Tags: In person

Step-by-step instructions

1. Celebrate your client’s amazing progress and work when playing Mightier and ask them if they would be interested in teaching you how to play Mightier. 
   
   
2. If the child is interested, ask them to show you how to put the heart rate monitor on and start up the tablet. 
   
   
3. Ask them to explain Mightier to you using the questions below or your own questions.
   
   What does Mightier do?
   How does Mightier work?
   What does Mightier help you with?
   
   
4. Ask them to lead you through a game. (You may have different games unlocked than your client. That is okay. You can ask them what game they recommend you play or what they like the best out of your unlocked games.) 
   
   
5. While playing, tilt the camera to show your screen while playing. Have the client coach you through their tips and tricks for game-play while asking questions about what to do next. 
   
   
6. Get into the red often. You most likely will get into the red regularly, but if you are not seeing many increases, you can put your arms above your head or engage in a smaller, less noticeable activity to get your heart rate up. 
   
   
7. When you are in the red, ask your client about this using the questions below or your own questions. Model calming skills and effective ways to bring your heart rate down.
   
   -What do I do when I am in the red?
   -What does it mean when I am in the red?
   -What can I do to get back down to the blue?
   -What is your favorite way to get back down to the blue?
   -Do you find it hard to get your heart rate down? I am finding it hard right now!
   -What do you notice about my heart rate?
   
   
8. Engage in play with your client for as long as you would like and at whatever cadence you would like. Throughout this time help your client to notice that everyone gets in the red and normalize their emotional experience.

Step-by-step instructions

1. Ask your client what they have noticed as a helpful way to get back down to the blue in Mightier. They may mention Mightier calming skills or others.
   
   
2. Provide psychoeducation around calming skills and how they work using the script below (or something similar):
   
   I can tell you have been working hard to learn skills that bring your heart rate down. That is great! There are many different calming skills that help people to calm down in real life and that help to bring kids back down to the blue in Mightier. There is no “right” calming skill, everyone is different, and finding what works for you best is important!
   
   
3. Explain that today you are going to try out your client’s own ideas for calming skills. 
   
   
4. Ask your client to draw pictures of at least 4 calming skills that they have tried or would like to try to help them go from the red to the blue that are different than the calming skills that Mightier teaches. (You can also download the optional worksheet). If they need suggestions or are feeling stuck, provide examples. 
   
   
5. Once your client has identified what skills they would like to try, ask them why they picked these skills and why they think they would be helpful. 
   
   
6. Have your client put on their heart rate monitor and turn on their tablet. 
   
   
7. Ask your client to get their heart rate up to the red. Encourage them to do jumping jacks, run in place, hold their hands over their head, dance to a favorite song, etc.. (You can also do this with them to help with adherence)
   
   
8. Once the child shares they are in the red encourage them to try out one of the skills they listed. (You can do the skill along with them to help with adherence). 
   
   
9. Once they are back in the blue, ask your client what they noticed about using this skill.
   
   -How did it feel to use the skill?
   -What did you notice about your heart rate?
   -What did you like about using this skill?
   -What did you not like about using this skill?
    
10. Encourage your client to try using these skills inside the Mightier games and in situations outside of Mightier that may be challenging. Brainstorm with your client potential ways to use these skills. 
    
    
11. Repeat this process for the other skills the client has identified in this session or in subsequent sessions. 

*Some clients may want to make a calming skills toolbox or calming skills ring of skills to serve as a reminder of skills. These can be on sheets of paper or can be drawings or cards that the client makes. 

*You can also use the “Calming Skill Cards” activity in the Clinician Toolkit as an example of potential skills for clients to try.

Step-by-step instructions

1. Have the client put on their heart rate monitor and turn on the tablet. 
   
   
2. Ask your client what they know about their body and their emotions. Some possible questions may include:
   
   -Do you notice anything about the connection between your feelings and how your body feels? 
   -What do you notice about your body when you feel __?
   
   
3. Ask your client what they notice about their body in relation to the areas of the Gizmo.
   
   -What do you notice about your body when you are in the red?
   -What do you notice about your body when you are in the blue?
   
   
4. Provide psychoeducation about body cues using the script below (or something similar):
   
   When we feel a feeling, our body may feel different. It may be that when we are worried we get an upset stomach or our legs or arms are shaky. Sometimes when we get angry our face can get red, our fists might clench, and we might get sweaty. These are clues that our body gives us. It can be helpful to learn our own body cues as they can help us to notice when we are feeling something so we can make a decision that will help us feel a bit better. Everyone’s body is different and everyone’s reactions to emotions are different.
   
   
5. Tell your client you are both going to experiment to see if they can notice other things about their body when they are in the different sections of the Gizmo. 
   
   
6. Ask your client to draw an outline of their body on a piece of paper and to grab a red writing utensil.
   
   
7. Ask your client to get into the red however they choose to. This can be a movement like jumping jacks, running in place, dancing, etc. For some clients later in their Mightier journey, they may be able to think of something that makes them frustrated or anxious to get into the red. 
   
   
8. Once they are in the red, ask your client to close their eyes and reflect on what their body feels like. Ask them to color in, highlight, or draw where they are feeling a change in their body once entering the red. This may take a few times to notice sensations for some clients.
   
   
9. Ask your client if they notice any of these changes in situations outside of playing Mightier. Reflect on situations that may come in handy to identify body cues. 
   
   
10. Repeat this process for the blue section of the Gizmo. 

Step-by-step instructions

1. Have the client put on their heart rate monitor and turn on their tablet.
   
   
2. Have your client share about events that happened since the last time you met with them. If prompts are needed, use below:
   
   What was the best part of your week?
   What is the most exciting thing that happened?
   What didn’t go as well as you had hoped?
   What was the worst part of this week?
   
   
3. While they are sharing experiences, ask your client to notice and report back where their heart rate is on the Gizmo.
   
   
4. When the client’s heart rate increases into the red or decreases in the blue, ask what they notice about their body and feelings when these changes occur.
   
   What do you notice about your body right now?
   What are you feeling right now as you talk about this experience with me?
   Do your feelings match your heart rate on the Gizmo?
   
   
5. Repeat this process with experiences that the client has had throughout the week. If the client is well-versed in Mightier language then you can ask the client to guess what section of the Gizmo they may be in before they tell a certain part of their story.
   

Step-by-step instructions

1. Have your client put on their heart rate monitor and turn on their tablet.

2. Ask your client what calming skills they have been using in Mightier.

3. Remind them that there are 4 calming skills that Mightier teaches: deep breathing, crossing the midline, progressive muscle relaxation, and tracing.

4. Ask your client if they would like to engage in a science experiment with the Mightier calming skills. Ask the client to guess which calming skill brings their heart rate down the quickest from red to blue. Ask them why they think this and ask what evidence they have to make this guess. Ask your client to rank the skills in order from quickest to slowest from red to blue.

5. Tell your client you are both going to experiment to see if their guesses are correct by timing how quickly they can get their heart rate back into the blue.

6. Ask your client to get their heart rate up to the red. Encourage them to complete jumping jacks, running in place, holding hands over their head, dancing to a favorite song, etc.. (You can also do this with them to help with engagement)

7. Once the child shares they are in the red set the stopwatch and encourage them to try out one of the skills. (You can do the skill along with them to help with adherence).

8. Share the time with the client and celebrate their hard work. Ask them what they noticed about using the skills and/or use questions below.
   
        -What did you notice about your heart rate when you used that skill?
         -What did you notice about your feelings when you used that skill?
         -What was helpful about using that skill?
         -What was difficult about using that skill?
   
   Repeat this exercise with the other 3 skills.

   *You can complete these challenges at a regular cadence throughout sessions to see if the client is able to recognize changes in their ability to regulate and use these skills.
   
   *You can also complete these challenges and ask clients to share and experiment with their own calming skills that they identify as helpful outside of the 4 Mightier calming skills. See the “Create Your Own Mightier Calming Skills” activity in the clinician tool kit for ideas.