Long-term effectiveness of Basic Body Awareness Therapy in psychiatric outpatient care. A randomized controlled study

Efficacy of basic body awareness therapy on functional outcomes: A systematic review and meta-analysis of randomized controlled trials

PURPOSE

This study examined the efficacy of basis body awareness therapy (BBAT) on functional outcomes and quality of life (QoL) in patients with mental health problems and long-lasting conditions including musculoskeletal disorders, chronic and psychosomatic pain, and neurological conditions.

MATERIAL AND METHODS

Randomized controlled trials (RCTs) were obtained from MEDLINE, EMBASE, CINAHL, CENTRAL, and PEDro from inception to April 1st, 2022. A random effects meta-analysis was performed to explore the efficacy of BBAT versus non-active and active control conditions.

RESULTS

Eight RCTs (n BBAT = 307, n controls = 428) were included. There was no evidence for reductions in anxiety (standardized mean difference [SMD] = -1.42, 95% confidence interval [CI] = -3.30 to 0.46, p = 0.14), depression (SMD = -0.82, 95% CI = -1.85 to 0.21, p = 0.12), and no improvements in global assessment of functioning for functioning (GAF-F) (SMD = 0.58, 95% CI = -0.03 to 1.19, p = 0.06) or for symptoms (GAF-S) (SMD = 0.76, 95% CI = -0.44 to 1.96, p = 0.21) in BBAT versus non-active control conditions. BBAT reduced anxiety significantly more than active interventions (SMD = -0.84, 95% CI = -1.17 to -0.51, p < 0.001). No significant differences between BBAT and active control conditions were found for reduction in depression (SMD = -1.16, 95% CI = -2.74 to 0.41, p = 0.15) or in self-reported pain (SMD = 0.08, 95% CI = -0.25 to 0.40, p = 0.65). Active control conditions were superior in improving QoL (SMD = 0.83, 95% CI = 0.49 to 1.17, p < 0.001), GAF-F (SMD = 1.58, 95% CI = 0.29 to 2.86, p = 0.016) and GAF-S (SMD = 1.19, 95% CI = 0.85 to 1.53, p < 0.001).

CONCLUSIONS

Physiotherapists should be cautious in adopting BBAT, noting there is no high-quality evidence to support its' use to improve functionality and QoL in patients with mental health problems and/or long-lasting conditions.

Basic Body Awareness Therapy versus standard care in hip osteoarthritis. A randomized controlled trial

BACKGROUND

Compensational movement patterns in hip osteoarthritis (HOA) are associated with hip dysfunction. Basic Body Awareness Therapy (BBAT) promotes functional movement quality and might, accordingly, be beneficial in HOA.

OBJECTIVE

To examine the outcomes of BBAT compared to standard care in people with HOA after first receiving patient education (PE).

STUDY DESIGN

A prospective, assessor-blinded, and block-randomized controlled trial.

METHODS

Community-living adults with HOA participating in PE were randomly allocated to an intervention group receiving BBAT in groups (12 sessions offered once a week), or a comparison group. Data at baseline (pretest) and at 6 months (posttest) were analyzed. Primary outcomes were pain during walking assessed by the Numeric Rating Scale (NRS) and function by the Hip Osteoarthritis Outcome Score, subscale ADL (HOOS A). Secondary outcomes addressed physical capacity, movement quality, and self-reported aspects of function and health.

RESULTS

At pretest, there were no significant differences in demographic and test data between the intervention (n = 51) and the comparison (n = 50) group. Forty-one intervention and 45 comparison participants completed the posttest. At posttest, no significant differences in change between groups were found on NRS (p = 0.694, effect size (ES) = 0.02) or HOOS A (p = 0.783, ES = 0.07). Among secondary outcomes, movement quality improved significantly more (p < 0.001, ES = 0.84) in the intervention group. Compliance with BBAT varied substantially. Per-protocol analysis showed changes in favor of the intervention group for self-efficacy (p = 0.049, ES = 0.36), health (p = 0.037, ES = 0.44), and function (p = 0.029, ES = 0.53) when only intervention participants who completed at least 10 sessions of BBAT were included.

CONCLUSIONS

BBAT was not found to be a more effective treatment modality than self-initiated standard care to reduce pain during walking and improve daily functioning in people with HOA. Movement quality was significantly more improved in participants receiving BBAT, and improvement in other health aspects was associated with sufficient therapy compliance.

The experience of Basic Body Awareness Therapy and its transfer to daily life amongst Danish military veterans with PTSD

INTRODUCTION

The prevalence of Post-Traumatic Stress Disorder (PTSD) among Danish military veterans is estimated to be around 10%, and treatment primarily consists of recommended psychological trauma-focused therapy.

AIM

The aim of the study was to explore veterans' experiences of their body and its potential transfer of that experience in their daily life after BBAT.

METHODS

A hermeneutic-phenomenological qualitative study using semi-structured individual interviews was used. A slightly modified Interpretive Phenomenological Analysis was applied in the data analysis. The participants were four Danish military veterans with PTSD who had completed 12 individual sessions of BBAT in addition to psychological trauma-focused therapy.

RESULTS

All participants found the BBAT treatment sessions calming and reported the overall treatment was a positive experience. Three participants experienced increased body awareness and were able to apply the exercises and principles of BBAT in their daily lives to varying degrees. All participants estimated the benefits would have been greater with more sessions.

CONCLUSION

BBAT showed potential for enhancing the bodily awareness of military veterans with PTSD experience and their ability to apply that awareness in their daily life. The degree of transfer of this skill to everyday life appeared to be dependent on the participants' mentalizing capacity.

IMPLICATIONS OF THIS STUDY

The results indicate a benefit in using body-oriented therapies such as BBAT in the treatment of military veterans with PTSD, as a supplement to trauma-focused treatment although it is hard to distinguish which treatment had which effect or if the combination of psychotherapy and BBAT had a joint effect. Future studies are needed due to the limited research in this field.

Experiences with basic body awareness therapy as an add-on to cognitive behavioural therapy among Danish military veterans with PTSD: An interview study

BACKGROUND

The Danish Veterans Centre offers a body-orientated therapy, Basic Body Awareness Therapy (BBAT), in addition to the psychological trauma-focused therapy to military veterans suffering from symptoms of post-traumatic stress disorder (PTSD). This study explored how the veterans a) experienced BBAT as a physiotherapeutic approach and as an add-on treatment to their usual Cognitive Behavioural Therapy (CBT) and b) whether it makes sense for the individual veteran to incorporate BBAT into their treatment.

MATERIALS AND METHODS

Individual semi-structured interviews with four veterans who had completed 12 BBAT sessions concurrently with their usual CBT treatment. Interviews were transcribed and analysed using Malterud's version of Giorgi's 4-step systematic text condensation.

RESULTS

Three main categories emerged: "Effects of treatment", "The setting of the treatment" and "Complementary nature of BBAT and CBT". Within each category were 2-5 underlying subgroups. Participants found it made sense to combine BBAT with their CBT since it benefitted them differently and addressed their bodily symptoms and improved body perception/awareness.

CONCLUSION

BBAT showed potential as a supplement to CBT and seemed to benefit the veterans through focusing on bodily symptoms and how to calm them. Future studies are needed because of the limited research on the topic.

The Effect of Physiotherapy Group Intervention in Reducing Pain Disorders and Mental Health Symptoms among Syrian Refugees: A Randomized Controlled Trial

Chronic pain is common among refugees, and often related to mental health problems. Its management, however, is often challenging. A randomized waitlist-controlled trial was designed to study the effect of group physiotherapy activity and awareness intervention (PAAI) on reducing pain disorders, and secondarily improving mental health, among Syrian refugees. A total of 101 adult Syrian refugees suffering from chronic pain were randomized to either the intervention group or the control group, which thereafter also received PAAI after a waiting period. Pain intensity measured by the Brief Pain Inventory (BPI) was the primary outcome. Scores from the Impact of Events Scale-Revised (IES-R 22) and the General Health Questionnaire (GHQ-12) were secondary outcomes. Intention-to-treat analyses (ITT) showed no effect of the intervention on either pain levels (regression coefficient [B {95% CI} of 0.03 {-0.91, 0.96}], IESR scores [4.8 {-3.7, 13.4}] or GHQ-12 scores [-0.4 {-3.1, 2.3}]). Yet, participants highly appreciated the intervention. Despite the negative findings, our study contributes to the evidence base necessary to plan targeted and effective health care services for refugees suffering from chronic pain and highlights the challenge of evaluating complex interventions adapted to a specific group.

Psychosocial interventions for conversion and dissociative disorders in adults

BACKGROUND

Conversion and dissociative disorders are conditions where people experience unusual neurological symptoms or changes in awareness or identity. However, symptoms and clinical signs cannot be explained by a neurological disease or other medical condition. Instead, a psychological stressor or trauma is often present. The symptoms are real and can cause significant distress or problems with functioning in everyday life for the people experiencing them.

OBJECTIVES

To assess the beneficial and harmful effects of psychosocial interventions of conversion and dissociative disorders in adults.

SEARCH METHODS

We conducted database searches between 16 July and 16 August 2019. We searched Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, and eight other databases, together with reference checking, citation searching and contact with study authors to identify additional studies.  SELECTION CRITERIA: We included all randomised controlled trials that compared psychosocial interventions for conversion and dissociative disorders with standard care, wait list or other interventions (pharmaceutical, somatic or psychosocial).  DATA COLLECTION AND ANALYSIS: We selected, quality assessed and extracted data from the identified studies. Two review authors independently performed all tasks. We used standard Cochrane methodology. For continuous data, we calculated mean differences (MD) and standardised mean differences (SMD) with 95% confidence interval (CI). For dichotomous outcomes, we calculated risk ratio (RR) with 95% CI. We assessed and downgraded the evidence according to the GRADE system for risk of bias, imprecision, indirectness, inconsistency and publication bias.

MAIN RESULTS

We included 17 studies (16 with parallel-group designs and one with a cross-over design), with 894 participants aged 18 to 80 years (female:male ratio 3:1).  The data were separated into 12 comparisons based on the different interventions and comparators. Studies were pooled into the same comparison when identical interventions and comparisons were evaluated. The certainty of the evidence was downgraded as a consequence of potential risk of bias, as many of the studies had unclear or inadequate allocation concealment. Further downgrading was performed due to imprecision, few participants and inconsistency. There were 12 comparisons for the primary outcome of reduction in physical signs. Inpatient paradoxical intention therapy compared with outpatient diazepam: inpatient paradoxical intention therapy did not reduce conversive symptoms compared with outpatient diazepam at the end of treatment (RR 1.44, 95% CI 0.91 to 2.28; 1 study, 30 participants; P = 0.12; very low-quality evidence). Inpatient treatment programme plus hypnosis compared with inpatient treatment programme: inpatient treatment programme plus hypnosis did not reduce severity of impairment compared with inpatient treatment programme at the end of treatment (MD -0.49 (negative value better), 95% CI -1.28 to 0.30; 1 study, 45 participants; P = 0.23; very low-quality evidence). Outpatient hypnosis compared with wait list: outpatient hypnosis might reduce severity of impairment compared with wait list at the end of treatment (MD 2.10 (higher value better), 95% CI 1.34 to 2.86; 1 study, 49 participants; P < 0.00001; low-quality evidence). Behavioural therapy plus routine clinical care compared with routine clinical care: behavioural therapy plus routine clinical care might reduce the number of weekly seizures compared with routine clinical care alone at the end of treatment (MD -21.40 (negative value better), 95% CI -27.88 to -14.92; 1 study, 18 participants; P < 0.00001; very low-quality evidence). Cognitive behavioural therapy (CBT) compared with standard medical care: CBT did not reduce monthly seizure frequency compared to standard medical care at end of treatment (RR 1.56, 95% CI 0.39 to 6.19; 1 study, 16 participants; P = 0.53; very low-quality evidence). CBT did not reduce physical signs compared to standard medical care at the end of treatment (MD -4.75 (negative value better), 95% CI -18.73 to 9.23; 1 study, 61 participants; P = 0.51; low-quality evidence). CBT did not reduce seizure freedom compared to standard medical care at end of treatment (RR 2.33, 95% CI 0.30 to 17.88; 1 trial, 16 participants; P = 0.41; very low-quality evidence). Psychoeducational follow-up programmes compared with treatment as usual (TAU): no study measured reduction in physical signs at end of treatment. Specialised CBT-based physiotherapy inpatient programme compared with wait list: no study measured reduction in physical signs at end of treatment. Specialised CBT-based physiotherapy outpatient intervention compared with TAU: no study measured reduction in physical signs at end of treatment. Brief psychotherapeutic intervention (psychodynamic interpersonal treatment approach) compared with standard care: brief psychotherapeutic interventions did not reduce conversion symptoms compared to standard care at end of treatment (RR 0.12, 95% CI 0.01 to 2.00; 1 study, 19 participants; P = 0.14; very low-quality evidence). CBT plus adjunctive physical activity (APA) compared with CBT alone: CBT plus APA did not reduce overall physical impacts compared to CBT alone at end of treatment (MD 5.60 (negative value better), 95% CI -15.48 to 26.68; 1 study, 21 participants; P = 0.60; very low-quality evidence). Hypnosis compared to diazepam: hypnosis did not reduce symptoms compared to diazepam at end of treatment (RR 0.69, 95% CI 0.39 to 1.24; 1 study, 40 participants; P = 0.22; very low-quality evidence). Outpatient motivational interviewing (MI) and mindfulness-based psychotherapy compared with psychotherapy alone: psychotherapy preceded by MI might decrease seizure frequency compared with psychotherapy alone at end of treatment (MD 41.40 (negative value better), 95% CI 4.92 to 77.88; 1 study, 54 participants; P = 0.03; very low-quality evidence). The effect on the secondary outcomes was reported in 16/17  studies. None of the studies reported results on adverse effects. In the studies reporting on level of functioning and quality of life at end of treatment the effects ranged from small to no effect.

AUTHORS' CONCLUSIONS

The results of the meta-analysis and reporting of single studies suggest there is lack of evidence regarding the effects of any psychosocial intervention on conversion and dissociative disorders in adults. It is not possible to draw any conclusions about potential benefits or harms from the included studies.

Trauma-affected refugees treated with basic body awareness therapy or mixed physical activity as augmentation to treatment as usual-A pragmatic randomised controlled trial

BACKGROUND

The prevalence of post-traumatic stress disorder (PTSD) is estimated to be as high as 30% among refugees. The coexistence of prevalent chronic pain is believed to maintain symptoms of PTSD and add complexity to the condition. Despite this, little evidence exists on how to treat PTSD and comorbid conditions best in trauma-affected refugees.

AIM

The aim of the present study was to investigate if adding either BBAT or mixed physical activity to the treatment as usual (TAU) for trauma-affected refugees with PTSD would increase the treatment effect compared to TAU alone.

METHOD

Randomised controlled trial, 3-armed parallel group superiority study, conducted at Competence Centre for Transcultural Psychiatry, Denmark. Participants were adult trauma-affected refugees with PTSD. Allocation ratio was 1:1:1, stratified for PTSD severity and gender. An open-label design was applied due to the nature of the intervention. Participants were randomised to receive either individual basic body awareness therapy (group B) or individual mixed physical activity (group M) one hour/week for 20 weeks plus TAU, or TAU only (group C). The primary outcome was PTSD severity measured by Harvard Trauma Questionnaire (HTQ). Trial registration: ClinicalTrials.gov, NCT01955538.

RESULTS

Of the 338 patients included (C/B/M = 110/114/114), 318 patients were eligible for intention-to-treat analysis (C/B/M = 104/105/109). On the primary outcome, intention-to-treat as well as per-protocol analyses showed small but significant improvement on scores from pre- to post-treatment in all three groups but with no significant difference in improvement between groups.

CONCLUSIONS

The findings do not provide evidence that either BBAT or mixed physical activity as add-on treatment bring significantly larger improvement on symptoms of PTSD compared to TAU alone for adult, trauma-affected refugees. There is a need for studies on potential subpopulations of trauma-affected refugees who could benefit from physical activity as a part of their treatment.

Patients' Experiences of a Stress-Management Programme in Primary Care

Introduction

Stress and stress-related ill health have a multifactorial impact; both on physical and mental health. To better meet this category of patients a primary care unit started a stress-management programme using cognitive behavioural therapy and basic body awareness therapy.

Purpose

To describe participant´s experiences of a primary care stress-management programme using cognitive behavioural therapy and basic body awareness therapy.

Methods

In a qualitative study, a semi-structured interview guide was used in individual interviews with 9 people, all women aged 41–57, working or on sick leave, who had enrolled in the stress-management programme. The material was analysed through qualitative content analysis.

Results

The analysis resulted in the theme “Process of change for a sustainable everyday living”. The participants described having gained awareness of the symptoms of their stress, knowledge and tools to manage their stress, ways to relax, awareness of their body, and the means to develop better habits and to change their behaviour. Fundamental in the material was the importance of participants’ identification with the others in the group.

Conclusion

The participants started a process of change with new knowledge and growth, but they encountered difficulties and obstacles. Behavioural change is a time-consuming process.

Body-Centered Interventions for Psychopathological Conditions: A Review

World-wide, billions of dollars are spent each year on body-centered interventions to alleviate both physical and psychological pathologies. Given the high demand and increasing popularity of body-centered interventions, there is need for a systematic organization of empirical evidence associated with body-centered therapies. This article reviews the psychological effects of body-centered interventions on emotional well-being, including both self and other-administered (receptive) therapies. Theory behind body-centered interventions rely upon the bidirectional communication pathway between the brain and body. We investigated the bidirectional communication pathway between the brain and body by evaluating evidence across multiple body-centered therapies. The research reviewed includes studies that investigate effects of massage therapy, reflexology, acupuncture, functional relaxation, emotional freedom technique, Rolfing, yoga, tai-chi, and dance/movement therapy on psychological conditions across the lifespan. Results demonstrated that overall, massage therapy, tai-chi, dance/movement therapy, functional relaxation, reflexology, acupuncture and emotional freedom technique seem to alleviate stress, depression, anxiety, bipolar disorder and facilitate pain reduction. Of these, the most robust evidence available was for massage therapy, indicating it is an effective intervention for numerous age groups and populations. Rolfing and reflexology had the least amount of support, with few studies available that had small sample sizes. Although these conclusions are limited by scarcity of high-quality empirical data and contradictory findings, available evidence indicates that body-centered interventions can be effective in reducing psychopathology and supports the proposed mechanism of the bidirectional pathway between the brain and body: the body holds the potential to influence the mind. Integrating body-centered therapies in both clinical settings and as self-care could lead to better outcomes. Lastly, we propose the first taxonomy of body-centered interventions and empirical evidence of their effectiveness for clinicians and researchers.

To increase physical activity in sedentary patients with affective - or schizophrenia spectrum disorders - a clinical study of adjuvant physical therapy in mental health

Purpose: To understand if physical therapy in addition to individualized psychiatric specialist treatment could aid sedentary patients with schizophrenia spectrum disorders or affective spectrum disorders to become more physically active and also to identify assessments suitable for measuring physical activity, physical function and movement motivation.Materials and methods: In a longitudinal, clinical study 18 sedentary patients that filled inclusion criteria were consecutively included. The patients were diagnosed with affective disorders (n = 10) or schizophrenia spectrum disorders (n = 8).Results: Fifteen patients fulfilled the 6-month treatment. The affective group significantly improved physical activity, walking capacity, physical function, exercise habits and attitudes. The schizophrenia spectrum group significantly improved the attitudes to the body and movements but did not increase their physical activity. Instruments to study physical activity, physical function and movement motivation were identified.Conclusion: The study revealed that physical therapy in addition to individualized psychiatric specialist treatment might be an aid for the patients to become more physically active. Patients with affective disorders reached recommended levels of moderate physical activity according to World Health Organization guidelines. Sedentary patients with schizophrenia spectrum disorders revealed positive attitude-changes, but no behavioral change.

A short work-directed rehabilitation to promote work capacity while depressed and anxious: a qualitative study of workers' experiences

PURPOSE

Most people with common mental disorders are working despite symptoms. This study explores individuals' experiences of a work-directed rehabilitation, provided by occupational therapists and physiotherapists, aiming to promote work capacity in persons with common mental disorders.

METHODS

A qualitative content analysis was used, and 11 women and 8 men with depression or anxiety disorder were interviewed. They were 25-66 years old, had different occupations and were working full or part-time.

RESULTS

The participants experienced a process interpreted as Increasing belief in one's capacity through supported reflection and practice. This theme reflects the shifting between "reflecting" and "doing" through rehabilitation and the growing hope for change. The increasing belief in one's capacity was developed through three stages, comprised of the categories To be supported by a professional, To realise things about oneself and To try new strategies for change.

CONCLUSIONS

Strategies suggested by occupational therapists and physiotherapists have the potential to promote work capacity in people who are working while depressed and anxious. The results may deepen the understanding among rehabilitation professionals about the importance of a person-centred approach to people with common mental disorders, and to combine reflection and practical exercises to support the development of work-related strategies.Implications for rehabilitationWork-directed rehabilitation provided by occupational therapists and/or physiotherapists is beneficial to people with common mental disorders.Rehabilitation professionals should focus on facilitating self-efficacy among people with common mental disorders.An individualised person-centred approach seems important in order to initiate change.

Effectiveness of movement and body awareness therapies in patients with fibromyalgia: a systematic review and meta-analysis

INTRODUCTION

Fibromyalgia is a long-term condition that is associated with widespread pain and is recognized as one of the major common causes of disability. The standard clinical guidance for fibromyalgia includes both pharmacological and non-pharmacological interventions. In the latter, different interventions are implemented such as aerobic exercises, flexibility exercises, strength training, stretching and body awareness (BA) therapies. The aims of this review were to provide a summary of movement and BA therapies in patients with fibromyalgia and to compare the different therapies in relation to outcomes.

EVIDENCE ACQUISITION

The search strategy was undertaken using the following databases from inception to October 2018: PubMed, Cinahl, PEDro, PsychoInfo and The Cochrane Library. Articles were eligible if they were randomized controlled trials (RCTs) comparing movement and BA therapies with another intervention.

EVIDENCE SYNTHESIS

Two authors independently extracted data and assessed trial quality; 418 studies were found, twenty-two of which met the inclusion criteria. Pain symptom was improved with movement and BA therapies such as, affective self-awareness, t'ai chi, yoga, belly dance, strengthening program and Resseguier method. Forest plot analysis in short term confirms positive trend in favor of BA; however, a great heterogeneity was found between trials.

CONCLUSIONS

This systematic review and meta-analysis shows positive results in favor of movement and BA therapies as adjunct treatment to usual care in patients who suffer from fibromyalgia. Further work in identifying the mechanism of action by which BA therapies benefit outcomes should be undertaken.

Experiences from group basic body awareness therapy by patients suffering from fibromyalgia: A qualitative study

The aim of this study was to obtain a deeper understanding of how patients with fibromyalgia experienced movement awareness through a basic body awareness therapy group treatment program. A total of 19 participants with fibromyalgia diagnosis were interviewed individually and in groups. Data collection was done from three sources: (1) interviews from the Basic Body Awareness Rating Scale (BARS) part 2 at baseline, at end of treatment, as well as at 12 and 24 weeks follow up; (2) focus group discussions that took place at the end of each session, and at the end of treatment; and (3) an in-depth focus group. Giorgi's method was followed for data construction and analysis. The researchers conducted 57 individual interviews, 10 focus groups, and one in-depth focus group. The findings revealed the following categories: "creating a new relation to self"; "change the pattern of body awareness"; "being in a group"; and "experiencing physical capacity", showing influences among them. Body awareness seems to have an impact in the therapeutic process in patients suffering from fibromyalgia.

Anxiety management: Participants' experiences of a physiotherapeutic group treatment in Swedish psychiatric outpatient care

Anxiety disorders are among the most persistent mental health syndromes. There is extensive research showing effectiveness of pharmacotherapy and psychotherapy interventions targeting anxiety, while knowledge is still sparse for other treatment options. The aim of this study was to explore how participants with anxiety disorders experience a physiotherapeutic group treatment in psychiatric outpatient care, and their perceived ability to manage anxiety within two months after participating in the treatment. Semi-structured interviews with participants were conducted to explore experiences of the treatment. Data were analyzed using qualitative content analysis, which resulted in one main theme: Reconnecting to the body in the supportive atmosphere of a group. Six categories reflect the main theme: (1) sharing with others supported by the group, (2) grounding oneself in the body, (3) getting to know the body and learning to manage its reactions, (4) learning to tolerate bodily sensations of anxiety, (5) gaining a more compassionate attitude toward oneself, and (6) challenging old patterns to become more active in life. The participants reported that their ability to reconnect to their bodies increased so that anxious sensations became more endurable and acceptable after treatment. The supportive group context was described as valuable, enabling the participants to feel safe enough to start exploring new ways to manage anxiety. In conclusion, this study suggests that a physiotherapeutic group treatment can be a useful add-on treatment to the standard treatment models of anxiety disorders, including psychotherapy and pharmacotherapy, since it targets the embodied, nonverbal domain of anxiety.

Therapeutically efficient components of Basic Body Awareness Therapy as perceived by experienced therapists - A qualitative study

BACKGROUND

Basic Body Awareness Therapy (BBAT) is a physiotherapeutic method used in rehabilitation to increase physical and emotional balance. The aim was to identify and describe perceived therapeutically efficient components of BBAT.

METHODS

Twenty-four experienced BBAT therapists participated in focus group interviews. The data were analysed with content analysis.

RESULTS

One central theme, the therapeutic space consisted of two categories; the therapeutic encounter and the therapeutic tools, which emerged as the core of the perceived therapeutically efficient components. The therapeutic encounter entailed the therapeutic approach, affect attunement, continuous interaction during treatment, affect mirroring and communicating by use of a person-centred approach. The therapeutic tools included adjustment and adaptation, the use of manual, verbal and non-verbal guiding, and creating an atmosphere of safety and sanctuary.

CONCLUSION

The significance of interaction by use of a person-centred approach combined with the ability to continuously adjust the treatment constituted useful guidelines when designing rehabilitation using BBAT treatment.

Enhancing Sense of Coherence and Mindfulness in an Ecclesiastical, Intercultural Group Training Context

Sense of coherence (SOC) and mindfulness (MI) are believed to promote the health and well-being of individuals and organisations. The aim of this longitudinal study was to contribute to the literature on the development of SOC through training and interventions and thereby explore the development of these constructs in a group of senior professionals in the German Catholic Church. A sample of eight participants voluntarily enrolled for a 12-day training programme spread over a period of nine months to develop intercultural and inter-religious competencies, SOC and MI. Quantitative scores of the pre- and post-test SOC and MI questionnaires were qualitatively analysed. Results indicate that the majority of participants scored lower in the post-test on SOC and slightly higher in MI. The discussion explores the pitfalls in the development of these constructs in the study's participants and highlights the implications for theory and practice. Practical training implications for developing SOC and MI are offered.

Affect school and script analysis versus basic body awareness therapy in the treatment of psychological symptoms in patients with diabetes and high HbA1c concentrations: two study protocols for two randomized controlled trials

Background

Depression is linked with alexithymia, anxiety, high HbA1c concentrations, disturbances of cortisol secretion, increased prevalence of diabetes complications and all-cause mortality. The psycho-educational method ‘affect school with script analysis’ and the mind-body therapy ‘basic body awareness treatment’ will be trialled in patients with diabetes, high HbA1c concentrations and psychological symptoms. The primary outcome measure is change in symptoms of depression. Secondary outcome measures are changes in HbA1c concentrations, midnight salivary cortisol concentration, symptoms of alexithymia, anxiety, self-image measures, use of antidepressants, incidence of diabetes complications and mortality.

Methods

Two studies will be performed. Study I is an open-labeled parallel-group study with a two-arm randomized controlled trial design. Patients are randomized to either affect school with script analysis or to basic body awareness treatment. According to power calculations, 64 persons are required in each intervention arm at the last follow-up session. Patients with type 1 or type 2 diabetes were recruited from one hospital diabetes outpatient clinic in 2009. The trial will be completed in 2016. Study II is a multicentre open-labeled parallel-group three-arm randomized controlled trial. Patients will be randomized to affect school with script analysis, to basic body awareness treatment, or to treatment as usual. Power calculations show that 70 persons are required in each arm at the last follow-up session. Patients with type 2 diabetes will be recruited from primary care. This study will start in 2016 and finish in 2023. For both studies, the inclusion criteria are: HbA1c concentration ≥62.5 mmol/mol; depression, alexithymia, anxiety or a negative self-image; age 18–59 years; and diabetes duration ≥1 year. The exclusion criteria are pregnancy, severe comorbidities, cognitive deficiencies or inadequate Swedish. Depression, anxiety, alexithymia and self-image are assessed using self-report instruments. HbA1c concentration, midnight salivary cortisol concentration, blood pressure, serum lipid concentrations and anthropometrics are measured. Data are collected from computerized medical records and the Swedish national diabetes and causes of death registers.

Discussion

Whether the “affect school with script analysis” will reduce psychological symptoms, increase emotional awareness and improve diabetes related factors will be tried, and compared to “basic body awareness treatment” and treatment as usual.

Trial registration

ClinicalTrials.gov: NCT01714986

Is that really my movement? - Students' experiences of a video-supported interactive learning model for movement awareness

Healthcare staff and students have a great risk of developing musculoskeletal symptoms. One cause of this is heavy load related work activities such as manual handling, in which the quality of individual work technique may play a major role. Preventive interventions and well-defined educational strategies to support movement awareness and long-lasting movement changes need to be developed. The aim of the present study was to explore nursing students’ experiences of a newly developed interactive learning model for movement awareness. The learning model, which is based on a life-world perspective with focus on interpersonal interaction, has been used with 11 undergraduate students from the second and final year. Each student participated in three individual video sessions with a facilitator. Two individual interviews were carried out with each student during the learning process and one interview 12–18 months after the last session. The interviews were audio-recorded and transcribed verbatim, and a phenomenological hermeneutic method inspired by Paul Ricoeur and described by Lindseth and Norberg was used to interpret the interviews and diary notes. The interpretation resulted in three key themes and nine subthemes. The key themes were; “Obtaining better preconditions for bodily awareness,” “Experiencing changes in one's own movement,” and “Experiencing challenges in the learning process.” The interactive learning model entails a powerful and challenging experience that develops movement awareness. The experience of meaningfulness and usefulness emerges increasingly and alternates with a feeling of discomfort. The learning model may contribute to the body of knowledge of well-defined educational strategies in movement awareness and learning in, for example, preventive interventions and ergonomic education. It may also be valuable in other practical learning situations where movement awareness is required.

Exercise or basic body awareness therapy as add-on treatment for major depression: a controlled study

BACKGROUND

While physical exercise as adjunctive treatment for major depression has received considerable attention in recent years, the evidence is conflicting. This study evaluates the effects of two different add-on treatments: exercise and basic body awareness therapy.

METHODS

Randomized controlled trial with two intervention groups and one control, including 62 adults on antidepressant medication, who fulfilled criteria for current major depression as determined by the Mini International Neuropsychiatric Interview. Interventions (10 weeks) were aerobic exercise or basic body awareness therapy (BBAT), compared to a single consultation with advice on physical activity. Primary outcome was depression severity, rated by a blinded assessor using the Montgomery Asberg Rating Scale (MADRS). Secondary outcomes were global function, cardiovascular fitness, self-rated depression, anxiety and body awareness.

RESULTS

Improvements in MADRS score (mean change=-10.3, 95% CI (-13.5 to -7.1), p=0.038) and cardiovascular fitness (mean change=2.4ml oxygen/kg/min, 95% CI (1.5 to 3.3), p=0.017) were observed in the exercise group. Per-protocol analysis confirmed the effects of exercise, and indicated that BBAT has an effect on self-rated depression.

LIMITATIONS

The small sample size and the challenge of missing data. Participants׳ positive expectations regarding the exercise intervention need to be considered.

CONCLUSIONS

Exercise in a physical therapy setting seems to have effect on depression severity and fitness, in major depression. Our findings suggest that physical therapy can be a viable clinical strategy to inspire and guide persons with major depression to exercise. More research is needed to clarify the effects of basic body awareness therapy.

'Girls need to strengthen each other as a group': experiences from a gender-sensitive stress management intervention by youth-friendly Swedish health services--a qualitative study

BACKGROUND

Mental health problems among young people, and girls and young women in particular, are a well-known health problem. Such gendered mental health patterns are also seen in conjunction with stress-related problems, such as anxiety and depression and psychosomatic complaints. Thus, intervention models tailored to the health care situation experienced by young women within a gendered and sociocultural context are needed. This qualitative study aims to illuminate young women's experiences of participating in a body-based, gender-sensitive stress management group intervention by youth-friendly health services in northern Sweden.

METHODS

A physiotherapeutic body-based, health-promoting, gender-sensitive stress management intervention was created by youth-friendly Swedish health services. The stress management courses (n = 7) consisted of eight sessions, each lasting about two hours, and were led by the physiotherapist at the youth centre. The content in the intervention had a gender-sensitive approach, combining reflective discussions; short general lectures on, for example, stress and pressures related to body ideals; and physiotherapeutic methods, including body awareness and relaxation. Follow-up interviews were carried out with 32 young women (17-25 years of age) after they had completed the intervention. The data were analysed with qualitative content analysis.

RESULTS

The overall results of our interview analysis suggest that the stress management course we evaluated facilitated 'a space for gendered and embodied empowerment in a hectic life', implying that it both contributed to a sense of individual growth and allowed participants to unburden themselves of stress problems within a trustful and supportive context. Participants' narrated experiences of 'finding a social oasis to challenge gendered expectations', 'being bodily empowered', and 'altering gendered positions and stance to life' point to empowering processes of change that allowed them to cope with distress, despite sometimes continuously stressful life situations. This intervention also decreased stress-related symptoms such as anxiousness, restlessness, muscle tension, aches and pains, fatigue, and impaired sleep.

CONCLUSIONS

The participants' experiences of the intervention as a safe and exploratory space for gendered collective understanding and embodied empowerment further indicates the need to develop gender-sensitive interventions to reduce individualisation of health problems and instead encourage spaces for collective support, action, and change.

Embodying the body in anorexia nervosa--a physiotherapeutic approach

Body dissatisfaction and disturbances in bodily sensations are prevailing qualities among patients with anorexia nervosa (AN). However, therapies addressing the body are typically marginalized within treatment programs for anorexia nervosa. The purpose of this article is to 1) describe common bodily symptoms and experiences of anorexia nervosa patients and discuss the accompanying physical and emotional impact, and 2) present physiotherapeutic approaches to help patients with anorexia nervosa. Recommendations are based on the author's clinical observations and patient testimonials, in addition to the theory and methodology outlined by Norwegian Psychomotor Physiotherapy (NPMP), body awareness therapies, and current knowledge on bodily stability. It is the author's experience that anorexia nervosa patients tend to have significant impairments in their body awareness, a restricted breathing pattern, significant muscular tension, poor postural stability, and they are frequently engaged in compulsive physical activity. A body awareness approach for these patients may contribute to novel ways of sensing and interpreting bodily signals, improving emotional awareness, experiencing the body and integrating the body as one's own, i.e., becoming an embodied person. Embodying the body in patients with anorexia nervosa by utilizing approaches from NPMP and body awareness therapies, in addition to stability training principles, may help stabilize the body and the mind, and thus, constitute a beneficial addition to overall treatment for anorexia nervosa.

Embodied identity--a deeper understanding of body awareness

The aims of this study were to explore and generate an understanding of the meaning of body awareness through explanations of the experience of body awareness given by professionals and patients in psychiatric rehabilitation. A total of 20 strategically selected healthy informants were interviewed individually and in groups. Thirteen previous interviews with physiotherapists and 11 previous interviews with patients in psychiatric rehabilitation, describing their experiences of body awareness therapy and its effects were reanalyzed and included in the data for this study; in all 44 informants were included. Grounded theory methods guided the data construction and analysis. A theoretical understanding was conceptualised from which a core category of body awareness emerged: the embodied identity. This core category was related to two categories: living in the body and living in relation to others and in society. The subcategory "living in the body" was conceived as an important aspect to become more aware of the body and to experience oneself fromwithin in order to recognize one's needs. A key point was the fact that bodily experiences always exists in the present moment. The experience of the body, the balance, and stability of the physical self were basic experiences that were connected to the conception of well-being and control. To understand one's emotions and needs through the awareness of the body were understood as the base for self-confidence, trust in one-self, and the ability to take care of oneself and one's needs physically and mentally. The subcategory "living in relation to others and in society" was conceived as an important aspect for the embodied self to interact with others and for societal participation. Working with the body in physiotherapy practice should include an understanding that body awareness is inseparable from the identity and may have an impact on the health of the individual. This implies that interventions to address problems in body awareness should be integrated into physiotherapy practice.

How can movement quality be promoted in clinical practice? A phenomenological study of physical therapist experts

BACKGROUND

In recent years, physical therapists have paid greater attention to body awareness. Clinicians have witnessed the benefits of supporting their patients' learning of movement awareness through the promotion of their movement quality.

OBJECTIVE

The aim of this study was to investigate how physical therapist experts promote movement quality in their usual clinical settings.

DESIGN

A phenomenological research design that included a sampling strategy was devised. Using specific criteria, 6 lead physical therapists nominated a group of physical therapist experts from the fields of neurology, primary health care, and mental health. Fifteen informants, 5 from each field, agreed to participate.

METHODS

In-depth interviews were conducted with a semistructured interview guide. The informants were invited to simply describe what they had experienced to be successful therapeutic processes for promoting movement quality. Each interview was audiotaped and transcribed. The data analysis was based on a multistep model.

RESULTS

Three main themes emerged from the data. First, the physical therapists' embodied presence and movement awareness served as a precondition and an orientation for practice. Embodied presence is a bodily felt sense, a form of personal knowing that evokes understanding and fosters meaning. Second, creating a platform for promoting movement quality revealed implementation of psychological attitudes. Third, action strategies for promoting movement quality suggested a movement awareness learning cycle and components for clinical use.

CONCLUSIONS

This study demonstrated specific attitudes and skills used by physical therapist experts to promote movement quality in their clinical practice. These results may serve as a therapeutic framework for promoting movement quality in clinical physical therapy, although further research is needed.