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Kalisvaart H, van Broeckhuysen-Kloth S, van Busschbach JT, Geenen R. Picturing disturbed body experience: A comparison of body drawings in persons with somatoform disorder and a general population sample. Psychiatry Res 2022; 314:114661. [PMID: 35691104 DOI: 10.1016/j.psychres.2022.114661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 05/05/2022] [Accepted: 05/31/2022] [Indexed: 11/19/2022]
Abstract
People with somatic symptom disorder or somatoform disorder are considered to have a troubled relationship to their body that is hard to assess with self-report questionnaires alone. To examine the potential value of own-body drawings as an assessment tool, objective features of drawings from 179 patients referred to treatment for somatoform disorder, were compared to those of 173 age-and-sex matched persons from the general population. While two factors had been found in the somatoform disorder sample, in the general population only the factor that reflected 'details' in own-body drawings was replicated. The two samples did not score differently on this factor. The general population sample showed a less strong association between objective body drawings scores on this 'details' factor and self-reported scores of body experience than the somatoform disorder sample. Moreover, the phenomenological contents of the drawings were more oriented towards health or appearance than the mostly mixed or unclear orientation of persons with somatoform disorder. Because the objective scoring of body drawings did not differ between groups while the contents of body drawings appeared to differ, the results suggest that this objective scoring of body drawings is not appropriate to distinguish people with and without somatoform disorder.
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Affiliation(s)
- Hanneke Kalisvaart
- Altrecht Psychosomatic Medicine Eikenboom, Altrecht, Zeist, the Netherlands; School of Human Movement and Education, Windesheim University of Applied Sciences, Zwolle, the Netherlands.
| | | | - Jooske T van Busschbach
- School of Human Movement and Education, Windesheim University of Applied Sciences, Zwolle, the Netherlands; University Center of Psychiatry, University Medical Center, University of Groningen, Groningen, the Netherlands
| | - Rinie Geenen
- Altrecht Psychosomatic Medicine Eikenboom, Altrecht, Zeist, the Netherlands; Department of Psychology, Utrecht University, Utrecht, the Netherlands
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Cost-effectiveness of adding psychomotor therapy to a multidisciplinary rehabilitation program for chronic pain. GLOBAL & REGIONAL HEALTH TECHNOLOGY ASSESSMENT 2020; 7:124-130. [PMID: 36627962 PMCID: PMC9677602 DOI: 10.33393/grhta.2020.2031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 07/06/2020] [Indexed: 01/13/2023] Open
Abstract
Introduction This study assesses the cost-effectiveness (CE) of a multidisciplinary pain rehabilitation program (treatment as usual [TAU]) with and without psychomotor therapy (PMT) for chronic pain patients. Methods Chronic pain patients were assigned to TAU + PMT or TAU using cluster randomization. Clinical outcomes measured were health-related quality of life (HRQOL), pain-related disability, and quality-adjusted life years (QALYs). Costs were measured from a societal perspective. Multiple imputation was used for missing data. Uncertainty surrounding incremental CE ratios was estimated using bootstrapping and presented in CE planes and CE acceptability curves. Results Ninety-four chronic pain patients (n = 49 TAU + PMT and n = 45 TAU) were included. There were no significant differences in HRQOL, Pain Disability Index, and QALYs between TAU + PMT and TAU. Direct costs in TAU + PMT were significantly higher than in TAU (mean difference €3327, 95% confidence interval [CI] 1329; 5506). However, total societal costs in TAU + PMT were not significantly higher than in TAU (mean difference €642, 95% CI -3323; 4373). CE analyses showed that TAU + PMT was not cost-effective in comparison with TAU. Conclusions Adding PMT to a multidisciplinary pain rehabilitation program is not considered cost-effective in comparison with a multidisciplinary pain rehabilitation program alone. The results of this study should be interpreted with caution because of the small sample size and high drop-out rate.
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Gibson J. Mindfulness, Interoception, and the Body: A Contemporary Perspective. Front Psychol 2019; 10:2012. [PMID: 31572256 PMCID: PMC6753170 DOI: 10.3389/fpsyg.2019.02012] [Citation(s) in RCA: 82] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 08/16/2019] [Indexed: 12/18/2022] Open
Abstract
Mindfulness is often used as an umbrella term to characterize a large number of practices, processes, and characteristics. Critics argue that this broad definition has led to misinformation, misunderstanding, and a general lack of methodologically rigorous research. Some of the confusion surrounding mindfulness is also believed to stem from an undifferentiated use of the term mindfulness and meditation. Mindfulness and all other forms of meditation have been shown to modulate the insula, which is the primary hub for interoception. Some have argued that interoception is foundational to mindfulness and may be the primary mechanism by which one benefits from the practice. However, much like the mindfulness literature, interoception remains broadly defined often without precision and with domain-specific meanings and implications. Research demonstrates that the insula and surrounding neural circuits are believed to be responsible for a number of other functions beyond interoception including attention, awareness, and all subjective experiences, much of which has been linked to the mindfulness literature. It has been assumed that mindfulness produces these neuroplasticity and functional effects. There is evidence that mindfulness and some of its benefits may be better described as increased interoception as a result of the neuroplasticity changes in the insula, and the development of the insula and surrounding neural circuits may cultivate dispositional mindfulness. The purposes of this article are to (1) highlight that it may be more accurate to link many of the identified benefits in the mindfulness literature to interoception and its neurological correlates and (2) propose attentional style as a means to clarify some of the confusion surrounding mindfulness, interoception, and meditation. Different meditations require different attentional styles. Attention can be analogous to a focal point with each focal point providing a unique perspective. Given that all meditative techniques modulate the insula, each meditation can provide a unique perspective from which to investigate complex interoceptive signals that may be unavailable from other meditative traditions. It may prove more useful to anchor scientific findings in the concrete body as a means to investigate those rather than a set of abstract, broadly defined meditative techniques.
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Affiliation(s)
- Jonathan Gibson
- Department of Humanities and Social Sciences, South Dakota School of Mines and Technology, Rapid City, SD, United States
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Chapman A, Poliakoff E, Chew-Graham CA, Brown RJ. Attending away from the body predicts increased physical symptom reports at six months in primary care patients. J Psychosom Res 2018; 113:81-88. [PMID: 30190054 DOI: 10.1016/j.jpsychores.2018.08.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Revised: 08/01/2018] [Accepted: 08/02/2018] [Indexed: 12/30/2022]
Abstract
OBJECTIVE High symptom reporting (HSR) and medically unexplained symptoms (MUS) are associated with considerable distress, disability, healthcare utilization and costs, but are poorly understood, and current treatments are of limited benefit. Most models of HSR and MUS implicate cognitive-perceptual factors, such as increased body-focused attention, reduced perceptual thresholds and a tendency to experience somatic misperception, but little is known about the causal role of these variables. We investigated this issue by studying whether there is a longitudinal relationship between perceptual-attentional variables and later clinical outcomes in primary care patients. METHOD Primary care patients (N = 102) completed clinical (physical symptom reporting, health anxiety and healthcare utilization) and perceptual-attentional (body-focused attention, perceptual threshold, somatic misperception) measures at baseline and then again six months later (N = 72). Hierarchical regression was used to examine cross-lagged relationships between baseline and follow-up scores. RESULTS Contrary to expectation, attending away from the body at baseline predicted increased not decreased symptom reporting six months later. Neither perceptual threshold nor somatic misperception predicted clinical outcomes at six months. CONCLUSIONS These findings suggest that body avoidance, rather than increased body focus, contribute to the development of HSR. Future studies should consider the potential clinical benefits of reducing bodily avoidance, via techniques that promote adaptive engagement with bodily sensations.
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Affiliation(s)
- Anna Chapman
- Northumberland, Tyne and Wear NHS Foundation Trust, United Kingdom
| | | | | | - Richard J Brown
- University of Manchester, United Kingdom; University of Manchester and Greater Manchester Mental Health NHS Foundation Trust, United Kingdom.
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Sertel M, Bakar Y, Şimşek TT. THE EFFECT OF BODY AWARENESS THERAPY AND AEROBIC EXERCISES ON PAIN AND QUALITY OF LIFE IN THE PATIENTS WITH TENSION TYPE HEADACHE. AFRICAN JOURNAL OF TRADITIONAL, COMPLEMENTARY, AND ALTERNATIVE MEDICINES : AJTCAM 2017; 14:288-310. [PMID: 28573246 PMCID: PMC5446455 DOI: 10.21010/ajtcam.v14i2.31] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND This study is to investigate the effect of Body Awareness Therapy (BAT) and Aerobic Exercises on pain and quality of life in patients with Tension-Type Headache (TTH). MATERIALS AND METHOD Sixty individuals with TTH diagnosis who referred Neurologist were incorporated into study. The individuals were randomly grouped into 3 as BAT (n=20), aerobic exercise (n=20) and control group (n=20). Pain severity of the individuals was evaluated by Visual Analog Scale (VAS) and pain diary, disability with ache; by Pain Disability Index (PDI) and Headache Impact Tests (HIT) and quality of life was evaluated by SF-36. Subsequent to first assessments, 3 sessions of 60 minutes per week throughout 6 weeks totally. RESULTS When the groups were compared at the end of the study, a significant decrease was observed in VAS, PDI and HIT values in the individuals in the BAT and aerobic exercise groups. With the individuals in group BAT and aerobic exercise all parameters of quality of life were observed to be increased significantly. CONCLUSION BAT and aerobic exercise programs to be applied on TTH patients were concluded to be important in decreasing the pain, in increasing the quality of life and in reducing pain-related daily constraints of the individuals.
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Affiliation(s)
- Meral Sertel
- Kırıkkale University, Faculty of Health Sciences, Departmant of Physical Therapy and Rehabilitation, Kırıkkale, 71451, Turkey
| | - Yeşim Bakar
- Abant İzzet Baysal University, School of Physical Therapy and Rehabilitation, Bolu, 14100, Turkey
| | - Tülay Tarsuslu Şimşek
- Dokuz Eylül University, School of Physical Therapy and Rehabilitation, İzmir, 35100, Turkey
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Improving the Multidisciplinary Treatment of Chronic Pain by Stimulating Body Awareness. Clin J Pain 2015; 31:660-9. [DOI: 10.1097/ajp.0000000000000138] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Bornemann B, Herbert BM, Mehling WE, Singer T. Differential changes in self-reported aspects of interoceptive awareness through 3 months of contemplative training. Front Psychol 2015; 5:1504. [PMID: 25610410 PMCID: PMC4284997 DOI: 10.3389/fpsyg.2014.01504] [Citation(s) in RCA: 152] [Impact Index Per Article: 16.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2014] [Accepted: 12/05/2014] [Indexed: 11/13/2022] Open
Abstract
Interoceptive body awareness (IA) is crucial for psychological well-being and plays an important role in many contemplative traditions. However, until recently, standardized self-report measures of IA were scarce, not comprehensive, and the effects of interoceptive training on such measures were largely unknown. The Multidimensional Assessment of Interoceptive Awareness (MAIA) questionnaire measures IA with eight different scales. In the current study, we investigated whether and how these different aspects of IA are influenced by a 3-months contemplative intervention in the context of the ReSource project, in which 148 subjects engaged in daily practices of "Body Scan" and "Breath Meditation." We developed a German version of the MAIA and tested it in a large and diverse sample (n = 1,076). Internal consistencies were similar to the English version (0.56-0.89), retest reliability was high (rs: 0.66-0.79), and the MAIA showed good convergent and discriminant validity. Importantly, interoceptive training improved five out of eight aspects of IA, compared to a retest control group. Participants with low IA scores at baseline showed the biggest changes. Whereas practice duration only weakly predicted individual differences in change, self-reported liking of the practices and degree of integration into daily life predicted changes on most scales. Interestingly, the magnitude of observed changes varied across scales. The strongest changes were observed for the regulatory aspects of IA, that is, how the body is used for self-regulation in daily life. No significant changes were observed for the Noticing aspect (becoming aware of bodily changes), which is the aspect that is predominantly assessed in other IA measures. This differential pattern underscores the importance to assess IA multi-dimensionally, particularly when interested in enhancement of IA through contemplative practice or other mind-body interventions.
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Affiliation(s)
- Boris Bornemann
- Department of Social Neuroscience, Max Planck Institute for Human Cognitive and Brain Sciences Leipzig, Germany
| | - Beate M Herbert
- Clinical Psychology and Psychotherapy, University of Tuebingen Tuebingen, Germany ; Health Psychology, University of Ulm Ulm, Germany
| | - Wolf E Mehling
- Department of Family and Community Medicine, Osher Center for Integrative Medicine, University of California San Francisco San Francisco, CA, USA
| | - Tania Singer
- Department of Social Neuroscience, Max Planck Institute for Human Cognitive and Brain Sciences Leipzig, Germany
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Mirams L, Poliakoff E, Brown RJ, Lloyd DM. Brief body-scan meditation practice improves somatosensory perceptual decision making. Conscious Cogn 2013; 22:348-59. [PMID: 22889642 DOI: 10.1016/j.concog.2012.07.009] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2012] [Revised: 07/09/2012] [Accepted: 07/12/2012] [Indexed: 02/04/2023]
Affiliation(s)
- Laura Mirams
- Division of Psychology, School of Psychological Sciences, Zochonis Building, University of Manchester, Brunswick Street, Manchester M13 9PL, UK.
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Mirams L, Poliakoff E, Brown RJ, Lloyd DM. Interoceptive and exteroceptive attention have opposite effects on subsequent somatosensory perceptual decision making. Q J Exp Psychol (Hove) 2012; 65:926-38. [DOI: 10.1080/17470218.2011.636823] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Evidence suggests that interoceptive and exteroceptive attention might have different perceptual effects. However, the effects of these different types of body-focused attention have never been directly compared. The current research investigated how interoceptive and exteroceptive attention affect subsequent performance on the somatic signal detection task (SSDT). In Experiment 1, 37 participants completed the SSDT under usual testing conditions and after performing an interoceptive heartbeat perception task. This task led to a more liberal response criterion, leading to increased touch reports in the presence and absence of a target vibration. This finding is consistent with suggestions that attending internally contributes to physical symptom reporting in patients with medically unexplained symptoms (MUS). In Experiment 2, 40 participants completed the SSDT before and after an exteroceptive grating orientation task. This task led to a more stringent response criterion, leading to decreased touch reports in the presence and absence of the target, possibly via a reduction in sensory noise. This work demonstrates that internal and external body-focused attention can have opposite effects on subsequent somatic perceptual decision making and suggests that attentional training could be useful for patients reporting MUS.
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Affiliation(s)
- Laura Mirams
- Division of Psychology, School of Psychological Sciences, University of Manchester, Manchester, UK
| | - Ellen Poliakoff
- Division of Psychology, School of Psychological Sciences, University of Manchester, Manchester, UK
| | - Richard J. Brown
- Division of Clinical Psychology, School of Psychological Sciences, University of Manchester, Manchester, UK
| | - Donna M. Lloyd
- Division of Psychology, School of Psychological Sciences, University of Manchester, Manchester, UK
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FUJINO HARUO. Effects ofDohsa-hourelaxation on body awareness and psychological distress1. JAPANESE PSYCHOLOGICAL RESEARCH 2012. [DOI: 10.1111/j.1468-5884.2012.00517.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Bekker MHJ, Croon MA, van Balkom EGA, Vermee JBG. Predicting individual differences in autonomy-connectedness: the role of body awareness, alexithymia, and assertiveness. J Clin Psychol 2008; 64:747-65. [PMID: 18425792 DOI: 10.1002/jclp.20486] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Autonomy-connectedness is the capacity for being on one's own as well as for satisfactorily engaging in interpersonal relationships. Associations have been shown between autonomy-connectedness components (self-awareness, sensitivity to others, and the capacity for managing new situations) and various indices of psychopathology. Both in a theoretical sense as well as for enhancing treatment and prevention, it is relevant to identify which factors most powerfully predict individual differences in autonomy-connectedness: body awareness, alexithymia, or assertiveness. The present study examined this question in a clinical sample of women who were diagnosed as having autonomy problems (N=52) and in a female nonclinical community sample (N=59). In line with expectations, assertiveness was a strong predictor of (all three components of) autonomy-connectedness, as was emotionalizing, one of the alexithymia-components, but the latter in an opposite direction than we had expected: the higher an individual's ability to emotionalize was, the less self-aware and capable to manage new situations that person was, and the more sensitive to others. Cognitive alexithymia contributed to self-awareness as well as to the capacity for managing new situations, and one of the components of body awareness appeared to predict capacity for managing new situations. Our results indicate that assertiveness training and the enhancement of emotion regulation are important elements of autonomy-connectedness targeted interventions.
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Affiliation(s)
- Marrie H J Bekker
- Tilburg University, Department of Clinical Psychology, P.O. Box 90153, 5000 LE Tilburg, The Netherlands.
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Landsman-Dijkstra JJA, van Wijck R, Groothoff JW. Improvement of balance between work stress and recovery after a body awareness program for chronic aspecific psychosomatic symptoms. PATIENT EDUCATION AND COUNSELING 2006; 60:125-35. [PMID: 16442454 DOI: 10.1016/j.pec.2004.12.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2004] [Revised: 11/26/2004] [Accepted: 12/03/2004] [Indexed: 05/06/2023]
Abstract
OBJECTIVE A 3-day residential body awareness program (BAP) was developed to teach people with chronic aspecific psychosomatic symptoms (CAPS) to react adequately to disturbances of the balance between a daily workload and the capacity to deal with it. The long-term effects of the program in improving the balance between work stress and recovery are presented in this study. The intervening effect of 'improved balance' on quality of life is also analysed. METHODS A pre-post design is used with post-measures at 2 and 12 months after the program, without controls (n = 122). Mean age is 42.5 years (S.D. = 9.0) and 60% of participants are female. RESULTS The results show participants become more active physically and socially, and at the same time take the opportunity to recover. There was a difference measured in changing balance for participants who are fully employed and participants who are not working or are working part-time due to health problems: the second group reintegrated into work, the first group spent more time socialising inside the family. Personal goals are realised by 85% of the participants. Realising personal goals and becoming more active is a mediating factor for increasing quality of life. The majority of the measured changes can be interpreted as clinically relevant outcomes with medium-to-large effect sizes. Spouses of the participants also confirm these effects. DISCUSSION AND CONCLUSION Evaluation of the BAP gives evidence to conclude that this program leads to long-term effects in CAPS. Participants react more adequately to disturbances between daily workload and the capacity to deal with this load. Two and 12 months after the 3-day program, they changed their behaviour to a more active lifestyle and increased self-management in coping with stress and psychosomatic symptoms. PRACTICE IMPLICATIONS By paying more attention to the balance between work stress and recovery, patient educators may be able to increase their effectiveness. Personal goal realization can be effective in guiding people by getting them out of the negative spiral.
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Landsman-Dijkstra JJA, van Wijck R, Groothoff JW. The long-term lasting effectiveness on self-efficacy, attribution style, expression of emotions and quality of life of a body awareness program for chronic a-specific psychosomatic symptoms. PATIENT EDUCATION AND COUNSELING 2006; 60:66-79. [PMID: 16332472 DOI: 10.1016/j.pec.2004.12.003] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2004] [Revised: 11/26/2004] [Accepted: 12/03/2004] [Indexed: 05/05/2023]
Abstract
OBJECTIVE A 3-day residential body awareness program (BAP) was developed to teach people with chronic a-specific psychosomatic symptoms (CAPS) to react adequately to disturbances of the balance between a daily workload and the capacity to deal with it. The long-term effects of the program on body awareness, psychological factors, psychosomatic symptoms and quality of life for people with CAPS are presented in this study. METHODS A pre-post design is used with post-measures 2 and 12 months after the program, without controls (n = 122). Mean age is 42.5 (S.D. = 9.0) and 60% is female. RESULTS The results showed an increase of body awareness, self-efficacy, expression of emotions and quality of life. Stress-related symptoms decreased and the attribution style was found to be less depressive. Participants achieved significantly higher levels of functioning at 2 months which increased significantly more at 12 months. The majority of the measured changes can be interpreted as clinically relevant outcomes with medium-to-large effect sizes. Spouses of the participants also confirm the found effects. DISCUSSION AND CONCLUSION Evaluation of the BAP gives evidence to conclude that this program leads to the theoretically expected long-term effects in CAPS. Participants react more adequately to disturbances between daily workload and the capacity to deal with this load. Two and 12 months after the 3-day program, they are more capable of self-management in coping with stress and psychosomatic symptoms. PRACTICE IMPLICATIONS This article sheds new light on the difficulties that individuals with psychosomatic symptoms and their professional interventionists encounter when attempting to manage the chronicity of the problems. By paying more attention to learning self-management by increasing body awareness and self-efficacy, patient educators may be able to increase their effectiveness.
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Sanderman R, Ranchor AV. The evaluation of self management of health problems and the value of randomized clinical trials. PATIENT EDUCATION AND COUNSELING 2004; 55:153-154. [PMID: 15530749 DOI: 10.1016/j.pec.2004.10.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
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