distance a dog sitting, without a muzzle, next to its owner and without a leash | |
| I can see at a medium distance a dog with a muzzle, sitting, without a leash and a little away from its owner | |
| I observe at a medium distance a dog or without a muzzle, sitting, without a leash and slightly away from its owner | |
| I observe a dog at a medium distance standing with a muzzle next to its owner and tied on a leash | |
| At a medium distance I see a dog standing, without a muzzle next to it from its owner and on a leash | |
| I can see at a medium distance a dog with a muzzle standing on a leash, somewhat separated from its owner | |
| At a medium distance I see a dog without a muzzle, standing and separated from its owner but on a leash | |
| I observe At a medium distance a white dog standing with a muzzle, without a leash but next to its owner | |
| I observe at a medium distance a dog standing, without a muzzle, next to its owner and without a leash | |
| I can see at a medium distance a dog with muzzle, standing, without a leash and a little far from its owner | |
| I observe at a medium distance a dog without a muzzle, standing, without a leash and a little far from its owner | |
| At a medium distance I see a dog of the sitting dog breed, muzzleless next to its owner and leashed and barking | |
| At a medium distance I watch a dog without a muzzle and barking, sitting and separated from its owner but tied on a leash | |
| I observe at a medium distance a dog sitting, without a muzzle, next to its owner and without a leash and barking | |
| I see far away a dog without a muzzle, sitting, without a leash and slightly away from its owner and barking | |
| At a medium distance I see a dog of the breed dog standing, without a muzzle next to its owner, tied on a leash and barking | |
| At a medium distance I see a dog without a muzzle and barking, from standing and separated from its owner but tied on a leash | |
| I observe at a medium distance a dog standing, without a muzzle, next to its owner, without a leash and barking | |
| I observe at a medium distance a dog without a muzzle, standing, without a leash, a little away from its owner and barking | |
| I see a dog nearby sitting muzzled next to its owner and tied on a leash | |
| Nearby I have a dog sitting muzzleless next to its owner and tied on a leashon a leash | |
| I can see near a dog with a muzzle sittingleash, somewhat detached from its owner. | |
| Nearby I observe a dog without b ozal, sitting and separated from its owner but tied on a leash | |
| I see a dog sitting near with a muzzle, without a leash but next to its owner | |
| I have a dog sitting nearby, without a muzzle, next to its owner and without a leash | |
| I can see near me a dog with a muzzle, sitting, without a leash and a little far from its owner | |
| I observe nearby a dog without a muzzle, sitting, without a leash and a little far from its owner | |
| I observe a dog nearby, standing, with a muzzle, next to its owner and on a leash | |
| Near me I see a dog standing, without a muzzle next to its owner and tied on a leash | |
| I have a dog near me with a muzzle standing on a leash, somewhat separated from its owner | |
| Near me I see a dog without a muzzle , standing and separated from its owner but tied on a leash | |
| I see near me a white dog standing with a muzzle, without a leash but next to its owner | |
| I closely observe a dog standing, without a muzzle, next to its owner and without correa | |
| Puedo ver cerca de mí un perro con bozal, de pie, sin correa y un poco alejado de su dueño | |
| Observo de cer ca un perro sin bozal, de pie, sin correa y un poco alejado de su dueño | |
| Cerca de mí veo a un perro de la raza perro sentado, sin bozal al lado de su dueño y atado con correa y ladrando | |
| Cerca puedo observar un perro sin bozal y ladrando, sentado y separado de su dueño pero atado con correa | |
| Observo de cerca un perro sentado, sin bozal, al lado de su dueño y sin correa y ladrando | |
| Tengo cerca un perro sin bozal, sentado, sin correa y un poco alejado de su dueño y ladrando | |
| Cerca de mí veo a un perro de pie, sin bozal al lado de su dueño, atado con correa y ladrando | |
| Cerca observo un perro sin bozal y ladrando, de pie y separado de su dueño pero atado con correa | |
| Observo cerca de mí un perro de pie, sin bozal, al lado de su dueño, sin correa y ladrando | |
| Observo cerca un perro sin bozal, de pie, sin correa, un poco alejado de su dueño y ladrando |
ESTE DOCUMENTO HA SIDO TRADUCIDO DEL ESPAÑOL MEDIANTE GOOGLE TRANSLATE Y NECESITA SER TRADUCIDO POR UN TRADUCTOR PROFESIONAL
Index Manual Bullying
1. Bullying and Virtual Reality
As Morán Sánchez (2006) points out, it is very difficult to detect how a harassment process. A small lie, a slight lack of respect, or an attempt at manipulation are sometimes such daily acts that they are even considered normal (Hirigoyen, 1999; Morán Sánchez, 2006). However, these types of behaviors can get worse, especially in the school context. This phenomenon considered on many occasions as a circumstantial issue typical of the immaturity of children and adolescents is, today, an alarming issue both due to its high incidence and the alteration it causes in the person who suffers from it (Morán Sánchez, 2006).
Bullying is a concept that is used to refer to those aggressive and intentional behaviors that are constantly practiced among schoolchildren. Although it may occur in other areas, the most common place where we find cases of bullying is at school (remember the concept of mobbing associated with the workplace). This harassing behavior can vary between more direct manifestations such as physical or verbal aggression (insults, threats, coercion, humiliation, nicknames …), to other more indirect forms in the form of social exclusion (defamatory rumors, contempt …) (Cerezo, 1997 ; Morán Sánchez, 2006; Ma Jesús Irrutia, Victor Arias, 2009).
Although the application of support therapies using Virtual Reality for the treatment of bullying cases is still a very novel fact, its effectiveness has already been proven in certain pioneering investigations in this field (Carmona et al, 2011; Langer et al, 2016 ; Quero et al., 2017; Seinfeld et al., 2018). In these studies we can see how immersive therapy through Virtual Reality is a very helpful tool both to carry out the evaluation process and the victim’s intervention. This new therapeutic format allows us to bring the victim closer to the threatening environment with the possibility of controlling the variables that occur in the situation of harassment and influence its maintenance.
In this way, Psious offers the therapist, through this new school environment, a useful tool to conduct evaluation and intervention sessions in relation to cases of bullying.
2. Psychological evaluation / intervention protocol proposed by Psious
All the information contained in this section is for guidance only. Psious environments are therapeutic tools that must be used by the healthcare professional within an evaluation and intervention process designed according to the characteristics and needs of the user. Also remember that you have the General Clinical Guide in which you have more information on how to adapt psychological intervention techniques (exposure, cognitive restructuring, etc.) to Psious settings.
2.1. Psychological evaluation and intervention for bullying
The psychological evaluation / intervention protocol for dealing with bullying cases is usually divided into three phases. A first evaluation phase, where information is collected on the psychological profile of the affected person (levels of self-esteem, anxiety, communication skills, problem solving skills, educational deficits of the parents, etc.) and information on the case of bullying. (type of assaults, frequency, place of occurrence, subjective assessment of the severity of the assaults, feeling of security and information about the assailants). A second intervention phase whose objective is usually focused on improving social skills and the degree of assertiveness (equipping the victim with effective strategies to improve their communication skills, increase their self-esteem, learn to protect and defend their rights, as well as express effectively and socially acceptable their emotions and desires to promote integration into the group). And finally a followup phase post-intervention-.
2.2. Assessment of victims of bullying
2.2.1. Evaluation objectives
factorsIndividual factors associated with the victim, such as: Low self-esteem; insufficient social skills to relate to other classmates; visible physical or cultural traits, different from those of the majority (ethnic, racial and cultural minorities); disability; anxiety disorders or other psychopathological disorders: mood disorders (depressive disorder), behavior disorders (attention deficit hyperactivity disorder, challenging disorder), adaptive disorders (with mixed alteration of emotions and behavior).
Family-related factors, such as: Inappropriate, authoritative, or negligent parenting practices; education on the margins of society; restricted family life forms (social, religious or cultural group communities); dysfunctional families; high pressure, demand and / or little objective expectations; little family communication.
Factors associated with the school, such as: Low participation in group activities; little communication between students and teachers; absence of reference authority figure in the school, profile of “good boy / girl” who never gives or gets into trouble; threats such as imposing silence on the victim on the part of the aggressor, on the part of other students, or in exceptional cases on the part of a teacher or the school itself, can lead to general behavior of self-deprivation of expression in the school environment, Poor relationships with peers …
Factors associated with the case of bullying, such as: Type of assaults (insults, physical assaults, comments, teasing …); place / is where these attacks occur (patio, classroom, bathrooms …); frequency of assaults; subjective assessment of the severity of the attacks; feeling of security (possible help) and information about the aggressors (number of people against them).
Research on bullying and victimization [Schwartz, 2000] has identified four different types of children:
2.2.2. Some useful instruments for the evaluation
For bullying: Bullying
For PTSD symptoms
Childhood post-traumatic stress syndrome explains that bullied children / adolescents develop a sense of imminent danger, pervasive restlessness or nervousness, and a type of recurrent and nonspecific anxiety with permanent sensation that something terrible is going to happen imminently to them or their loved ones.
The harassed child / adolescent develops a hyperreaction to frustration, or to environmental stimuli such as a strong light, a door that closes suddenly, loud noises, etc …
Childhood post-traumatic stress syndrome generates an extraordinary and intense irritability that the victim of bullying she projects immediately on her family and colleagues.
It also causes a type of hypervigilance that consists of enormous mistrust and suspicion of the intentions of others.
Among the tests that can be used to assess post-traumatic harm among victims of bullying in childhood and adolescence are the following:
For anxiety symptoms
For symptoms of depression
Others:
2.3. Intervention for victims of bullying
It is important to note that in this section we will only show and suggest some points to guide the intervention through the virtual environment of Psious to address bullying or bullying. The treatment must be adapted to the characteristics of each patient and the therapist may adapt it according to their criteria. A good first orientation can be obtained in Protocol of action in situations of bullying – UNICEF
2.3.1. Therapy steps to overcome bullying
As we have seen in the evaluation section, the treatment of bullying cases is usually carried out in 3 phases: evaluation, intervention and follow-up.
By using our environment it will be possible to bring the victim of bullying closer to a similar situation that helps us carry out the approach of the different phases of bullying treatment.
In this first phase we will confront our patient with the environment in order to evaluate his behavior in relation to the problem. During the course of the scene and once its execution is finished, we will try to collect relevant information about the case, through a semi-structured interview 2. We will therefore focus on knowing the patient’s profile. It is important to collect information both from the intrapersonal part (as I am), and from the interpersonal part (as they see me and I relate to others). In this way, once the initial exploration has been carried out, we will have more information to determine a personalized action plan.
In this second phase our objective of locating the patient in the environment will be to try to execute theaction plan appropriateor training in relation to the evaluation phase. Therefore, we will provide the patient with those tools that help them solve psychopathological aspects that contribute to aggravating or maintaining the problem of bullying.
The following table summarizes groups different useful aspects to work in cases of bullying and the different techniques often applied:
| Aspects psychopathological | therapeutic techniques |
| Deficitselfesteem | Restructuringcognitive |
| anxiety | diaphragmatic breathing / relaxation (can leverage environments relaxation Psious) |
| Deficit problem solving | Training in problem solving / Training in self-instruction |
| Social skills / assertiveness | Training in communication skills / debate / discussion / argumentation |
Summary table: Adapted from Morán Sánchez, 2006
2 The relevant information to collect is detailed in section 2.2 .one.
It is important, once the intervention has been carried out, to schedule follow-up sessions after a period of time. In this way we can ensure the effectiveness of the intervention and detect possible aspects that may need to be reinforced again.
2.3.2. Proposal for intervention for victims of bullying
Below we show you a proposal for intervention with PSIOUS for victims and participants in situations of bullying.
The following proposal is made to evaluate coping styles in a school conflict situation.
Session 1
| Item | Environment | Setting | Event |
| Psychoeducation anxiety | What are emotions How do we feel emotions | ||
| Being alone in the hall, waiting for the teacher to arrive and start the exam | Institute, easy, just | ||
| Being with a few classmates in the hall before an exam and they seem very calm | Institute, easy, few people | ||
| Being doing an exam that is short in a classroom full of people | Anxiety before exams | Institute, easy, many people | many people Start exam |
Session 2
| Item | Environment | Configuration | Event |
| Being with a few classmates in the hallway before an exam and they seem very calm | Anxiety exams | Institute, easy, many people | |
| Being in class and being approached by a classmate alone to rebuke | Bullying | Just | Begin |
| Identification emotional states (up to 12 years old) | Mindfulness kids: Summer | Exercises in Summer environment, especially Energy recharge and end of summer | Begin |
| Control of physiological activation: Breathing exercises | Relaxation Breathing Under the sea / Prairie | At the patient’s choice, adjust the frequency of comfortable breathing for the patient | Begin |
Session 3
| Item | Environment | Configuration | Event |
| To be in class and to be approached by a single partner to reprimand | bullying | Accompanied | Begin |
| Focus Attention | Mindfulness kids: Winter | Introduction, home and lighthouse | Begin |
| Control of physiological activation: Breathing exercises | Relaxation Breathing Sea / Meadow | At the patient’s choice, adjust the comfortable breathing rate for the patient. | Begin |
Session 4
| Item | Environment | Configuration | Event |
| Being with a few classmates before an exam and they seem very calm | Anxiety exams | Institute, easy, many people | start |
| Social skills training | Audience | Few people | Start, easy questions |
| Generation pleasant emotions | Mindfulness kids: Autumn | Introduction, Pinwheel | start |
Session 5
| Item | Environment | Setting | Event |
| Being with few peers in class before an exam and they seem very calm | anxiety exams | Institute, difícill, many people | begin |
| Generation pleasant emotions | Mindfulness kids: Autumn | Introduction, Pinwheel and Projection joy and end of autumn | begin |
Session 6
| Item | Environment | Configuration | Event |
| Being in class and being approached by a companion to be shocked | bullying | Accompanied | Begin |
| Training in social skills | Audience | Many people | Start, difficult questions |
| Generation Activation | Mindfulness kids: summer | Introduction, magic items , recharges energy, End of summer | beginning |
Session 7
| Item | Environment | Configuration | Event |
| Being with a few classmates before an exam and they seem very calm | Anxiety exams | Institute, easy, many people | start |
| Generation Activation | Mindfulness kids: summer | Introduction, magic items, recharge energy, End of summer | start |
| control physiological arousal: breathing exercises | Relaxation breathing Under the sea / Meadow | a choice of the patient, adjust frequency comfortable breathing for the patient | start |
RECALLS thathave the Clinical Guide toabout PROCEDURES THERAPEUTIC wITH EVIDENCETHUMB AND HOW TO ADAPT THEM TO THE INTERVENTION WITH THE VIRTUAL ENVIRONMENTS OF PSIOUS
3. Recommendations for use
It is always interesting and positive to try to complement the Virtual Reality experience with comments, questions or indications to facilitate that the patient can more easily put himself in situation and feel a greater immersion in the environment.
Some examples could be: “Imagine that these are your classmates with whom you are having problems” … “How does it feel to see them?” “What do you think they think of you?” “Which one do you feel the most uncomfortable with and why?” “Which generates the most fear or anxiety?” “Which one do you trust or give you greater security?” “Do they make you nervous?” “What do they usually do when the teacher is away?”, Etc.
In turn, it is highly recommended to try to keep the patient in the same body position in which the protagonist of the scene is (in this case, sitting at the classroom desk).
Similarly, it can be useful to add any element of the scene or context where the events happen. In this case, offering the patient a pen or pencil and a notebook can help to make the immersion more effective and provide the child / adolescent with the sensations of the conflictive environment.
4. Recommended Bibliography
Arce, R., Velasco, J., Novo, M., & Fariña, F. (2014). Preparation and validation of a scale for the evaluation of bullying. Iberoamerican Journal of Psychology and Health, 5 (1), 71–104.
Birleson P. Hudson I, Gray-Buchanan D, Wolff S. (1987). Clinical Evaluation of a Self-Rating Scale for Depressive Disorder in Childhood (Depression Self-Rating Scale). J. Child Psychol. Psychiat 28, 43-60 https://doi.org/10.1111/j.1469-7610.1987.tb00651.x
Cerezo, F. (1997). Aggressive behavior at school age. Madrid: Pyramid.
Da Silva, JL, de Oliveira, WA, de Mello, FC, de Andrade, LS, Bazon, MR, & Iossi Silva, MA (2017). Anti-bullying interventions in schools: a systematic literature review. Ciência & Saúde Coletiva, 22 (7), 2329–2340. https://doi.org/10.1590/1413-81232017227.16242015
Del Barrio, V., Moreno-Rosset, C., López-Martínez, R., (1999). The Children’s Depression Inventory [CDI; Kovacs, 1992]. Its application in the Spanish population. Clinica y Salud 10, 393-416.
Ezpeleta, L., De La Osa, N., Domenech, JM, Navarro, JB, & Losilla, JM (1997). Test-retest reliability of the Spanish adaptation of the diagnostic interview for children and adolescents (DICA-R). Psicothema, 9 (3), 529–539.
García Pérez, EM and Magaz Lago, A. (2011 a). PEE Profile of educational styles (ed. Rev.). Bilbao: COHS Human Sciences Consultants.
García Pérez, EM and Magaz Lago, A. (2011 b). EMA Magellan Adaptation Scales (ed. Rev.). Bilbao: COHS Human Sciences Consultants.
Guillén, KG, Rojas Molina, L., Astorga, R., Joya, R., & et al. (2015). Protocol of action in situations of Bullying, 57. Retrieved from https://www.unicef.org/costarica/Documento-Protocolo-Bullying.pdf
Hollon, SD, & Kendall, PC (1980). Cognitive self-statements in depression: Development of an automatic thoughts questionnaire. Cognitive Therapy and Research, 4 (4), 383–395. https://doi.org/10.1007/BF01178214
Hirigoyen, MF (1999). Moral harassment. Barcelona: Paidós.
Irurtia Muñiz, MJ, Avilés Martínez, JM, Arias González, V., & Arias Martínez, B. (2009). The treatment of victims in the resolution of bullying cases. AMAzônica (Revista de Psicopedagogia, Psicologia Escolar E Educaçao), 2 (1), 76–99.
Kirisci, L., Clark, DB, & Moss, HB (1997). Reliability and Validity of the State-Trait Anxiety Inventory for Children in Adolescent Substance Abusers: Journal of Child & Adolescent Substance Abuse, 5 (3), 57–70.
Kovacs, M. (1992). Children’s Depression Inventory (CDI). Toronto, ON: Multi-Health Systems Inc.
Langer, LI, Aguilar-Parra, JM, Ulloa, VG, Carmona-Torres, JA, & Cangas, AJ (2016). Substance Use, Bullying, and Body Image Disturbances in Adolescents and Young Adults Under the Prism of a 3D Simulation Program: Validation of MySchool4web. Telemedicine and E-Helath, 22 (1), 18–30. https://doi.org/10.1089/tmj.2014.0213
Melero, S. (2017). Cognitive-behavioral intervention in an adolescent victim of bullying. With Children and Adolescents, 4, 149–155.
Morán Sánchez, C. (2006). Cognitive-behavioral intervention in bullying: a clinical case of bullying, 2, 51–56.
Piñuel, I and Oñate, A. (2007a). AVE, Harassment and School Violence Test. Madrid: TEA Editions.
Piñuel, I. and Oñate, A. (2007b) Bullying and School Violence in Spain: Report Cisneros X. Madrid: IIEDDI
Pynoos, RS, Frederick, C., Nader, K., Arroyo, W., Steinberg, A., Eth, S., et al. (1987). Life threat and posttraumatic stress in school-age children. Archives of General Psychiatry, 44, 1057–1063.
Quero, S., Andreu-Mateu, S., Moragrega, I., Baños, RM, Molés, M., Nebot, S., & Botella, C. (2017). A Cognitive-Behavioral Program Using Virtual Reality for the Treatment of Adaptive Disorders: A Case Series. Argentine Journal of Psychological Clinic, 26 (1), 5–18.
Reynolds, CR and Richmond, BO (2012). CMASR-2. Revised Anxiety Scale in Children Revised (2nd ed). Mexico: Modern Manual.
Seinfeld, S., Arroyo-Palacios, J., Iruretagoyena, G., Hortensius, R., Zapata, LE, Borland, D., … Sanchez-Vives, MV (2018). Offenders become the victim in virtual reality: impact of changing perspective in domestic violence. Scientific Reports, 8 (1), 1–11. https://doi.org/10.1038/s41598-018-19987-7
Serrano, A. and Iborra, I. (2005). Report Violence between classmates at school. Valencia, Spain: Reina Sofía Center for the Study of Violence. Recovered from http://www.centroreinasofia.es
Schwartz, D. (2000). Subtypes of Victims and Aggressors in Children’s Peer Groups. Journal of Abnormal Child Psychology, 28 (2), 181–192.
5. Annexes
5.1. Self-registration of negative thoughts
Name: _________________________________________ Date: ___________
| Date | Day and Time | Situation what happened? | With whom? | Thought | Emotion | Behavior |
5.2. Action protocol in bullying situations – UNICEF
Index OCD Manual
1. OCD and Virtual Reality
According to the American Psychiatric Association, the obsessivecompulsive disorder is an anxiety disorder in which people have undesirable thoughts, ideas or sensations (obsessions), which carry out ritualized behaviors (compulsions) or repetitive thoughts (neutralizations). These behaviors, such as washing hands, checking or cleaning, interfere in a significant way with the daily activities and social relationships of a person. (Gorrindo, T., Parekh, R., 2015)
For OCD’s differential diagnosis there must be presence of obsessions and/or compulsions that consume a lot of time (more than one daily hour), which cause stress, harm work and social relationships, as well as other important areas. (APA, 2007). The cognitive-behavioral therapy, the treatment with medication, apart from other somatic therapies of cerebral stimulation, have been till now the most effective alternatives to treat this disorder (APA, 2007).
Virtual reality appears as a good alternative tool to the traditional techniques used in mental disorder treatments and in obsessive compulsive disorders among others. Virtual Reality allows the standardization and the control on the parameters of the exposure sessions. Likewise, it turns out to be very useful to repeat the exposure to the fear or anxiogenic situations as many times as necessary, making the customization and flexibilization of the therapeutic process much easier.
Psious’s environments allow you the use of diverse psychological intervention techniques: exposure, cognitive restructuring, systematic desensitization, training in social skills… Use the most adapted characteristics of the patient and use those with major empirical support to obtain better results.
2. Psychological evaluation/ intervention protocol
All the information in this section is indicative. Psious’ environments are therapeutic tools that must be used by the sanitary professional inside an evaluation and intervention process designed according to the characteristics and needs of the user.
Remember that you have a General Clinical Guide where you will find more information on how to adapt the psychological intervention techniques (exposure with response prevention, cognitive restructuring…) to Psious’ environments.
2.1 OCD Evaluation
2.1.1 Evaluation objectives
2.1.2 Useful tools for the OCD evaluation
Considering the evaluation objectives, we will enumerate some of the tools that can be useful to obtain relevant information about the characteristics of your user. Remember that good objectives definitions, patient characterization and planification of the intervention are important for the therapeutical efficiency and effectiveness just like the user satisfaction. In the bibliography you will find articles where you can revise the characteristics of the proposed tools:
Self-report:
Tests for behavioral approach:
2.1.3 Exposure hierarchy elaboration with Psious’ environments:
Once we have all the evaluation information we can proceed to elaborate an exposure hierarchy. For that, we need to make some questions made to plan the intervention with virtual reality: e.g. what level of discomfort, on a scale from 0 to 100, does it cause you to be sitting on a toilet? What level of discomfort from 0 to 100 does it cause you to wash your hands? Do you think there’s something that can cause you even more discomfort than that?
2.2 OCD intervention example
SESSION 1
Psychoeducation: inform the patient about OCD. What are the causes, symptoms, prevalence, and definition.
The main objective will be familiarizing the patient with virtual reality and the work dynamics.
Recommended protocol for the first session:
| Item | USA’s | Environment | Settings | Event |
| Be at a public toilet’s door | 20 | OCD | Clean | Outside the toilet |
| I place myself in front of a public clean toilet cubicle’s door. | 30 | OCD | Clean | Inside the toilet |
| After entering a clean public toilet, I enter the toilet cubicle and look at the toilet. | 35 | OCD | Clean | Standing inside the cubicle |
SESSION 2
Homework
Recommended protocol for the second session:
| Item | USA’s | Environment | Settings | Event |
| In front of a clean public toilet, I touch the wall with my left hand. | 40 | OCD | Clean | Touch the wall (standing inside the cubicle) |
| Walk through Ramblas with many people. | 40 | OCD | Dirty | Outside the toilet |
| Inside the cubicle of a clean public toilet. I grab paper and I throw it in the trash | 40 | OCD | Clean | Grab paper |
| I touch the toilet brush in a clean public toilet | 45 | OCD | Clean | Touch toilet brush |
| I lower the toilet lid in a clean public toilet to sit on it | 45 | OCD | Clean | Lower lid |
SESSION 3
Homework
Recommended protocol for the third session:
| Item | USA’s | Environment | Settings | Event |
| I sit on a clean public toilet | 50 | OCD | Clean | Sitting on the toilet |
| Sitting on a clean public toilet, I then touch the wall with my left hand | 50 | OCD | Clean | Touching the wall (sitting onthe toilet) |
| I enter a public toilet that doesn’t smell well with paper all over the floor and I place myself in front of the toilet cubicle | 50 | OCD | Dirty | Inside the toilet |
| I flush the toilet after using it (clean public toilet) | 55 | OCD | Clean | Flush the toilet |
| I place myself in front of the sink in a clean public toilet | 60 | OCD | Clean | In front of the sink |
SESSION 4
Homework
Recommended protocol for the fourth session:
| Item | USA’s | Environment | Settings | Event |
| Standing outside a clean public toilet, I open the door, I stand in front of the cubicle, I open the door, I stand in front of the toilet, lower the lid and I sit down | 60 | OCD | Clean | From outside until sitting on the toilet |
| I enter the cubicle and it smells bad, it’s dirty and it has urine drops | 60 | OCD | Clean/Easy | Standing inside the cubicle |
| In the cubicle of a clean public toilet, I grab paper and I throw it in the trash | 65 | OCD | Clean/Easy | Washing hands |
| Sitting on a clean public toilet, I grab paper, I stand up, I flush the toilet, I stand in front of the sink, I wash my hands without touching the faucet, the soap or the dryer. | 70 | OCD | Clean/Easy | Complete |
| I touch the walls of the cubicle of a dirty and smelly toilet | 70 | OCD | Dirty | Touching the wall (standing in the toilet cubicle) |
SESSION 5
Homework
Recommended protocol for the fifth session:
| Item | USA’s | Environment | Settings | Event |
| I use the sink in a public toilet after using the toilet. I touch the faucet, the soap and the hand dryer | 75 | OCD | Clean/Difficult | Washing hands |
| Sitting on a clean public toilet, I grab paper, I stand up, I flush the toilet, I stand in front of the sink and I use it touching faucet, soap and hand dryer | 75 | OCD | Clean/Difficult | From sitting on the toilet to washing hands |
| I´m outside a clean public toilet, I open the door and I stand in front of the cubicle. I open the door and I stand in front of the toilet. I lower the lid, I sit on the toilet, I grab paper, I stand up, I flush the toilet and I stand in front of the hand dryer. I wash my hands without touching the faucet, soap or hand dryer. | 75 | OCD | Clean/Easy | Complete |
| I grab paper from the cubicle in a dirty public toilet and I then throw it in the trash | 75 | OCD | Dirty | Grabbing paper |
| I touch the toilet brush inside a cubicle of a dirty public toilet | 80 | OCD | Dirty | Touching toilet brush |
SESSION 6
Homework
Recommended protocol for the sixth session:
| Item | USA’s | Environment | Settings | Event |
| Standing outside a dirty public toilet, I open the door, I stand in front of the cubicle I open the door, I stand in front of the toilet, I lower the lid and sit on the toilet, I grab paper, I stand up, I flush the toilet and I stand in front of the sink. I wash my hands, I touch the faucet, soap and hand dryer | 80 | OCD | Clean/Difficult | Complete |
| Lower the lid of a dirty public toilet | 85 | OCD | Dirty | Lower the lid of a dirty public toilet |
| Sitting on a dirty public toilet | 90 | OCD | Dirty | Sitting on the toilet |
| While I’m sitting on a dirty public toilet, I touch the wall with my left hand | 90 | OCD | Dirty | Touching the wall (sitting on the toilet) |
| I’m standing outside a dirty public toilet, I open the door, I stand in front of the cubicle, I open its door, I stand in front the toilet, I lower the lid and I sit on it. | 90 | OCD | Dirty | From standing outside until sitting on the toilet |
SESSION 7
Homework
Recommended protocol for the seventh session:
| Item | USA’s | Environment | Settings | Event |
| I flush a dirty public toilet and it smells bad after having used it | 95 | OCD | Dirty | Flushing toilet |
| I stand in front of the sink of a public toilet that stinks | 95 | OCD | Dirty | In front of the sink |
| I wash my hands in a dirty public toilet without touching the faucet, soap or hand dryer. | 95 | OCD | Dirty/Easy | Washing hands |
| I’m standing outside a dirty public toilet, I open the door, I stand in front of the cubicle, I open the door, I standing front of the toilet, I lower the lid, I sit down, I grab paper, I stand up, I flush the toilet, I stand in front of the sink and I wash my hands without touching the faucet, soap and hand dryer. | 95 | OCD | Dirty/Easy | Complete |
SESSION 8
Homework
Recommended protocol for the eighth session:
| Item | USA’s | Environment | Settings | Event |
| I use the sink in a dirty public toilet, touching the faucet, soap and hand dryer | 95 | OCD | Dirty/Difficult | Washing hands |
| Sitting on a dirty public toilet, I grab paper, I stand up, flush the toilet, I stand in front of the sink, and I wash my hands without touching the faucet, soap or hand dryer | 95 | OCD | Dirty/Easy | From sitting down until washing hands |
| Sitting on a dirty public toilet, I grab paper, I stand up, flush the toilet, I stand in front of the sink, and I wash my hands touching the faucet, soap and hand dryer | 100 | OCD | Dirty/Difficult | From sitting down until washing hands |
| I find myself outside a dirty public toilet, I open the door, I stand in front of the cubicle, I open the door, I stand in front of the toilet, I sit on the toilet, I grab paper, I flush the toilet, I stand in front of the sink and i wash my hands touching faucet, soap and hand dryer. | 100 | OCD | Dirty/Difficult | Complete |
4. Use recommendations
To favor a better immersion, the therapist can contribute adding comments.
For example:
5. Recommended bibliography
American Psychiatric Association. Practice guideline for the treatment of patients with obsessive-compulsive disorder. Arlington, VA: American Psychiatric Association, 2007.
Kim, K., Kim, Ch. H., Kim, S. Y., Roh, D., Kim., S. I. (2009). Virtual Reality for Obsessive-Compulsive Disorder: Past and the Future. Official Journal of Korean Neuropsychiatric Association, 6, 115-121
Ortiz, J. F. (2002). Trastorno obsesivo-compulsivo (TOC). Acta Neurol Colomb, 18 (1), 51-65.
Reid, J.M., Storch, E.A. & Murphy, T.K. (2011). Clinical Correlates and Treatment Response of the Yale-Brown Obsessive Compulsive Scale Auxiliary Items. Cognitive Therapy and Research, 35, 404-413
Bejerot, S., Edman, G., Anckarsäter, H., Berglund, G., Gillberg, C. et al. (2014). The Brief Obsessive-Compulsive Scale (BOCS): a self-report scale for OCD and obsessive-compulsive related disorders. Nordic Journal of Psychiatry, 68(8), 549-559. http://dx.doi.org/10.3109/08039488.2014.884631
Freeman, J., Flessner, Ch. A,. y Garcia, A. (2011). The Children’s YaleBrown Obsessive Compulsive Scale: Reliability and Validity for Use Among 5 to 8 Year Olds with Obsessive- Compulsive Disorder. J Abnorm Child Psychol, 39, 877-883.
Steketee, G., Chambless, D. L., Tran, G. Q., Worden, H., y Gillis. M. M. (1996). Behavioral Avoidance Test for Obsessive Compulsive Disorder. Behaviour Research and Therapy, 34 (1), 73-83. http://dx.doi.org.sire.ub.edu/10.1016/0005-7967(95)00040-5
Sánchez, J., López, J. A., López, J. A., Marín, F., Rosa, A. I., y Gómez. A. (2011). The Maudsley Obsessive-Compulsive Inventory: A reliability generalization meta-analysis. International Journal of Clinical and Health Psychology ,11(3), 473-493.
Bamber, D., Tamplin, A., Park, R. J., Kyte, Z. A., Goodyer, I. M. (2002). Development of a Short Leyton Obsessional Inventory for Children and Adolescents. Journal of the American Academy of Child & Adolescent Psychiatry 41 (10), 1246-1252. http://dx.doi.org.sire.ub.edu/10.1097/00004583-200210000-00015
Obsessive-compulsive disorders; research conducted at mental health institute has provided new information about obsessivecompulsive disorders. (2014). Mental Health Weekly Digest, , 31. Retrieved from https://search-proquest-com.sire.ub.edu/ docview/1516545423?accountid=15293
Gorrindo, T., y Parekh, R. (2015). What Is Obsessive-Compulsive Disorder?. American Psychiatric Association. https://www.psychiatry.org/patients-families/ocd/what-is-obsessivecompulsive-disorder
6. Annexe
6.1 Hierarchy for OCD
| Item | Discomfort level (0-100) |
| Being in front of a clean public toilet’s door. | |
| I stand in front of a toilet cubicle door of a clean public toilet. | |
| Enter the cubicle and stare at the toilet. | |
| Standing in front of a clean public toilet, I touch the wall with my left hand. | |
| I’m inside a clean public toilet cubicle, I grab paper and I throw it in the trash. | |
| I touch the brush of a clean public toilet. | |
| I lower the lid of a clean public toilet. | |
| I sit on a clean public toilet. | |
| Sitting on a clean public toilet, I touch the wall with my left hand. | |
| I flush the toilet after having used a clean public toilet. | |
| I stand in front of a sink in a clean public toilet. | |
| I wash my hands in a clean public toilet after using the toilet, without touching the faucet, soap and hand dryer. | |
| I wash my hands in a clean public toilet after using the toilet, without touching the faucet, soap and hand dryer. | |
| I’m outside a clean public toilet, I open the door, I stand in front of the toilet cubicle, I open the door, I stand in front of the cubicle, I lower the lid and I sit on it. | |
| I’m sitting on a clean public toilet, I grab paper, I stand up, I flush the toilet, I stand in front of the sink, I wash my hands without touching the faucet, the soap or the hand dryer. | |
| I’m sitting on a clean public toilet, I grab paper, I stand up, I flush the toilet, I stand in front of the sink, I wash my hands touching the faucet, the soap or the hand dryer | |
| I’m outside a clean public toilet, I open the door, I stand in front of the cubicle, I open the door, I stand in front of the toilet, I lower the lid, I sit on the toilet, I grab paper, I flush the toilet, I stand in front of the sink, I wash my hands without touching the faucet, soap or hand dryer. | |
| I’m outside a clean public toilet, I open the door, I stand in front of the cubicle, I open the door, I stand in front of the toilet, I lower the lid, I sit on the toilet, I grab paper, I flush the toilet, I stand in front of the sink, I wash my hands touching the faucet, soap or hand dryer. | |
| Being in front of a dirty public toilet’s door. | |
| I enter a public toilet that stinks and has paper all over the floor and I stand in front of the toilet cubicle. | |
| I enter a cubicle in a smelly and dirty public toilet and the toilet has urine drops. | |
| I touch the walls of a cubicle in a smelly and dirty public toilet. | |
| I touch the brush inside the cubicle of a dirty public toilet. | |
| I grab paper inside the cubicle of a dirty public toilet and I throw it in the trash. | |
| I lower the lid of a dirty public toilet. | |
| Sitting on a dirty public toilet | |
| Touching the wall of the cubicle with my left hand sitting on a dirty public toilet | |
| I flush a dirty public toilet after using it and at the same time it smells bad. | |
| I stand in front of the sink of a dirty and smelly public toilet. | |
| I wash my hands in a dirty public toilet, without touching the faucet, soap or hand dryer, but they’re next to me. | |
| I use the sink of a dirty public toilet after using the toilet, touching the faucet, soap and hand dryer. | |
| I’m outside a dirty public toilet, I open the door, I stand in front of the toilet cubicle, I open the door, I stand in front of the cubicle, I lower the lid and I sit on it. | |
| I’m sitting on a dirty public toilet, I grab paper, I stand up, I flush the toilet, I stand in front of the sink, I wash my hands without touching the faucet, the soap or the hand dryer. | |
| I’m sitting on a dirty public toilet, I grab paper, I stand up, I flush the toilet, I stand in front of the sink, I wash my hands touching the faucet, the soap or the hand dryer. | |
| I’m outside a clean public toilet, I open the door, I stand in front of the cubicle, I open the door, I stand in front of the toilet, I lower the lid, I sit on the toilet, I grab paper, I flush the toilet, I stand in front of the sink, I wash my hands without touching the faucet, soap or hand dryer. | |
| I’m outside a dirty public toilet, I open the door, I stand in front of the cubicle, I open the door, I stand in front of the toilet, I lower the lid, I sit on the toilet, I grab paper, I flush the toilet, I stand in front of the sink, I wash my hands touching the faucet, soap or hand dryer. | |
| What discomfort level does it produce you, at the present moment, to be in a public toilet? (doesn’t belong to the hierarchy) | |
| Other situations: |
Index Test Anxiety Manual
1. Test Anxiety and Virtual Reality
Test anxiety has been defined as the emotional, physiological and behavioral responses that occur around the potential consequences of negative evaluations or a future test or exam (Zeidner, 1998)
Spielberg and Vagg (1995) have described that test anxiety as an element of general anxiety which is composed of processes of cognitive attention that interfere with performance in academic situations or test. Like Sapp, Durand and Farrel (1995) who consider it as a case of general anxiety disorder related to being tested. Studies about the start, prevalence and incidence indicate that the start of the problem may be very early (7 years), although the major manifestations occur in adolescence, Von Der Embse, N., Barterian, J., & Segool, N. (2013) estimate that between 10 and 40% of the child/adolescent population may suffer from it. Other studies indicate a high incidence, around 48%, on the university access (Kavakci, O., Semiz, M., Kartal, A., Dikici, A., & Kugu, N., 2014).
Systematic desensitization (SD) through exposure is shown to be effective itself to reduce test anxiety (Hembree, 1988) in addition to having a positive effect on academic results and a decrease in overall anxiety and trait status.
The therapeutic approaches that combine SD with cognitive restructuring and study techniques are the ones that show a greater reduction of the anxiety before test (Talbot, 2016).
The virtual reality environments are capable of generating the anxious response that appears because of the test to be able to perform the gradual exposure. In addition, virtual reality is equally effective as exposure by imagination and achieves a greater reduction of avoidance behaviors than exposure by imagination (Gutiérrez-Maldonado, Alsina, Carvallo, Letosa & Magallón, 2007). This may be because virtual reality allows a greater generalization of the coping response learned.
Psious environments allow you to use different techniques of psychological intervention: exposure, cognitive restructuring, systematic desensitization, training in social skills…, use those that are more appropriate to the characteristics of your patient and build on those with greater empirical support to get better results.
2. Psychological evaluation/ intervention protocol
All information contained in this section is for guidance. Psious environments are therapeutic tools that must be used by the healthcare professional that is driving an evaluation and intervention process designed according to the characteristics and needs of the user.
You must also remember that you have the General Clinical Guide in which you have more information on how to adapt the techniques of psychological intervention (exposure, systematic desensitization, cognitive restructuring…) to the Psious environments.
2.1 Test Anxiety Evaluation
2.1.1 Evaluation Objectives
2.1.2 Some useful tools for evaluating Test Anxiety
Taking into account the evaluation objectives we will list some tools that may be useful to obtain relevant information about the characteristics of your user. Remember that a good definition of objectives, patient characterization and intervention planning are important for the therapeutic efficiency and effectiveness, as well as for the satisfaction of your user. In the bibliography you will find the articles that will serve you to review the characteristics of the tools proposed below:
Self-Reports:
2.1.3 Elaboration of the exposure hierarchy with Psious environments:
Once we have the information from the evaluation we can proceed to elaborate the exposure hierarchy. In order to do this, we can ask a series of questions (e.g., what level of discomfort, on a scale from 0 to 100, does it generate you to study for a test?, What level of discomfort, on a scale from 0 to 100, would it generate to you having to do an admission test for the university?, Do you think there is something that can generate an even greater discomfort?) aimed at planning the intervention through virtual reality
2.1.3.1 Hierarchy Examples
In the annex you will find a self-report tool to get the hierarchy of action using Psious environments.
2.2 Example of Intervention in Test Anxiety
Before moving on to the hierarchy example that could be used in an intervention to treat test anxiety, we must bear in mind that this type of problem comprises more factors than those that you can work on through exposure techniques.
As discussed above, it’s important to distinguish what type of component characterizes the anxiety of the patient, since this can guide the psychological intervention in the first moment. We must keep in mind that the test anxiety is multidimensional.
Systematic desensitization (DS) through exposure is shown to be effective by itself to reduce test anxiety (Hembree, 1988) in addition to having a positive effect on academic results and a decrease in overall anxiety and trait status.
The therapeutic approaches that combine DS with cognitive restructuring and study techniques are the ones that show a greater reduction of the test anxiety (Talbot, 2016). Remember that exposure is an equally effective but more efficient technique than DS and that, in addition, virtual reality exposure is equally effective as exposure by imagination and achieves a greater reduction of avoidance behaviors than exposure by imagination (GutiérrezMaldonado, Alsina, Carvallo, Letosa & Magallón, 2007).
In terms of study techniques, it can be taught the importance of properly managing time and planning, understanding that in order to optimize the study, it is necessary to plan short-, medium- and long-term objectives. Techniques may also be used for the control of activation such as relaxation in case of having a patient with excessive physiological activation.
Another useful technique in these cases is cognitive restructuring, especially in those patients with excessive concern and with distorted thoughts centered on the negative consequences of not being successful in the test. During the preparation for the test, the student can be told to analyze the rationality of his/her thoughts, to think about which ones he/she habitually has and how they can interfere with his/her performance. In addition to this, you can tell the patient to draw up a list of alternative thoughts (selfinstructions) so they can choose one of them when their mind focuses on a negative thought while they are doing a test. Remember that the patient can practice using all these strategies in the virtual reality environment.
environment. In this case the scene used is University, but the same example could be used with the High School environment.
SESSION 1
Psychoeducation: Inform the patient about the fear of animals (causes, symptoms, prevalence…).
The main objective will be to familiarize the patient with virtual reality and the work dynamic.
The recommended protocol for the first session:
| Item | SUDs | Environment | Configuration | Event |
| Being at home a few days before an important test | 20 | Home | Sun, Day | |
| Being on the subway before doing a test | 25 | Metro | Iluminated, easy | Enter |
| Being alone in the hallway, waiting for the teacher to arrive and start the test | 35 | University | Easy, alone | |
| Being with a few classmates in the hallway before a test while they look very calm | 40 | University | Easy, few students |
SESSION 2
Homework
The recommended protocol for the second session:
| Item | SUDs | Environment | Configuration | Event |
| Being alone waiting for the teacher, and when he arrives he nicely ask you to come in | 40 | University | Easy, alone | Teacher appears |
| Being with a lot of people in the hallwaybefore an exam and they seemvery quiet | 45 | University | Easy, a lot of students | |
| Being with a few classmates in the hallway, and when the teacher appears he asks you to come in | 50 | University | Easy, Few students | Teacher appears |
| Waiting for the teacher with some classmates that seem very nervous | 60 | University | Hard, Few students |
SESSION 3
Homework
The protocol recommended for the third session:
| Item | SUDs | Environment | Configuration | Event |
| Waiting for the teacher with a lot of people in the hallway, and they are very nervous and agitated | 60 | University | Hard, A lot of students | No event |
| Be with some classmates waiting in the hallway, the teacher appears and tells you to come in very seriously | 65 | University | Difficult, Few students | Teacher appears |
| Being in class about to start a test, the classmates seem calm | 70 | University | Easy, Few students | Enters the classroom |
SESSION 4
Homework
El protocolo recomendado para la cuarta sesión:
| Item | SUDs | Environment | Configuration | Event |
| To see the result after doing a test | 70 | University | Easy, Few students | Finish the test |
| Being alone with the teacher while he seems very serious | 75 | University | Hard, Alone | Enters the classroom and then, No event |
| Waiting for the test to begin and see that the large number of colleagues around you seem very nervous | 80 | University | Hard, A lot of students | Enters the classroom and then, No event |
SESSION 5
Homework
The protocol recommended for the fifth session:
| Item | SUDs | Environment | Configuration | Event |
| Be alone with the teacher and start the test | 80 | University | Easy, Alone | Start the exam |
| Doing a short test in a crowded classroom | 85 | University | Easy, A lot of students | Start the exam |
| Doing a short test and notice that the teacher is watching a lot | 90 | University | Hard, A lot of students | Start the exam |
SESSION 6
Homework
The recommended protocol for the sixth session:
| Item | SUDs | Environment | Configuration | Event |
| The class murmur is being reduced and the teacher starts the test | 90 | University | Easy, Few students | Start the exam |
| Be doing a very long test and the teacher is watching you a lot | 95 | University | Hard, A lot of students | Start the exam |
| Doing a long test and several classmates are announcing aloud that they have already finished | 100 | University | Hard, A lot of people | Start the exam (some time has to pass) |
REMEMBER THAT YOU CAN USE THE CLINICAL GUIDE TO INFORM YOU OF THE THERAPEUTIC PROCEDURES WITH EMPIRICAL EVIDENCE AND HOW TO ADAPT THEM TO THE INTERVENTION WITH THE PSIOUS VIRTUAL ENVIRONMENTS
3. Use Recommendations
The therapist can contribute to a better immersion through comments that put the patient in the context of the simulation; in this way you will experience the exhibition more realistically.
4. Recommended Bibliography
Ali, M. S., & Mohsin, M. N. (2013). Test Anxiety Inventory (TAI): Factor analysis and psychometric properties. Journal of Humanities and Social Science, 8(1), 73-81
Alsina, I., Carvallo, C. y Gutiérrez-Maldonado, J. (2007). Validity of virtual reality as a method of exposure in the treatment of test anxiety. Behavior Research Methods, 39 (4), 844-851. R
Botella et al. (2012): La realidad virtual para el tratamiento de los trastornos emocionales: una revisión. Anuario de psicología clínica y de la Salud. Volumen 08 • Pág. 7 a 21
Brown, T. A., DiNardo, P. A., & Barlow, D. H. (1994). Anxiety disorders interview schedule for DSM-IV (ADIS-IV), adult version. Albany (NY): Graywind Publications Inc.
Cunha, M., & Paiva, M. J. (2012). Text Anxiety in Adolescents: The role of self-criticism and acceptance and mindfulness skills. The Spanish journal of psychology, 15(2), 533
Kavakci, O., Semiz, M., Kartal, A., Dikici, A., & Kugu, N. (2014). Test anxiety prevalance and related variables in the students who are going to take the university entrance examination. Dusunen Adam, 27(4), 301.
Krijn, et al. (2004) Virtual reality exposure therapy of anxiety disorders: A review, Clinical Psychology Review, Volume 24, Issue 3, Pages 259-281, ISSN 0272-7358, http://dx.doi.org/10.1016/j. cpr.2004.04.001. (http://www.sciencedirect.com/science/article/pii/ S0272735804000418)
Liebert, R. M., & Morris, L. W. (1967). Cognitive and emotional components of test anxiety: A distinction and some initial data. Psychological reports, 20(3), 975-978.
Mandler, G and Sarason, S B, (1952). A study of anxiety and learning. Journal of Abnormal and Social Psychology, 47, 166–173
Gutiérrez-Maldonado, J., Alsina-Jurnet, I., Carvallo-Becíu, C., LetosaPorta, A., y Magallón-Neri, E. (2007). Aplicaciones clínicas de la realidad virtual en el ámbito escolar. Cuadernos de medicina psicosomática y psiquiatría de enlace, 82, 32-51.
Heredia, D., Piemontesi, S., Furlan, L., y Pérez, E. (2008). Adaptación de la Escala de Afrontamiento ante la ansiedad e incertidumbre preexamen:(COPEAU). Avaliação psicológica, 7(1), 1-9.
Hembree, R. (1988). Correlates, causes, effects, and treatment of test anxiety. Review of educational research, 58(1), 47-77.
Hodapp, V., Glanzmann, P., y Laux, L. (1995). Theory and measurement of test anxiety as a situation-specific trait. En Charles Spielberger (Ed). Test anxiety: Theory, assessment, and treatment, (47-58). Philadelphia: Taylor & Francis.
Rodríguez, J. O., Alcázar, A. I. R., Caballo, V. E., García-López, L. J., Amorós, M. O., y López-Gollonet, C. (2003). El tratamiento de la fobia social en niños y adolescentes: una revisión meta-analítica. Psicología Conductual, 11, 599-622.
Sapp, M., Farrell, W., y Durand, H. (1995). The effect of mathematics, reading, and writing tests in producing worry and emotionality test anxiety with economically and educationally disadvantaged college students. College Student Journal, 29, 122–125.
Sarason, I. G. (1972). Experimental approaches to test anxiety: Attention and the uses of information. Anxiety: Current trends in theory and research, 2, 383-403.
Spielberger, C.D. (1980). Test Anxiety Inventory Palo Alto, C.A: Consulting Psychologists Press.
Spielberger, C. D & Vagg, P.R. (1995). Test Anxiety: Theory Assessment and Treatment Washington D.C. Taylor Francis, 3-14.
Talbot, L. (2016). Test Anxiety: Prevalence, Effects, and Interventions for Elementary School Students. James Madison Undergraduate Research Journal (JMURJ), 3(1), 5.
Valero, L. (1999). Evaluación de ansiedad ante exámenes: Datos de aplicación y fiabilidad de un cuestionario CAEX. Anales de psicología, 15(2), 223-231.
Von Der Embse, N., Barterian, J., & Segool, N. (2013). Test anxiety interventions for children and adolescents: A systematic review of treatment studies from 2000–2010. Psychology in the Schools, 50(1), 57-71.
Zeidner, M. (1998). Test anxiety: The state of the art. Springer Science & Business Media.
5. Annexe
5.1 Self-report Hierarchy Test Anxiety
| Item | Discomfort level (0-100) |
| I am at home a few days before performing an important test | |
| All students are in class today performing a very short test of anxiety | |
| While I’m alone in the hallway, the teacher is going to question me, and with a friendly voice, he invites me to go to the classroom | |
| The test that I’m doing today is quite long, and the class I’m in is very full | |
| I find myself in the hallway with several classmates who seem calm although we have a test. The teacher comes to the classroom with a very serious look and asks us to come in | |
| I am alone in the classroom with the teacher, who seems quite friendly, waiting for the test anxiety to start | |
| I’m waiting in the hallway for the teacher to start the test today, and there are many people who also wait and seem quite anxious | |
| I’m alone in the hallway, waiting for the teacher to start a test | |
| I and a few of my classmates are about to start the Science Test, they all seem pretty calm and the teacher is relaxed | |
| I’m alone in the classroom with a very serious teacher who seems to be watching me, waiting for the anxiety test to start | |
| I’m with a lot of people in the hallway waiting for the teacher to start the test today, and I can see how the others are quite calm | |
| I’m just sitting in the classroom, waiting for the teacher, who seems quite friendly, to start the history test | |
| At the end of the test I have been doing, the teacher shows me the result on a screen | |
| I find myself in the hallway with a few classmates who seem quite nervous, and we are waiting for a test | |
| As the test will begin, the murmur of the classmates goes down until nothing is heard | |
| I and a few classmates are waiting for the teacher to start a test, and it seems that they are relaxed and calm | |
| I’m in class about to perform an anxiety test, in the class there are enough people who are very uneasy and also the teacher seems very serious and fairly controlling | |
| While I am in the middle of the test, one of my colleagues announces aloud that he is finished | |
| After waiting for a while alone in the hallway, the teacher appears and tells me to go to class very seriously | |
| I’m the only student in class and I am doing a science test | |
| I find myself in class with many classmates, and we are doing a brief history test | |
| I’m in the hallway with several classmates who seem quite nervous. Suddenly the teacher appears and kindly tells us that we can go to the classroom | |
| I’m alone in the classroom with the teacher, who is quite serious, waiting for the start of the natural sciences test | |
| While I and some of my classmates were waiting quietly for the teacher to arrive, he appeared and kindly told us to go to class | |
| I’m alone in a classroom doing an anxiety test | |
| I’m in the history classroom, and I find myself doing a brief test on this topic with many classmates | |
| While I and some colleagues who look very anxious are waiting for the teacher, he comes and tells us in a friendly way that we can go to the classroom | |
| In the class where the history test is done, we are just me and the teacher, who seems very serious | |
| I’m in class about to take a history test. The classroom is full of people who seem very calm, and the history teacher is calm and friendly | |
| I find myself doing a long anxiety test, and the class is quite full | |
| I’m alone in the classroom with the teacher, who seems very calm, waiting for the start of the natural sciences test | |
| I’m inside the subway, because I’m going to do the test I have today | |
| I meet many classmates in the classroom where the natural sciences test will start, the teacher seems very serious and the students are nervous | |
| I’m in class about to do an anxiety test, the class is full of people who are quite calm and also the teacher is very kind | |
| I find myself alone with the history teacher, doing a test | |
| I am with many colleagues doing a long test of natural sciences | |
| I’m in class about to take a history test. The classroom is full of people who seem very nervous, and the teacher is a bit serious and not very kind |
5.2 Study material and exams for Institute
5.2.1 Evalutaion objectives
Note: The study/examination material on “Psychology: Anxiety” will be valid for both High School and University environments..
Study material
Anxiety
Anxiety (from the Latin anxiety-anxiety- “anguish, grief”) is a response of involuntary anticipation of the organism to stimuli that can be external or internal, such as thoughts, ideas, images, etc., that are perceived by the individual as threatening and dangerous, and is accompanied by an unpleasant feeling or somatic symptoms of tension. This is a warning sign that warns of imminent danger and allows the person to take the necessary steps to deal with a threat.
Adaptive or non-pathological anxiety is a normal feeling or emotional state in certain situations and is a habitual response to different stressful everyday situations. Therefore, some degree of anxiety is even desirable for the normal handling of environmental demands or demands. It is only when it exceeds a certain intensity, when the systems that trigger the normal anxiety response are unbalanced, or when the adaptive capacity between the individual and the environment is exceeded, that anxiety becomes pathological, causing significant discomfort, with physical, psychological and behavioral symptoms, most of the time very nonspecific.
A wide range of medical conditions can produce symptoms of anxiety. To clarify whether these are the direct physiological consequence of a medical disease, the necessary clinical history data, physical examination, laboratory tests and complementary studies are evaluated in terms of the patient’s symptoms. Having high levels of neuroticism increases the risk of developing anxiety symptoms.
The difference between normal and pathological
Anxiety Normal anxiety is adaptive and allows the person to respond to the stimulus in an appropriate way. It is presented before real or potential stimuli (not imaginary or non-existent). The reaction is qualitatively and quantitatively proportional in time, duration and intensity.
Anxiety is considered pathological when the stimulus exceeds the organism’s ability to adapt and a nonadaptive, intense and disproportionate response appears, interfering with daily functioning and diminishing performance. It is accompanied by an unpleasant and demotivating sensation, physical and psychological symptoms, and persists beyond the reasons that have triggered it. Pathological anxiety has the following characteristics: it manifests itself intensely; it is prolonged and maintained over time more than it should be, it appears spontaneously without a triggering stimulus (endogenously), it arises in the face of stimuli that should not generate the anxiety response and there is an inadequate response with respect to the stimulus that provokes it.
The boundary between normal anxiety and pathological anxiety is not easy to define and may vary between individuals depending on personality traits or, above all, on what has been described as an “anxiety-prone cognitive style. The diagnostic criteria in the Diagnostic and Statistical Manual of Mental Disorders, Fourth and Fifth Edition (DSM-IV and DSM-5, respectively), indicate that anxiety should be considered pathological when “Anxiety, anxiety, worry or physical symptoms cause clinically significant discomfort or social, occupational or other major areas of activity impairment”. It is useful to distinguish between “state” anxiety, which is episodic and transient, and “trait” anxiety, which is persistent and may reflect a “prone to anxiety” personality.
If a person reacts with high levels of anxiety to a situation that others do not experience as much anxiety at some point in time, it can be considered simply a high intensity reaction, or an acute reaction at a level that is not too high, that is punctual and not extreme. This is usually not a disturbance.
The problem arises when this form of acute reaction is excessively intense, such as in panic attacks or anxiety attacks (where the person cannot control his or her anxiety and reaches extreme levels), or when such an acute reaction is established as a habit, i. e. if a high intensity anxiety reaction becomes chronic, or becomes very frequent.
An acute anxiety reaction is not always pathological, but can be very adaptive. For example, when the situation that causes it requires a strong alarm reaction that prepares for the Action (if a high concentration on a task for which many resources of attention are needed) is required; or if it requires high activation at a physiological level because more muscle tightening, more blood pumping, more oxygen, etc. is needed. Such an anxiety reaction helps to respond better to this situation.
Social Ani¡xiety
Social anxiety or interpersonal anxiety is the anxiety (emotional discomfort, fear, anguish, fear, tension, apprehension, or worry) that a person feels in various social situations, where he or she interacts with others, and where it can potentially be evaluated, examined, or judged by others. The difference between social anxiety and normal anxiety is that the former involves a relatively intense sense of fear in social situations (greater than normal anxiety and less than social anxiety disorder) and especially in situations that are unfamiliar or in which the subject feels or thinks he or she may be evaluated by others.
Social anxiety occurs for different reasons. Social developmental anxiety occurs in childhood as a normal part of the development of social activity, and is a stage that is overcome over time, but chronic anxiety can persist (perhaps inadvertently) until adolescence or early adulthood and can lead to a picture of social phobia or the development of a personality by avoidance. The frequency of social anxiety experimentation and what kind of situations occurs varies from subject to subject. Safety behaviors play an essential role in differentiating between social anxiety and social phobia and in maintaining the problem.
Social skills
Social skills (sometimes referred to as social competence) do not have a unique and specific definition, since there is a conceptual confusion in this respect, since there is no consensus on the part of the scientific-social community; however, this can be defined according to its main characteristics, and these indicate that social skills are a set of behaviors learned in a natural way (and that they can therefore be taught), which are manifested in interpersonal, socially accepted situations (what is known as “social competence”).
Not in vain, they are also behaviors associated with animals, manifested in relationships with other beings of the same species. In the case of people, they endow the individual who owns them with a greater capacity to achieve the objectives they seek, maintaining their self-esteem without harming that of the people around them. These behaviors are fundamentally based on mastery of communication skills, and require good emotional self-control on the part of the person acting. In many mental illnesses the area of social skills is one of the most affected, so work in psychosocial rehabilitation is very important.
Origin and development of social skills
Although the old dimension related to social behaviour has always been a concern, it was not until the mid1970s that the field of social skills achieved, it is still being studied and researched. The origins of social skills go back to Salter, around 1949, who is considered one of the fathers of behavioral therapy, and who developed in his book Conditioned Reflex Therapy (six techniques for skills).
Several studies based on the beginnings of the socalled Salter behavioral therapy were born. These sources mentioned above were developed in the United States, while in Europe, the English Argyle and Kendon (1967) related the term social skill to social psychology, defining it as “an organized, coordinated activity, in relation to an object or a situation, which involves a chain of sensory, central and motor mechanisms; one of its main characteristics is that the act, or sequence of acts, is continuously under the control of the entrance”.
Assertiveness
Assertiveness is a model of interpersonal relationship that consists of knowing one’s own rights and defending them, respecting others; it has as a fundamental premise that all people have basic rights or assertive rights. As a strategy and style of communication, assertiveness is situated in the middle between two other polar behaviors: passivity, which consists of allowing third parties to decide for us, or overlook our ideas; and on the other hand we have aggressiveness, which occurs when we are not able to be objective and respect the ideas of others.
The concept of assertiveness is usually defined as a communicational behavior in which the person does not attack or submit to the will of others, but expresses his or her convictions and defends his or her rights. It is also a form of conscious, congruent, direct and balanced expression, whose purpose is to communicate our ideas and feelings or defend our legitimate rights without the intention to hurt or harm, acting from an inner state of self-confidence, rather than the limiting emotionality typical of anxiety, guilt or anger. Having a criterion of our own within society is essential to communicate in a better way.
Test anxiety
When the exam dates arrive, some students begin a calvary, which is sometimes difficult to get out of. Feelings of insecurity, anguish, fear, blockages or thoughts such as “I won’t be able to pass this or that subject…”;”I get to study and I stay blank…”;”When I’m on an exam I’m unable to answer, I stay blank…” or physiological sensations such as tremors, tachycardia, difficulty sleeping…”appear. All of these symptoms converge into what experts have called test anxiety. Examination anxiety has been defined as emotional, physiological, and behavioral responses that occur around the potential consequences of negative assessments or a future test, test, or examination (Zeidner, 1998). Spielberg and Vagg (1995) have described test anxiety as an element of general anxiety and as a process of cognitive attention that interferes with performance in academic situations or tests. Like Sapp, et al. (1995)13 that consider it a case of general anxiety disorder related to being examined.
Different components (Hodapp, 1991,1995)14 of test anxiety have been identified:
There are three different coping styles that relate to the different components of anxiety testing in different ways (Stöber, 2014):
The following is a description of the main coping strategies for dealing with test anxiety:
Use the information included in the document and that provided by your psychologist to better manage the necessary anxiety you need to have before an exam!
Bibliography
Iruarrizaga et al. Reducción de la ansiedad a través del entrenamiento en habilidades sociales.
Grupo de Trabajo de la Guía de Práctica Clínica para el Manejo de Pacientes con Trastornos de Ansiedad en Atención Primaria. Madrid: Plan Nacional para el SNS del MSC. Unidad de Evaluación de Tecnologías Sanitarias. Agencia Laín Entralgo. Comunidad de Madrid; 2008. Guías de Práctica Clínica en el Sistema Nacional de Salud SNS: UETS No 2006/10. 2008. Consultado el 5 de abril de 2015.
Lorenzo Fernández et al. (2013). Manual de Farmacología Básica y Clínica. Panamericana. ISBN 978-84- 9835-437- 9.
Jeronimus et al. (2016). Neuroticism’s prospective association with mental disorders halves after adjustment for baseline symptoms and psychiatric history, but the adjusted association hardly decays with time: a meta-analysis on 59 longitudinal/ prospective studies with 443 313 participants. Psychological Medicine 46 (14): 2883-2906. doi:10.1017/S0033291716001653.PMID 27523506.
Área de Psiquiatría de la Universidad de Oviedo CIBERSAM, ed. (2010/2011). Ansiedad.
P. Lorenzo et al. (2008). Velázquez. Farmacología Básica y Clínica (18 edición). Panamericana. p. 275.
Nuss, P (2015 Jan 17). Anxiety disorders and GABA neurotransmission: a disturbance ofbmodulation. Neuropsychiatr Dis Treat 11: 165-75. doi:10.2147/NDT. S58841. PMC 4303399.PMID 25653526.
Sociedad Española para el Estudio de la Ansiedad y el Estrés – SEAS (ed.). Ansiedad normal y ansiedad patológica – ¿Las diferencias individuales en la reacción de ansiedad ante una misma situación indican patología?. Consultado el 5 de abril de 2015.
Marta Vélez C. Conductas de Seguridad en la Ansiedad Social.
Zeidner, Moshe. Test anxiety: The state of the art. Springer Science & Business Media, 1998.
Spielberger, C.D. and P.R. Vagg, 1995. Test anxiety: A Transactional Process Model. In: C.D. Spielberger Research, Competencies for Analysis and and P.R. Vagg, (Eds.), Test Anxiety: Theory, assessment and treatment. Washington, DC Taylor and Francis, pp: 3-14.
Sapp, M., Farrell, W., & Durand, H. (1995). The effects of mathematics, reading, and writing tests in producing worry and emotionality test anxiety with economically and educationally disadvantaged college students. College Student Journal.
Hodapp, V. (1991). Das Prüfungs. ngstlichkeitsinventar TAI-G: Eine erweiterte und modifizierte Version mit vier Komponenten [The Test Anxiety Inventory TAI-G: An expanded and modified version with four components]. Zeitschrift für Pädagogische Psychologie , 5 , 121-130.
Stöber, Joachim. Dimensions of test anxiety: Relations to ways of coping with pre-exam anxiety and uncertainty. Anxiety, Stress & Coping 17.3 (2004): 213-226.
Exam
V. Configuration: Easy
| Statement | Answer |
| Social skills are a set of learned behaviors that we use to relate to each other | True |
| Social anxiety is the fear of being tested negatively. | True |
| Fear is an emotion that doesn’t help under any circumstances. | False |
| Fear allows us to face adverse situations, avoid dangers, flee or avoid threats. Only sometimes, the levels of the fear are very high and hinder our psychological, social, academic and/or work performance | True |
| Fear of tests only appears when we haven’t studied. | False |
| Anxiety is healthy when it allows us to defend ourselves. | True |
| Planning for long-term testing is the only and best way to eliminate test anxiety. | False |
| Physical anxiety may be resolved without thinking about the test. | False |
| Sometimes, our thinking can cause anxiety. | True |
| Anxiety may be the cause of being blocked during an evaluation. | True |
Exam
V. Configuration: Difficult
| Statement | Answer |
| Social skills are set of learned behaviors that we use to interact with other people and that help us to obtain things and manage situations in our environment. | True |
| Social anxiety is fear of being evaluated negatively: we think that another person believes that what we have done, said, etc. is wrong or wrong. | True |
| Fear is an emotion that doesnt help under any circumstances. | False |
| Fear allows us to face adverse situations, avoid dangers, flee or avoid threat. Only sometimes, the levels of fear are very high and hinder our psychological, social, academic and/or work performance. | True |
| Fear of exams only appears if we haven’t studied. | False |
| Anxiety is healthy when it allows us to perceive (hearing, seeing…), think and act more clearly | True |
| A good way to manage test anxiety is to set long-term goales. | False |
| Physical anxiety may be resolved unthought-out until the time of the test is done. | False |
| Sometimes, our thinking can cause us more anxiety than something that’s really going on: I may be more eager to think about the test than to do the test | True |
| What happens when we get stuck on a test is that the anxiety is too high and doesn’t let us do what we’ve learned. | True |
5.2.2 History: “The recent Spain”
Study material
THE RECENT SPAIN
Objectives
The Governments of Democracy
Investigate Ask someone close to you about a recent and important event in history of Spain (1975-2009) and how he experienced it personally.
Alfonso remembers with nostalgia the Transition
After Franco’s death on November 20,1975, Spain went through a transition period on which the foundations of democracy in our country were laid.
First name: Alfonso Muñoz Garrido
Origin: Almogía (Málaga)
Language: Español
Contained
1. From Dictation to Democracy
The Democratic Transition The “Transition” begins after Franco’s death and the proclamation as King of Juan Carlos I in 1975 and can be terminated in 1982, with the coming to power of the first government From the Second Republic.
Juan Carlos I appoint Adolfo Suarez, a man with a firm interest in the country’s economy, as president of the government Commitment to the return to democracy. And let’s not forget that the role of civil society, which, through its mobilization and vote, marked the way forward, the implementation of a democratic system but without a radical rupture with the democratic system The past.
The word “Transition” means the transition from the Franco dictatorship to the current system democratic
Documento
“Freedom without Wrath”, a hymn of the epoch
This song of the Andalusian band Jarcha was initially intended to promote The first street exit to Diario16 in 1976, but it was banned by the authorities. Soon, without However, it became a kind of anthem of this historical period of the Beginnings of the Transition.
Dicen los viejos que en este país Hubo una guerra Que hay dos Españas que guardan aún El rencor de viejas deudas
Pero yo sólo he visto gente Que sufre y calla, dolor y miedo Gente que sólo desea Su pan, su hembra y la fiesta en paz
Libertad, libertad Sin ira libertad Guárdate tu miedo y tu ira
Porque hay libertad Sin ira libertad Y si no la hay sin duda la habrá
Libertad, libertad Sin ira libertad Guárdate tu miedo y tu ira
Porque hay libertad Sin ira libertad Y si no la hay sin duda la habrá
Dicen los viejos que este país necesita Palo largo y mano dura Para evitar lo peor
Dicen los viejos que hacemos Lo que nos da la gana Y no es posible que así pueda haber Gobierno que gobierne nada
Dicen los viejos que no se nos dé rienda suelta Que todos aquí llevamos La violencia a flor de piel
Pero yo sólo he visto gente Muy obediente, hasta en la cama Gente que tan sólo pide Vivir su vida, sin más mentiras y en paz
Libertad, libertad Sin ira libertad Guárdate tu miedo y tu ira
Porque hay libertad Sin ira libertad Y si no la hay sin duda la habrá.
DEMOCRATIC TRANSITION
THE START OF CHANGE
The first government of the monarchy, led by Carlos Arias Navarro, is too continuist, but, since 1976, with the presidency of Adolfo Suárez – a young man from the Franco regime but eager for change – a series of important initiatives are taken: an amnesty is decreed for political prisoners and the return of the exiles is facilitated; political parties, including the Communist Party of Spain, are legalized.
THE 1977 ELECTIONS
On 15 June 1977, the first democratic elections to the Cortes were held since February 1936. They represent the victory of Adolfo Suarez’s party, the Union of Democratic Center (UCD), while the Spanish Socialist Workers’ Party (PSOE) became the main political leader in the country. Opposition party.
The fundamental task of these new courts will be the drafting of a Constitution, which later, it will be ratified by the Spanish people in the referendum of December 6, 2009. 1978.
DIFFICULT TIMES
The Transition, however, was not an easy period: there were fears of the memory of the Civil War, army posture, and weakness of political parties or inexperience politics of Spanish society. This political process must also be seen as a way of context of violence caused by terrorism (particularly ETA) and a situation of economic crisis and therefore of abundant labor conflicts. In spite of everything, the Transitions Spanish became a model to imitate in the process of peaceful change of a dictatorial government model to another democratic one.
1. From Dictatorship to Democracy
The Spanish Constitution of 1978
The Courts that emerged after the 1977 elections saw the need to create a new text Constitutional but shared by all, what is called a “consensus” policy. A presentation was thus created with seven representatives of different political parties (“the The Constitution “) which submitted a preliminary bill to the Courts in January 1978. The text was approved on 31 October 1978 by the Congress of Deputies (325 votes in favour, 6 against and 14 abstentions) and later by the Senate.
On 6 December 1978, the Spanish people approved the text in a referendum constitutional (87% of votes in favour). Finally, the king sanctions the new legal framework (27 December 1978).
In a referendum, special political decisions are subject to popular vote transcendence.
THE 1978 CONSTITUTION
WHAT IS A CONSTITUTION?
The Constitution is the fundamental law of a State (that’s why it is called also the “Magna Carta”), and it is important because:
STRUCTURE
The Constitution consists of a Preamble (the declaration of intent), a Preliminary Title and ten more Titles (total 169 articles), as well as several additional provisions, and final (as on possible reform).
In the Preliminary Title, Spain is defined as a “social and democratic state of right “, in which national sovereignty resides in the people. The form of State is the Parliamentary monarchy. Political pluralism and the importance of political pluralism are recognized, as is the importance of Trade unions and business associations.
TITLE I. RIGHTS AND FUNDAMENTAL DUTIES
The Spaniards are guaranteed universal human rights and all freedoms the death penalty, recognizes freedom of education, freedom of religion and belief, freedom of religion or belief, freedom of religion or belief, freedom of religion or belief. And the market economy. It also proclaims that there is no official state religion. Among the duties, to defend Spain (although it acknowledges conscientious objection), the economic support of the State and knowledge of the Castilian language (although recognizes the official status of other languages in their respective territories.
TITLES II TO VII. THE AUTHORITIES OF POWER
Parliamentary monarchy is established as a form of state, with the role of arbitrator but not government.
Parliament is the guarantor of national sovereignty, with a bicameral composition (Congress and Parliament), and assumes legislative power. The president of government, the executive branch, is elected by Parliament and must to answer to him.
Liberties and rights are guaranteed by the Ombudsman, a judiciary which is independent and ultimately the Constitutional Court.
TITLE VIII. THE TERRITORIAL ORGANIZATION OF THE STATE
As stated in article 2,”the Constitution is based on the indissoluble unity of the Spanish Nation, a common and indivisible homeland of all Spaniards, and recognizes and guarantees the right to autonomy of the nationalities and regions that make up it and solidarity among all of them”. Each autonomy will have its own government, a parliament, a statute and the corresponding powers. The role of local authorities, such as municipalities, is also highlighted.
1. From Dictatorship to Democracy
The Governments of Democracy
The different parties that have managed to gain access to government in recent Spain have developed their policy around a number of common themes:
THE GOVERNMENTS OF DEMOCRACY AND TRANSITION
THE GOVERNMENT OF ADOLFO SUÁREZ (1976-1981)
Adolfo Suarez, who has been in power since 1976, sees his position consolidated with the triumph of UCD in the 1977 and 1979 elections. The strong international economic crisis led to a policy of consensus on economic and social issues (the Moncloa Covenants, 1977).
Self-government is restored in the so-called “historical nationalities” (such as Catalonia or the Basque Country) and the process is opened to the rest of preautonomies.
Terrorism strikes very hard in this period, with the highest numbers of ETA and GRAPO victims throughout the democratic period.
THE END OF THE UCD (1981-1982)
The internal dissensions in the UCD force the resignation of Suarez, which is replaced by Leopoldo Calvo Sotelo. At the height of the inauguration of the new president of government (23 February 1981) there was an attempted military coup d’ état that failed, highlighting the king’s intervention and the role of the media. During Calvo Sotelo’s brief government, he joined the Western NATO political-military organization, with an initial opposition from the PSOE. The strong economic crisis continues.
FIRST STAGE OF SOCIALISM (1982-1996)
The 1982 elections granted absolute majority to the PSOE, and Felipe González became president of the government. In domestic politics, it stands out for completing the autonomic map, an important social policy and a liberal economic policy, which confronts the unions on several occasions (general strikes). From an external point of view, the referendum for remaining in NATO in 1986 (with victory of the yes) and, in particular, integration into the European Communities (accession signed in June 1985). The social cost of its economic policy, the fight against terrorism and some cases of corruption were decisive for the end of the government.
THE PP GOVERNMENTS (1996-2004)
José Mª Aznar consolidates a strong centre-right party (Popular Party) that leads him to victory in the 1996 elections and, especially, in 2000 (absolute majority). It highlights the success of its economic policy, which allows it to join the single currency (euro) in 2002. The compulsory military service is gone.
From the external point of view, it is clearly allied with the government’s policy Bush, especially after the 9/11 attacks in the United States. (2001).
The political cost of government support for the Iraq war and the impact of the U. S. military on Iraq’s people 11 March 2004, the attacks provoke the defeat of the PP in the elections of March 11, 2004.
SECOND STAGE OF SOCIALISM (2004- )
José Luis Rodriguez Zapatero becomes president in 2004. Your first effort is devoted to foreign policy issues (removal from Iraq) and social policy (Law on the Protection of the Rights of the Child). Marriage), although the strong economic crisis that began in the late 1990s, led to a growing 2007 has since then strongly conditioned government policy.
2. The new Spanish company
Demographics
From 1978 onwards, there were changes in the natural movement of the Spanish population: the strong economic crisis, the massive incorporation of women into the public sphere and the new family models meant that Spain came to have one of the lowest fertility rates in the world. This, coupled with one of the highest life expectancies, results in a rapid ageing of the population, which is still not very pronounced today because it was based on an initial model that was still young.
With regard to migratory movements, the number of inmates between Autonomous Communities is decreasing and in a few years it has gone from being a country that issues emigrants abroad to another where immigrants are already a statistically important part of the State’s population.
THE SPANISH DEMOGRAPHIC STRUCTURE, A REFLECTION OF ITS CHANGES SOCIAL (1975- 2009)
The Spanish population of 1975, a model of a young population
The Spanish population at the beginning of the 21st century, a new demographic model
ANALYSIS OF AN AGE PYRAMID
Population ageing: the improvement of the economic and social situation in Spain facilitates an increase in life expectancy, one of the highest in the world. This fact, together with the low birth rate, means that a significant percentage of the Spanish population is located in the highest areas of the pyramid.
More women: Female life expectancy is higher than male life expectancy, so in the mature population there is a significant gender imbalance in favour of women.
The children of the “baby boom”: the 1960s and early 1970s corresponded to so-called “developmentalism”, a favourable economic situation that facilitated an increase in birth rates, although another cause was that the woman was still placed especially in the domestic sphere. At present the group that was born at this time is the largest of the pyramid
Low birth rate: From 1978 onwards, the strong economic crisis caused by the rise in oil prices and the social and political changes caused by the Transition (more women’s freedom, free contraceptives, new family models) caused a significant drop in the birth rate to one of the lowest fertility rates in the world.
a new baby boom? In the beginning of the 21st century, there was a slight upturn in the birth rate, due to several factors, most notably the arrival of young immigrants.
with different demographic patterns – although they adapt quickly to the Spanish model – and, above all, given the late age at which Spanish women have their first child, the significant number of women in their thirties.
2. The new Spanish company
New social guidelines
The transformations that have affected Spanish society since the Transition have been spectacular:
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THE VALUE OF EXPERIENCE
Oral history is a technique of historical science that uses oral sources as a fundamental basis for the reconstruction of the past. And in this fortnight, in which we try to learn more about our most recent history, it can be a very valid instrument to approach it in a different way.
In order to work on oral history we need three elements: firstly, to obtain sufficiently interesting testimonies; secondly, a methodology of our own, which in this case is the preliminary preparation of an interview; and finally, technical means, such as a tape recorder or a camera, to later make a faithful transcription of the content.
If we don’t have it all, we can always call on the Archive of Experience (link at http://www.archivodelaexperiencia.es). This is a vast project, initiated in 2007, which seeks to recover the testimonies of Spaniards who have lived through different historical stages (from the Republic to Democracy) and which reflect their experiences on the most varied themes: cinema, social changes, the impact of tourism, sports celebrations, major political events, etc…
Although oral history is an attractive way of working with history – and also of relating to our elders – it also has its drawbacks, especially the great subjectivity of any kind of personal testimony, as well as the need to choose testimonies appropriate to the subjects dealt with. The type of interview and questions may also condition the respondent’s response.
2. The new Spanish company
The culture
Two elements stand out when analyzing the culture of recent Spain. Firstly, the attempt to identify the signs of Spanish identity through the recovery of silenced voices (in exile or extinguished by the cultural monolithic Francoism) and to create a new model – always rooted in our common past – more in keeping with a modern and democratic Spain.
Secondly, the achievement of individual and collective freedoms led to a veritable cultural explosion, encompassing all spheres (music, film, painting, comics, etc.) and many territories of the State.
Madrid’s “Movida” was a “pop” movement that emerged in the late seventies and 1970s. Related to the night, with a great interest in alternative culture.
THE CULTURE OF TRANSITION
THE RETURN OF THE GUERNICA
Picasso’s painting “Guernica” is a symbol of our Civil War and an icon of 20th century art. First time hung in the Pavilion of the Spanish Republic in The 1937 International Exhibition in Paris as a tribute to the Basque city, victim of savage bombardments, was exhibited for decades at the Museum of Modern Art in New York, at the express request of the Malaga painter, who asked that the painting return to his country when democracy returned. Thus, after four years of intense negotiations, on 9 September 1981 the table returns to Spain. It was one of the most symbolic successes of the Spanish Transition and a great cultural event.
THE RECOVERED CULTURES
The return to democratic normality allows the return of many intellectuals who had lived in exile outside of Spain and who; therefore, their work had hardly had any repercussions in our country, or had even been forbidden.
On the other hand, the cultures in Catalan, Basque, Galician and other minority languages of the State, which had even been persecuted by Franco’s regime, see a resurgence that is clearly observed in the world of education, literature or cinema and in everyday and official use in society in general.
THE “MOVIDA”
One of the most significant aspects of the beginnings of the Transition was the explosion that took place in all sorts of cultural fields: cinema, music, comics, painting, etc., which we reflect here with a Madrid expression, the “movida”: a “pop” movement, fruit of the environment of freedom, so desired by many creators, which was established at the end of the seventies and beginning of the eighties and which spread throughout Spain.
THE ROLE OF ADMINISTRATIONS
To understand the increase in the “consumption” of cultural products produced in our country during this period (cinema, reading, attending shows or exhibitions), It is necessary to take into account the increase in the standard of living of the Spanish population and the significant role played by all types of administrations, both central (in 1977 the Ministry of Culture is created), and regional or local. In this way, important infrastructures (auditoriums, museums, libraries) appear and intense campaigns (reading, theatrical circuits or digital literacy, etc.) are carried out that decentralize and popularize culture.
3. The economy of recent Spain
The global economic crisis of the 1970s contributed to making the democratic transition process even more difficult. From the mid-1980s onwards, however, there was a strong economic development which, in the mid-1990s, led Spain to become the eighth country in the world in terms of Gross Domestic Product and was also among the first in terms of Human Development, since the economic prosperity achieved in recent years has made it possible to increase social spending, which has ultimately shaped the welfare state.
Next, we will analyze the different economic junctures of recent years and the strengths and weaknesses of the Spanish economy.
THE ECONOMY OF RECENT SPAIN
A DIFFICULT ECONOMIC TRANSITION
The global crisis caused by the sharp rise in oil prices seriously affected the fragile Spanish economy of the late 1970s: inflation, unemployment, state bankruptcy and trade deficit.
The policy of the centrist governments (Moncloa Covenants of 1977) and the first socialist governments was very similar: higher tax pressure, conversion of the most obsolete industrial sectors (such as mining, textiles or steel) and increased public spending. The crisis was only finally overcome by 1986, several years behind the overall recovery in the Western world.
THE IMPACT OF INTEGRATION ON EUROPE
Spain’s entry into the European Communities in 1986 was undoubtedly a modernization factor for several reasons:
A GLOBALIZED ECONOMY
From the mid-1990s onwards, Spain was able to face an increasingly globalized world economy.
WEAKNESSES OF THE SPANISH ECONOMIC MODEL
In times of economic crisis, such as the one that began in 2007, however, the weaknesses of the Spanish economic model are shown:
4. Spain opens up to the world
Foreign policy
The different governments of Democracy have maintained – despite their differences – the same broad lines of foreign policy, which can be defined as follows:
MISSIONS OF DEFENCE ABROAD
Since 1989,100,000 Spanish military personnel have participated in more than 50 military and humanitarian aid operations on four continents. Whether under the banner of the United Nations, the European Union or NATO, the three armies have participated in all kinds of missions, some in highly conflict-ridden areas, and even at the expense of an significant tribute in human lives.
The most frequent have been peace missions. They send observers (unarmed officers to verify the maintenance of a ceasefire or to patrol borders) or armed troops (acting to ensure humanitarian aid and peace in an area).
In 2009, there are four ongoing missions:
ATALANTA. Somalia waters
Based on United Nations resolutions, its basic objective is to guarantee the safety of navigation in the area against the constant attack of Somali pirates. The European Security and Defence Policy decided in 2008 to send a multinational fleet to the Indian Ocean to contribute to deterrence, prevention and protection against pirate attacks.
Spain has sent several frigates and maritime patrol planes to this area, which is heavily frequented by the Spanish deep-sea fishing fleet.
EUFOR “Althea”. Bosnia-Herzegovina
The European Union designed this operation in 2004, under the aegis of previous UN resolutions. Heir to previous missions following the Balkan wars that led to the disintegration of the former Yugoslavia in the 1990s, the current force is smaller (2,000 men and women, more than 10% of whom are Spanish), and above all has a police purpose.
It also collaborates with the International Criminal Tribunal in The Hague to prosecute and arrest those accused of war crimes in the aforementioned Balkan wars.
It is scheduled for completion – at least with respect to Spanish participation – throughout the year. Of 2010.
ISAF. Afganistán
The Spanish government authorized the participation of Spanish military units in the International Security Assistance Force (ISAF) in support of the Afghan interim government. The first Spanish units arrived in the country at the end of January 2002.
The activities of the Spanish contingent are directed in two ways: on the one hand, to facilitate reconstruction activities in the province of Badghis, and on the other hand, to provide support for the security of the rest of the international forces in western Afghanistan. They have also worked to guarantee the country’s general elections.
FREE HYDALGO. Lebanon
The Palestinian-Israeli crisis of 2006 led the UN to increase its mediation forces along the Lebanese-Israeli border (USFIL). Spain committed itself from the outset to the mission and, after the mandatory parliamentary authorisation, which received close support for unanimity and no vote against, sent a contingent of 1,100 troops, who were assigned command of Sector East of the deployment.
The Spanish contingent carries out important mine clearance and explosives disposal activities, and also collaborates with the civilian authorities for the reconstruction of the area and other cultural and educational projects.
Observers in other missions
There are also currently Spanish observers who depend on the United Nations (so-called “blue berets”) in different peace missions in Kosovo, the Democratic Republic of Congo, and Chad and also in the Republic of Congo. Central African
4. Spain opens up to the world
Spain in Europe
Although there were already some timid attempts during the Franco regime, it was not until the arrival of democracy in Spain that Spain’s entry into what were then known as the European Communities (now the European Union) could be considered.
In July 1977, the formal application for membership was made and in February 1979, the talks began, but they were not concluded until 12 June 1985 with the signing of the Accession Treaty. Spain became a full member of the European Communities on 1 January 1986.
Spain and Portugal joined together in what was then called “The Europe of the Twelve”.
Since its accession, the Spanish State has actively participated in the process of European construction. Its incorporation coincides with one of the stages in which the greatest impetus has been given to effective economic integration and greater political cooperation, as well as geographical expansion.
SPAIN IN EUROPE
SPAIN IN THE INSTITUTIONS
Spain is heavily involved in the policy of the Union and its three main institutions:
A SINGLE MARKET
Spain’s integration into the European Union in 1986 has been a decisive modernisation factor for the Spanish economy. The necessary opening up of the Spanish economy to a single European market has meant a spectacular increase in trade and capital exchanges. The impact of EU policies in Spain has also extended to all productive and service sectors, and has enabled Spanish companies to compete in a globalised economy.
Also noteworthy is Spain’s entry into the leading group of the Economic and Monetary Union (the euro replaces the peseta in 2002).
A POLICY OF SOLIDARITY
The Cohesion Policy, through its various funds (Regional, Social and Cohesion), guarantees the reduction of inequality both between states and regions and between citizens of the Union.
Spain has received funds worth 0.8% of our GDP each year since 1987, although at present this has been reduced by exceeding our country’s average GDP in the Union. EU aid has made it possible to modernise the country’s infrastructure, create thousands of jobs over many years and benefit, through social policies, the unemployed, young people and women.
CITIZENS’ EUROPE
One of the objectives of the Treaty on European Union (Maastrich, 1992) was the consolidation of a “Citizens’ Europe”: it thus creates a single European citizenship and fully guarantees the freedom to travel, live, work and study in any of the Member States. Like the Erasmus programme for university students: in the 2006-2007 academic year more than 27,000 Europeans studied at Spanish universities, while 22,300 Spaniards studied abroad.
Another example is the freedom of movement which, through the Schengen Agreement, has made it possible to remove most of the internal border controls of the Member States.
OTHER COMMUNITY POLICIES
Much of Spanish legislation has to comply with European legislation, so the impact of Europe in Spain is even greater. We can highlight policies The EU’s policy on health, labour, environment, agriculture and fisheries.
There is also important European cooperation in areas such as security, foreign policy, and development aid or asylum and immigration policy.
Exam
V. Configuration: Easy
| Statement | Answer |
| The referendum by which the Spanish people approved the Constitution was held on 6th February 1976. | False |
| The leader of the winning party in the first democratic elections was Adolfo Suárez. | True |
| The leader of the Spanish Socialist Workers’ Party in the electoral victory of 1982 was Felipe González. | True |
| The Popular Party won the eleccions of 1992 and 1996. | False |
| Before the emerge of Izquierda Unida (IU) in 1986, as an electoral coalition of left-wing parties, the main electoral asset of the Left in previous general elections to the courts was the Communist Party of Spain (PCE). | True |
| From around 1976 onwards, there was a marked decline in the Spanish birth rate. | True |
| The main causes of the fall in birth rates in Spain since 1976 are: problems in the fertility of Spanish men, the discovery of male contraceptive methods and the economic crisis. | False |
| In recent years there has been a rebound in birth rates thanks to the late motherhood of Spanish women in the large age of 30 years and the arrival of young immigrants with other demographic patterns. | True |
| The rebound in births and late motherhood will lead to a collapse in life expectancy due to collapse in hospitals and a heavy burden on pensions. | False |
| A combination of a low birth rate and high life expectancy, as is currently the case in Spain, can lead to a rapid ageing of the population, a crisis in the pension system and a decline in the system productive | True |
Exam
V. Configuration: Difficult
| Statement | Answer |
| In 1983, during the government of the Union of Democratic Center (UCD) a group of civil guards took over the Congress of Deputies. | False |
| On 6 December 1978, the Spanish people approved the Constitution by referendum | True |
| The main characteristics of our electoral system since 1979 are: to elect our representatives to Congress and the Senate every 4 years (approximately), the electoral district is provincial and in the elections to the Senate, the person and not the party is chosen | True |
| The order of the presidents of Spanish democracy is: Suárez, Calvo-Sotelo, González, Aznar, Zapatero, Rajoy | True |
| The president of Spain during the 1978 coup d’ état was Leopoldo Calvo – Sotelo Bustelo. | False |
| Spain joins the European Communities as a full member on 1 January 1982. | False |
| The Spanish economic model in times of global economic crisis, such as that of 2007, presents a series of weaknesses such as excessive dependence on tourism, low skilled labor and little capacity to attract immigration. | False |
| Spain joins the Treaty Organization of the United Nations North Atlantic in the early 1980s | True |
| One of the objectives of the Treaty on European Union (Maastrich, 1992) was the consolidation of a “Citizens’ Europe”: thus creating a single European citizenship. | True |
| The Euro replaced the peseta in 2000 | False |
5.2.3 Natural Science: “The cell, unity of life” Study material
The Cell, Unity of Life
Objective
In this fortnight you will learn to:
Before you start
1. Organizational Levels
All matter is organized. Starting from an element that is associated with others and increases the complexity of the structure.
In the same way, living matter is organized in different levels of complexity.
Atomic Level. Consisting of atoms. The atoms that form living matter are known as bioelements. The most important bioelements are carbon, hydrogen, oxygen, nitrogen, sulphur and phosphorus.
Molecular level. This level is made up of molecules that originate by binding two or more atoms. The molecules that make up living matter are called biomolecules. Biomolecules can be inorganic such as water, mineral salts or gases, or organic such as carbohydrates, lipids, proptides and nucleic acids.
Cellular Level. Cells are included. Every cell is made up of the lower levels, molecular and atomic. The complexity of this level is much greater, since the cell is an anatomical and functional unit, which means that it is the smallest structure that could survive on its own in the middle.
Pluricellular level. It involves the association of several cells that may form an organism complete. This level can be subdivided into the next sublevels:
The whole forms the pluricellular individual.
Population Level. It includes the group of individuals of the same species that live in a specific place and at a certain time, being able to relate to each other.
Ecosystem Level. It encompasses the relationships that are between populations living in a given country and the region. Place (biocenosis) and the place where it is located. Inhabit (biotope). Large ecosystems are they call biomes. The set of biomes forms the BIOSPHERE.
2. Cellular Theory
Cells are the basis of all organisms, since all living beings are made up of cells. But the cell and its structure could not be known until the gadgets needed to see it were created. Those who gadgets are the microscopes.
In 1665, the scientist Robert Hooke described a sheet of cork he looked at under a microscope. Hooke saw a lot of cells he called cells.
Subsequently, many scientists have looked at the microscope and described the different cell structures.
All the observations made have led to the creation of Cellular Theory. It contains four main concepts:
This theory was developed by several researchers, including SchWann and Schleiden (1839), Virchow (1885) and Santiago Ramón y Cajal (1906).
3. The cell
Applying cell theory, we know that all organisms are composed of cells, but cells can be of different types. In addition, living beings can be made up of one or more cells.
The cells are classified according to the degree of complexity they present in their structure. This is how they distinguish themselves:
The organisms are made up of cells. Depending on the number of them they present, there are two types:
They are those formed by a single cell. The cell performs all vital functions. They can be prokaryotes or eukaryotes. Examples of this type of organisms are bacteria, cyanophilic algae, protozoa and many eukaryotic algae.
Sometimes they live in stable groups, called colonies. In this case, some cells perform one type of function and other cells perform another. However, each cell can live independently of the colony, assuming all vital functions.
They are living beings, all eukaryotes, formed by many cells. All the cells of the body have emerged from a single cell that has formed the others. Therefore, all cells have the same genetic information, even if they do not express the same genetic information. Way.
Cells do not survive in isolation, as they lose some capacities in order to specialize in a particular function. This is how the various tissues that can form a pluricellular organism are formed.
Examples of pluricellular organisms are animals, including humans, plants, fungi and many eukaryotic algae.
The Prokaryotic cell
Prokaryotes do not contain a nucleus that protects the genetic material. Prokaryotes are bacteria and cyanophilic algae. They all belong to the Monas Kingdom.
They usually have the following parts:
Many bacteria have scourges, which are structures that allow the cell to move.
Other bacteria present Pili that are rigid structures that start from the cell membrane. They serve to connect the cells so that they can transmit information.
EXTENSION OF BACTERIA
Some bacteria have a viscous capsule. The capsule is a protective structure against bactericidal agents, although it also allows them to be associated with other bacteria.
Bacteria occur on their own or in colonies. In these colonies there is no specialization of any kind cell phone. Bacteria that are separated from the colony can live independently.
Bacteria can take different forms. They can be elongated (bacillus), round (coco), elongated with a flagellum (vibrio) or spring-like (spiryl).
Cyanophilic algae, or cyanobacteria, are very large prokaryotes cells that contain tilacoids inside. These are membrane bags with chlorophyll in them. They do the photosynthesis with it
The eukaryotic cell
The eukaryote cell has the genetic material protected by a membrane forming the nucleus, In addition, in cytoplasm there are structures called cell organelles that perform different functions.
4. Eukaryotic Cell Parts
There are two types of endoplasmic reticulum:
Rough endoplasmic reticulum, has a rough appearance due to the fact that it has ribosomes associated with the membrane of the organulus. Its function is to produce proteins that act inside a gallbladder or outside the cell.
Smooth endoplasmic reticulum without ribosomes. Its function is to synthesize lipids.
The function of the mitochondria is to produce most of the energy required by the cell through oxidation processes of organic matter. It uses organic matter and oxygen, releasing energy and carbon dioxide. This process is called Cellular Breathing.
Tilacoids are grouped together into small<piles called grana. Vesicle-free space is the stroma of chloroplast, where circular DNA, RNA and ribosomes, similar to bacteria, are found. Chloroplasts are organelles that use light and water to transform inorganic matter (CO2) into organic matter (glucose). This process is known as Photosynthesis, there are other types of plastos in plant cells. These organelles usually accumulate reserve matter or colored substances.
When the cell enters division, chromatin spiralizes into chromosomes
The parts of a chromosome are as follows:
Not all chromosomes are the same. Depending on the length of the chromosome arms, they are classified into metacentric, submetacentric, acrocentric and telocentric chromosomes.
5. Cellular Functions
Every organism performs a series of functions to keep alive and generate individuals like him.
The cell is the simplest living being, yet it also performs these functions.
6. Cellular Functions
It is the set of changes that a cell undergoes from its formation from a cell division until it divides to form two new cells.
The cell cycle has a different duration between cells of different living beings, even between cells of the same living being. In any case, most of the cycle is occupied by the interface. After that, cell division occurs.
INTERFACE
This phase is the one that does not present great visible changes in the structure of chromatin. However, the cell is in full synthesis activity for all types of substances, including those needed to divide after the interface.
It is divided into periods called G1, S and G2. The first period appears after the division that originated the cell, so it must synthesize a large number of molecules and increase its size, increasing the number of organelles inherited from the cell that originated it.
The process is based on the addition of nucleotides of complementary bases to the existing strands. From each double helix thread a new thread is made
Once the process is complete, the cell contains the genetic information in duplicate on each chromosome. This way, it will be possible to divide into the two daughter cells formed by cell division.
MYTHOSIS
Mitosis is an asexual cell division that forms two genetically identical cells and stem cell clones. It consists of the equitable distribution of genetic information and the subsequent separation of cells when the cytoplasm is divided by cytokinesis. This latter process is not necessary for mitosis to occur.
Mitosis is divided into prophase, metaphase, anaphase and telophase.
The process usually continues with a cytokinesis, in which the cytoplasms of the two new cells are separated.
EXTENSION OF CITOSINESIS
In animal cells, a contractile ring is produced that contracts in the area where the equatorial plaque used to be, strangling the cytoplasm of this region. At the end of the process, the space is so small that the membrane plasma melts and separates one daughter cell from the other.
In plant cells, cytokinesis is produced by the intervention of microtubules of the cytoskeleton arranged in the cell equator and vesicles of the Golgi apparatus containing the substances that form the cell wall. The Lasallian blisters fuse together, forming a disc filled with hemicellulose and pectin. Disc membrane fuses with the plasma membrane, so that the two daughter cells are separated and between them appears the middle film. This primordial wall is shared by the two cells and is crossed at many points by bridges cytoplasmic, which form plasmodesmos.
Cytokinesis involves a distribution of stem cell organelles to newly formed daughter cells. This distribution occurs equally when the divided cytoplasm is half. Once divided, the cell grows increasing the number of organelles. In the case of mitochondria and plastidios, these organelles have certain autonomy of division, increasing their number depending on the physiological needs of the cell.
Cytokinesis is not evenly distributed among cytoplasmic components. Twinning is an asexual mode of reproduction in which the stem cell duplicates and gives its genetic information to the daughter who receives the least amount of cytoplasm. This division model is produced in yeasts.
MEIOSIS
Meiosis is a model of cell division in which information is exchanged between homologous chromosomes and the number of chromosomes in the formed cells is reduced by half, so they are haploids.
Thus, when two haploid cells merge, the formed cell restores the number of chromosomes so that this number remains unchanged over time. On the contrary, the content of the genetic information that appears in that new cell has changed. This evolutionary advance allows genetically varied beings to appear, which may be better or worse adapted than their parents to the environment in which they develop.
Meiosis occurs in two stages of division, called the first Meiotic Division and the second Meiotic Division. Each one of them is divided in + phases that receive the name of prophase, metaphase, anaphase and telophase.
FIRST MESIOTIC DIVISION
Profase I
Chromatin condenses into chromosomes, visible under an optical microscope, which are attached at the ends to the nuclear sheath.
The homologous chromosomes (of the same couple) come together, producing a pair in which genetic information exchange (genetic combination) takes place, by means of an overcrossing of the chromatids.
At a cytoplasmic level, the achromatic spindle has been formed from microtubules that come from the Polar Regions, where the pairs of centrioles are located, one in each cell pole.
Metaphase I
The equatorial plaque is originated by the binding of the homologous chromosomes to the microtubules of the acromatic spindle.
Anaphase I
The homologous chromosomes are separated, each moving to an opposite pole of the cell. Half of the (n) chromosomes appear in each pole.
Telophase I
The chromosomes reach the cell poles. Around them the membrane is formed and the nucleolus appears. . energetically, a cytokinesis is produced, which involves a distribution of cytoplasm, which in many cases is inequitable.
SECOND MEIOTIC DIVISION
No DNA duplication occurs between the first and second divisions.
Profase II
The chromosomes are condensed again, with their two different chromatides, the result of the genetic recombination caused by overcrossing. Disappears the nucleolus and the nuclear sheath and chromosomes attach to the microtubules of the new achromatic spindle.
Metaphase II
The chromosomes are arranged in the cellular equator, forming the equatorial plaque.
Anaphase II
The chromatids of each chromosome are separated, each to a pole.
Telophase II
A nuclear sheath is organized around the chromosomes that are gradually being discarded. The nucleolus appears and the cytoplasmic content is distributed by cytokinesis.
RESULT OF MEIOSIS
The result obtained is 4 cells (sometimes only one) with half the genetic information of the cell from which it originates. Each cell obtained is different from the other cells, since there has been a great variability due to the distribution of the homologous chromosomes and the distribution of the chromatids. Furthermore, chromatides are different from those that appeared in the stem cell, due to the exchanges generated by overcrossing.
The cells obtained in meiosis can fuse with others, producing a new cell that has the same genetic content as the initial cell. However, through this mechanism it is impossible to form a genetically identical cell.
Meiosis implies an evolutionary advance in the form of reproduction of organisms when there is an exchange of genetic materials from different cells, thus generating genetically new cells, different from the progenitors. This variability means that the possibility of adapting some organisms to the changing conditions in the environment where they live, surviving the best adapted ones.
7. DIFFERENCES BETWEEN CELLS
PROCARIOTE CELL AND EUCARIOT CELL
ANIMAL CELL AND PLANT CELL
Plants are made up of cells, just like animals. However, although most cell structures that function the same way, they have other structures than those of animal cells.
Exam
V. Configuración: Fácil
| Statement | Answer |
| In mitosis, two cells are obtained genetically identical to the stem cell | True |
| Golgi’s apparatus is associated with ribosomes | False |
| Microscopes were created after to state cellular theory | False |
| The cytoskeleton of animal cells is organized By centrioles | True |
| The eukaryotic cell contains genetic material in a compartment that we call core | True |
| A coconut bacteria has a round shape | True |
| Single-celled organs do not survive in isolation | False |
| The ecosystem level includes living beings that live in a place and relationships that are established among them | True |
| Plasma membrane only appears in cells animals, plant cells present cellular wall | False |
| Mitochondria has a smooth inner membrane | False |
Exam
V. Setting up: Difficult
| Statement | Answer |
| The prokaryotic cell has the genetic material dispersed by the cytoplasm | True |
| In meiosis, two identical cells are produced in the meiosis genetic information that the stem cell | False |
| Some prokaryotes may present chloroplasts | False |
| Cellular theory says that the cell is the unit anatomical and functional of living beings | True |
| Chloroplast performs cellular respiration | False |
| The smooth endoplasmic reticulum serves to store lipids | True |
| Proteins form in ribosomes | True |
| The cilia and phagelos have the function of protecting the cell | False |
| Within the organizational levels of the subject matter, the Carbon would be found at the molecular level | False |
| Prokaryotic cell may have plasmids | True |
5.3 Study material and exams for Univeristy/ Oppositions
5.3.1 Biology: “Genetics”
Study material
GENETICS
Lecture 1
We will begin this course with the question: What is a gene?
This question will take us four lectures to answer because there are actually several different definitions that are appropriate in different contexts.
We will start with a physical definition of the gene. Conceptually this is the simplest and it will give me an excuse to briefly review some of the molecular biology that you probably already know.
Genes are made of DNA
For this course we will mostly think of DNA as an information molecule not as a chemical substance.
In 1953, Watson and Crick deduced that the structure of DNA was a double helix. It was not the helical structure per se, but the discovery of complementary base pairing that revealed how information could be encoded in a molecule and how this information could be exactly duplicated each cell division. Replication.
In order to extract information from the DNA, the cell again uses the complementary base-pairing to make a copy of the information copied onto an RNA molecule. This is known as Transcription. RNA is chemically less stable than DNA and mRNA can be thought of as a temporary copy of DNA’s information.
Transcription
Translation
Folded proteins:
Gene: DNA segment needed to make a protein
Genes are typically 103 – 104 base pairs in size although they can be much larger. For example, the human dystrophin gene is 2 x 106 base pairs.
E. coli has about 4,200 genes which isn’t very many considering that at least 1,000 different enzymes are needed carry out just the basic biochemical reactions in a cell. The smallest genome for a free-living organism (i.e. a cell, not a virus) is that of the bacterium Mycoplasma genetalium which encodes only 467 genes. Humans are at the other end of the spectrum of complexity and have about 35,000 genes.
In the demonstration in class you see how a mutation in the Shibire gene in the fly Drosophila gives a heat sensitive protein that is required for synaptic transmission. When the flies that carry this mutation are warmed by the projector lamp they become paralyzed.
This example illustrates two powerful aspects of genetic analysis. First, we can follow microscopic changes in the DNA such as the Shibire mutation as they are revealed by the macroscopic consequences of the mutation such as a paralyzed fly. Second, we have a very precise way of studying the function of individual proteins by examining the consequences of eliminating just that one protein function in an otherwise normal organism.
Alleles: Alleles:Alleles: different versions of the same gene. Often alleles are referred to as mutants but actually this usage is often incorrect particularly when we discuss naturally occurring variants in a population.
Mutation: an altered version of a gene when we have “witnessed” the alteration but not when it is preexisting in the population.
Genotype: Genotype:Genotype: all alleles of an individual
Wild type: defined standard genotype
The concept of wild-type is used as a defined reference for organisms where we can do breeding experiments. Of course there is no realistic way to define a standard genotype for humans, therefore “wild type” has no meaning when we discuss human genetics.
The physical definition of the gene is a very good one but there are many instances where we wish to study genes whose DNA sequences are not known. For example, say we have isolated a new mutant fly that is also paralyzed and we want to know whether this mutation is also in the Shibire gene. We will see in the next several lectures that we can answer this question without knowledge of the DNA sequence either by a test for gene function known as a complementation test or by a test of the chromosomal position of the mutation by recombinational mapping. In practice, these other ways of defining genes by function or by position are often much more useful than a definition based on the DNA sequence.
Lecture 2
In this lecture we are going to consider experiments on yeast, a very useful organism for genetic study. Yeast is more properly known as Saccharomyces cerevisiae, which is the single-celled microbe used to make bread and beer. Yeast can exist as haploids of either mating type α (MATα) or mating type a (MATa). Haploid cells of different mating type when mixed together will mate to make a diploid cell.
Haploids and diploids are isomorphic – meaning that a given mutation will cause essentially the same change in haploid and diploid cells. This allows us to look at the effect of having two different alleles in the same (diploid) cell.
All yeast needs to grow are salts, minerals, and glucose (minimal medium). From these compounds, yeast cells can synthesize all of the molecules such as amino acids and nucleotides that are needed to construct a cell. The synthesis of complicated molecules requires many enzymatic steps. When combined, these enzymatic reactions constitute a biochemical pathway.
Consider the pathway for the synthesis of the amino acid histidine.
Each intermediate compound in the pathway is converted to the next by an enzyme. For example, if there is a mutation in the gene for enzyme 3 then intermediate C can not be converted to D and the cell can not make histidine. Such a mutant will only grow if histidine is provided in the growth medium.
This type of mutation is known as an auxotrophic mutation auxotrophic mutation and is very useful for genetic analysis.
| growth on minimal | growth on minimal + histidine | |
| His+ (wild type) | + | + |
| His– | – | + |
Phenotype: All traits of an organism (with an emphasis on trait under investigation).
Homozygote: Homozygote: diploid with two like alleles of same gene.
Heterozygote: diploid with two different alleles of same gene.
Recessive Allele: trait not expressed in heterozygote.
| genotype | phenotype | Mate to : | diploid genotype | diploid phenotype |
| MATa His3– | His– | MATα His3– | His3–/His3– | His– |
| MATa His3– | His– | MATα His3+ | His3–/His3+ | His+ |
Based on the His– phenotype of the His3–/His3+ heterozygote, we would say that His3– is recessive to wild type.
Let’s consider a different kind of mutation giving resistance to copper that occurs in a gene known as CUP1.
| genotype | phenotype | Mate to : | diploid genotype | diploid phenotype |
| MATa Cup1r | copper resistant | MATα Cup1+ | Cup1r/Cup1+ | copper resistant |
Dominant Allele: trait is expressed in heterozygote
Cup1r is dominant to wild type (Cup1+).
The terms dominant and recessive are simply shorthand expressions for the results of particular experiments. If someone says a particular allele is dominant that means that at some point they constructed a heterozygous diploid and found that the trait was expressed in that diploid.
Note: Sometimes an allele will have more than one phenotype and may be recessive for one and dominant for another. In such cases, the phenotype must be specified when one is making statements about whether the allele is dominant or recessive. Consider for example, the allele for sickle cell hemoglobin in humans designated Hbs. Heterozygous individuals (Hbs/Hba) are more resistant to malaria, thus Hbs is dominant for the trait of malaria resistance. On the other hand, Hbs/Hba heterozygotes do not the debilitating sickle cell disease, but Hbs/Hbs homozygous individuals do. Therefore, Hbs is recessive for the trait of sickle cell disease.
Once we find out whether an allele is dominant or recessive, we can already infer important information about the nature of the allele. The following conclusions will usually be true.
Recessive alleles usually cause the loss of something that is made in wild type
Dominant alleles usually cause increased activity or new activity
It turns out that the Cupr allele actually carries more copies of the gene for a copper binding protein and therefore increases the activity of the gene.
Last lecture we defined the gene structurally as the DNA needed to encode a protein. We can now define a gene in a new way based on its function. Using the phenotypic difference between wild type and a recessive allele we can use a Complementation test to determine whether two different recessive alleles are in the same gene.
Say you isolate a new recessive histidine requiring mutation that we will call HisX–. In principle, this mutation could be in His3 or it could be in any of the other genes in the histidine biosynthetic pathway. In order to distinguish these possibilities we need a test to determine whether HisX the same as His3.
To carry out a complementation test, one simply constructs a diploid carrying both the His3– and HisX– alleles.
An easy way to do this would be to mate a MATα HisX– strain to a MATa His3– strain.
| possibility tion | genotype of diploid | phenotype of diploid | complementa |
| HisX= His3 | His3–/His3– | His– | No |
| HisX≠His3 | His3–/His3+, HisX–/HisX+ | His+ | Yes |
Having performed this test, if the two mutations don’t complement we conclude that they are in the same gene. Conversely, if they do complement we conclude that they are in different genes.
This test only works for recessive mutations. Think about what the outcome would be if HisX– were dominant.
The complementation test can be thought of in the following way. If I have an allele with an observable phenotype whose function can be provided by a wild type genotype (i.e., the allele is recessive) — I can ask whether the function that was lost because of the recessive allele can be provided by another mutant genotype. If not, the two alleles must be defective in the same gene. The beauty of this test is that the trait can serve as a read-out of gene function even without knowledge of what the gene is doing at a molecular level.
Definitions from the Language of Genetics
Gene: The fundamental unit of heredity, which can be defined in three ways: i) A gene can be defined in molecular terms as a segment of DNA carrying the information necessary to express a complete protein or RNA molecule, including the promoter and coding sequence. ii) A gene can be defined by function with a group of recessive mutations that do not complement each other. iii) A gene can be defined by position with a single-locus segregation pattern in a cross between lines with different alleles. Examples are a 1:3 phenotypic ratio in the F2 generation in a cross between diploid organisms or a 2:2 segregation pattern in yeast tetrad analysis.
Alleles: Distinguishable versions of the same gene.
Locus: The site on a chromosome where a gene is located. Usually defined by recombinational mapping relative to neighboring loci.
Genotype: The allelic constitution of an individual, usually with emphasis on the gene or genes under examination.
Phenotype: All of the traits or characteristics of an organism, usually with emphasis on traits controlled by the gene or genes under examination.
Wild type: A standard genotype that is used as a reference in breeding experiments. Note that for human crosses there is no standard genotype and the concept of wild-type is therefore not meaningful.
Haploid: A cell or organism with one set of chromosomes (1n).
Diploid: A cell or organism with two sets of chromosomes (2n).
Homozygous: The condition of having two like alleles in a diploid.
Heterozygous: The condition of having two different alleles in a diploid.
Dominant allele: An allele that expresses its phenotypic effect or trait in the heterozygous state.
Recessive allele: An allele whose phenotypic effect or trait is not expressed in a heterozygout state.
Incomplete dominance: The case where a heterozygote expresses a phenotype intermediate between the corresponding homozygote phenotypes.
Complementation test: A test of gene function where two genotypes with recessive alleles are combined by a cross to test whether the genotype of one parent can supply the function absent in the genotype of the other parent.
F1: First generation produced by interbreeding of two lines.
F2: Generation produced by interbreeding of F1 individuals.
Incomplete penetrance: Cases where certain alleles are not always expressed to give observable traits because of other environmental or genetic influences.
True-breeding: Refers to a line of individuals that on intercrossing always produce individuals of the same phenotype. This can almost always be taken to mean that the individuals are homozygous
Lecture 3
Now let’s consider diploid organisms:
The genotype of the zygote will depend on which alleles are carried in the gametes.
When heterozygotes mate their offspring will have different phenotypes: If A is dominant to a, the two possible phenotypes will be the phenotype of a/a or the phenotype of A/A and A/a.
When we do breeding experiments it is important to know the genotypes of the parents. But as you can see from the example above individuals with the dominant trait could be either A/A or A/a. A method to control this type of variation is to start with populations that we know to be homozygous. One way to do this is to keep inbreeding individuals until all crosses among related individuals always produce identical offspring. This is known as a true-breeding population and all individuals can be assumed to be homozygous.
True Breeding: homozygous for all genes
Say we have a true breeding line of shibire flies these flies are paralyzed and have genotype shi–/shi–.
First, we can test to see whether the shibire allele is dominant or recessive.
shi–/shi– x (wild type) shi+/shi+ -> all are shi–/shi+
(The offspring from a cross of two true breeding lines is known as the F1 or first filial generation). The F1 flies appear like wild type therefore shi– is recessive (not expressed in heterozygote)
Say we have isolated a new paralyzed mutant that we call par.
We start with a true breeding par– strain that we mate to wild type. We find that the mutation is not expressed in the F1 heterozygotes and therefore is recessive.
To find out whether par– is the same as shi– we can do a complementation test since both mutations are recessive. For this test, we cross a true breeding par– strain to a true breeding shi– strain.
par–/par– x shi–/shi– -> F1 (these flies must inherit both shi– and par–)
| Possible outcome | Complementation? | Explanation | Inferred genotype |
| F1 not paralyzed | shi– and par– complement | par– genotype can supply function missing in shi– and vice versa | par–/par+ shi+/shi– |
| F1 paralyzed | shi– and par– do not complement | par– has lost function needed to restore shi | shi–/shi– |
Let’s look more carefully at gene segregation in a cross between F1 flies
shi–/shi+ x shi–/shi+
What is the probability of a paralyzed fly in the next (F2) generation?
Definition:
Probability problems can be solved by accounting for every outcome, but usually it is easier to combine probabilities.
p(paralyzed F2 fly) = p(inherit shi- from mother and inherit shi- from father)
Product rule: p(a and b) = p(a) x p(b)
(note the product rule only applies if a and b are independent which is the case here since the allele from mother does not affect the allele from the father)
p(shi– from mother) = ½
p(paralyzed) = 1/2 x 1/2 = ¼
p(not paralyzed) = 1 – 1/4 = ¾
Thus in the F2 generation the phenotypic ratio will be, 1 paralyzed : 3 not paralyzed
A 1 : 3 phenotypic ratio among the F2 in a breeding experiment shows that alleles of a single gene are segregating.
This actually constitutes a third definition of a gene. Historically, this was the first definition of the gene developed by Gregor Mendel in the 1860s. Mendel was able to detect single genes segregating in pea plants because he looked at simple traits and started with true-breeding strains.
Let’s see how these ideas can be applied to a very interesting problem in the evolution of corn. Domestic corn is derived from wild progenitor Teosinte. There is no historical record of how the breeding was done to produce Maize but there is a genetic record of the differences between Teosinte and Maize recorded the genomic differences between these two species. Maize and Teosinte can be crossed to give viable progeny.
Teosinte x Maize -> F1 all same and unlike either parent -> F2 50,000 plants ~1/500 look like Teosinte and ~1/500 look like Maize
How many genes contribute to the differences between the two kinds of plants?
Let’s designate the genes that differ as A, B, C, D …
For each gene there are two alleles: the allele present in Teosinte and the allele present in Maize.
For the A gene we will designate these alleles AT and AM respectively. For the B gene there will be alleles BT and BM and so on for all the genes that differ.
Let’s follow the A gene through the cross between Maize and Teosinte
AT/AT x AM/AM
F1 : AT/AM
Because the F1 don’t look like either parent, let’s assume that the alleles are codominant.
Codominant: heterozygote different than either homozygote.
Incomplete dominance: heterozygote expresses the traits of both homozygous parents. (Alternatively, the genes that differ could have a mixture of dominant and recessive alleles).
1/4 will look like Teosinte.
For two genes that differ:
AT/AT BT/BT 1/4 x 1/4 = 1/16 will look like Teosinte.
Similarly, for three genes the probability will be 1/64. For four genes it will be 1/256, and for five genes it will be 1/1024.
Since ~1/500 look like Teosinte the conclusion is that 4–5 genes differ between wild corn (Teosinte) and domestic corn (Maize). Using modern methods, it has been confirmed that there are about five significantly different alleles and several of these have been located using mapping methods.
4 Lecture
From the last lecture, we followed gene segregation in a cross of a true breeding shibire fly with a wild type fly.
Shibire x wild type -> F1: all not paralyzed -> F2: 3 not paralyzed : 1 paralyzed
This is the segregation pattern expected for a single gene. But in an actual experiment how do we know that the phenotypic ratio is really 3 : 1 ?
There is no logical way to prove that we have a 3 :1 ratio. Nevertheless, we can think of an alternative hypothesis then show that the alternative hypothesis does not fit the data. Usually, we then adopt the simplest hypothesis that still fits the data.
A possible alternative hypothesis is that recessive mutations in two different genes are needed to get a paralyzed fly.
In this case a true breeding paralyzed fly would have genotype: a/a , b/b
Whereas wild type would have genotype: A/A , B/B
F1: A/a B/b not paralyzed
F2: p(a/a and b/b) = (1/4 )2 = 1/16
p(a/a and B/–) = 1/4 x 3/4 = 3/16
p(b/b and A/–) = 3/16
p(A/– and B/–) = the rest = 9/16
This is the classic ratio for two gene segregation 9 : 3 : 3 : 1 (paralyzed)
For our hypothesis we should see a phenotypic ratio of 15 not paralyzed : 1 paralyzed.
Therefore, to distinguish one-gene segregation from two-gene segregation we need a statistical test to distinguish 3 : 1 from 15 : 1. Intuitively, we know that in order to get statistical significance, we need to look at a sufficient number of individuals.
For a chi-square test you start with a specific hypothesis that gives a precise expectation. The test is then applied to the actual experimental results and will give the probability of obtaining the results under the hypothesis. The test is useful for ruling out hypotheses that would be very unlikely to give the actual results.
Say we look at 16 flies in the F2 and observe 14 not paralyzed and 2 paralyzed flies.
Under the hypothesis of two genes we expect 15 not paralyzed flies and 1 paralyzed fly.
We calculate the value χ2 using the formula below. Where O is the number of individuals observed in each class and E is the number of individuals expected for each class.
degrees of freedom (df) = number of classes – 1
From the table using 1 df, 0.05 < p < 0.5
The convention we use is that p ≤ 0.05 constitutes a deviation from expectation that is significant enough to reject the hypothesis. Therefore, on the basis of this sample of 16 flies we can’t rule out the hypothesis that two genes are required. Say we look at 64 F2 flies and find that 12 are paralyzed. For the hypothesis of two genes the expectation is that 4 would be paralyzed. The χ2 for this data:
From the table p < 0.005 so we reject the two-gene hypothesis.
Let’s use this data to test the hypothesis of one gene segregation which would be expected to give 16 paralyzed flies from 64 F2 flies,
From the table using 1 df, 0.5 < p < 0.5. Thus the data still fits the hypothesis of onegene segregation.
So far, the hypothesis that one gene is responsible for the paralyzed trait is the simplest explanation that fits the data.
The way to distinguish most easily between a heterozygote and a homozygote expressing a dominant trait is to cross to a homozygous recessive test strain.
Test cross: cross to homozygote recessive:
A/Ax a/agives all A/a. i.e. all offspring will express the dominant trait.
A/ax a/agives 1/2 A/aand 1/2 a/a. i.e. one half of the offspring will express the dominant trait.
Mendelian inheritance in humans
For humans we can’t do test crosses, of course, but by following inheritance of a trait for several generations the modes of inheritance can usually be identified by applying basic principles of Mendel. The following are guidelines for identifying different modes of inheritance in pedigrees.
Autosomal dominant
Exceptions to this rule will occur if a new mutation arises in one of the parents (in real life a more likely explanation is extramarital paternity). Another possibility is incomplete penetrance, where other genetic or environmental factors prevent the trait from being expressed in one of the parents.
Autosomal recessive
X-linked inheritance
If the trait is rare then the vast majority of affected individuals will be male which is the hallmark of X-linked traits.
Conditional probabilities
Consider the following pedigree of a recessive trait.
p(affected child) =
However, if they have a child that is affected we must reassess the probability that their next child will be affected.
p(both parents carriers) = 1. So, p(next child affected) = ¼
This example shows how probability calculations are based on information. The probability changes not because the parents have changed but because our information about them has.
HANDBOOK for PROBABILITY CALCULATIONS
Many problems in diploid genetics rely on basic concepts of probability. This is because each individual inherits at random only one of two possible copies of a gene from each parent. Thus, breeding experiments or inheritance in human pedigrees have probabilistic rather than absolute outcomes. Everyone has an intuitive sense of probability but what we need is a precise definition that will allow probabilities to be manipulated quantitatively.
Probabilities are usually defined in terms of possible outcomes of a trial. A trial could be the toss of a coin, the roll of a die, or two parents having a child. If we define a specific event a, p(a) or the probability of a, can be defined as follows: after a very large number of trials, p(a) is simply the fraction of trials that give outcome a. In principle, we could determine p(a) by actually performing a large number of trials and directly measuring the fraction of trials that produce event a. This is sometimes called the “Monte Carlo method” named after a famous European casino and works well for computer simulations of complicated phenomena. However, in many cases there is a much simpler way to calculate probabilities. To directly calculate classical probabilities one must know enough about a process to break down the possible outcomes of a trial into some number of equally probable events. In these cases the probability of event a is:
p(a)= na/N
where na is the number of outcomes that satisfy the criteria for a and N is the total number of equally probable outcomes. Note that since N includes all possible outcomes, na ≤ N and 0 ≤ p(a) ≤ 1.
Example: A couple has two children, what is the probability that they are both girls? Assuming that the chances of having a boy or a girl are equal, there are 4 equally probable ways of having two children (boy, boy; girl, boy; boy, girl; girl, girl) and the probability of two girls is 1/4 or 0.25.
For classical probability problems you will always be able to arrive at the correct answer by writing out all of the possible outcomes of a trial and counting the fraction of outcomes that satisfy the criteria for a given event. Often, enumerating all of the outcomes for a trial is time-consuming and error-prone. It is usually faster and easier to break a problem down into simple parts and then to combine the probabilities for the individual parts. The following are useful ways that probabilities can be combined to speed probability calculations.
PRODUCT RULE
p(a and b) = p(a) x p(b) if a and b are independent.
Two events are considered independent if they do not influence one another. The criterion of independence is very important — application of the product rule for events that are not independent will give an incorrect answer.
Examples: To find the probability that a couple with three children have three boys we first note that the sex of one child has no influence on the sex of another and therefore constitute independent events. For each child, p(boy ) = 1/2 and by the product rule p(3 boys) = 1/2 x 1/2 x 1/2 = 1/8.
First, for a recessive trait to be expressed the progeny must inherit the recessive allele from both the mother and the father. Since the probability of inheriting a given allele from a heterozygote is 1/2, p(mutant from mother and mutant from father) = 1/2 x 1/2 = 1/4. Second, since unlinked genes are inherited independently, we can use the product rule again to calculate p(recessives at gene A and recessives at gene B) = 1/4 x 1/4 = 1/16.
SUM RULE
The probability that either a or b will occur can be written as p(a or b). If two events a and b cannot both occur they are mutually exclusive and the number of events that satisfy a or b is na + nb. It should be apparent from our definition of probability that:
A useful special case of the sum rule arises when we consider p(not a). By definition p(a) and p(not a) are mutually exclusive and they encompass all possible outcomes. Thus:
p(a or not a) = 1 = p(a) + p(not a) and p(not a) = 1 – p(a)
Examples: Find the probability that a family with three children has at least one girl. We begin by noting that instead of trying to count all possible families with at least one girl it is easier to realize that p(at least one girl) is the same as p( not all boys). Since p(all boys) = 1/8, p(not all boys) = 1– 1/8 = 7/8 = p(at least one girl).
In a cross where both parents are heterozygous for recessive mutations in two unlinked genes, what is the probability that one of their progeny will express at least one of the dominant traits? p(at least one dominant) = 1 – p(both recessive), and from above, p(both recessive) = 1/16. Therefore p(at least one dominant) = 1 – 1/16 = 15/16.
In cases where two events a and b are independent but not mutually exclusive, we can still calculate p(a or b). In this case we note that the two events a and (b and not a) are mutually exclusive and encompass all outcomes that satisfy a or b or both. For these mutually exclusive events we can apply the sum rule. Thus,
p(a or b) = p(a or [b and not a]) = p(a) + p(b and not a)
Since b and not a are independent:
p(a) + p(b and not a) = p(a) + p(b) x p(not a) = p(a) + p(b) x [1 – p(a)] = p(a) + p(b) – [p(a) x p(b)]
Note that in the case where a and b are mutually exclusive, p(a) x p(b) = 0 giving the same formula as for the sum rule.
Example: We can use this formula as another way to solve the last example, which is a case in which the two events are independent but not mutually exclusive. p(at least one dominant) = p(dominant at gene A or dominant at gene B) = p(dominant at gene A)+p(dominant at gene B) – [p(dominant at gene A) x p(dominant at gene B )] = 3/4 + 3/4 – [3/4 x 3/4] =6/4 – 9/16 = 15/16.
Lecture 5
Until now our analysis of genes has focused on gene function as determined by phenotype differences brought about by different alleles or by a direct test of function – the complementation test.
For the next lectures our analysis will be concerned with the tests of gene position starting with the position of genes on chromosomes and finally mapping point mutations at the resolution of single nucleotide pairs.
We’ve taken it for granted that genes reside on chromosomes, but how do we know this? Let’s review the properties of gene segregation.
Consider two different traits.
A/A, B/B x a/a, b/b
The gametes from one parent will be A, B and from the other parent a, b
These gametes will then give an F1 generation of all A/a, B/b
Crosses between F1 individuals will give an F2 generation with a 9 : 3 : 3 : 1 phenotypic ratio as shown before.
A better way to look at segregation is by a test cross of the F1 heterozygote to a homozygous recessive individual.
A/a, B/b x a/a, b/b
The possible gamete genotypes from the F1 will be:
The corresponding genotypes of the offspring in the testcross will be:
Each offspring receives either one or the other parental allele: gene segregation.
For most gene pairs, the frequency of each of the four classes of gametes is the same indicating that the two genes segregate independently: independent assortment.
At the turn of the century microscopes allowed people to watch chromosomes in the nuclei of dividing cells. (human cells, for example, contain 46 chromosomes).
The chromosomes in dividing somatic cells go through Mitosis:
The net result of mitosis is to distribute a replica of each chromosome into the two daughter cells.
The stages of mitosis are as follows:
The cell has evolved a simple mechanical mechanism to insure that after mitosis each daughter cell has received exactly one copy of each chromosome. (Failure of proper chromosome segregation is known as nondisjunction). The steps in the mechanism are as follows: 1) After DNA replication two daughter chromosomes known as sister chromatids are held together by special proteins known as cohesins. 2) As chromosomes align in metaphase microtubule spindles attach to centromeres on each chromatid. 3) Once all of the chromatids are attached to spindles a protease known as separase becomes active (Actually unattached chromatids produce a signal to keep separase inactive and only when every chromaitid pair is under tension generated by spindles pulling in opposite directions is the inhibitory signal turned off.) 4) Finally, active separase cleaves the cohesin proteins detaching sister chromatids and allowing them be pulled apart by the spindle to be distributed to different daughter cells.
Cells in production of germ cells such as pollen undergo a very different kind of division, Meiosis Meiosis.
Meiosis differs from mitosis in twofundamental respects: 1) in meiosis there are two rounds of chromosome segregation for one round of synthesis so each germ cell receives only one of the two homologous chromosomes and 2) in meiosis the homologs pair with one another then move to opposite poles.
Chromosomes behave in meiosis the same way that Mendel showed genes to behave.
Each germ cell receives only one of the two homologs, a behavior that is analogous to gene segregation.
The relative alignment of chromosomes is arbitrary which is analogous to independent assortment of genes.
What was needed to show that genes are on chromosomes was a chromosome that could be identified in the microscope and that carried an allele for a trait that could also be followed. The proof for chromosome theory would then depend on correlating the segregation of the trait with segregation of the chromosome.
T.H. Morgan proved chromosome theory in 1910 using Drosophila.
Flies normally have brick-red eyes. The first white-eyed mutant was found by Morgan’s wife, Lillian, who worked in the lab.
white O(M) x red O(F) (wild type) -> F1: all red -> F2: 3 red : 1 white (but only males)
Thus, the white mutation behaves like a recessive allele, but there was something unusual about the white mutation because only the male flies in the F2 have white eyes.
white O(M) x red O(F) (heterozygote from F1) -> 1 red : 1 white
In this case equal numbers of males and females have white eyes. Again this is consistent with white being a recessive trait. The most informative cross is the reciprocal of the first cross.
white O(F) x red O(M) (wild type) ↓ red O(F) , white O(M)
Ignoring the sex of the flies, it looks as if a wild type is heterozygous: the wild type O allele is always passed on to the daughters and the white allele is passed on to sons.
The explanation is that eye color gene is on the sex determining chromosome X. Males only have one copy of the X chromosome and daughters always get one copy of the X from the mother and one copy from the father.
Thus, the trait for red eyes is always inherited along with the X chromosome from the father. The absence of red (giving white eyes) always goes with the Y chromosome.
6 Lecture
When we talk about gene position the term locus is used to designate the chromosomal location of a gene.
What we are going to do is to map genes relative to one another. To begin, we need two genes on the same chromosome. Last lecture we saw how you could tell whether a gene is on the X chromosome by how alleles of the gene are inherited differently by males and females.
Consider two mutations on the X chromosome of Drosophila; crossveinless and white eye.
| Genotype | Phenotype |
| Xcv+w+Y | wild type |
| Xcv- w+Y | crossveinless wings |
| Xcv+w- Y | white eye |
Xcv-w+Yx Xcv+w-Xcv+w- (true breeding)
All of the daughters from this cross will have two different X-chromosomes, which differ at two loci: Xcv+w-Xcv-w+
We want to follow these X chromosomes into the next generation so after a cross we look at male flies.
parental classes: Xcv+w-Y (crossveinless, white) and Xcv-w+Y (wild type)
crossover classes: Xcv-w-Y (crossveinless, white) and Xcv+w+Y (wild type)
In the crossover classes the alleles appear to have separated and moved from one X to the other. Genes on the same chromosome often do not assort independently. Such behavior is known as Linkage Linkage.
unlinked — crossover classes appear at same frequency as parental classes. (Note that traits that show independent assortment are unliked)
weakly linked – crossover classes appear often but less often than parental classes.
tightly linked — crossover classes appear rarely or never.
To see what’s really going on we need to look at the chromatids in prophase of meiosis in the mother.
Crossovers between homologous chromosomes occur more or less at random during meiosis. To give you a rough idea of how frequent these crossovers are, in several different well studied organisms (Yeast, Drosophila, and humans) there is about one crossover per chromosome arm per meiosis. The geneticist uses these random crossovers as a tool to measure distance. Distance can be obtained because crossovers between two points that are close together will rarely occur whereas crossovers between points that are far apart will occur frequently.
Definition of genetic distance:
map distance (m.u. or cM) = 100 x crossover gametes / total gametes
(In order to detect both dominant and recessive alleles, we look at males only)
| cv- W+ | 430 |
| CV+w- | 450 |
| cv- w- | 52 |
| CV+W+ | 68 |
Number of crossover gametes = 120
Total gametes = 1,000
Distance = 100 x 120 / 1000 = 12 cM
It is important to note that once a map distance between two genetic markers has been established this distance can be used to calculate the expected numbers of each type of progeny. For example, if you know that two mutations are 12 cM apart then you should expect that 6% of the progeny from a cross will be of each of recombinant class.
Things get interesting when we make several pairwise crosses between genes on the same chromosome.
We can use this data to construct a Genetic Map
Genetic maps have the following properties:
(The first genetic map was constructed in 1911 by Alfred Sturtevant when he was a sophomore student in Morgan’s lab)
It is important to remember that genetic distances are measured using a property of meiosis (genetic recombination) that varies from one organism to another. The relationship between genetic distance and actual physical distance can be summarized in this way:
Genetic distance Genetic distance = physical distance x recombination rate
The actual relationship between genetic distance in cM and physical distance in base pairs (bp) depends on the recombination rate and is different for different organisms
For example: Human: 1.3 cM/Mbp Yeast: 360 cM/Mbp
Sometimes recombination rates in the male and female of a species are different. In Drosophila there is no recombination in the male so the genetic distance between markers on the same chromosome are always zero when examined by meiosis in the male. In humans the recombination rate (and therefore map distances) in the female are twice that of the male.
Another issue that often causes confusion concerns the map distances of genes that are far apart on the same chromosome.
The physical length of a genetic interval is proportional to the frequency of crossovers that occur in that interval during meiosis but in a cross we are not actually counting crossovers rather we are counting the number of recombinant progeny that are produced.
The number of recombinants provide a good approximation of distance for short intervals but as the interval length increases, multiple crossovers are possible making the relationship between frequency of recombinants and crossovers not linear.
If the measured distance in a cross is statistically indistinguishable from 50 cM then we say that the genes are unlinked. But this doesn’t mean that distances greater than 50 cM can not be obtained. By adding intervals, longer distances that are meaningful can be obtained. For example, if all the intervals between linked genes in the human genome are added together the total length of the genome (in males) is 2,500 cM.
Exam
V. Configuration: Easy
| Statement | Answer |
| In 1956, Watson and Crick deduced that the structure of DNA was a double helix. | False |
| Genes are typically 103 – 104 base pairs in size although they can be much larger. | True |
| A mutation is an altered version of a gene when we have “witnessed” the alteration but not when it is preexisting in the population. | True |
| Alleles refers to different versions of different genes | False |
| Yeast, a very useful organism for genetic study, is more properly known as “Saccharomyces cerevisiae”. | True |
| Homozygous is the condition of having two different alleles in a diploid. | False |
| The genotype of a zygote will depend on which alleles are carried in the gametes. | True |
| Breeding experiments or inheritance in human pedigrees have probabilistic rather than absolute outcomes | True |
| Genes on the same chromosome often do not assort independently. Such behavior is known as “incomplete dominance”. | False |
| When we talk about gene position the term “locus” is used to designate the chromosomal location of a gene. | True |
Exam
V. Configuration: Difficult
| Statement | Answer |
| Regarding yeast, haploid cells of different mating type when mixed together will mate to make a diploid cell. | True |
| “Incomplete penetrance” refers to cases where certain alleles are not always expressed to give observable traits because of other environmental or genetic influences | True |
| The way to distinguish most easily between a heterozygote and a homozygote expressing a dominant trait is to cross to a homozygous dominant test strain. | False |
| “True-breeding” refers to a line of individuals that on intercrossing always produce individuals of the same phenotype | True |
| The modes of inheritance in humans can usually be identified by doing test crosses. | False |
| Using the phenotypic difference between wild type and a recessive allele we can use a “complementation test” to determine whether two different recessive alleles are in the same gene. | True |
| Regarding the autosomal dominant mode of inheritance of a trait, affected individuals must have at least one affected parent, except if a new mutation occurs in one of the parents, or if incomplete penetrance occur in one of the parents. | True |
| Regarding the autosomal recessive mode of inheritances, if a trait is very rare, it means that it is impossible that parents of affected individual are themselves related (e.g. cousins). | False |
| Failure of proper chromosome segregation during cell division is known as “independent assortment”. | False |
| One of the properties of genetic maps is that distances are approximately additive (mapped points fall on a line). | True |
Manual Index Social Anxiety
1. Social Anxiety and Virtual Reality
The fifth version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V), replaces the old term of social phobia with social anxiety disorder. This modification represents a change in the conceptualization of the disorder, in which is understood that the condition exists in a variety of social settings.
Virtual Reality (VR) is a beneficial tool for the treatment of Social Phobia, as it exposes the patient to social interactions, cognitive restructuring, social skills training and allows to train the patient on relaxation techniques. Moreover, the virtual exposure can be applied in an anxiogenic or unfavorable situation (seated, noisy, mid-conversation, etc), which is useful to design the exposure to the needs to the patient’s needs.
2. Psious-based Evaluation protocol
Aside of the virtual exposure to social anxiety, this environment can also be used as an evaluation tool to test the patient’s social skills.
Launch the environment after giving the minimal explanation to the patient about what he/she will see. Evaluate the patient’s behavior while the environment is reproduced, at a verbal and nonverbal level:
Non verbal
Verbal
Finally, after the session evaluate what happened at a cognitive level by asking specific questions.
3. Psious-based Treatment protocol
Protocol
General workflow for VR sessions for Social Anxiety and Social Skills
– Introduce the environment to the patient, saying, for example: “You are in a pub with your friends chatting about a variety of topics, you should intervene in specifics moments giving your opinion…”
Session description
SESSION 1 PSYCHOEDUCATION
The hierarchy will have two levels: easy and difficult, according to the configuration variables: mates and waitress’ kindness.
SESSION 2 RELAXATION
Homework:
SESSION 3-8 VR EXPOSURE + TRADITIONAL TECHNIQUES
Homework:
SESSION 9 RELAPSE PREVENTION
4. Bibliography
Gebara, C., Barros-Neto, T., Gertsenchstein, L., Lotufo-Neto, F. (2015). Virtual reality exposure using three-dimensional images for the treatment of social phobia.
Hartanto, D., Kampmann, I.L., Morina, N., Emmelkamp, P.G., Neerincx, M.A. y Brinkman, W. (2014). Controlling social stress in virtual reality environments. PLos ONE, 9(3), 1-17-. doi: 10.1371/journal. Pone.0092804
Herbelin, B., Vexo, F. y Thalmann, D. (2002). Sense of presence in virtual reality exposures therapy. Virtual Reality Laboratory, Federal Institute of Technology (EPFL). Recuperado de: http://citeseerx.ist. psu.edu/viewdoc/download?doi=10.1.1.9.9590&rep=rep1&type=pdf
Klinger, E., Bouchard, S., Légeron, P., Roy, S., Lauer, F., Chemin, I. y Nugues, P. (2005). Virtual Reality Therapy versus Cognitive Behavior Therapy for Social Phobia: A preliminary controlled study. CyberPsychology & Behavior, 8(1):76-88. DOI: 10.1089/cpb.2005.8.76
McNeil, D.W. y Randall, C.L. (2014). Conceptualizing and describing Social Anxiety and its disorders. En S.G. Hofmann y P.M. DiBartolo (Eds.), Social Anxiety. Clinical, developmental, and social perspectives (pp. 3-21). Londres: Elsevier.
Morrison, J. (2015). DSM-5: Guía para el diagnóstico clínico. México, D.F.: El Manual Moderno
5. Annexes
5.1. ARelaxation Self-recording.
Name: ………………………………………………………………….
Date:……………………..
| Date | Time | DEGREE of relaxation (0-100) Before | DEGREE of relaxation (0-100) After | Duration | Difficulties or comments |
5.2. Self-exposure Self-recording
Nombre: ………………………………………………………………….
Fecha:……………………..
| Day | Time | DESCRIPTION OF THE SITUATION (in the case of self-exposure to the feared situation) | ANXIETY LEVEL (0-10) | COMMENTS |
Index Relaxation Manual
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:
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:
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:
.
3. Summary table of relaxation exercises and environments
| LEVEL 1 | LEVEL 2 | LEVEL 3 | LEVEL 4 |
| DIAPHRAGMATIC BREATHING | |||
| Breathing exercise under the sea and on the meadow | Island 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:
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:
Recommended Protocol:
Homework:
SESSION 2: JACOBSON’S EXERCISE AND DIAPHRAGMATIC PRAGMATIC BREATHING
Before starting the exercise:
Recommended Protocol:
Homework:
SESSION 3: JACOBSON’S EXERCISE AND DIAPHRAGMATIC BREATHING
Before starting the exercise:
Recommended Protocol:
Homework:
SESSION 4 : PROGRESSIVE MUSCULAR RELAXATION AND DIAPHRAGMATIC BREATHING
Before starting the exercise:
Protocolo recomendado:
Homework:
SESSION 5 : PROGRESSIVE MUSCULAR RELAXATION AND DIAPHRAGMATIC BREATHING
Before starting the exercise:
Recommended Protocol:
Homework:
SESSION 6 : RELAPSE PREVENTION
Recommended protocol for the sixth session:
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
6.2. Relaxation selfrecording
Name:______________________________ Date:____________________
| Date | Hour | Degree of relaxation (0-100) Before | Degree of relaxation (0-100) After | Used time | Difficulties or comments |
Index Mindfulness Manual
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:
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
Recommended protocol for the first session
Homework:
SESSION 2
Recommended protocol for the second session
Homework:
SESSION 3
Recommended protocol for the third session
Homework:
SESSION 4
Recommended protocol for the fourth session
Homework:
SESSION 5
Recommended protocol for the fifth session
Homework:
SESSION 6
Recommended protocol for the sixth session
Homework:
SESSION 7
Recommended protocol for the seventh session
Homework:
SESSION 8
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
| 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.
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.
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.
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 energy.
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.
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.
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.
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 … 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.
Index Generalized Anxiety Manual
1. Generalized Anxiety Disorder and Virtual Reality
The main objective in the treatment of generalized anxiety disorder (GAD) is to get the complete and prolonged remission of symptoms, as well as the restoration of the operational level of presymptomatic (Dilbaz, Cavus Y Darcin, 2011). However, not all patient respond well to treatment of choice: Cognitive Behavioural Therapy. Which can be combined with training on relaxation techniques and/or pharmacological treatment.
Research conducted about this topic shows that treatment with virtual reality (VR) is a good alternative for people with GAD (Gorini & Riva, 2008). Mainly because it eases the learning process as well as the creation of a relaxing mood. particularly complicated in people with chronically raised voltage as in the case of this disorder.
Moreover, Psious virtual environments specially designed for the treatment of GAD, are very useful as the therapist can carry out exposure to the patient’s worrying in two different environments: a house and subway
2. Psious – based treatment protocol
Protocol
In the following lines, a treatment protocol using Psious virtual environments is offered as an example.
However, it is noteworthy that this tool should accommodate the cognitive behavioural therapeutic framework used by the therapist, and combining it with techniques such as cognitive restructuring, training in problem solving and worry exposure. It must adapt to the needs and particularities of the patient.
On the other hand, for training in relaxation techniques, Psious has specific environments that will facilitate their learning.
The suggested protocol is an adaptation of the intervention protocol of Brown, O’Leary and Barlow (2001) for GAD.
Our proposal has a total of ten sessions instead of the 13 of the original, as VR facilitates the therapeutic process compared to the imagination (Both in the exposure and learning relaxation techniques), so the treatment’s duration is reduced.
Treatment session description
SESSION 1 PSYCHOEDUCATION
Homework:
Self-Assessment daily levels of worrying and mood through self-reports provided ( see Annexes 5.1.)
SESSION 2 INTRODUCTION TO RELAXATION
Homework:
Self-Assessment daily levels of worrying and mood through self-reports provided (Annexes 5.1.)
SESSION 3 RELAXATION
Homework:
SESSION 4 INTRODUCTION TO THE COGNITION’S ROLE
Homework:
Daily practise of relaxation techniques and self-reports (Annexes 5.1, 5.2. and 5.4)
SESSION 5 EXPLORATION OF THE COGNITIVE DISTORTIONS
Homework:
Daily practise of relaxation techniques and self-reports (Annexes 5.1, 5.2. and 5.4)
SESSION 6 INTRODUCTION TO WORRY EXPOSURE
Homework:
Daily practise of relaxation techniques, self-reports and daily worry exposure (Annexes 5.1, 5.2, 5.3 and 5.4)
SESSION 7 VR EXPOSURE
Homework:
Daily practise of relaxation techniques, self-reports and daily worry exposure (Annexes 5.1, 5.2, 5. 3 and 5.4)
SESSION 8 RELAXATION AND WORRYING PREVENTION
Homework:
Daily practise of relaxation techniques, self – reports and daily worry exposure ( Annexes 5.1, 5.2, 5.3 and 5.4) and the prevention of worrying conducts must be applied.
SESSION 9 TIME MANAGEMENT AND PROBLEM SOLVING
Homework:
Daily practise of relaxation techniques, self – reports and daily worry exposure ( Annexes 5.1, 5.2, 5.3 and 5.4) and the prevention of worrying conducts must be applied.
SESSION 10 REVISION OF SKILLS AND TECHNIQUES
3. Use recommendations
Use recommendations
n these environments, with the aim of enhancing the effectiveness of the VR, the therapist plays a very important role with regard to the patient’s suggestion, as by specific comments, may put the patient in situation before starting the exposure. This will enhance the patient ’s sense of presence, strengthen the subjective feeling that he is in the virtual environment.
It is therefore important to use real elements of everyday life of the patient in order to build a story as close as possible to reality, as this will help the virtual environment to be more significant from the patient’s viewpoint and can generate an emotional attachment to perform worry exposure.
For the first four scenes, the therapist should explain to the patient that he or she is at home and depending on which scene the therapist should emphasize some stressors elements.
For example, for the first scene, before reproducing the debate, the therapist can ask the patient to imagine that he or she has just put the baby to sleep and that the intercom is on the coffee table with him or her activated to be aware of the baby.
With this, the patient whose concern is that something wrong may happen to their children, will start building an emotional bond from the beginning, associating the simulation to real life. So once the patient will realize they are talking about babies on the television, his or her anxious reaction will be probably stronger.
For the second scene, it is also important to create the emotional bond by making the patient to pay attention to the elements of the scene indicating that a child lives in that house (a toy, a ball..). This scene is also designed for people with an excessive worrying for their children, in this case that something bad may occurs to them by leaving them in the care of others.
As for the third scene, as in the television they are giving the weather forecast and talking about heavy rains , may be of interest to previously indicate the patient that it is the time when his or her partner comes home from work, coming by car, etc. Therefore, you will work on the concern that something bad happens to a loved one, thus using actual data that the patient has provided the therapist previously, his or her worrying will be increased, as well as his or her reaction.
For the fourth scene, the importance lies in making the patient to notice what is on the table: a medical report and a bottle of pills . To do this , we can start commenting that a few days ago the patient went to the doctor to get some recognition or analysis (add more information depending on the patient ) and has already collected the results.
This will make when the patient will hear on television talking about a disease, for example cancer, to react with a higher level of worrying and excessive anxiety. So, we can work on excessive worrying of having a medical condition or deadly disease and overestimation of probabilities.
Finally, in the fifth scene, the therapist can tell the patient he or she is going to take the subway to go at work (or to go to an important event…), so he or she must be punctual.
The fact that the subway will remain stopped for a while will be stressing by itself, so influencing him or her will reinforce the worry.
5. Recommended bibliography
Bados, A. (2005). Trastorno de ansiedad generalizada. Recuperado de la web del dipósito digital de la Universidad de Barcelona: http:// diposit.ub.edu/dspace/bitstream/2445/357/1/116.pdf
Bastida de Miguel, A.M. (2012). Tratamiento cognitivo-conductual aplicado a un caso de insomnio severo comórbido con ansiedad generalizada. Revista de Psiquiatria, 16(3), 2-36. Recuperado de http://www.psiquiatria.com/revistas/index.php/psiquiatriacom/ article/viewFile/1395/1266/
Brown, T.A., O’Leary, T.A. y Barlow, D.H. (2001). Generalized Anxiety Disorder. En D.H. Barlow (Ed.), Clinical Handbook of Psychological Disorders: A Step-by-Step Treatment Manual (pp. 154-208). Nueva York: The Guilford Press.
Dilbaz, N., Cavus, S.Y. y Darcin, A.E. (2011). Treatment resistant Generalized Anxiety Disorder. En S. Selek (Ed.), Different views of Anxiety Disorders (pp. 219-232). Rijeka: InTech.
Gorini, A., Pallavicini, F., Algeri, D., Repetto, C., Gaggioli, A. y Riva, G. (2010). Virtual Reality in the treatment of Generalized Anxiety Disorders. En B.K. Wiederhold, G. Riva y S.I. Kim (Eds.), Annual Review of Cybertherapy and Telemedicine (pp. 39-43). Amsterdam: IOS Press. Wittchen, H.U. y Hoyer, J. (2001). Generalized Anxiety Disorder: nature and course. Journal of Clinical Psychiatry, 62(11), 15-19. Recuperado de http://psychologie.tu-dresden.de/i2/klinische/mitarbeiter/ publikationen/hoyer/Pdf/504.pdf
Wittchen, H.U. (2002). Generalized Anxiety Disorder: prevalence, burden, and cost to society. Depression and Anxiety, 16(4), 162-171. doi: 10.1002/da.10065
5. Annexes
5.1 Weekly self – recording of anxiety and depression (Barlow)
| Date | Average Anxiety (0-8) | High Anxiety (0-8) | Average Depression media (0-8) | Medium positive affect (0-8) | Percent of daily worrying |
5.2 Self – Assessment cognitive form (Barlow)
| Trigger or event | Automatic Thought | Anxiety (0-8) | Probabilities (0-100) | Alternative explanation | Realistic probabilities(0-100) | Anxiety (0-8) |
5.3 Daily self – recording of worrying exposure (Barlow)
Begin and end time:
| Anxiety (0-8) | Symptoms during the exposure | Worrying Content | Possible worst result feared | Anxiety (0-8) | Possible alternatives | Anxiety (0-8) |
5.4 Self – recording of relaxation and subjective evaluation
| Used time (start – end) | Subjective assessment of the physical condition before starting | Subjective assessment of the physical condition at the end |