Article

To sense and make sense of anxiety: Physiotherapists' perceptions of their treatment for patients with generalized anxiety

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Abstract

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.

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... There are connections between psychiatric physiotherapy and mindfulness-based therapies; for example, practice through Zen meditation and experience-based exercises that expose patients to keeping themselves in the present moment and helping them to become more flexible in their approach to life (Hayes, Strosahl, and Wilson, 2003;Mehling et al., 2011). Although they are similar in some aspects, psychiatric physiotherapy takes its starting point in experiencing body and movement, involving mindful awareness of gravity, muscle activity, the skeleton, stability, breathing, balance, space, flow, and presence (Bunkan, 2008;Danielsson, Hansson Scherman, and Rosberg, 2013;Gyllensten, Skär, Miller, and Gard, 2010). ...
... Habitual patterns in the body such as how the body reacts in a situation that causes anxiety can be explored and understood in embodied therapies; that is, therapies using a somatic approach that focuses on body memory and emotional and mindful presence (Fuchs and Koch, 2014). This exploring of habitual patterns in the body is believed to be a central part in psychiatric physiotherapeutic treatment, enabling new possibilities to interpret and act on bodily sensations (Danielsson, Hansson Scherman, and Rosberg, 2013). ...
... An important aspect of the physiotherapeutic treatment of anxiety is to work on the ability to stay in contact with the body and bodily reactions, even when these reactions are fearful and uncomfortable. Another important aspect is learning more about how the body reacts when anxiety appears, learning to discern different bodily sensations and thus increasing the patients' embodied self-trust (Danielsson, Hansson Scherman, and Rosberg, 2013). Positive treatment effects such as reduced symptoms, increased body awareness, and improved physical coping resources following affectfocused body psychotherapy have been demonstrated in patients with generalized anxiety disorder (Levy Berg, 2009) and following BBAT in patients with mood disorders (Gyllensten, Ekdahl, and Hansson, 2009;Gyllensten, Hansson, and Ekdahl, 2003). ...
Article
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.
... In their work, Danielsson et al. [13] and Olund et al. [14] suggest homelikeness as a valuable theoretical framework for the physiotherapy management of anxiety. In this context, the concept of homelikeness relates to the impact of anxiety on the structure of one's existence, in which the body is a central component. ...
... Anxiety was found to affect self-efficacy, participation, rehabilitation progression and treatment adherence, with many factors influencing the presence of anxiety in PwMS; factors directly relating to the disease, psychosocial issues, or the rehabilitation process itself. With the introduction of homelikeness theory to explain the presence of anxiety in the body, [13,14] qualitative interviews highlighted both physical and social influences contributing towards feeling unhomelike. In the context of chronic illness, Svenaeus [33] suggests illness brings about feelings of unhomelikeness in the social world, reflected in the findings of this study. ...
Article
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Background: Anxiety is common for people with Multiple Sclerosis (PwMS) and is higher in those with relapsing-remitting MS (RRMS) and in community-based samples. Anxiety can impact self-efficacy, pain, fatigue, engagement in physical activity and treatment adherence, all of which influence the rehabilitation process. Little is known about how physiotherapists manage anxiety in PwMS and the challenges associated with anxiety throughout the rehabilitation process, in community and outpatient settings. Methods: A mixed-methods design, combining a cross-sectional survey and semi-structured interviews with UK-physiotherapists, was used to answer the research question. To inform the qualitative study, a cross-sectional survey collected data from physiotherapists working in neurology to understand the impact and management of anxiety in people with MS (PwMS) during rehabilitation. Analysis used descriptive statistics and the findings formed the interview guide. Semi-structured interviews with specialist physiotherapists explored barriers and facilitators to managing anxiety in PwMS in community and outpatient settings, identified perceived physiotherapy training needs and offered suggestions to develop physiotherapy research and practice. Themes were derived inductively. Results: The survey suggested how PwMS present with anxiety, its impact during rehabilitation, physiotherapy management practices, and physiotherapist skills and training needs. Five semi-structured interviews with specialist physiotherapists expanded on the survey findings and identified five main themes: Understanding the MS journey, modifying assessment and treatment, anxiety management toolbox, lagging behind Musculoskeletal Physiotherapy, and gaining knowledge and skills. Conclusion: Physiotherapists encounter anxiety in PwMS in community and outpatient rehabilitation and perceive they have a role in managing it as it presents. Facilitators included communication, listening skills and opportunities to develop strong therapeutic relationships. Poor training and support, lack of clinical guidelines and limited research evidence were considered barriers. Clinically relevant learning opportunities, interprofessional working, and greater support through clinical supervision is recommended to better develop physiotherapy practice.
... The responsiveness depends on the physiotherapist's ability to be present and open, and the ability to interpret the mutual attunement (Chowdhury and Bjorbaekmo, 2017). This involves, for example, the ability "to stay in the moment", to endure discomfort expressed by the patient or felt in the room, and to distinguish the patient's feelings from the therapist's own feelings (Danielsson, Hansson Scherman, and Rosberg, 2013). The ability to suggest adequate "dosage" (i.e. ...
Article
Objective: To analyze definitions and related requirements, processes, and operationalization of person-centered goal-setting in the physiotherapy research literature; to discuss those findings in relation to underlying principles of person-centeredness; and to provide an initial framework for how person-centered goal-setting could be conceptualized and operationalized in physiotherapy. Methods: A literature search was conducted in the databases: CINAHL, PubMed, PEDro, PsycINFO, REHABdata and Scopus. A content analysis was performed on how person-centered goal-setting was described. Results: A total of 21 articles were included in the content analysis. Five categories were identified: 1) Understanding goals that are meaningful to the patients; 2) Setting goals in collaboration; 3) Facing challenges with person-centered goal-setting; 4) Developing skills by experiences and education; and 5) Changing interaction and reflective practice. These categories were abstracted into two higher-ordered interlaced themes: 1) To seek mutual understanding of what is meaningful to the patient; and 2) To refine physiotherapy interaction skills, which we suggest would be useful for further conceptualization. Conclusion: In this analysis, we interpreted person-centered goal-setting in physiotherapy as a process of interaction toward a mutual understanding of what is meaningful to the patient. Future research may explore how to integrate mindful listening, embodied interaction and continuous ethical reflection with different assessments and treatment methods.
... Además, la conciencia gradual de las sensaciones corporales generadas por el tratamiento fisioterapéutico de la ansiedad constituye una oportunidad para encontrar y manejar los síntomas presentados por el paciente (irritabilidad, hiperventilación, inquietud, entre otros). Además, la fisioterapia ayuda al paciente a aprender a lidiar con la ansiedad en lugar de escapar de ella y a discernir y comprender las diferentes sensaciones corporales, lo que permite controlar los síntomas y prevenir su desbordamiento (18). ...
Article
Full-text available
Physical exercise can be an important part of the management of people with psychiatric illnesses, since a considerable number of longitudinal and cross-sectional studies has shown that it constitutes a preventive strategy and an adjuvant approach to the treatment of mental disorders. In that sense, it has been demonstrated that the most effective forms of physical exercise are aerobic exercises (such as walking, jogging, cycling, swimming, among others) and strengthening. The aim of this article is to present a general update about physical exercise as an adjuvant treatment of mental disorders. This is a narrative review, not systematic, focused on primary literature selected from a search in PubMed, SciELO and LILACS. The key terms used were: “physical exercise and mental health”, “physiotherapy and mental health”, “physical exercise and mental disorders” and “physical exercise and psychiatry.” These articles were supplemented with books and book chapters, highlighting duplicate findings. All members of the research team participated in the review of the literature. Although there are excellent studies and reviews that analyze in detail the role of physical exercise in the specific treatment of some mental disorders, it was considered that a more general revision was needed to provide guidance to psychiatrists and physiotherapists in this field of integration of physical and mental health. [Full text available in Spanish]
... In addition, the gradual awareness of the body sensations generated by the physiotherapeutic treatment of anxiety constitutes an opportunity to find and manage the symptoms presented by the patient (irritability, hyperventilation, restlessness, among others). In addition, physiotherapy helps the patient to learn how to cope with anxiety rather than escape from it and to discern and understand the different body sensations, thus managing the symptoms and preventing them from overflowing (Danielsson, Hansson Scherman, & Rosberg, 2013). ...
Article
It is known that physiotherapy has the potential to improve the quality of life of people with mental disorders (Richardson et al., 2005). This is achieved through two main ways: by optimizing the patient’s physical health and by alleviating the patient’s psychosocial disability (Pope, 2009). There is evidence that improvements in body function (including balance and flexibility) are associated with a feeling of greater safety and increased self-esteem in patients. Also, an improvement in posture can benefit self-image and elevate mood, as well as decrease pain in different body sites (such as the back or neck). Finally, there is also strong evidence to suggest that an adequate exercise regimen effectively improves the wellbeing of people with depression and anxiety (Babyak et al., 2000; Craft & Perna, 2004; Hedlund & Gyllensten, 2010; Lichtman et al., 2008). Taking into consideration that anxiety disorders are among the most prevalent psychiatric conditions worldwide and that their disabling nature is often underestimated, it is necessary that all psychiatrists, psychologists and other health professionals be able to offer therapeutic alternatives to this challenging group of patients. Currently, the treatment of anxiety disorders is based on psychotropic drugs, psychotherapy and, in addition, physiotherapy (Catalán-Matamoros, 2009; Kaur, Masaun, & Bhatia, 2013). Physiotherapeutic approaches have beneficial effects in various emotional states, among which anxiety disorders are highlighted (Kaur et al., 2013). The most notable improvements are observed in patients undergoing rhythmic, aerobic, respiratory exercise programs and who use large muscle groups (swimming, jogging, walking and cycling, among others), from low to moderate intensity. These exercises should be performed progressively, with sessions lasting between 15 and 30 minutes at least three times a week. The results will be obvious after 10 weeks of treatment. In the case of anxiety disorders, the improvement observed is due to an increase in the release of endorphins, changes in body temperature and cerebral blood flow and a positive impact on the hypothalamicpituitary-adrenal axis and on the physiological reactivity to stress (Guszkowska, 2004). In addition, the gradual awareness of the body sensations generated by the physiotherapeutic treatment of anxiety constitutes an opportunity to find and manage the symptoms presented by the patient (irritability, hyperventilation, restlessness, among others). In addition, physiotherapy helps the patient to learn how to cope with anxiety rather than escape from it and to discern and understand the different body sensations, thus managing the symptoms and preventing them from overflowing (Danielsson, Hansson Scherman, & Rosberg, 2013). We fully agree with the statement that the integration of the physiotherapist in mental health services can only be achieved with the correct training of professionals (Catalán-Matamoros, 2009). This has been achieved in part in several countries of the world. In Paraguay, for example, the Department of Psychology and Psychopathology is responsible for providing the focus of physiotherapy in mental health to students of the School of Kinesiology and Physiotherapy of the National University of Asunción. The current challenge is to enable psychiatrists, psychologists and physiotherapists to work and evaluate patients together, in order to design and deliver therapeutic interventions that include not only psychotropic drugs and psychotherapy, but also physiotherapeutic approaches specially designed for this type of patients. Here, and in conclusion, the Latin phrase ‘mens sana in corpore sano’ acquires a special relevance, since it recognizes that the human being is duality of body and mind, and that the mind-body mutual interactions have a definite repercussion on the person’s physical and mental health. [Free eprints available at: http://www.tandfonline.com/eprint/Qv7tgmeBbz2AUbSaNUx9/full]
... Our results convey an essential relational sphere in BBAT, understood as two-dimensional. First, the results propose an intra-subjective dialogue between I as sensing subject and me as the object to sense, as for example in the participants' descriptions of noticing concrete details on a physiological level to feel more present and able to take in outer impressions, or in the increased awareness of the self*emerging from observing objective features of one's body and movement (Danielsson, Hansson Scherman, & Rosberg, 2013). Second, the numerous statements about the growing coherence in the group and the meaning of embodied communication with the physical therapist suggest an interrelational dimension, also previously suggested (Gyllensten et al., 2003b). ...
Article
Although there is a vast amount of research on different strategies to alleviate depression, knowledge of movement-based treatments focusing on body awareness is sparse. This study explores the experiences of basic body awareness therapy (BBAT) in 15 persons diagnosed with major depression who participated in the treatment in a randomized clinical trial. Hermeneutic phenomenological methodology inspired the approach to interviews and data analysis. The participants’ experiences were essentially grasped as a process of enhanced existential openness, opening toward life, exceeding the tangible corporeal dimension to also involve emotional, temporal, and relational aspects of life. Five constituents of this meaning were described: vitality springing forth, grounding oneself, recognizing patterns in one's body, being acknowledged and allowed to be oneself, and grasping the vagueness. The process of enhanced perceptual openness challenges the numbness experienced in depression, which can provide hope for change, but it is connected to hard work and can be emotionally difficult to bear. Inspired by a phenomenological framework, the results of this study illuminate novel clinical and theoretical insight into the meaning of BBAT as an adjunctive approach in the treatment of depression.
... A salient finding in this study is that the dance sessions played a part in how the girls could use their embodied self-trust and enriched body awareness as a stepping stone to a newly won positive attitude towards themselves and others. This is consistent with Danielsson, Hansson Scherman, and Rosberg (2013), who described increased body awareness as an opportunity to encourage an embodied self-trust, and find ways to withstand and manage anxiety symptoms. Moreover, Gyllensten, Skar, Miller, and Gard (2010) suggest that bodily experiences and reflections can lead to a more positive experience of the body and self, and that the basis for selfconfidence and well-being lies in the ability to understand one's own emotions and needs through the awareness of the body. ...
Article
Full-text available
Adolescent girls today suffer from internalizing problems such as somatic symptoms and mental health problems at higher rates compared to those of previous decades, and effective interventions are warranted. The aim of this study was to explore the experiences of participating in an 8-month dance intervention. This qualitative study was embedded in a randomized controlled trial of a dance intervention for adolescent girls with internalizing problems. A total of 112 girls aged 13-18 were included in the study. The dance intervention group comprised 59 girls, 24 of whom were strategically chosen to be interviewed. Data were analyzed using qualitative content analysis with an inductive approach. The experiences of the dance intervention resulted in five generic categories: (1) An Oasis from Stress, which represents the fundamental basis of the intervention; (2) Supportive Togetherness, the setting; (3) Enjoyment and Empowerment, the immediate effect; (4) Finding Acceptance and Trust in Own Ability, the outcome; and (5) Dance as Emotional Expression, the use of the intervention. One main category emerged, Finding Embodied Self-Trust That Opens New Doors, which emphasizes the increased trust in the self and the ability to approach life with a sense of freedom and openness. The central understanding of the adolescent girls' experiences was that the dance intervention enriched and gave access to personal resources. With the non-judgmental atmosphere and supportive togetherness as a safe platform, the enjoyment and empowerment in dancing gave rise to acceptance, trust in ability, and emotional expression. Taken together, this increased self-trust and they discovered a new ability to "claim space." Findings from this study may provide practical information on designing future interventions for adolescent girls with internalizing problems.
... For individuals with anxiety, sensing the body may allow the individual to make sense of the feeling of anxiety by challenging the fearful experience and connecting with the body. These actions may lead to endurance and understanding of bodily expressions of anxiety (Danielsson, Scherman, and Rosberg, 2013). In addition, trusting the body may facilitate an ability to bear painful or frightening emotions and to relate to others and oneself (Gard and Gyllensten, 2000). ...
Article
This article describes and evaluates initial steps of a gender-sensitive, youth-friendly group intervention model designed for teenage girls and young women who experience stress-related or psychosomatic problems. Fifty-four young women (16-25 years of age) participated in a gender-sensitive physiotherapy stress management course at a youth health center. Inclusion criteria were self-defined stress-related problems and a wish to participate in the group intervention. Measurements of aspects of body perception, self-image, multiple somatic problems, and mental health symptom areas were assessed both before and after intervention with the Body Perception Questionnaire ad modum Schiöler, social analysis of social behavior, and Adult Self-Report scale. Significant positive changes were found in aspects of body perception, self-image, and mental health and somatic symptoms. The changes were most significant in lower internalization of anxiety and depression symptoms. Symptoms such as headaches and sleeping problems decreased. Participants were more satisfied with their bodies and more able to listen to body signals. Among cognitive issues, significant change occurred in thought problems, but not in attention problems. The intervention model needs further evaluation in controlled trials, but is promising and should be developed further in other physiotherapy settings and subgroups of young people.
... Our results convey an essential relational sphere in BBAT, understood as two-dimensional. First, the results propose an intra-subjective dialogue between I as sensing subject and me as the object to sense, as for example in the participants' descriptions of noticing concrete details on a physiological level to feel more present and able to take in outer impressions, or in the increased awareness of the self*emerging from observing objective features of one's body and movement (Danielsson, Hansson Scherman, & Rosberg, 2013). Second, the numerous statements about the growing coherence in the group and the meaning of embodied communication with the physical therapist suggest an interrelational dimension, also previously suggested (Gyllensten et al., 2003b). ...
Article
Full-text available
Although there is a vast amount of research on different strategies to alleviate depression, knowledge of movement-based treatments focusing on body awareness is sparse. This study explores the experiences of basic body awareness therapy (BBAT) in 15 persons diagnosed with major depression who participated in the treatment in a randomized clinical trial. Hermeneutic phenomenological methodology inspired the approach to interviews and data analysis. The participants’ experiences were essentially grasped as a process of enhanced existential openness, opening toward life, exceeding the tangible corporeal dimension to also involve emotional, temporal, and relational aspects of life. Five constituents of this meaning were described: vitality springing forth, grounding oneself, recognizing patterns in one’s body, being acknowledged and allowed to be oneself, and grasping the vagueness. The process of enhanced perceptual openness challenges the numbness experienced indepression, which can provide hope for change, but it is connected to hard work and can be emotionally difficult to bear. Inspired by a phenomenological framework, the results of this study illuminate novel clinical and theoretical insight into the meaning of BBAT as an adjunctive approach in the treatment of depression.
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Devido aos novos desafios gerados por este novo cenário mundial e o consequente aumento da gravidade e da intensidade com que as pessoas tem se mostrado ansiosas e estressadas, desenvolvemos esta cartilha para um melhor entendimento e como identificar estas condições por meio do reconhecimento dos principais sinais e sintomas. Além disso, este material apresenta orientações sobre como você pode lidar melhor com as reações físicas e emocionais geradas pela ansiedade e pelo estresse, tendo como principal foco a respiração.
Thesis
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Globally, psychological health problems are currently among the most serious public health challenges. Adolescent girls suffer from internalizing problems, such as somatic symptoms and mental health problems, at higher rates than in decades. By age 15, over 50 % of all girls experience multiple health complaints more than once a week and one in five girls reports fair or poor health. The overall aim of this study was to investigate the effects of and experiences with an after-school dance intervention for adolescent girls with internalizing problems. The intervention comprised dance that focused on resources twice weekly for 8 months. Specifically, this thesis aimed to: I) investigate the effects on self-rated health (SRH), adherence and over-all experience; II) evaluate the effects on somatic symptoms, emotional distress and use of medication; III) explore the experiences of those participating in the intervention; and IV) assess the cost-effectiveness. A total of 112 girls aged 13 to 18 years were included in a randomized controlled trial. The dance intervention group comprised 59 girls, and the control group 53. In paper I, the dance group showed increased SRH scores compared to the control group (p = .02). Girls in the intervention group showed high adherence and a positive overall experience. In paper II, the dance group exhibited a decrease in somatic symptoms (p = .021), emotional distress (p = .023) and use of medication (p = .020) compared to the control group. In paper III, a strategic sample of 24 girls was interviewed. Qualitative content analysis was performed, and five generic categories emerged. Two were “An Oasis from Stress” and “Supportive Togetherness”, which was shown to represent the fundamental basis and setting of the intervention. The main category, participants’ central experience, was understood as “Finding embodied self-trust that opens new doors”. Paper IV revealed that, due to decreased number of visits to the school nurse and an increase in health related quality of life; the intervention was considered to be cost-effective (combined with the usual school health services). In summary, the results of this thesis show that this dance intervention for adolescent girls with internalizing problems generated positive health effects and proved to be cost-effective. For this target group, a non-judgmental environment and supportive togetherness proved to be of importance for participation. The results of this study may provide practical information for school health care staff and caregivers in designing future interventions. https://oru.diva-portal.org/smash/get/diva2:902081/FULLTEXT01.pdf
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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 after inclusion. The ABP patients received one session of treatment per week during 1 year. Three self-report questionnaires were administered; Symptom Checklist—90, Beck Anxiety Inventory, and the WHO (Ten) Well-Being Index. In both groups, there was a significant improvement. On termination, the ABP group had improved significantly more on the SCL-90 Global Symptom Index than the TAU group, whereas the differences were short of significance on the other two scales. The integration of bodily techniques with a focus on affects in a psychodynamically informed treatment seems to be a viable treatment alternative for patients with GAD. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
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Scand J Caring Sci; 2010; 24; 620–634 Exploring person-centredness: a qualitative meta-synthesis of four studies Person-centredness as a concept is becoming more prominent and increasingly central within some research literature, approaches to practice and as a guiding principle within some health and social care policy. Despite the increasing body of literature into person-centred nursing (PCN), there continues to be a ‘siloed’ approach to its study, with few studies integrating perspectives from across nursing specialties. The purpose of this paper is to present the results of a study undertaken to explore if the secondary analysis of findings from four different and unrelated research studies (that did not have the main aim of researching person-centredness) could inform our understanding of person-centred nursing. A qualitative meta-synthesis was undertaken of the data derived from the four unrelated research studies undertaken with different client groups with long-term health conditions. A hermeneutic and interpretative approach was used to guide the analysis of data and framed within a particular person-centred nursing framework. Findings suggest ‘professional competence’ (where competence is understood more broadly than technical competence) and knowing ‘self’ are important prerequisites for person-centred nursing. Characteristics of the care environment were also found to be critical. Despite the existence of expressed person-centred values, care processes largely remained routinised, ritualistic and affording few opportunities for the formation of meaningful relationships. Person-centred nursing needs to be understood in a broader context than the immediate nurse–patient/family relationship. The person-centred nursing framework has utility in helping to understand the dynamics of the components of person-centredness and overcoming the siloed nature of many current perspectives.
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Although mindfulness-based therapy has become a popular treatment, little is known about its efficacy. Therefore, our objective was to conduct an effect size analysis of this popular intervention for anxiety and mood symptoms in clinical samples. We conducted a literature search using PubMed, PsycINFO, the Cochrane Library, and manual searches. Our meta-analysis was based on 39 studies totaling 1,140 participants receiving mindfulness-based therapy for a range of conditions, including cancer, generalized anxiety disorder, depression, and other psychiatric or medical conditions. Effect size estimates suggest that mindfulness-based therapy was moderately effective for improving anxiety (Hedges's g = 0.63) and mood symptoms (Hedges's g = 0.59) from pre- to posttreatment in the overall sample. In patients with anxiety and mood disorders, this intervention was associated with effect sizes (Hedges's g) of 0.97 and 0.95 for improving anxiety and mood symptoms, respectively. These effect sizes were robust, were unrelated to publication year or number of treatment sessions, and were maintained over follow-up. These results suggest that mindfulness-based therapy is a promising intervention for treating anxiety and mood problems in clinical populations.
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The objective of this study was to examine the effect of Norwegian psychomotor physical therapy on subjective health complaints and psychological symptoms. A non-randomized waiting list controlled design was used. Physiotherapists in Norway recruited patients for a treatment group (n = 40) and waiting list control group (n = 22). Patients on the waiting list could only be included for 6 months, as they then started treatment. Symptoms registration was obtained from both groups at baseline and 6 months, and only for the treatment group also at 12 months. The following self-report forms were used; Subjective Health Complaints Inventory (SCH); Beck Depression Inventory-II (BDI-II); Spielberger State-Trait Anxiety Inventory-Trait (STAI-T); Bergen Insomnia Scale (BIS); Fatigue Questionnaire (FQ); Quality of Life Inventory (QOLI); The Client Satisfaction Questionnaire (CSQ). The patients had had widespread and clinically significant health problems for an average of 9 years upon entrance to the study. After 6 months in psychomotor physical therapy, all the measured symptoms in the treatment group were significantly reduced, but only quality of life was significantly reduced when compared to the waiting list control group. After 12 months in therapy, the patients in the treatment group had continued to improve on all measured variables. The symptoms of anxiety and depression, as well as quality of life, were improved from clinical to non-clinical level. Norwegian psychomotor physical therapy seems to have potential for reducing symptoms of subjective health complaints, depression, anxiety, insomnia, fatigue and improving quality of life, although the process takes time. Further research is needed to gain more rigorous data, and randomized controlled studies are highly welcomed.
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While cognitive behavior therapy has been found to be effective in the treatment of generalized anxiety disorder (GAD), a significant percentage of patients struggle with residual symptoms. There is some conceptual basis for suggesting that cultivation of mindfulness may be helpful for people with GAD. Mindfulness-based cognitive therapy (MBCT) is a group treatment derived from mindfulness-based stress reduction (MBSR) developed by Jon Kabat-Zinn and colleagues. MBSR uses training in mindfulness meditation as the core of the program. MBCT incorporates cognitive strategies and has been found effective in reducing relapse in patients with major depression (Teasdale, J. D., Segal, Z. V., Williams, J. M. G., Ridgeway, V., Soulsby, J., & Lau, M. (2000). Prevention of relapse/recurrence in major depression by mindfulness-based cognitive therapy. Journal of Consulting and Clinical Psychology, 6, 615-623). Eligible subjects recruited to a major academic medical center participated in the group MBCT course and completed measures of anxiety, worry, depressive symptoms, mood states and mindful awareness in everyday life at baseline and end of treatment. Eleven subjects (six female and five male) with a mean age of 49 (range=36-72) met criteria and completed the study. There were significant reductions in anxiety and depressive symptoms from baseline to end of treatment. MBCT may be an acceptable and potentially effective treatment for reducing anxiety and mood symptoms and increasing awareness of everyday experiences in patients with GAD. Future directions include development of a randomized clinical trial of MBCT for GAD.
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DefinitionEpilepsy is a collection of complex disorders of the brain, which involve a wide range of manifestations and which are due to a large variety of causes. The quintessential feature that defines epilepsy is the occurrence of epileptic seizures. Although many definitions, all fairly similar, have been provided in the past, The International League Against Epilepsy (ILAE) and the International Bureau for Epilepsy (IBE) proposed the following definition of an epileptic seizure:“A transient occurrence of sign and/or symptoms due to abnormal excessive or synchronous neuronal activity in the brain.”(Fisher et al. 2005)Although there is little to quarrel with in this definition, it is worth noting that epileptic seizures are not simply a direct result of excess excitation. They result from an imbalance between inhibitory and excitatory influences (Scharfman 2007). In some instances, it is a loss of inhibition rather than specifically an increase in excitation that may lie at ...
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Two consecutively selected groups of patients at an outpatient psychiatric clinic were studied (experimental (E) and control (C) groups). Both groups received conventional treatment, and in the E group psychiatric psysiotherapeutic treatment (PPT) was added. The effects of PPT were assessed immediately after termination of PPT and after a further 3.5 months. The instrument used for assessments were the SASB, measuring self-image; the SCL-90, measuring symptoms; and a semistructured interview focusing on satisfaction with treatment and treatment outcome. The patients were diagnosed on the basis of DSM-III-R, and a judgement of the level of psychologic development was made. Immediately after the E group's termination of PPT, patients in both groups had a less consistent self-image with more self-attack and lower self-control than a sample of “normals”, and the patients receiving PPT had an even less normal self-image, with more self-attack, lower self-control, and a more conflictive self-image than the C group. Both patient groups also had higher symptom ratings than the “normal” sample. At the second assessment the E group had a more normal self-image and the same symptom ratings as the “normals”, whereas the C group seemed to have deteriorated over time both in self-image and in symptoms. The value of PPT and how it might take part in the process of improvement in the patients is discussed.
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.
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The aim was to study the outcome of Basic Body Awareness Therapy (Basic BAT) added to treatment as usual (TAU) compared to TAU only, for patients with mood, somatoform or personality disorders in psychiatric outpatient services. Seventy-seven patients were randomized to Basic BAT and TAU (n = 38) or TAU only (n = 39). Patients were assessed at baseline and after 12 sessions of Basic BAT, 3 months after baseline. At the termination of Basic BAT sessions, patients receiving Basic BAT in addition to TAU showed significant improvements concerning the quality of movements using the Body Awareness Scale-Health (BAS-H), and psychiatric symptoms and attitudes towards body and movement using the Body Awareness Scale interview, compared to the TAU-only patients. A significant improvement in favour of the patients receiving Basic BAT was also shown with regard to self-efficacy, physical coping resources and sleep. Age and sex showed no significant influence on outcome. The results indicate that Basic BAT in addition to TAU, in a relatively short intervention period improves the body awareness and attitude towards the body as well as self-efficacy, sleep and physical coping resources compared to TAU only. This study indicates a positive short-term outcome of the Basic BAT treatment. However, studies of the long-term outcome remain to be undertaken.
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Content analysis is a method for analysing the content of a variety of data, such as visual and verbal data. It enables the reduction of phenomena or events into defined categories so as to better analyse and interpret them. This paper provides an overview of content analysis from a marketing perspective. The basic concepts and techniques are presented for operationalising content analyses. As a methodology, it can be both qualitative, usually in developmental stages of research, and quantitative where it is applied to determine frequency of phenomena. Thus, it lends itself to the use of computers to analyse data and, therefore, some of the main packages currently available to researchers are mentioned. The benefits and limitations of adopting content analysis are discussed along with an introduction to sequential analysis, a complementary approach which may be used to enhance understanding and strengthen research design.
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Abstract The aim of the study was to describe, using qualitative phenomenographic interviews, how physiotherapists experience client participation in physiotherapy interventions. The objective of phenomenographic research is to identify and describe various ways of experiencing the investigated phenomenon. Eleven respondents were strategically selected according to the maximum variation strategy with variations in: gender, seniority and areas of physiotherapy. Three qualitatively different descriptive categories were indentified with critical variations in paradigms of health and goal-setting procedures – A: Collaboration, i.e. an experience of client participation from a biopsychosocial collaborative view of intervention in which the client enter into equal partnership with the physiotherapist and thereby are jointly responsible for intervention, goal-setting and outcome; B: Guidance, i.e. an experience of client participation from a guided biomedical view of intervention, in which the client is guided by the physiotherapist in an unequal partnership in intervention and goal-setting; and C: Expertise, i.e. an experience of client participation from a paternalistic, biomedical view of intervention, in which the client sees the physiotherapist as an expert, who decides and controls the intervention and goal-setting. The results have made some earlier tacit professional physiotherapy knowledge explicit and may increase the understanding of how different experiences of client participation influence interventions.
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Estimates of 12-month and lifetime prevalence and of lifetime morbid risk (LMR) of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) anxiety and mood disorders are presented based on US epidemiological surveys among people aged 13+. The presentation is designed for use in the upcoming DSM-5 manual to provide more coherent estimates than would otherwise be available. Prevalence estimates are presented for the age groups proposed by DSM-5 workgroups as the most useful to consider for policy planning purposes. The LMR/12-month prevalence estimates ranked by frequency are as follows: major depressive episode: 29.9%/8.6%; specific phobia: 18.4/12.1%; social phobia: 13.0/7.4%; post-traumatic stress disorder: 10.1/3.7%; generalized anxiety disorder: 9.0/2.0%; separation anxiety disorder: 8.7/1.2%; panic disorder: 6.8%/2.4%; bipolar disorder: 4.1/1.8%; agoraphobia: 3.7/1.7%; obsessive-compulsive disorder: 2.7/1.2. Four broad patterns of results are most noteworthy: first, that the most common (lifetime prevalence/morbid risk) lifetime anxiety-mood disorders in the United States are major depression (16.6/29.9%), specific phobia (15.6/18.4%), and social phobia (10.7/13.0%) and the least common are agoraphobia (2.5/3.7%) and obsessive-compulsive disorder (2.3/2.7%); second, that the anxiety-mood disorders with the earlier median ages-of-onset are phobias and separation anxiety disorder (ages 15-17) and those with the latest are panic disorder, major depression, and generalized anxiety disorder (ages 23-30); third, that LMR is considerably higher than lifetime prevalence for most anxiety-mood disorders, although the magnitude of this difference is much higher for disorders with later than earlier ages-of-onset; and fourth, that the ratio of 12-month to lifetime prevalence, roughly characterizing persistence, varies meaningfully in ways consistent with independent evidence about differential persistence of these disorders.
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SummaryThe role of physiotherapists in the management of anxiety disorders is becoming increasingly recognised, yet the research base of this practice is limited. This study sets out to identify the current physiotherapy management of anxiety disorders in the UK. A questionnaire seeking information about treatment approaches, and the rationale for their use, was distributed to a stratified systematic sample of 80 physiotherapists working within mental health in the UK. The response rate was 71%. The results showed that exercise was used more frequently than any other treatment approach, with aerobic exercise the most popular form. Most respondents used relaxation, and the Laura Mitchell method of relaxation was favoured. Classes were found to be more popular than individual treatments for exercise and relaxation approaches. Most respondents used respiratory control, although a quarter of these used it infrequently. Massage was used to differing extents by 82%, and 60% practised complementary therapies, but generally used them infrequently. Research-based evidence formed the basis for treatment choice for fewer than half of respondents, while effectiveness in practice was the reasoning for most. Outcome measures to evaluate practice were used to differing extents by 88% of respondents. Subjective scales and questionnaires were used most frequently.
Article
ObjectiveTo define patient-centredness from the patient's perspective in the context of physiotherapy for chronic low back pain (CLBP).DesignQualitative study using semi-structured interviews to explore perceptions of various aspects of physiotherapy management of CLBP.SettingPhysiotherapy departments in one geographical area of the UK National Health Service.ParticipantsTwenty-five individuals who had received physiotherapy for CLBP within the previous 6 months.ResultsSix key themes emerged as the dimensions that the participants perceived to be important for patient-centred physiotherapy: communication; individual care; decision-making; information; the physiotherapist; and organisation of care. Communication was the most important dimension, underpinning the five other dimensions as well as being a distinct dimension of patient-centred physiotherapy.ConclusionsPhysiotherapists should have an understanding of the six dimensions of patient-centred physiotherapy for CLBP. Improving physiotherapists’ communication skills may better facilitate patient-centred physiotherapy, and therefore enhance the experience of physiotherapy for this client group.
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Exercise training may be especially helpful for patients with generalized anxiety disorder (GAD). We conducted a randomized controlled trial to quantify the effects of 6 weeks of resistance (RET) or aerobic exercise training (AET) on remission and worry symptoms among sedentary patients with GAD. Thirty sedentary women aged 18-37 years, diagnosed by clinicians blinded to treatment allocation with a primary DSM-IV diagnosis of GAD and not engaged in any treatment other than pharmacotherapy, were randomly allocated to RET, AET, or a wait list (WL). RET involved 2 weekly sessions of lower-body weightlifting. AET involved 2 weekly sessions of leg cycling matched with RET for body region, positive work, time actively engaged in exercise, and load progression. Remission was measured by the number needed to treat (NNT). Worry symptoms were measured by the Penn State Worry Questionnaire. Results: There were no adverse events. Remission rates were 60%, 40%, and 30% for RET, AET, and WL, respectively. The NNT was 3 (95% CI 2 to 56) for RET and 10 (95% CI -7 to 3) for AET. A significant condition-by-time interaction was found for worry symptoms. A follow-up contrast showed significant reductions in worry symptoms for combined exercise conditions versus the WL. Exercise training, including RET, is a feasible, low-risk treatment that can potentially reduce worry symptoms among GAD patients and may be an effective adjuvant, short-term treatment or augmentation for GAD. Preliminary findings warrant further investigation.
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Long-term diseases are today the leading cause of mortality worldwide and are estimated to be the leading cause of disability by 2020. Person-centered care (PCC) has been shown to advance concordance between care provider and patient on treatment plans, improve health outcomes and increase patient satisfaction. Yet, despite these and other documented benefits, there are a variety of significant challenges to putting PCC into clinical practice. Although care providers today broadly acknowledge PCC to be an important part of care, in our experience we must establish routines that initiate, integrate, and safeguard PCC in daily clinical practice to ensure that PCC is systematically and consistently practiced, i.e. not just when we feel we have time for it. In this paper, we propose a few simple routines to facilitate and safeguard the transition to PCC. We believe that if conscientiously and systematically applied, they will help to make PCC the focus and mainstay of care in long-term illness.
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Depression and anxiety are the most common psychiatric conditions seen in the general medical setting, affecting millions of individuals in the United States. The treatments for depression and anxiety are multiple and have varying degrees of effectiveness. Physical activity has been shown to be associated with decreased symptoms of depression and anxiety. Physical activity has been consistently shown to be associated with improved physical health, life satisfaction, cognitive functioning, and psychological well-being. Conversely, physical inactivity appears to be associated with the development of psychological disorders. Specific studies support the use of exercise as a treatment for depression. Exercise compares favorably to antidepressant medications as a first-line treatment for mild to moderate depression and has also been shown to improve depressive symptoms when used as an adjunct to medications. While not as extensively studied, exercise has been shown to be an effective and cost-efficient treatment alternative for a variety of anxiety disorders. While effective, exercise has not been shown to reduce anxiety to the level achieved by psychopharmaceuticals.
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To appraise the evidence for comparative efficacy and tolerability of drug treatments in patients with generalised anxiety disorder. Systematic review of randomised controlled trials. Primary Bayesian probabilistic mixed treatment meta-analyses allowed pharmacological treatments to be ranked for effectiveness for each outcome measure, given as percentage probability of being the most effective treatment. Secondary frequentist mixed treatment meta-analyses conducted with random effects model; effect size reported as odds ratio and 95% confidence interval. Medline, Embase, BIOSIS, PsycINFO, Health Economic Evaluations Database, National Health Service Economic Evaluation Database, and Database of Abstracts of Reviews of Effects via DataStar, and Cochrane Database of Systematic Reviews via Cochrane Library (January 1980 to February 2009). Eligibility criteria Double blind placebo controlled randomised controlled trials; published systematic reviews and meta-analyses of randomised controlled trials. Randomised controlled trials including adult participants (aged ≥ 18) receiving any pharmacological treatment for generalised anxiety disorder. Data abstraction methods Titles or abstracts reviewed initially, followed by review of full text publications for citations remaining after first pass. A three person team conducted screening; an independent reviewer checked a random selection (10%) of articles screened. Data extracted for meta-analysis were also independently reviewed. Proportion of participants experiencing ≥ 50% reduction from baseline score on Hamilton anxiety scale (HAM-A) (response), proportion with final HAM-A score ≤ 7 (remission), proportion withdrawing from trial because of adverse events (tolerability). The review identified 3249 citations, and 46 randomised controlled trials met inclusion criteria; 27 trials contained sufficient or appropriate data for inclusion in the analysis. Analyses compared nine drugs (duloxetine, escitalopram, fluoxetine, lorazepam, paroxetine, pregabalin, sertraline, tiagabine, and venlafaxine). In the primary probabilistic mixed treatment meta-analyses, fluoxetine was ranked first for response and remission (probability of 62.9% and 60.6%, respectively) and sertraline was ranked first for tolerability (49.3%). In a subanalysis ranking treatments for generalised anxiety disorder currently licensed in the United Kingdom, duloxetine was ranked first for response (third across all treatments; 2.7%), escitalopram was ranked first for remission (second across all treatments; 26.7%), and pregabalin was ranked first for tolerability (second across all treatments; 7.7%). Though the frequentist analysis was inconclusive because of a high level of uncertainty in effect sizes (based on the relatively small number of comparative trials), the probabilistic analysis, which did not rely on significant outcomes, showed that fluoxetine (in terms of response and remission) and sertraline (in terms of tolerability) seem to have some advantages over other treatments. Among five UK licensed treatments, duloxetine, escitalopram, and pregabalin might offer some advantages over venlafaxine and paroxetine.
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In this paper, an attempt is made to develop an understanding of the essence of illness based on a reading of Martin Heidegger's pivotal work Being and Time. The hypothesis put forward is that a phenomenology of illness can be carried out through highlighting the concept of otherness in relation to meaningfulness. Otherness is to be understood here as a foreignness that permeates the ill life when the lived body takes on alien qualities. A further specification of this kind of otherness can be found with the concept of unhomelike being-in-the-world. Health, in contrast to this frustrating unhomelikeness, is a homelike being-in-the-world in which the lived body in most cases has a transparent quality as the point of access to the world in understanding activities. The paper then proposes that the temporal structure of illness can be conceptualised as an alienation of past and future, whereby one's past and future appear alien, compared with what was the case before the onset of illness. The remainder of the paper follows two paths as regards the temporality of illness. The first path explores the temporality of the body in relation to the temporality of the being-in-the-world of the self. One way of understanding the alienating character of illness is that nature, as the temporality of our bodies, ceases to obey our attempts to make sense of phenomena: the time of the body no longer fits into the time of the self. The second path explored in the paper is that of narrativity. When we make sense of the present, in relation to our future and past, we do so in a special manner, namely, by structuring our experiences in the form of stories. Illness breaks in on us as a rift in these stories, necessitating a retelling of the past and a re-envisioning of the future in an effort to address and change their alienated character. These stories, however, never allow us to leave the silent otherness of our bodies behind. They are stories nurtured by the time of nature at the heart of our existence. It is then claimed that the idea of life's being a story must be understood in a metaphorical sense, and an exploration of how phenomenology addresses the metaphoric quality of its conceptuality is ushered in. It is pointed out that metaphors can be systematically related to each other and that they always have a founding ground in the orientation and basic activities of the lived body. Therefore, if the concepts used in working out a phenomenological theory of health and illness are, to a certain extent, metaphorical, one could, nevertheless, claim that the metaphoric qualities of the phenomenological concepts are primary in referring back to the lived body and the way it inhabits the world.
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Anxiety disorders, as a group, are among the most common mental health conditions and frequently cause significant functional impairment. Both psychotherapeutic and pharmacologic techniques are recognized to be effective management strategies. This review provides a discussion of the major classes of psychotropic medications investigated in clinical trials of the following anxiety disorders: panic disorder, social anxiety disorder, generalized anxiety disorder, posttraumatic stress disorder, and obsessive-compulsive disorder. Findings suggest that both selective serotonin reuptake inhibitors and serotonin-norepinephrine reuptake inhibitors are useful first-line agents for most of the anxiety disorders, particularly given the frequent comorbidity with mood disorders. Highly serotonergic agents are preferred for obsessive-compulsive disorder. Other antidepressants, such as tricyclic antidepressants or monoamine oxidase inhibitors, are generally reserved as second- and third-line strategies due to tolerability issues. Evidence for other agents, including anticonvulsants and atypical antipsychotics, suggests that they may have an adjunctive role to antidepressants in cases of treatment resistance, while azapirones have been used effectively for generalized anxiety disorder, and a substantial body of evidence supports benzodiazepine use in panic disorder and generalized anxiety disorder. Despite notable advances, many patients with anxiety disorders fail to adequately respond to existing pharmacologic treatments. Increased research attention should be focused on systematizing pharmacologic and combined pharmacologic-psychosocial strategies to address treatment resistance and developing novel treatments for anxiety disorders.
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Our aim with the present study was to explore the lived experiences of the process leading to exhaustion. Within a hermeneutic phenomenological perspective, semistructured interviews were conducted with eleven individuals on sick leave because of exhaustion disorder. The findings were interpreted as a process of five stages of losing one's homelikeness in the body and in the familiar world: (a) the body calling for attention, (b) loss of self-recognition, (c) uncanniness, (d) fighting for survival, and (e) existential breakdown. Findings help us to identify early signs of exhaustion disorder and highlight the need for treatments that focus on bodily experiences and habitual stress-related patterns. Helping the patient to regain homelikeness is an important treatment goal.
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Generalized anxiety disorder (GAD) is frequent and has a great impact on quality of life. Its prevalence in the general population and in primary care has been established previously in Spain; however it still must be determined in the mental health. An epidemiological, multicenter and cross-sectional study was carried out, collecting demographic data, reason for consultation and presence of GAD diagnosis according to ICD-10 criteria of their first 75 visiting patients on a randomly selected representative sample of 312 psychiatrists. Data from 20,347 subjects was recorded. Clinic prevalence of GAD was 13.7% (95% confidence interval: 13.3-14.2). The most frequent reason for psychiatric consultation was depressive symptoms (26.7%) followed by symptoms of anxiety (18.2%). In 71.4% of GAD patients, the reason for consultation was anxiety symptoms. GAD clinic prevalence in Spain is high. Almost one out of three GAD-patients visits the psychiatrist office for a reason other than this condition.
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This article is an attempt to analyse the experience of embodiment in illness. Drawing upon Heidegger's phenomenology and the suggestion that illness can be understood as unhomelike being-in-the-world, I try to show how the way we live our own bodies in illness is experienced precisely as unhomelike. The body is alien, yet, at the same time, myself. It involves biological processes beyond my control, but these processes still belong to me as lived by me. This a priori otherness of the body presents itself in illness in an uncanny and merciless way. The unhomelike breakdown of our everyday being-in-the-world suffered in illness is explored through Heidegger's notion of the world being a "totality of relevance", a pattern of meaning played out between different "tools". The lived body is compared to a broken tool that alters and obstructs our way of being "thrown" and "projecting" ourselves in the meaning patterns of the world through feelings, thoughts and actions. The similarities and differences between this unhomelikeness of illness and the specific unhomelikeness of authentic understanding, reached according to Heidegger in existential anxiety, are discussed. In order to illustrate how the lived body can present itself as "broken" and "other" to its owner, and in what way this unhomelike experience calls for help from health-care professionals, I make use of a clinical example of a severe and common disease: stroke.
Article
Generalized, persistent, and free-floating anxiety was first described by Freud in 1894, although the diagnostic term generalized anxiety disorder (GAD) was not included in classification systems until 1980 (Diagnostic and Statistical Manual for Mental Disorders, Third Edition [DSM-III]). Initially considered a residual category to be used when no other diagnosis could be made, it is now widely accepted that GAD represents a distinct diagnostic category. Since 1980, revisions to the diagnostic criteria for GAD in the DSM-III-R and DSM-IV classifications have markedly redefined this disorder, increasing the duration criterion to 6 months and increasing the emphasis on worry and psychic symptoms. This article reviews the development of the diagnostic criteria for defining GAD from Freud to DSM-IV and compares the DSM-IV criteria with the criteria set forth in the tenth revision of the International Classification of Diseases. The impact of the changes in diagnostic criteria on research into GAD, and on diagnosis, differential diagnosis, and treatment of GAD, will be discussed.
Article
Generalized anxiety disorder (GAD) is a chronic and highly prevalent disorder in the adult population, yet it remains a relatively poorly understood condition. Clinicians may be familiar with the symptoms of enduring excessive worrying, anxiety, and hypervigilance that are characteristic of GAD, but may not necessarily recognize that these are usually symptoms of a distinct psychiatric disorder. Despite changes in diagnostic criteria, estimates of prevalence for GAD are remarkably consistent across epidemiologic studies. Lifetime prevalence in the general population is estimated at 5% (DSM-III and/or DSM-III-R criteria), with rates as high as 10% among women aged 40 years and above, and cross-sectional rates among primary care attenders are about 8%, making GAD the most prevalent anxiety disorder in primary care. The age at onset of GAD differs from that of other anxiety disorders: prevalence rates are low in adolescents and young adults but increase substantially with age. Females are at greater risk than males, and the disorder is correlated with being unemployed or a housewife or having a chronic medical illness. GAD is frequently associated with comorbid depression and other anxiety and somatoform disorders. Significant GAD-specific disability occurs even when comorbidity is not present.
Article
Qualitative content analysis as described in published literature shows conflicting opinions and unsolved issues regarding meaning and use of concepts, procedures and interpretation. This paper provides an overview of important concepts (manifest and latent content, unit of analysis, meaning unit, condensation, abstraction, content area, code, category and theme) related to qualitative content analysis; illustrates the use of concepts related to the research procedure; and proposes measures to achieve trustworthiness (credibility, dependability and transferability) throughout the steps of the research procedure. Interpretation in qualitative content analysis is discussed in light of Watzlawick et al.'s [Pragmatics of Human Communication. A Study of Interactional Patterns, Pathologies and Paradoxes. W.W. Norton & Company, New York, London] theory of communication.
Article
Little is known about lifetime prevalence or age of onset of DSM-IV disorders. To estimate lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the recently completed National Comorbidity Survey Replication. Nationally representative face-to-face household survey conducted between February 2001 and April 2003 using the fully structured World Health Organization World Mental Health Survey version of the Composite International Diagnostic Interview. Nine thousand two hundred eighty-two English-speaking respondents aged 18 years and older. Lifetime DSM-IV anxiety, mood, impulse-control, and substance use disorders. Lifetime prevalence estimates are as follows: anxiety disorders, 28.8%; mood disorders, 20.8%; impulse-control disorders, 24.8%; substance use disorders, 14.6%; any disorder, 46.4%. Median age of onset is much earlier for anxiety (11 years) and impulse-control (11 years) disorders than for substance use (20 years) and mood (30 years) disorders. Half of all lifetime cases start by age 14 years and three fourths by age 24 years. Later onsets are mostly of comorbid conditions, with estimated lifetime risk of any disorder at age 75 years (50.8%) only slightly higher than observed lifetime prevalence (46.4%). Lifetime prevalence estimates are higher in recent cohorts than in earlier cohorts and have fairly stable intercohort differences across the life course that vary in substantively plausible ways among sociodemographic subgroups. About half of Americans will meet the criteria for a DSM-IV disorder sometime in their life, with first onset usually in childhood or adolescence. Interventions aimed at prevention or early treatment need to focus on youth.
Article
Muscle relaxation therapy (MRT) has continued to play an important role in the modern treatment of anxiety disorders. Abbreviations of the original progressive MRT protocol [Jacobson, E. (1938). Progressive relaxation (2nd ed.). Chicago: University of Chicago Press] have been found to be effective in panic disorder (PD) and generalized anxiety disorder (GAD). This review describes the most common MRT techniques, summarizes recent evidence of their effectiveness in treating anxiety, and explains their rationale and physiological basis. We conclude that although GAD and PD patients may exhibit elevated muscle tension and abnormal autonomic and respiratory measures during laboratory baseline assessments, the available evidence does not allow us to conclude that physiological activation decreases over the course of MRT in GAD and PD patients, even when patients report becoming less anxious. Better-designed studies will be required to identify the mechanisms of MRT and to advance clinical practice.
Article
This paper examines how the term "empowerment" has been used in relation to the care and education of patients with chronic conditions over the past decade. Fifty-five articles were analysed, using a qualitative method of thematic analysis. Empowerment is more often defined according to some of its anticipated outcomes rather than to its very nature. However, because they do not respect the principle of self-determination, most anticipated outcomes and most evaluation criteria are not specific to empowerment. Concerning the process of empowerment, our analysis shows that (i) the educational objectives of an empowerment-based approach are not disease-specific, but concern the reinforcement or development of general psychosocial skills instead; (ii) empowering methods of education are necessarily patient-centred and based on experiential learning; and (iii) the provider-patient relationship needs to be continuous and self-involving on both sides. Our analysis did not allow for the unfolding of a well-articulated theory on patient empowerment but revealed a number of guiding principles and values. The goals and outcomes of patient empowerment should neither be predefined by the health-care professionals, nor restricted to some disease and treatment-related outcomes, but should be discussed and negotiated with every patient, according to his/her own particular situation and life priorities.
Article
Previous meta-analyses assessing the effectiveness of Cognitive Behavioural Therapy (CBT) for Generalized Anxiety Disorder (GAD) used general measures of anxiety to assess symptom severity and improvement (e.g., Hamilton Anxiety Ratings Scale or a composite measure of anxiety). While informative, these studies do not provide sufficient evidence as to whether CBT significantly reduces the cardinal symptom of GAD: pathological worry. The current meta-analysis employed stringent inclusion criteria to evaluate relevant outcome studies, including the use of the Penn State Worry Questionnaire as the main outcome variable. Results showed a large overall effect size (ES) that was moderated by age and modality of treatment. Specifically, the largest gains were found for younger adults and for individual treatment. Analyses also revealed overall maintenance of gains at 6- and 12-month follow-up. Clinical implications of different treatment packages are discussed, as well as potential explanations for the differential effectiveness of CBT.
Article
In this paper, I explore the questions of how and to what extent new antidepressants (selective serotonin-reuptake inhibitors, or SSRIs) could possibly affect the self. I do this by way of a phenomenological approach, using the works of Martin Heidegger and Thomas Fuchs to analyze the roles of attunement and embodiment in normal and abnormal ways of being-in-the-world. The nature of depression and anxiety disorders - the diagnoses for which treatment with antidepressants is most commonly indicated - is also explored by way of this phenomenological approach, as are the basic structures of self-being. Special attention is paid in the analysis to the moods of boredom, anxiety and grief, since they play fundamental roles in depression and anxiety disorders and since their intensity and frequency appear to be modulated by antidepressants. My conclusion is that the effect of these drugs on the self can be thought of in terms of changes in self-feeling, or, more precisely, self-vibration of embodiment. I present the idea of a spectrum of bodily resonance, which extends from the normal resonance of the lived body, in which the body is able to pick up a wide range of different moods; continuing over various kinds of sensitivities, preferences and idiosyncrasies, in which certain moods are favored over others; to cases that we unreservedly label pathologies, in which the body is severely out of tune, or even devoid of tune and thus useless as a tool of resonance. Different cultures and societies favor slightly differently attuned self-styles as paradigmatic of the normal and good life, and the popularity of the SSRIs can therefore be explained, not only by defects of embodiment, but also by the presence of certain cultural norms in our contemporary society.
Exploring person-centeredness: A qualitative meta-synthesis of four studies M 1962 Phenomenology of Perception The Humanities Press Mishler EG 1991 Research Interviewing. Context and narrative Stein MB 2010 The pharmacologic treatment of anxiety disorders: A review of progress
  • B B Karlsson
  • J Dewing
B, Karlsson B, Dewing J, Lerdal A 2010 Exploring person-centeredness: A qualitative meta-synthesis of four studies. Scandinavian Journal of Caring Sciences 24: 620–634 Merleau-Ponty, M 1962 Phenomenology of Perception. New York, The Humanities Press Mishler EG 1991 Research Interviewing. Context and narrative. Cambridge, MA, Harvard University Press Ravindran LN, Stein MB 2010 The pharmacologic treatment of anxiety disorders: A review of progress. Journal of Clinical Psy-chiatry 71: 839–854
Lärande som förändrat deltagande
  • C Martin
Martin C 2009 Lärande som förändrat deltagande. In: Hansson Scherman M and Runesson U(ed) Den lärande patienten [The learning patient], pp 63–86.