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a, b, c. Path analysis between affect-consciousness (AC) and BAI, GSI and WWBI at baseline (T0) and follow-up (T1). Full lines signify positive and dotted lines negative relations. The thicker the line the higher the path coefficient. The arrows coming from the right symbolise the residual variance.

a, b, c. Path analysis between affect-consciousness (AC) and BAI, GSI and WWBI at baseline (T0) and follow-up (T1). Full lines signify positive and dotted lines negative relations. The thicker the line the higher the path coefficient. The arrows coming from the right symbolise the residual variance.

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Article
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The aim of this study was to explore the long-term effects of affect-focused body psychotherapy (ABP) for patients with generalized anxiety disorder (GAD). A group of 61 consecutive patients, 21–55 years old, were randomized to ABP and psychiatric treatment as usual (TAU). The patients were assessed before treatment and followed up 1 and 2 years af...

Citations

... Emotion-focused (Levy Berg, Sandell, & Sandahl, 2009) and interpersonallyoriented psychodynamic treatments have demonstrated preliminary efficacy in open trials for GAD patients (Crits-Christoph, 2002). For example, brief dynamic psychotherapy led to substantive reductions in poor interpersonal functioning (Crits-Christoph, Connolly, Azarian, Crits Christoph, & Shappell, 1996). ...
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Interpersonal and emotional processing therapy (I/EP) was developed in the early 1990s as an attempt to remedy the shortcomings of cognitive‐behavioral therapy. It cohesively unifies interpersonal, emotional, and cognitive problems of the therapeutic change process and human functioning. This chapter presents an overview of the process and implementation of I/EP for the treatment of generalized anxiety disorder (GAD). Facilitating the deepening of emotional experiences for GAD patients is an integral part of I/EP. The fostering of emotional awareness is utilized as exposure to the waxing and waning of difficult and challenging emotions. Ultimately, I/EP aims to provide clients with safe corrective experiences to process, and to express emotions in the presence of another individual and overcome their fear of vulnerability with others. Effective I/EP may require GAD clients to have formal exposure to negative emotional contrasts and their related interpersonal issues.
... While pharmacological treatment options for GAD exist, psychological treatments may be preferable and better tolerated by patients (Tryer & Baldwin, 2006). Currently, cognitive-behavior therapy (CBT) has the strongest evidence base (Cuijpers et al., 2014;Hofmann & Smits, 2008), but several studies indicate that treatments based on psychodynamic principles may also be effective in this population (Andersson et al., 2012;Crits-Christoph, Gibbons, Narducci, Schamberger, & Gallop, 2005;Leichsenring et al., 2009;Levy Berg, Sandell & Sandahl, 2009). Traditionally, psychodynamic treatments have placed a stronger emphasis on insight into problematic relationship patterns and processing of wardedoff emotions compared to CBT (Crits-Christoph, 2002;Blagys & Hilsenroth, 2000). ...
... The observed pre-post effect sizes are comparable to those reported in other psychodynamic treatment studies of GAD (e.g. Crits-Christoph et al., 2005;Leichsenring et al., 2009;Levy Berg et al., 2009), while the treatments in our study averaged only 8.3 sessions. As an independent outcome measure, we also found healthcare cost reductions following treatment where patients went from high to within normal population cost ranges. ...
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The objective of this study was to evaluate the clinical- and cost-effectiveness of Intensive Short-Term Dynamic Psychotherapy (ISTDP) for generalized anxiety disorder (GAD). We further aimed to examine if a key clinical process within the ISTDP framework, termed the level of mobilization of unprocessed complex emotions (MUCE), was related to outcome. The sample consisted of 215 adult patients (60.9% female) with GAD and comorbid conditions treated in a tertiary mental health outpatient setting. The patients were provided an average of 8.3 sessions of ISTDP delivered by 38 therapists. The level of MUCE in treatment was assessed from videotaped sessions by a rater blind to treatment outcome. Year-by-year healthcare costs were derived independently from government databases. Multilevel growth models indicated significant decreases in psychiatric symptoms and interpersonal problems during treatment. These gains were corroborated by reductions in healthcare costs that continued for 4 years post-treatment reaching normal population means. Further, we found that the in-treatment level of MUCE was associated with larger treatment effects, underlining the significance of emotional experiencing and processing in the treatment of GAD. We conclude that ISTDP appears to reduce symptoms and costs associated with GAD and that the ISTDP framework may be useful for understanding key therapeutic processes in this challenging clinical population. Controlled studies of ISTDP for GAD are warranted.
... In relationship with an understanding, warm and accepting other, clients learn to trust in their inner resources, including their perceptions and feelings and to feel more confident in their capacity to cope with life's challenges. Moreover, a healing therapeutic relationship characterized by empathy, acceptance, prizing and congruence has been found to be helpful in the treatment of anxiety (Levy Berg, Sandell, & Sandahl, 2009). Experiential tasks in EFT include focusing to increase awareness and symbolization of experience; two-chair dialogs to resolve negative treatment of self, for example self-silencing; and empty chair dialogs to process painful interactions with others. ...
Article
Emotion-focused psychotherapy proposes that maladaptive emotional processing and a vulnerable sense of self is core to generalized anxiety disorder (GAD). This paper examined changes in clients’ maladaptive emotions and negative treatment of self in a good and a poor outcome case in emotion-focused psychotherapy. Transcribed sessions were coded using a measure of emotion derived from Plutchik’s wheel of emotion and a measure of negative treatment of self based on subscales of the Measure of Client Productive Processing. The changes observed across therapy for each client on each dimension were compared and contrasted and the trajectory of change plotted and described. The findings provide a preliminary model of change in GAD to inform future investigations of the change process in GAD and the development of a task analytic model of resolution for clients with GAD.
... 95% CI [Ϫ0.07, 0.24]); however, the confidence interval overlaps with the original effect size maintaining format equivalence. We found one potential outlier that met one of the Levy Berg et al. (2009) criteria of nonoverlapping confidence intervals; however, the average effect size study did not meet their second criteria (effect size above 1.0 or below Ϫ1.0). ...
Article
There are mixed findings regarding the differential efficacy of the group and individual format. One explanation of these mixed findings is that nearly all-recent meta-analyses use between-study effect sizes to test format equivalence introducing uncontrolled differences in patients, treatments, and outcome measures. Only 3 meta-analyses were located from the past 20 years that directly tested format differences in the same study using within-study effect sizes; mixed findings were reported with a primary limitation being the small number of studies. However, we located 67 studies that compared both formats in the same study. Format equivalence (g = −0.01) with low effect size heterogeneity (variability) was found in 46 studies that compared identical treatments, patients, and doses on primary outcome measures. Format equivalence (g = −0.06) with moderate effect size heterogeneity was found for 21 studies that compared nonidentical treatments; however, allegiance to a specific format moderated differences in effect sizes. There were no differences between formats for rates of treatment acceptance, dropout, remission, and improvement. Additionally, there were no differences in outcome between formats by patient diagnosis; however, differences in pre-to-post improvement were explained by diagnosis with depression, anxiety, and substance disorder posting the highest outcomes and medical and childhood disorders the lowest. Findings are discussed with reference to the practical challenges of implementing groups in clinical practice from an agency, clinician, and reimbursement perspective.
... There has been little scientific research on body psychotherapy. There have been studies (more in Europe than in the States) which confirm its effectiveness for severe mental disorders (Ventling, 2002;Price et al., 2007Price et al., , 2012Levy Berg et al., 2009;Röhricht, 2014). Surprisingly, there has been little investigation into its mechanisms, although current neuropsychology seems to offer supportive and suggestive evidence. ...
Article
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Basic to all motile life is a differential approach/avoid response to perceived features of environment. The stages of response are initial reflexive noticing and orienting to the stimulus, preparation, and execution of response. Preparation involves a coordination of many aspects of the organism: muscle tone, posture, breathing, autonomic functions, motivational/emotional state, attentional orientation, and expectations. The organism organizes itself in relation to the challenge. We propose to call this the "preparatory set" (PS). We suggest that the concept of the PS can offer a more nuanced and flexible perspective on the stress response than do current theories. We also hypothesize that the mechanisms of body-mind therapeutic and educational systems (BTES) can be understood through the PS framework. We suggest that the BTES, including meditative movement, meditation, somatic education, and the body-oriented psychotherapies, are approaches that use interventions on the PS to remedy stress and trauma. We discuss how the PS can be adaptive or maladaptive, how BTES interventions may restore adaptive PS, and how these concepts offer a broader and more flexible view of the phenomena of stress and trauma. We offer supportive evidence for our hypotheses, and suggest directions for future research. We believe that the PS framework will point to ways of improving the management of stress and trauma, and that it will suggest directions of research into the mechanisms of action of BTES.
... Contemporary CBT treatments for GAD, such as metacognitive therapy (Wells & King, 2006) and acceptance-based behavior therapy (Treanor, Erisman, Salters-Pedneault, Roemer, & Orsillo, 2011), emphasize the function of worry as an avoidance strategy of internal experiences (Behar, Dobrow DiMarco, Hekler, Mohlman, & Staples, 2009). However, aside from CBT, other types of psychotherapies for GAD have also been developed, such as psychodynamic therapies (Leichsenring et al., 2009;Levy Berg, Sandell, & Sandahl, 2009), non-directive supportive therapy (Stanley, Beck, & DeWitt Glassco, 1996), and spiritual therapy (Koszycki, Raab, Aldosary, & Bradwejn, 2010). Most of the therapies are delivered as individual face-to-face treatments, although a number of studies have examined group treatments of GAD (e.g., Dugas et al., 2003) and guided self-help therapies (Bowman, Scogin, Patton, & Gist, 1997). ...
... Effect sizes and 95% confidence intervals of each study are presented in Fig. 2. After removal of a potential outlier (of which the 95% CI of the effect size did not overlap with the 95% CI of the pooled effect size; Levy Berg et al., 2009) the effect size increased to g = 0.87 (95% CI: 0.74-0.99), while heterogeneity was low and non-significant (I 2 = 24; 95% CI: 0-50). ...
... The majority of studies used a waiting list control group that received treatment between the post-treatment assessment and followup, and only limited studies were available to examine the effects of psychotherapies at follow-up. We could calculate the Odds Ratio (OR) for a positive outcome of psychotherapy versus a control group at follow-up in three studies, with follow-up periods ranging from 3 to 15 months (Levy Berg et al., 2009;Stanley et al., 2009;Wetherell, Gatz, & Craske, 2003). When we pooled all outcomes for all time points together the OR for a positive outcome was OR = 1.53 (0.91-2.58) indicating a trend (p b 0.1) that psychotherapy may result in a better outcome than the control groups (I 2 = 0; 95% CI: 0-90). ...
Article
Recent years have seen a near-doubling of the number of studies examining the effects of psychotherapies for Generalized Anxiety Disorders (GAD) in adults. The present article integrates this new evidence with the older literature through a quantitative metaanalysis. A total of 41 studies (with 2,132 patients meeting diagnostic criteria for GAD) were identified through systematic searches in bibliographical databases, and were included in the meta-analysis. Most studies examined the effects of cognitive behavior therapy (CBT). The majority of studies used waiting lists as control condition. The pooled effect of the 38 comparisons (from 28 studies) of psychotherapy versus a control group was large (g = 0.84; 95% CI: 0.71~0.97) with low to moderate heterogeneity. The effects based on self-report measures were somewhat lower than those based on clinician-rated instruments. The effects on depression were also large (g = 0.71; 95% CI: 0.59~0.82). There were some indications for publication bias. The number of studies comparing CBT with other psychotherapies (e.g., applied relaxation) or pharmacotherapy, was too small to draw conclusions about comparative effectiveness or the long-term effects. There were some indications that CBT was also effective at follow-up and that CBT was more effective than applied relaxation in the longer term.
... As for treatments, physiotherapists work with several of the methods mentioned above, mainly physical exercise and relaxation training (Walker and Shepherd, 2001). Different body-mind-oriented physiotherapy approaches have also been found to reduce anxiety, for example, basic body awareness training (Gyllensten, Hansson, and Ekdahl, 2003;Mattsson, Egberg, Armelius, and Mattsson, 1995;Roxendal, 1985); Norwegian psychomotor physical therapy (Breitve, Hynninen, and Kvåle, 2010;Thornquist and Bunkan, 1991); and affect-focused body psychotherapy (Berg, Sandall, and Sandall, 2009). ...
Article
The generalized anxiety is characterized by long-term psychological and physiological discomfort. Pharmacological and psychotherapeutic interventions have been extensively examined, whereas knowledge is scant regarding other professional perspectives. This article focuses on the physiotherapeutic perspective on anxiety, exploring physiotherapists' perceptions of their treatment for patients with generalized anxiety. Semi-structured interviews were conducted with 10 physiotherapists working in psychiatry or primary health care. Data were analysed using qualitative content analysis, resulting in one main category and five subcategories. The main category "To sense and make sense of one's anxiety" reflects the idea that physiotherapy works through immediate, tangible bodily experiences to help a person understand and handle his or her anxiety better. Five subcategories reflected different aspects of this main category: (1) the body is the arena of anxiety, (2) to get in touch with oneself, (3) to get down-to-earth with oneself, (4) to make sense of bodily sensations, and (5) to gain trust in one's capability to handle anxiety. In conclusion, the gradual bodily awareness of sensations, to sense and make sense of anxiety in physiotherapy treatment, becomes an opportunity to find ways to withstand and to manage symptoms of anxiety, encouraging an embodied self-trust. The emphasis on the immediately lived body involves the potential to learn how to endure anxiety instead of running away from it, to discern and to understand different sensations, leading to an integration of anxiety as being part of oneself rather than overflowing oneself.
... The BAI (Beck, Epstein, Brown, & Steer, 1988) was used as a measurement of self-reported anxiety. The BAI was chosen because of its validity and wide usage with the counseling client population as well as the diverse college student population (Contreras, Fernandez, Malcarne, Ingram, & Vaccarino, 2004;Levy Berg, Sandell, & Sandahl, 2009;Pillay, Edwards, Sargent, & Dhlomo, 2001). The BAI is a 21-item scale developed with an adult clinical population to measure the severity of anxiety in adult and adolescents. ...
Article
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With the rise in stress and anxiety among college students, there is a need for more comprehensive and effective counseling options for counselors in college counseling centers. This study investigated the impact of using biofeedback and brief counseling in treating stress and anxiety in an ethnically diverse college student population. Results indicated that participants who received biofeedback training and counseling had greater reduction in anxiety symptoms than did participants who received counseling alone. Implications for augmenting biofeedback training to traditional college counseling model are discussed.
... Indeed, the only study to our knowledge that has supported use of AP over a separate treatment reported decreased scores on two composite scores of the Symptoms Checklist-90 (SCL-90) (Derogatis, Lipman, Rickels, Uhlenhuth, & Covi, 1974), which reflected global anxiety and global distress other than anxiety (Levy Berg, Sandell, & Sandahl, 2009). The type of AP described in this study was referred to as Affect Based Psychotherapy (ABP), which integrates physiotherapy and emotional awareness training with a psychodynamic framework (e.g., Monsen & Monsen, 1999). ...
Chapter
The inclusion of worry as the central feature of generalized anxiety disorder (GAD) has resulted in an explosion of treatment packages based on well-supported theoretical models. Although many of these models fall under the rubric of cognitive behavior therapy (CBT), they each focus on distinct cognitive components. The current chapter provides a critical review of the existing research for each of these treatment packages, for the purpose of establishing a contemporary view of what constitutes best practice. Evidence for the efficacy of analytic psychotherapy is also reviewed. Current methodological issues are examined in order to present a clear summary of statistically and clinically significant change, with the ultimate goal of identifying current empirically supported treatments for individuals suffering from GAD.Keywords:generalized anxiety disorder;cognitive behavior therapy;clinical significance;outcome research;meta-analysis;empirically supported treatments
... Affect-focused body psychotherapy (ABP) was created by integrating physiotherapy with affect-focused psychotherapy. In a previous study (Levy Berg, Sandell, & Sandahl, 2009), ABP was evaluated for patients with generalised anxiety disorder (GAD), compared to a control group (psychiatric treatment as usual). Significant improvement in psychiatric symptoms was found in both groups, although improvement concerning psychological distress was more pronounced in the ABP group. ...
... Participation was voluntary and based on informed consent. In our previous work (Levy Berg et al., 2009), the long-term effects of ABP for GAD were explored using a randomised clinical trial. A group of 61 consecutive patients presenting to outpatient psychiatric services with GAD were randomly allocated to participate in either ABP or a control treatment (psychiatric Treatment as Usual; TAU). ...
In a previous study, 61 patients with generalised anxiety disorder were randomised to participate in affect-focused body psychotherapy (ABP) or treatment as usual. In this current study a sub sample, 30 of the patients in the ABP group has been interviewed. A qualitative interview was used in order to investigate how the patients experienced participation in one year of ABP therapy. It was found that an initial open attitude towards the treatment and an understanding of the mind-body unity seemed to be a crucial factor in motivating the patient to take an active part in treatment. Key themes concerning shame and control were found in the material. Getting in touch with one's body eventually gave rise to a feeling of being in control, e.g. noticing muscular tension and being able to influence it as well as understanding the connection between bodily symptoms and emotions. Anxiety signals become transformed into meaningful signals about one's life situation instead of provoking fear. The end result of therapy could be understood in terms of how patients managed to integrate bodily feelings into their perception of themselves, thus attaining a deeper experience of their lived body. The clinical implications of the study are that the therapist should be flexible and sensitive, adjusting the treatment in accordance to the patient's own understanding of the body. The therapist should also initially limit shameful feelings and anxiety by ensuring that the patient understands the meaning of the interventions and what is expected from him/her, thus giving the patient a sense of control.