Phenomenological Research Needs to be Renewed: Time to Integrate Enactivism as a Flexible Resource

Abstract

Qualitative research approaches under the umbrella of phenomenology are becoming overly prescriptive and dogmatic (e.g., excessive and unnecessary focus on the epoché and reduction). There is a need for phenomenology (as a qualitative research approach) to be renewed and refreshed with opportunities for methodological flexibility. In this process paper, we offer one way this could be achieved. We provide an overview of the emerging paradigm of post-cognitivism and the aligned movement of enactivism which has roots in phenomenology and embodied cognition. We argue that enactivism can be used as a flexible resource by qualitative researchers exploring the unfolding of first-person (subjective) experience and its meanings (i.e., the enactive concept of sense-making). Enactive approaches are commonly tethered to "E-based" theory, such as the idea that sense-making is a 5E process (Embodied, Embedded, Enacted, Emotive, and Extended). We suggest that enactivism and E-based theory can inform phenomenological research in eclectic and non-prescriptive ways, including integration with existing methods such as observation/interviews and thematic analysis with hybrid deductive-inductive coding. Enactivism-informed phenomenological research moves beyond methodological individualism and can inform novel qualitative research exploring the complex, dynamic, and context-sensitive nature of sense-making. We draw from our enactive study that explored the co-construction of pain-related meanings between clinicians and patients, while also offering other ways that enactive theory could be applied. We provide a sample interview guide and codebook, as well as key components of rigor to consider when designing, conducting, and reporting a trustworthy phenomenological study using enactive theory.

Full text

Regular Article
Phenomenological Research Needs to be
Renewed: Time to Integrate Enactivism as a
Flexible Resource
Peter Stilwell
1
and Katherine Harman
2
Abstract
Qualitative research approaches under the umbrella of phenomenology are becoming overly prescriptive and dogmatic
(e.g., excessive and unnecessary focus on the epoch´
e and reduction). There is a need for phenomenology (as a qualitative research
approach) to be renewed and refreshed with opportunities for methodological flexibility. In this process paper, we offer one way
this could be achieved. We provide an overview of the emerging paradigm of post-cognitivism and the aligned movement of
enactivism which has roots in phenomenology and embodied cognition. We argue that enactivism can be used as a flexible
resource by qualitative researchers exploring the unfolding of first-person (subjective) experience and its meanings (i.e., the
enactive concept of sense-making). Enactive approaches are commonly tethered to “E-based” theory, such as the idea that sense-
making is a 5E process (Embodied, Embedded, Enacted, Emotive, and Extended). We suggest that enactivism and E-based theory
can inform phenomenological research in eclectic and non-prescriptive ways, including integration with existing methods such as
observation/interviews and thematic analysis with hybrid deductive-inductive coding. Enactivism-informed phenomenological
research moves beyond methodological individualism and can inform novel qualitative research exploring the complex, dynamic,
and context-sensitive nature of sense-making. We draw from our enactive study that explored the co-construction of
pain-related meanings between clinicians and patients, while also offering other ways that enactive theory could be applied.
We provide a sample interview guide and codebook, as well as key components of rigor to consider when designing, conducting,
and reporting a trustworthy phenomenological study using enactive theory.
Keywords
phenomenology, enactivism, enactive approach, embodiment, qualitative research
Introduction
The enactive approach (now commonly referred to as enacti-
vism) is a theory of cognition that is grounded in the philoso-
phical movement of phenomenology as well as the cognitive
sciences (Varela et al., 1991). Enactivist frameworks typically
view cognition as sense-making, referring to personal signifi-
cance or meaning that a person generates or “enacts” by inter-
acting in their environment. Since the 1990s, many strands of
enactivism have developed and are now rapidly gaining popu-
larity among philosophers and researchers studying sense-
making (for an introduction to some varieties of enactivism,
see Ward et al., 2017). However, as recently highlighted
(Fernandez, 2020; Zahavi & Martiny, 2019), many enactive
concepts are rarely used in qualitative research despite their
potential to offer novel insight into complex clinical phenom-
ena, including the evolving sense-making of people living with
challenging health condition(s) as they engage in healthcare.
Further, existing qualitative research approaches under the
umbrella of phenomenology are becoming overly prescriptive
and dogmatic.
Studies deviating from the approaches outlined by prominent
qualitative researchers are being criticized and denied their
“phenomenological” status (e.g., see Smith [2018] and
van Manen [2017]). Philosophers have also joined these debates;
see Zahavi’s 2019c commentary regarding issues with van Man-
en’s interpretations of phenomenology and its negative impact
1
Faculty of Health, Dalhousie University, Halifax, Nova Scotia, Canada
2
Faculty of Health, School of Physiotherapy, Dalhousie University, Halifax,
Nova Scotia, Canada
Corresponding Author:
Peter Stilwell, Faculty of Health, Dalhousie University, 5869 University Ave.
PO Box 15000 Halifax, Nova Scotia, Canada B3H 4R2.
Email: peterstilwell@dal.ca
International Journal of Qualitative Methods
Volume 20: 1–15
ªThe Author(s) 2021
DOI: 10.1177/1609406921995299
journals.sagepub.com/home/ijq
Creative Commons CC BY: This article is distributed under the terms of the Creative Commons Attribution 4.0 License (https://creativecommons.org/licenses/by/4.0/)
which permits any use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and
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on qualitative research. Also see Zahavi’s (2019a) commentary
regarding Giorgi’s questionable insistence on the use of the
epoch´e and reduction. To us, these debates indicate a need for
phenomenology (in the form of a qualitative methodology) to be
renewed and refreshed, moving away from the overly compli-
cated steps and dogma that are impeding the practical relevance
of phenomenological qualitative research. This process paper
offers a way to move in this direction.
We start by outlining why qualitative research is vital to
better understand the experiences of individuals living with
complex, subjective health conditions. While doing this,
we explore the concept of “subjectivity” as it is a central con-
cept in enactive approaches to sense-making. We then provide
an overview of the emerging paradigm of post-cognitivism and
how it contrasts with traditional ways of understanding cogni-
tion (sense-making). Enactivism sits within the post-cognitivist
paradigm and we outline the philosophical assumptions that
generally come with enactive approaches to sense-making.
We then argue that enactivism can be used as a flexible
resource by qualitative researchers exploring the unfolding of
first-person experience and its meanings (i.e., the enactive con-
cept of sense-making). We draw from our own enactive work
(Stilwell, 2020; Stilwell et al., 2020; Stilwell & Harman, 2019)
that explored the co-construction of pain-related meanings
between clinicians and patients, while also offering other ways
that enactive theory could be applied in phenomenological
research.
Qualitative Health Research and Subjectivity
When considering the top ten leading causes of years lived with
disability, five are conditions with strong subjective elements
(i.e., they are embodied, first-person experiences involving
sense-making): low back pain #1, migraine #2, major depres-
sion #5, neck pain #6, and anxiety #9 (Hay et al., 2017). These
subjective conditions contrast with conditions, such as iron-
deficiency anemia, that are diagnosed through laboratory
investigation (e.g., blood hemoglobin value) rather than a
patient’s report of their experience. Qualitative research not
only explores individuals’ experiences, it also effectively iden-
tifies common concerns, preferences, and expectations that
patients have about potential or received treatment. This can
provide clinicians with an enhanced understanding of these
factors, leading to healthcare that improves patients’ experi-
ences and outcomes. For example, qualitative research about
persistent pain has included findings that patients feel
dismissed and stigmatized, and offer suggestions about how
care could be optimized (Bunzli et al., 2013; Holloway et al.,
2007; Slade et al., 2009). Ultimately, qualitative research can
inform humanistic approaches to the care of those who are
suffering.
Qualitative research on subjective conditions is essential
due to epistemological constraints related to assessment in
healthcare. Peoples’ subjective experiences, such as pain, are
from a first-person perspective; these experiences cannot be
directly assessed or “seen” through scientific measurement or
testing (Stilwell & Harman, 2019; Wideman et al., 2019).
Therefore, the person with the experience of interest has an
epistemic privilege; their qualitative narrative is the best avail-
able proxy for others to infer that they are experiencing the
subjective condition of interest, such as pain (Stilwell &
Harman, 2019; Wideman et al., 2019). In this sense, first-
person (subjective) experience is private. Of clinical relevance,
a clinician cannot deny that a person is in pain (for example)
when they say they are experiencing it. Nor can a clinician say
that a patient is feeling pain when they deny it.
At this point, it is important to unravel the word “subjective”
as it is used in different ways and often creates confusion in
interdisciplinary work. As outlined by de Haan (2020b, p. 85):
“Experiences are of a ‘subjective’ structure ...(they) are not
subjective as opposed to objective, they are subjective as
opposed to being views from nowhere.” Further, as noted by
Gallagher and Zahavi (2012, p. 21), some mistake phenomen-
ology to be a subjective account of experience; however, they
note that “ ...a subjective account of experience should be
distinguished from an account of subjective experience.”
To try to avoid confusion, we align with the terminology com-
monly used by enactivist thinkers (Fuchs, 2020; Thompson,
2005). For current purposes, the most relevant terminology is
the lived body (body as subject) and living body (body as
object). In this sense, the body has a double status of being a
“subject-object”: a subjectively lived body and an objective
living body (see Fuchs, 2020; Thompson, 2005). The lived and
living body are part of the single person in an environment;
therefore, as outlined by de Haan (2020a, 2020b), the lived
body (subjective experience) cannot be reduced to the living
body (physiological processes). Also, physiological processes
do not simply “add up” to the lived body, nor can we fully
“map” bodily processes (identified through third-person meth-
ods) onto the experientially lived body (de Haan, 2020a,
2020b). These ideas are reflected and further unraveled in
Figure 1 and toward the end of the paper.
As reflected in Figure 1, we can use some terms inter-
changeably, such as the lived body and subjective experience.
Also, living body, body as object, or reference to physiological
or biological processes. Now, Figure 1 can be considered in the
context of pain as an example of a common subjective experi-
ence. Although there are pain-related physiological measures
(e.g., quantitative biomarkers) and people often behave in cer-
tain ways when they are experiencing pain (e.g., facial expres-
sions and bodily movement patterns), the experience of pain
itself (i.e., the lived body) cannot be found through third-person
biomedical investigations of the living body. Therefore, for
people who are conscious and have the capacity to communi-
cate, we rely on their qualitative narrative to gain insight into
their experience of pain and how their sense-making changes as
they navigate health services.
Phenomenological qualitative research is well positioned to
explore sense-making, which can inform ways to improve
patients’ experiences and outcomes. However, there is a need
for methodological flexibility in phenomenological research to
open up opportunities to conduct clinically meaningful
2International Journal of Qualitative Methods

research without having to follow overly complicated, confus-
ing, and likely unnecessary procedures. In this paper we sug-
gest that phenomenological research can be conducted in
non-traditional ways, moving beyond individual interviews and
a narrow view of sense-making that only focuses on what it is
like to have an experience. We argue that enactivism offers new
theoretical considerations and may help researchers better
explore the complex nature of sense-making, while still being
attuned to valuable concepts often found in phenomenological
research such as embodiment, embeddedness, intersubjectivity,
spatiality, relationality, and temporality.
Post-Cognitivist Paradigm
Qualitative researchers are expected to consider and report
their philosophical paradigm (world view), methodology
(sometimes called qualitative design), and methods (Creswell,
2013, 2014). Here we take time to outline post-cognitivism as
enactive approaches sit within this paradigm and these ideas
are not yet reflected in texts on qualitative methods. The post-
cognitivist paradigm is rapidly evolving and starting to take a
coherent shape as authors declare the various philosophical
assumptions it entails, separating it from some existing para-
digms and merging it with others. To understand what has been
referred to as the post-cognitivist paradigm (Lobo, 2019),
we contrast it with cognitivism.
A key feature of the traditional or classical cognitivist para-
digm is that the mind/cognition should be understood through
third-person analyses of the brain, downplaying the role of the
body and context (Thompson, 2007). This contrasts with the
post-cognitivist paradigm that emphasizes the importance of
the full living body, context, interaction in the environment,
and first-person experience (lived body). In the post-
cognitivist paradigm, cognition is broadly understood as
sense-making that brings forth (enacts) experience/meaning
from a concerned point of view. More specifically, Engel,
(2010) outlined core assumptions of cognitivism and post-
cognitivism in relation to cognition. These assumptions are
summarized in Table 1.
Post-cognitivism builds on many lines of work, especially
phenomenological philosophy as is apparent in the terminology
in Table 1 (e.g., being-in-the-world, embodiment, and
situatedness). Further, Engel referred to the divergence from
cognitivism as the pragmatic turn, making reference to the
action-oriented viewpoints of those who developed pragma-
tism. However, these same assumptions apply to what is now
being referred to as the post-cognitivist paradigm (Lobo, 2019);
therefore, we use this label in Table 1. That said, we do appreci-
ate that post-cognitivism encompasses aspects of pragmatism
(see Gallagher, 2017). We also appreciate overlap between the
post-cognitivist paradigm and constructivism.
It is important to note that working in the post-cognitivist
paradigm does not negate or remove the role of sub-personal
systems or mechanisms (Lobo, 2019). Instead, there is an
attempt to take into account the role of the brain, the body, and
the environment to generate a big picture view of sense-making
(cognition) that is richer than the cognitivist view that the brain
(mind) is essentially a data processing computer (Lobo, 2019).
In other words, post-cognitivists argue that sense-making cannot
be fully understood by only looking in the brain (centralist
approach) or other tissues in the body (peripheralist approach).
Rather, a more comprehensive approach is required to appreciate
Figure 1. Embodiment schematic redrawn and modified from Fuchs (2011, 2020) with inspiration from de Haan (2020a, 2020b). Note. The lived
body (subjective experience) is non-reducible; it cannot be reduced to the living body (physiological processes) that can be investigated from a
third-person perspective. Yet, as indicated by the arrows, there is influence (circular or organizational causality) between the lived and living
body (we discuss this further, including integration of sociocultural influences, later in the paper. Also see de Haan, 2020b). While the living body
(by itself) is not the unit of analysis for experience, it certainly limits or allows the types of experiences an individual can have. *It is important to
note that the experience of others can only be inferred from a second-person perspective through interacting with them and witnessing their
behaviors or verbal reports.
Stilwell and Harman 3

how a person (with a body and brain) interacts with their envi-
ronment in a particular situational context. While evolution,
genetics, and bodily pathology certainly affect and set limits to
the types of experiences humans have, in the post-cognitivist
paradigm the first-person experience (i.e., subjective, lived
body) cannot be reduced to a bodily process (e.g., objective,
central or peripheral physiological processes) abstracted from
the environment, context, and meaning. Throughout the rest of
the paper, we include commentary on decision-making and
examples from our exploratory enactive qualitative study of
pain-related meanings (see chapter three in Stilwell, 2020) and
our related work (Stilwell et al., 2020; Stilwell & Harman,
2019). Working within the paradigm of post-cognitivism, we
now outline the decision to integrate enactivism into our
research, followed by the specific assumptions of enactivism.
From Phenomenology Frustrations
to Finding Enactivism
To contextualize the decision to integrate enactivism into our
qualitative research, we provide some background details.
Early in his doctoral studies, the first author felt constrained
by available qualitative research methodologies (i.e., narrative
research, grounded theory, ethnography, case study, phenom-
enology) when considering the following: his alignment with
what is now being referred to as the post-cognitivist paradigm;
his specific assumptions about pain; and his desire to study
patient-clinician interaction and the co-construction of pain-
related meanings. The first author attempted to design a phe-
nomenological study, but struggled when it came to making a
decision whether to align with descriptive phenomenology
(Husserl) or interpretive (hermeneutical) phenomenology
(Heidegger and Gadamer).
To better understand phenomenological concepts
(e.g., epoch´e, bracketing, and the reduction) and connect phe-
nomenology as a philosophy to phenomenology as a qualitative
research approach, he began reviewing the work of van Manen
who is highly cited among qualitative researchers. He began to
note contradicting and confusing advice and felt uncomfortable
with van Manen’s unnecessarily complicated procedures and
strong views as to what phenomenological research should
entail. He felt interpretive phenomenology was the closest
methodology aligning with his paradigm and research ques-
tions, yet it was missing key elements of interest that he wanted
to apply to pain (e.g., contemporary aspects of embodied cog-
nition and enactivism—described in more detail shortly).
Further, he had concerns because aspects of his desired quali-
tative research endeavors were far from what is considered
“proper” phenomenology according to prominent authors, such
as van Manen and Giorgi as reflected in Zahavi’s recent com-
mentaries (Zahavi, 2019a, 2019c).
An exploration of the enactive literature led the first author
to use enactive theory to guide his qualitative research as it is
rooted in phenomenology and contained elements of interest
that were not apparent in other phenomenological approaches.
This was an unusual strategy as there was no clear alignment
with well-known phenomenological qualitative research
approaches. As we only briefly introduced enactivism in the
introduction, in the next section we provide some historical
information and the theoretical assumptions of enactivism that
guided our work.
Enactivism
The connections between enactivism and phenomenology are
apparent in the literature, making enactivism well positioned as
a resource that phenomenological qualitative researchers can
draw from. As pointed out by Thompson, Varela first thought
of the name “the enactive approach” in the summer of 1986
when he started writing The Embodied Mind. This book
(Varela et al., 1991) is credited as introducing the enactive
approach, now commonly referred to as enactivism.
Yet, before introducing the term “enactive,” Thompson noted
that “ ...Varela had been using “the hermeneutic approach” to
emphasize the affiliation of his ideas to the philosophical
school of hermeneutics—an affiliation also emphasized by
other theorists of embodied cognition at the time (see Varela
et al., 1991, pp. 149–150).” (Thompson, 2005, p. 423).
Many authors have expanded on the work of Varela et al.
(1991) and applied enactive theory in many ways to various
areas, such as: mathematics education (Reid, 1996), architec-
ture (Jelic et al., 2016), brain injury (Mart´ınez-Pern´ıa et al.,
2016), schizophrenia (Kyselo, 2016), cerebral palsy (Martiny,
2016), correctional (criminal) rehabilitation (Dent et al., 2020),
Table 1. Point-by-Point Comparison of Classical Cognitivist and
Postcognitivist Assumptions Regarding Cognition (Engel, 2010,
p. 220–222).
Classical Cognitivism Postcognitivism
Cognition is understood as
computation over mental
(or neural) representations.
Cognition is understood as
capacity of enacting a world.
The subject of cognition is not
engaged in the world, but
conceived as a detached
“neutral” observer.
The subject of cognition is an
agent immersed in the world
(as suggested by the
phenomenological concept of
being-in-the-world).
Intentionality is explained by the
representational nature of
mental states.
System states acquire meaning by
their relevance in the context
of action.
The processing architecture of
cognitive systems is conceived
as being largely modular and
context-invariant.
The architecture of cognitive
systems is conceived as being
highly dynamic, context-
sensitive, and captured best by
holistic approaches.
Computations are thought to
occur in a substrate-neutral
manner.
The functioning of cognitive
systems is thought to be
inseparable from its substrate
or incarnation (embodiment).
Explanatory strategies typically
reference to inner states of
individual cognitive systems.
Explanations make reference to
agent-environment or agent-
agent-interactions
(situatedness).
4International Journal of Qualitative Methods

memory (Peeters & Segundo-Ortin, 2019), placebo effects
(Ongaro & Ward, 2017), autism (De Jaegher, 2013), and clin-
ical reasoning in both physiotherapy (Øberg et al., 2015) and
psychiatry (de Haan, 2020a). Further, there are now many pub-
lished books dedicated to advancing enactivism in different
ways (Durt et al., 2017; Gallagher, 2017; Stewart et al.,
2010), with some attending to more radical ideas than others
(Hutto & Myin, 2013, 2017). Despite its roots in phenomenol-
ogy, qualitative researchers rarely utilize the rich literature base
of enactivism. Although enactivism is relatively new and still
evolving as a movement, we suggest it is time for increased
integration of enactivism into phenomenological research.
Enactivism builds on and extends phenomenological con-
siderations regarding the mind/cognition and has potential for
increased methodological flexibility as compared to existing
phenomenological qualitative approaches. Others (Di Paolo
& De Jaegher, 2019) have also noted limitations when taking
a purely phenomenological perspective (especially Husserl’s
descriptive phenomenology) and how phenomenology can be
built upon by using enactive theory. With an enactive perspec-
tive, experience and meaning are not to be found in elements
belonging to the environment/clinician or the internal
dynamics of the person alone; instead, they belong to the rela-
tional domain established between the two (De Jaegher &
Di Paolo, 2007). As outlined by Gallagher (2017), enactivist
approaches to sense-making/cognition can be characterized by
the background assumptions outlined in Table 2. Regarding
Point Number 2 in the Table, to be clear, this is not appealing
to subjective idealism; rather, enactive thinkers view the
“world” in the sense of the meaningful experience that is
always about or directed toward something—the world or
umwelt that presents itself to each individual thanks to their
sensorimotor repertoire (Thompson, 2007).
Enactive research questions are along the lines of: why does
something mean something, for someone, in a particular his-
torical and interactive situation; and what is at stake for this
person? (Di Paolo et al., 2018). However, it is important to
acknowledge that there is still debate as to how enactivism
relates to research (i.e., is it a philosophy, paradigm, research
program, methodology?) (Gallagher, 2017). We suggest that
enactivism can be used as a flexible resource. We used it as
a way to conceptualize pain (Stilwell & Harman, 2019) and we
used that work to help shape and test our exploratory
enactivism-informed phenomenological study on pain/mean-
ing (Stilwell, 2020). In the next section, we provide more
details on the enactive theory that informed our phenomenolo-
gical study.
Sense-Making as an E-Based Process
Inspired by enactivism (including “4E” cognition; see Newen
et al., 2018), we proposed an enactive approach to pain, in that
pain is a mode of sense-making and that sense-making is a 5E
process: Embodied,Embedded,Enactive,Emotive,and
Extended (Stilwell & Harman, 2019). The 5E process of
sense-making is depicted in Figure 2 where each of the Es are
interconnected and constitute sense-making. We have
described each of the Es in detail elsewhere (Stilwell, 2020;
Stilwell et al., 2020; Stilwell & Harman, 2019); however we
provide a brief summary here.
In general, embodied means that sense-making is only pos-
sible by having a body and that different modes of sense-
making are shaped by bodily processes and interactions.
Table 2. Seven Assumptions of Enactivism Outlined by Gallagher
(2017, p. 6).
Enactivist Background Assumptions
1. Cognition is not simply a brain event. It emerges from processes
distributed across brain–body–environment. The mind is
embodied; from a first-person perspective embodiment is
equivalent to the phenomenological concept of the lived body.
From a third-person perspective the organism–environment is
taken as the explanatory unit.
2. The world (meaning, intentionality) is not pre-given or predefined,
but is structured by cognition and action.
3. Cognitive processes acquire meaning in part by their role in the
context of action, rather than through a representational mapping
or replicated internal model of the world.
4. Enactivist approaches have strong links to dynamical systems
theory, emphasizing the relevance of dynamical coupling and
coordination across brain–body–environment.
5. In contrast to classic cognitive science, which is often
characterized by methodological individualism with a focus on
internal mechanisms, enactivist approaches emphasize the
extended, intersubjective, and socially situated nature of cognitive
systems.
6. Enactivism aims to ground higher and more complex cognitive
functions not only in sensorimotor coordination, but also in
affective and autonomic aspects of the full body.
7. Higher-order cognitive functions, such as reflective thinking or
deliberation, are exercises of skillful know-how and are usually
coupled with situated and embodied actions.
Figure 2. Simplified 5E cycle of sense-making that enacts (brings
forth) personal significance and meaning (Stilwell & Harman, 2019).
Stilwell and Harman 5

Embodiment includes both the lived and living body as
reflected earlier in Figure 1 and encompasses well-known phe-
nomenological concepts including spatiality, relationality, and
temporality. Embedded means that an embodied person is
always in and of an environment and that sense-making is
shaped by a person’s relationship and interactions with their
physical and sociocultural environment. Enactive means that
embodied, embedded people have a concerned point of view
and are action-oriented; sense-making is shaped by possibilities
for action and action-perception cycles. In other words, we
perceive through bodily action or in terms of “what we can
do.” Enactivists commonly explain this theory of perception
using the concept of affordances (Chemero, 2003; Gibson,
1977), which are possibilities for action shaped by the relation
between a person and their environment. Emotive means that
emotion/affect shape or “color” sense-making and we are
directed to salient aspects of ourselves and our environment.
Extended means that non-biological items and engagement
with large-scale institutions (e.g., cultural, academic, scientific,
legal, etc.) can be a part of or shape sense-making (see Galla-
gher, 2018b).
Typically, enactivism is tethered to multiple “Es” and peo-
ple often talk in terms of E-cognition, E-based theory, or
E-approaches. Hutto and Abrahamson (forthcoming) use an
effective analogy, suggesting that E-approaches are like a fam-
ily where sometimes members do not get along with others.
For example, some reject the idea that sense-making/cognition
is extended but accept the other Es. These practices have led to
different mixes of the Es in the form of 3E and 4E approaches.
However, we view each of the 5 Es presented above as building
on each other and connected and interpreted through an enac-
tive lens. In the context of pain, our consideration of the 5 Es
together is referred to as the enactive approach to pain (Stilwell
& Harman, 2019). In other words, the enactive approach to pain
represents the 5E family, with enactivism at the core.
Just as we (Stilwell & Harman, 2019) advocate to not look at
asingle factor (e.g., just the brain or a body part) to explain
experience, we believe enactivism-informed qualitative
research should do the same. For example, when conducting
research in the context of healthcare for conditions with strong
subjective elements, we need to look at the individual AND the
environment, including the broader context (e.g., talk to both
the patient and clinician, review clinical and laboratory find-
ings etc.). As done in our pain study (which we will discuss in
more detail shortly), we suggest that the unit of analysis in
enactive-informed phenomenological research is (at least) the
individual with a particular experience with serious consider-
ation of their context, including how each of the Es intertwine
and shape that person’s sense-making. We expand upon this in
the following section, offering guidance as to how enactivism
can inform qualitative methods. We also bring it together at the
end of this paper in Table 3. We feel that enactivism/5E theory
can be applied to many experiences and processes that
researchers are interested in, not just pain as was the case in
our research.
Enactive Methods: Observation/Interviews
and Thematic Analysis
To best integrate enactive theory into phenomenological qua-
litative research, we suggest that a combination of observation
and semi-structured interviews provide rich, mutually enligh-
tening data. More specifically, we advocate for observation of
real-time, real-life interactions between the person(s) with the
experience of interest and their environment, including others
who may act as scaffolding for the experience (e.g., healthcare
provider or others playing an important role in an individual’s
sense-making). Also, to explore the extended aspect of sense-
making, we suggest exploring engagement with artifacts or
what some call material actants (Ellingson, 2017; e.g., medical
equipment, medications, assistive devices, tools, etc.). Here, it
is important to note that while meaning can be generated in
person-person interaction in a specific context (e.g., clinician-
patient interaction in a clinical setting), we must appreciate that
individual meanings are qualitatively different. We discuss this
further in the following sections.
Sampling
When integrating enactivism into phenomenological research,
we suggest that a wide range of purposive sampling strategies
can be used. Depending on the research question and popula-
tion of interest, specific cases may be sought out where one or a
group of individuals have specific experiences and character-
istics. Alternatively, maximum variation sampling (Palinkas
et al., 2015) may be used to explore common features of an
experience (e.g., pain) across a group with varied characteris-
tics. Sample size will also vary; a priori estimates and rationa-
lizing “saturation” is difficult; therefore, we suggest
consideration of information power (Malterud et al., 2016).
With this approach the duration of observation and number
of interviews will depend on the aim of the study, sample
specificity, use of established theory, quality of dialogue/obser-
vation, and analysis strategy. Similar to traditional phenomen-
ological qualitative research, a smaller sample size is expected
relative to other approaches (e.g., study using grounded
theory).
Data Collection
When conducting enactivism-informed phenomenological
research, we believe that both observation and interviews are
important as together they offer a way to investigate interaction
and intersubjectivity between one or more people in a specific
context (including embodied-enactive interaction with arti-
facts). However, the data collection approach may vary
depending on the research question, participants, and the envi-
ronment of interest. We also encourage researchers to take field
notes which can be reviewed and incorporated into the analysis
(described shortly).
In our pain study (Stilwell, 2020), we audio-recorded clin-
ical appointments between clinicians and their patients with
6International Journal of Qualitative Methods

low back pain, then interviewed each (clinician, patient) to
explore individual perspectives, their thoughts about their
interactions during the recorded appointment, and their past
experiences with other clinicians and patients. This data col-
lection approach allowed us to explore a range of interactions
and situations, from relationship formation and breakdowns to
relationship repairs and advances; each situation and context
shaping patients’ unique meanings and phenomenal experi-
ence. Similar to narrative research, we were able to piece
together and explore patients’ evolving narratives and sense-
making while also taking a phenomenological approach by
asking what these experiences were like and exploring gener-
ated meanings. This is one example as to how enactive theory
guided us toward taking an eclectic approach to explore the
complexities and multifaceted nature of sense-making—mov-
ing beyond only focusing on what it is like to have a certain
experience.
Context-based, 5E interview questions stray from traditional
phenomenological lines of questioning, especially those that
follow Husserl-based, descriptive approaches focusing solely
on the invariant structures of experience. Instead, we suggest
that enactivism-informed interview questions have more in
common with interpretive phenomenology that emphasize the
importance of context and how we cannot simply study a phe-
nomenon that is removed from background information (Con-
roy, 2003; Laverty, 2003). However, as we outline below,
we do suggest drawing from Høffding and Martiny (2016) who
have both enactive and Husserlian influences.
Høffding and Martiny (2016) argue that subjectivity cannot
be reduced to objectivity; we cannot dismiss or discredit sub-
jective experience with second- or third-person data. Yet, dif-
ferent types of data can mutually inform each other (we come
back to this point later in the paper). Further, Høffding and
Martiny (2016) note that an exploration of subjectivity directly
confronts us with the embodied, enactive, and embedded
aspects of experience. Researchers may not need to always
explicitly ask about each of the 5 Es to be given information
that is 5E-rich (e.g., a question not directly asking about emo-
tion may elicit a narrative about and imbued with emotion).
We discuss further inspiration from Høffding and Martiny
(2016) in the next section (Making Data Collection Fully
Enactive).
For those looking for a starting point when developing an
enactive/5E-based interview guide, in the Supplemental Mate-
rial we provide some sample pain-related interview questions
directed at patients; these questions were informed by the
E-based literature, Høffding and Martiny (2016), as well as
phenomenological interview tips provided by Gallagher and
Francesconi (2012). These questions can be adapted for other
subjective conditions and contexts. That said, we also encour-
age researchers to draw from the enactive literature to generate
their own questions. This includes drawing from theory that is
rarely touched on in qualitative research, such as the extended
mind thesis and its enactive development (see Clark &
Chalmers, 1998; Gallagher, 2018b; Thompson & Stapleton,
2009). For example, consideration of the transparency
constraint (see Thompson & Stapleton, 2009) can guide inter-
view questions regarding when and how artifacts or material
items (such as assistive supports, wheel chairs, prosthetics, and
the many rapidly evolving health wearables) become inti-
mately coupled to a person and play an important role in shap-
ing their experience and engagement in the world.
In our pain study (Stilwell, 2020), in addition to drawing
from the interview-based resources described above, our inter-
view questions were guided by enactive/5E theory found in
Stilwell & Harman, 2019. With this, we explored patient-
clinician dynamics, the clinical context, and each patient’s
unique situation. This included discussions (with both clini-
cians and patients) regarding clinical findings and laboratory
results (e.g., spinal imaging reports). While we explored both
clinicians’ and patients’ culture, past experiences, incoming
knowledge, and expectations—we focused especially on clin-
icians’ pain-related explanations and clinician-patient interac-
tions as potential scaffolding for patients’ experience of pain
and pain-related meanings. In the individual patient interviews,
we aimed to better understand patients’ evolving sense-
making, including their experiences of receiving explanations
for their pain, prognosis, and treatment. This included enactive-
inspired (Di Paolo et al., 2018) questions, such as what/why
pain-related meanings were significant to them (patients) given
current interactions with their healthcare provider, their past
experiences (e.g., receiving pain-related explanations from
other clinicians), and their expectations of the future. In the
following section, we provide more in-depth interview consid-
erations that have data analysis implications.
Making Data Collection Fully Enactive
Enactive qualitative research reveals the particular shape or
manifestation of participants’ experience, and this includes the
researcher’s participation in the process of sense-making.
In other words, the unfolding of an interviewee’s experience
in qualitative interviews is not a reifying recapture of
“objective,” pre-reflective, past experience. Meanings are not
always apparent to participants and new meanings can unfold
through interview questions, participant reflection, and the eli-
citation of narratives. This aligns with the process described by
Varela and Shear (1999) where non-conscious or sub-personal
phenomena may be perceived pre-reflectively without people
being consciously aware of them. Then, with prompting during
an interview, shapes and manifestations of experience can sur-
face while pre-reflexive phenomena unfold allowing the inter-
viewee to then verbally describe it. In this sense, we also
suggest borrowing from Høffding and Martiny (2016) which
will now be briefly discussed.
Høffding and Martiny (2016) state that some researchers
might think that congruency is needed between an experience
and its description. In other words, that they need to seek to
capture (through data collection) a description of an experience
that corresponds to the person’s actual past experience.
However, Høffding and Martiny (2016, p. 6) describe how this
belief reflects a confusion between objectivity and subjectivity
Stilwell and Harman 7

as it: “ ...presupposes that an experience is like any object—an
apple, car or planet.” They argue that considering an experi-
ence as an object will lead one to an approach in which the
descriptions of experience can be final or complete, treated as
static data subject to reliability or reproducibility. Our perspec-
tive, and in particular with regard to pain, is that a person’s
experience is not something to be objectified, but to be under-
stood. It is dynamic and can change with reflection and explo-
ration. Guided by enactive theory, the goal of interviews (and
analysis) is not to verify the accuracy of participants’ descrip-
tions. Rather, as described above, the aim is to explore the
shape or manifestation of experience/meaning—which is fluid
and context dependent.
By context dependent, we are referring to the changing
situations that afford different modes of sense-making based
on relations and interactions between an acting individual and
their environment (physical and sociocultural). Like other
situations, research interviews are in a sociocultural context
and there is a co-generation of knowledge (Høffding &
Martiny, 2016; Zahavi & Martiny, 2019). This co-generation
of knowledge between the interviewer and interviewee has
been described as “fully enactive” (Thompson, 2017, p. 43).
Data Analysis
After organizing the collected data, it is helpful to read the
transcripts and listen/watch the audio/video files. This provides
the opportunity to get a feel for the data and to generate initial
overall impressions. Before coding, this also allows researchers
to reflect on tone, silence, hesitation, and other nuances that
may shape interpretation during data analysis.
In addition to the post-cognitivist and enactivist assump-
tions detailed earlier, enactive data analysis can draw inspira-
tion from the various sources that formed the foundation of
enactivism, as well as contemporary enactive literature. In the
analysis phase of our pain study, we drew from, among other
resources, phenomenology (e.g., Heidegger, 1927/1996;
Merleau-Ponty, 1962), enactive-ecological psychology and
psychiatry (e.g., Gibson, 1977; Fuchs, 2005), and the
intersubjective-focused approach to enactivism called partici-
patory sense-making (De Jaegher & Di Paolo, 2007). Further,
Figure 2 in Stilwell and Harman (2019) was referred to
throughout the analysis.
As suggested by Zahavi (2019c), we believe that enactivism-
informed phenomenological research can avoid abstruse and
excessively complicated (unnecessary) phenomenological con-
siderations and practices that are advocated in the qualitative
methods literature. This may allow researchers to maintain rele-
vance to their area of inquiry without getting weighed down in
analysis processes that may confuse and muddy, rather than
improve the clarity and relevance of qualitative research.
Additionally, we suggest that pre-existing knowledge (pre-
understandings) and use of theory should be harnessed, rather
than contained as advocated by some qualitative researchers
(see Zahavi, 2019a and 2019b outlining the debate and confusion
regarding the use of bracketing, the reduction, and the epoch´ein
qualitative research conducted by non-philosophers).
We suggest that researchers integrating enactive theory into
their phenomenological studies can draw from thematic anal-
ysis as it is a flexible method that is often incorporated into
studies with varied methodologies. Thematic analysis is a het-
erogenous method; however, it is generally used to identify,
analyze, and report patterns (themes) in data. Thematic analysis
is widely accepted as a helpful method for “ ...examining the
perspectives of different research participants, highlighting
similarities and differences, and generating unanticipated
insights” (Nowell et al., 2017, p. 2). Although thematic analysis
has few structured prescriptions and procedures, we suggest
borrowing from the hybrid deductive-inductive approach to
coding and theme development described by Fereday and
Muir-Cochrane (2006). An a priori codebook can be created
using enactive theory, guiding deductive coding. During anal-
ysis, new data-driven sub-codes/codes can be inductively gen-
erated and incorporated into the codebook. Ongoing integration
of enactive theory and associated empirical research can also
generate new sub-codes/codes.
An initial version of our a priori codebook from our pain
study is provided in the Supplemental Material. Deductive
groupings of codes (nodes in NVivo) can be set up for each of
the Es (Embodied, Embedded, Enactive, Emotive, Extended).
Within each code, sub-codes (i.e., child nodes in NVivo) can
be created that explore particular aspects of the E-based con-
struct. It may be helpful to include pertinent operational defini-
tions to continually revisit during coding. Although sub-codes
may fit under multiple Es, a best-fit approach can be employed
that is subject to change as analysis progresses. For deductive
coding, text/video is coded, allocating segments of meaningful
text/video to the deductively derived codes and sub-codes from
the codebook. As the project progresses, the codebook can be
elaborated and refined; this is consistent with guides on devel-
oping codebooks, noting that this is often an iterative and team-
based process and there is a need for the team to be comfortable
with uncertainty as the research progresses (DeCuir-Gunby
et al., 2011).
When potentially valuable text is identified that does not sit
well with existing codes and sub-codes from the codebook, they
can be placed under a code titled “other.” Memos/journaling can
be used to constantly track evolving thoughts. New sub-codes
can be generated when multiple similar segments of coded text
appear or when a content area is deemed to be a relevant outlier
that is worthy of further reflection/investigation. Throughout the
data analysis process, the researcher(s) looks across the codes/
sub-codes and takes reflexive notes regarding connections and
new insights. This provides the opportunity to inductively create
new sub-nodes in the “other” category or under the Es. New non-
E codes and subsequent sub-codes can be created if warranted.
If two or more authors are involved in coding, regular meet-
ings can be arranged to discuss coding, update the codebook, and
come to a consensus regarding key themes (this was the case in
our pain study). Early in data analysis, meetings can be espe-
cially helpful to discuss the reliability of the codes (Fereday &
8International Journal of Qualitative Methods

Muir-Cochrane, 2006). This was also done in our pain study,
which helped ensure both authors were applying the codes in a
similar manner. Researchers may want to take notes during these
meetings; this is a form of audit trail (Nowell et al., 2017).
Further, continued meetings throughout analysis can facilitate
ongoing reflexivity, consideration of incoming perspectives, and
shared interpretive analysis of the data. As well, shared analysis
and regular meetings (as well as peer debriefing, external
review, and auditing) may increase the credibility and depend-
ability of the research (Nowell et al., 2017).
Throughout the data analysis process, existing E-based the-
ory and empirical data can be integrated into the perspective
the data are coded with. Frequently reviewing E-based theory
and research can stimulate new considerations of the data.
This process can help identify potential influences/contextual
factors or taken-for-granted influences that have been over-
looked. In the section below titled “Sample Findings,” we pro-
vide some findings from our study to demonstrate how the use
of enactive theory shaped our interpretations and findings.
In the later stages of the analysis, themes are generated
(defined and named) that move beyond the individual codes.
This process involves consideration of patterns and the ways
the Es interact together to shape participants’ assigned mean-
ings and experiences. It is important to note that initially separ-
ating the Es is somewhat artificial; however, in our pain study it
helped break up and organize data and forced us to consider
how the Es were at play in our data. As analysis progressed and
themes started to develop, we had better appreciation for rela-
tions between the Es and moved beyond the individual codes
within each of the Es. In our pain study, we found that a clear
separation of the themes was not realistic; therefore, we
ordered and reported on them in a specific sequence—each
theme building on the previous one(s). By the end of the last
theme, there was an overall narrative about the entire data set
that was specific to our research aim. Similar to Thorne (2020)
we suggest that analysis does not simply stop at theme identi-
fication; rather, researchers should engage in critical reflection
and further integrate theory to enhance insight and add value to
the literature and the author(s) respective field(s). This process
continues during the writing phase, and when sharing and dis-
cussing findings and their potential application.
Write, Share, Discuss, and Reflect
Systematically organizing and documenting the research pro-
cess and decisions will help when it comes to disclosing and
reporting study details to others so that they can judge its cred-
ibility, dependability, and confirmability (Nowell et al., 2017).
During the analysis and writing process, it can be helpful to
discuss and present preliminary results and challenges with
others (e.g., colleagues, supervisors, conference attendees).
This is a form of peer debriefing and a means of establishing
trustworthiness. Further, it can provide the opportunity to con-
sider the practical relevance of the findings/themes. When pre-
senting themes and the overall findings, discussing with others
and referring back to the literature can create a more robust
narrative (Nowell et al., 2017). In the end, providing detailed
findings (thick descriptions) can help others judge the potential
transferability of the research findings (Nowell et al., 2017).
In relation to our pain study, the first author presented pre-
liminary findings at conferences and at an international philo-
sophy summer school for doctoral students. Also, both authors
presented findings and discussed enactive theory on podcasts,
and during an online webinar and live question and answer.
This all led to new considerations of the findings. For example,
the first author sought out and incorporated additional litera-
ture; the concept of corporealization as described by Fuchs
(2005) helped us better describe a theme through an enactive
lens. We expand on this in the “Sample Findings” section
below.
Further, we highly suggest taking a fully embodied and
enactive approach to knowledge translation. For example, in
our pain study we worked with an artist/researcher to develop
art pieces (see Stilwell et al., 2020) that reflected the pain-
related metaphors we heard clinicians use with their patients.
Our experience was that the use of art in presentations and
writings helped audience members/readers connect with the
work and underlying theory at a deeper level. Using art and
connecting with others can also prompt further exploration of
theoretical integration, as new ideas, inspiration, and literature
may be identified and applied to the analysis.
Preliminary themes can be sent to the participants, asking
them to provide feedback if they wish. Guided by enactive
theory, this “member checking” is not meant to validate static
experiences—rather, it is a continuation of the conversation
and an extension of the findings if participants choose to pro-
vide feedback. Even when the full manuscript is complete (and
shared, published etc.), we suggest not considering it as some-
thing final; instead, it is a conversation that is to be built upon.
Sample Findings From an Enactive Study
General Overview
As noted above, our pain study (see chapter three in Stilwell,
2020) was guided by enactive theory and we focused on clin-
ical interactions involving pain-related explanations and diag-
noses. Our analysis focused on the patients’ sense-making in
relation to their diagnoses and engagement in healthcare. Here
we provide more study details. We audio-recorded appoint-
ments between clinicians (physiotherapists and chiropractors)
and their patients with low back pain, then interviewed each
(clinician, patient). Seven dyads (physiotherapists or chiroprac-
tors and their patients) were recruited, resulting in 21 record-
ings (7 appointments and 14 individual interviews).
We identified four themes related to how clinical interactions
and their contexts created affordance spaces (Gallagher, 2017)
for patients’ sense-making.
Within our themes we found that pain-related metaphors
were used bi-directionally and co-constructed between clini-
cians and patients, shaping patients’ meanings. Patients’ phe-
nomenal experiences of integrating competing pain
Stilwell and Harman 9

explanations ranged from validation and hope to frustration and
anger. Clinicians’ pain explanations either aligned or con-
trasted with patients’ evolving pain narratives. This sense-
making process included inter-bodily touch and movement,
anatomical models, and imaging findings. Often, patients were
set up to view their bodies as flawed. In conclusion, our find-
ings provided further insight into why and how disabling back
pain is partly iatrogenic. Clinician-patient interactions guide
the way patients attune to and engage in their environments,
shaping perception and meaning. Of clinical relevance pertain-
ing to patient (dis)empowerment and placebo/nocebo effects,
we found that clinicians’ taken-for-granted words and interac-
tions can act as scaffolding for patients’ meanings, shaping the
experience of pain for better or worse.
Utility of Enactive, 5E Theory
Informed by the enactive concept of participatory sense-
making (De Jaegher & Di Paolo, 2007), we found that clinical
interactions sometimes took on a life of their own—resulting in
unintended meanings that could enrich or impede patients’
therapeutic progress. Our focus on intersubjective clinician-
patient dynamics led us to non-dualist, non-reductive, and
non-individualistic ways of understanding the generation of
meaning and placebo/nocebo effects. In many situations, clin-
ician’s words and the use of anatomical models and imaging
findings (X-ray, CT, MRI) formed strong emotive scaffolding
for patients’ pain-related sense-making. In some cases, spinal
models and imaging findings (in conjunction with clinicians’
pain-related explanations) appeared to negatively and dramati-
cally change the way patients viewed their bodies and how they
engaged in the world. In conjunction, we also observed the use
of metaphors between clinicians and patients, many of which
suggested that the body is a machine to be fixed. In many cases,
this led to the body becoming (even more) the focus of the
patient’s attention in that it was corporealized; in the words
of Fuchs (2005), the body became more of a burdensome obsta-
cle—the body was opaque rather than transparent.
A concurrent exploration of the E-based literature related to
language and metaphor revealed the concept of enactive meta-
phor (Gallagher & Lindgren, 2015), which are metaphors that
are acted out or brought into existence through action. Enactive
metaphor is not a different kind of metaphor; rather, it is a way
of engaging with metaphor (Gallagher & Lindgren, 2015).
This literature had a significant impact on the first author’s
analysis and contributions to theme development. As a result,
the concept of enactive metaphor was integrated into the cod-
ing scheme. Then, in the analysis it became apparent that enac-
tive metaphor was often used unknowingly in the clinical
interactions that we had recorded and other clinical interactions
that the patients described. For example, the use of palpation,
movement, and bodily feedback was used by clinicians to
“show” patients so-called knotted,ropey,ortight muscles.
Elsewhere (Stilwell et al., 2020), we describe how these types
of clinical interactions involving enactive metaphor may be a
powerful, yet overlooked learning mechanism that can shape
patients’ agency and affordances (i.e., their possibilities for
action). We identified some situations where enactive meta-
phor was unhelpful as it linked the living body (body as object)
to the lived body (body as subject) in overly simplistic and
reductive ways (e.g., the patient was shown, through the use
of touch and movement, that they have persistent pain because
they have knotted muscles, slipped spinal discs, or no core
stability—rather than considering pain as complex and
multidimensional).
Using enactive theory also helped us better understand how
diagnoses can result in dual meanings in that sense-making
could be simultaneously shaped in both positive and negative
ways. In our study, many patients were relieved and felt vali-
dated when they received an explanation for their pain that they
deemed to be credible and that aligned with their evolving
sense-making. However, we found examples where these same
explanations were simultaneously nocebic, unknowingly to the
clinician and patient, relaying inaccurate views of pain
(e.g., injury or nociception has a linear relationship with pain,
tissues are not healed until pain dissipates, pain is permanent or
not malleable, etc.).
Without recordings of clinical appointments and interviews
with clinicians, we believe that we would not have fully appre-
ciated patients’ contexts, including the specific diagnoses and
pain explanations received and how these were often “lost in
translation”. Unintended negative meanings were often gener-
ated, shaping patients’ sense-making in suboptimal ways.
Theuseofenactivetheoryalsodirectedustoconsiderthe
importance of action or action possibilities (i.e., affordances)
in relation to diagnoses and pain explanations. In many situa-
tions, it appeared that pain-related explanations limited
patients’ affordances, leaving them in ineffective treatment
programs and possibly compounding pain-related disability.
Some patients viewed their bodies as flawed leading them to
continue on a search for a fix and to invest time (and money)
into long-term passive care, rather than engaging in guideline-
based recommendations, such as self-management.
Our findings led us to describe enactive therapeutic
approaches that may help clinicians avoid some of the subop-
timal practices identified in our study. This demonstrates the
depth of the enactive literature and how it can be used.
For example, the idea of working to therapeutically “open up”
or reconstruct a patient’s affordance space is found in recent
enactive literature (for example, see Gallagher, 2018a). View-
ing rehabilitation in terms of shaping affordances is a novel
way to approach care and aligns with contemporary, evidence-
based views on rehabilitation and health (e.g., Buchbinder
et al., 2018; Huber et al., 2016) that recommend focusing on
patients’ strengths rather than weaknesses, and guiding patients
to adapt to achieve meaningful activities and goals that they
have personally identified. When thinking in terms of a
patient’s affordances, we are simultaneously directed to con-
sider both the patient’s body (lived and living) and their envi-
ronment which offers a range of invitations to act, depending
on the patient’s concerns, skills, and abilities. This leaves us to
consider multiple data sources which offer rich insight into a
10 International Journal of Qualitative Methods

patient’s sense-making, yet also presents a challenge which we
address in the next section.
Addressing the Integration Problem
Gallagher has outlined some of the challenges that arise when
integrating enactivism into research initiatives and clinical
practice (Gallagher, 2018a, 2020). As detailed above, enacti-
vism does not focus only on the brain, environment, or beha-
vior; rather, there is focus on dynamics between the person and
environment. This is a challenge as it is impossible to take into
consideration all factors at once in a robust way. This same
issue is apparent in interpretive phenomenology as indicated by
van Manen: “to do hermeneutic phenomenology is to attempt
to accomplish the impossible: to construct a full interpretive
description of some aspect of the lifeworld, and yet to remain
aware that lived life is always more complex than any explica-
tion of meaning can reveal” (van Manen, 1990, p. 18). We have
to appreciate that all phenomenological research (regardless of
the approach taken), requires an appreciation that full or final
descriptions are unachievable and no single theme can com-
pletely unlock full meaning (van Manen, 1990).
Enactivism also aligns with interpretive phenomenology’s
non-reductive approach; the end goal is not to reduce an expe-
rience to the sum of its parts, as this is impossible. Instead,
there is an attempt to understand the expression of the whole,
while still considering the parts (van Manen, 1990). Yet, an
enduring challenge that we have struggled with, both clinically
and academically, is how to best connect different types of data
when investigating first-person experience (i.e., the so-called
integration issue). As outlined by Thorne (2016, p. 138), pain
researchers have long recognized the difficulties in fully recon-
ciling “ ...the relationship between subjective and objective
knowledge”. For complex human issues such as pain, Thorne
suggests that it shouldn’t be an either/or situation regarding
attending to either subjectivity or objectivity. She warns that
we cannot simply draw conclusions about how people feel by
observing how they behave, yet she also notes there are limita-
tions to interview data. Similarly, Sandelowski (2002) has
noted the seduction and limitations of just using patient inter-
views. Therefore, she argues that qualitative health research
can benefit from supplementing patient interviews with obser-
vation, communication with clinicians, and review of medical
records. This is what we did in our study (Stilwell, 2020) and it
was prompted by our exploration of enactive theory. However,
the integration challenge remains; how can we best integrate
various data while fully respecting participants’ experiences.
Further, we have to appreciate the “blind spot” (Frank et al.,
2019) of science: scientific knowledge is built on and filtered
through the first-person perspective (i.e., experience has pri-
macy; science cannot step “outside” researchers’ lived experi-
ence). While different techniques have been proposed over the
years to “triangulate” data to address the integration issue,
de Haan’s recent enactive framework (2020a, 2020b) for psy-
chiatric conditions offers a promising solution.
de Haan based her framework on the enactive, life-mind con-
tinuity thesis (Froese & Di Paolo, 2009; Maturana & Varela,
1992; Thompson, 2007) and outlined how there are four con-
nected/continuous, yet non-reducible dimensions in the single
person-environment system. These four dimensions are: physio-
logical, experiential, sociocultural, and existential. Expanding on
the description we provided in Figure 1, we can consider the
connections between thefour dimensions by considering circular
or organizational causality, while maintaining that experience
cannot be reduced to physiological processes (living body).
Appealing to complexity theory and dynamical systems theory,
de Haan refers to experiential processes as being more global,
while physiological processes are more local. Further, she notes
the asymmetry in global-to-local and local-to-global interactions:
experiential processes necessarily include physiological pro-
cesses (changes in experiential processes always include changes
in some physiological processes); yet, not all changes in physio-
logical processes involve or “add up” to changes in experiential
processes (de Haan, 2020b).
She suggests that clinicians and patients can collaborate to
construct personalized network models that map out potential
connections across the four dimensions and how this may be
shaping a patient’s health concern (de Haan, 2020b—see Chap-
ter 8 for example models). We feel this type of approach is not
just relevant for clinical practice, it could also be integrated into
enactive-informed phenomenological research; the
Figure 3. Iceberg model adapted from Farthing (2016) to depict the
key elements in the enactive phenomenological research approach we
presented in this paper. Note. The tip of the iceberg represents
research methods as they are the more visible/tangible processes
(i.e., the “doing” tools). Most of the iceberg (underwater) represents
the less visible/tangible (theoretical) methodology and paradigm—
including guiding philosophical assumptions (i.e., the “thinking” tools).
The underwater foundation (methodology and paradigm) provides the
support for the tip (methods). As depicted in the figure, often deli-
neation between methodology and paradigm is somewhat blurred.
Stilwell and Harman 11

personalized network models could be constructed between the
research team and the person(s) with the experience of interest.
This leads us to, as de Haan argues, a convincingly non-dualist
and non-reductive approach to exploring experience.
For example, a personalized network model could contain:
relevant lab and clinical exam findings (physiological dimen-
sion); the patient’s self-reported experience, such as anxiety,
pain, worry, etc. (experiential dimension); the clinician’s diag-
nosis and advice/education (sociocultural dimension); and the
patient’s reflections and stance on the diagnosis (existential
dimension). Then, connections could be drawn between the
dimensions (for examples see Chapter 8 in de Haan, 2020b).
Clinical diagnoses, observation of engagement with artifacts,
and other information could be used to shape interview ques-
tions and elicit participants’ reflections and meanings that may
otherwise be taken-for-granted by participants and might not
surface during interviews. With this, we can move well beyond
the methodological individualism that is often found in
phenomenological research.
While we did not specifically draw out network models with
the patients in our study, we encourage others to try this. How-
ever, we recognize that this is a challenging task and requires
the researcher(s) to have the ability and expertise to collect data
across the four dimensions and then use this information to
inform qualitative interview questions and analysis. Yet, this
is also a strength in that it could encourage the construction of
more diverse, interdisciplinary research teams (i.e., involving
qualitative and quantitative researchers, philosophers, clini-
cians, and patient partners).
Rigor
If readers of a study are unsure how the researchers analyzed
their data or what assumptions informed their analysis, it is
difficult to gauge its trustworthiness (Nowell et al., 2017).
When integrating enactivism into a qualitative study (or when
conducting any qualitative study for that matter), early consid-
eration and use of the consolidated criteria for reporting quali-
tative research (COREQ) can promote the study’s validity,
transparency, and trustworthiness (Tong et al., 2007).
For example, in our pain study we added a Supplemental File
with the 32-item COREQ checklist—including additional
study details. We also suggest reviewing and incorporating the
thematic analysis rigor components outlined by Fereday and
Muir-Cochrane (2006) and Nowell et al., (2017). We have
discussed many of these rigor components in this paper, includ-
ing: the importance of documentation and reporting, such as
journaling and keeping an audit trail of decisions; shared anal-
ysis, peer debriefing, and regular meetings to increase credibil-
ity; and providing detailed findings (so-called thick
descriptions) so that others can judge potential transferability
of the research findings.
Table 3. Steps Outlining Ways an Enactive Phenomenological Study Could Be Conducted
Step Description
1. Determine Unit of
Analysis
The unit of analysis is (at least) the individual(s) with the situation/experience of interest and serious consideration
of their context—including each of the 5 Es.
2. Sampling Purposive sampling, depending on population and phenomena of interest.
3. Interview Guide
Development
Use enactive/5E theory to develop semi-structured guide.
4. Data Collection Observation and interviews; however, this may vary.
5. Data Storage &
Organization
Transcribe and organize files/documents (consider data management software). Establish the 5E codebook and a
way of taking memos and documenting reflective thoughts during data analysis.
6. Review Files Read transcripts and review files (audio/video).
7. Deductive Coding Code text, allocating segments of meaningful text to the 5E-based codes/sub-codes. Discuss code reliability if
working in a team so codes are applied in similar ways.
8. Inductive Coding Generate new, data-based codes (when appropriate). Add these to the codebook (discuss with research team).
Discuss code reliability if working in a team.
9. Integration Review E-based theory and research; add new codes/sub-codes (when appropriate). Discuss with research team
and document decisions and thoughts.
10. Theme Generation Reflect on patterns and interactions among the 5Es. Connect coded text across codes/sub-codes to create
overarching themes. Define and name themes. Review the themes; incorporate external review and audits (if
deemed to be appropriate).
11. Writing & Reflection To express findings, engage in writing and reflective practices. This can include embodied-enactive practices such
as using art to represent findings. Take a critical approach and further integrate theory to enhance insight and
add value to the literature and the author(s) respective field(s). Consider using the COREQ and review
reporting elements that enhance thematic analysis rigor and trustworthiness.
12. Discuss Findings Discuss and share findings with others (e.g., colleagues or conference delegates). This step may include member
checking, as appropriate. This step may prompt further discussion and thematic refinement.
13. Re-write Write and re-write to produce a report (e.g., manuscript).
14. Share Disseminate/publish report. Consider ways to share reflection pieces that convey the findings in more accessible
ways (e.g., share and discuss art).
Note. Although we outline the use of 5E theory, Researchers may have different philosophical commitments and choose to ground their work in 3E or 4E theory.
12 International Journal of Qualitative Methods

Summary
There is a need for phenomenology (as a qualitative research
approach) to be renewed and refreshed with opportunities for
methodological flexibility. In this paper, we argued that one
way to achieve this is by using enactivism as a flexible
resource. We outlined how enactivism sits within the post-
cognitivist paradigm and gave examples of ways that enacti-
vism could be integrated into existing qualitative methods.
Figure 3 visually depicts the paradigm, methodology, and
methods we discussed. When integrating enactivism into phe-
nomenological research, as visualized in Figure 3, we can call
this methodology “enactivism-informed phenomenology,” or
more broadly “an enactive phenomenological approach” when
referring to both methodology and methods.
In Table 3 we summarize one way to conduct enactive
phenomenological research. Although 14 steps are presented
in sequence, this is not a linear process—many of the steps are
iterative in nature and can be modified or adapted.
Conclusion
In this process paper, we presented enactivism as a flexible
resource that can be integrated into phenomenological
research. We provided examples from our own study that inte-
grated enactivism into existing methods (observation/inter-
views and thematic analysis with hybrid deductive-inductive
coding guided by E-based/5E theory). This approach to quali-
tative research offers novel ways to explore conditions and
situations with a subjective element (i.e., experiences of living
with a health condition such as pain, depression, or anxiety and
engaging in health services). Integrating enactivism into qua-
litative research is still in early stages. We encourage qualita-
tive researchers to explore what we have presented, and we
welcome collaboration with philosophers and qualitative
researchers to help refine and adapt these ideas.
Acknowledgments
Dr. Stilwell would like to thank Dr. Brenda Sabo of Dalhousie
University for guidance and support during his PhD studies from
which this manuscript stemmed. The authors also acknowledge the
anonymous reviewers for their contributions, especially regarding
how to best position enactivism within qualitative research. Thanks
to slidehunter.com for the free use of the iceberg template used in
Figure 3.
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect to
the research, authorship, and/or publication of this article.
Funding
The author(s) disclosed receipt of the following financial support for
the research, authorship, and/or publication of this article:
We received funding from the Canadian Chiropractic Guideline
Initiative and the Faculty of Health Research Development Fund for
conducting the research this process paper was based on.
ORCID iD
Peter Stilwell https://orcid.org/0000-0002-2858-9588
Supplemental Material
The supplemental material for this article is available online.
References
Buchbinder, R., van Tulder, M., O
¨berg, B., Costa, L. M., Woolf, A.,
Schoene, M., Croft, P., Buchbinder, R., Hartvigsen, J., Cherkin, D.,
Foster, N. E., Maher, C. G., Underwood, M., van Tulder, M.,
Anema, J. R., Chou, R., Cohen, S. P., Menezes Costa, L., Croft,
P., & ...Woolf, A. (2018). Low back pain: A call for action.
The Lancet,391(10137), 2384–2388. https://doi.org/10.1016/
S0140-6736(18)30488-4
Bunzli, S., Watkins, R., Smith, A., Schu
¨tze, R., & O’Sullivan, P.
(2013). Lives on hold. The Clinical Journal of Pain,29(10),
907–916. https://doi.org/10.1097/AJP.0b013e31827a6dd8
Chemero, A. (2003). An outline of a theory of affordances. Ecological
Psychology,15(2), 181–195. https://doi.org/10.1207/S153
26969ECO1502_5
Clark, A., & Chalmers, D. (1998). The extended mind. Analysis,
58(1), 7–19. https://doi.org/10.1111/1467-8284.00096
Conroy, S. A. (2003). A pathway for interpretive phenomenology.
International Journal of Qualitative Methods,2(3), 36–62.
https://doi.org/10.1177/160940690300200304
Creswell, J. W. (2013). Qualitative inquiry and research design.
Choosing among five approaches (3rd ed.). Sage.
Creswell, J. W. (2014). Research design: Qualitative, quantitative,
and mixed methods approaches. Sage.
de Haan, S. (2020a). An enactive approach to psychiatry. Philosophy,
Psychiatry, & Psychology,27(1), 3–25. https://doi.org/10.1353/
ppp.2020.0001
de Haan, S. (2020b). Enactive psychiatry. Cambridge University
Press. https://doi.org/10.1017/9781108685214
De Jaegher, H. (2013). Embodiment and sense-making in autism.
Frontiers in Integrative Neuroscience,7(March), 1–19. https://
doi.org/10.3389/fnint.2013.00015
De Jaegher, H., & Di Paolo, E. (2007). Participatory sense-making: An
enactive approach to social cognition. Phenomenology and the
Cognitive Sciences,6(4), 485–507.
DeCuir-Gunby, J. T., Marshall, P. L., & McCulloch, A. W. (2011).
Developing and using a codebook for the analysis of interview
data: An example from a professional development research proj-
ect. Field Methods,23(2), 136–155. https://doi.org/10.1177/
1525822X10388468
Dent, H., Nielsen, K., & Ward, T. (2020). Correctional rehabilitation
and human functioning: An embodied, embedded, and enactive
approach. Aggression and Violent Behavior,51, 101383. https://
doi.org/10.1016/j.avb.2020.101383
Di Paolo, E. A., Cuffari, E. C., & De Jaegher, H. (2018). Linguistic
bodies: The continuity between life and language. MIT Press.
Di Paolo, E. A., & Jaegher, H. De. (2019). Microphenomenology of
first encounters: A sympathetic critique. Constructivist Founda-
tions,14(2), 185–187.
Stilwell and Harman 13

Durt, C., Fuchs, T., & Tewes, C. (2017). Embodiment, enaction, and
culture: Investigating the constitution of the shared world.MIT
Press.
Ellingson, L. L. (2017). Embodiment in qualitative research.
Routledge.
Engel, A. K. (2010). Directive minds: How dynamics shapes cogni-
tion. In J. Stewart, O. Gapenne, & E. A. Di Paolo (Eds.), Enaction:
Towards a new paradigm for cognitive science (pp. 219–243). MIT
Press.
Farthing, S. (2016). Research design in urban planning: A student’s
guide. Sage. https://doi.org/10.4135/9781473921375
Fereday, J., & Muir-Cochrane, E. (2006). Demonstrating rigor using
thematic analysis: A hybrid approach of inductive and deductive
coding and theme development. International Journal of Qualita-
tive Methods,5(1), 80–92. https://doi.org/10.1063/1.2011295
Fernandez, A. V. (2020). Embodiment and objectification in illness
and health care: Taking phenomenology from theory to practice.
Journal of Clinical Nursing,29(21-22). https://doi.org/10.1111/
jocn.15431
Frank, A., Gleiser, M., & Thompson, E. (2019). The blind spot of science
is the neglect of lived experience. Aeon Essays. https://aeon.co/
essays/the-blind-spot-of-science-is-the-neglect-of-lived-experience
Froese, T., & Di Paolo, E. A. (2009). Sociality and the life–mind
continuity thesis. Phenomenology and the Cognitive Sciences,
8(4), 439–463. https://doi.org/10.1007/s11097-009-9140-8
Fuchs, T. (2005). Corporealized and disembodied minds. Philosophy,
Psychiatry, & Psychology,12(2), 95–107.
Fuchs, T. (2011). The Brain - A mediating organ. Journal of Con-
sciousness Studies,18(7), 196–221.
Fuchs, T. (2020). The circularity of the embodied mind. Frontiers in
Psychology,11(August). https://doi.org/10.3389/fpsyg.2020.
01707
Gallagher, S. (2017). Enactivist interventions: Rethinking the mind.
Oxford University Press.
Gallagher, S. (2018a). The therapeutic reconstruction of affordances.
Res Philosophica,95(4), 719–736. https://doi.org/10.11612/
resphil.1723
Gallagher, S. (2018b). The extended mind: State of the question.
The Southern Journal of Philosophy,56(4), 421–447. https://doi.
org/10.1111/sjp.12308
Gallagher, S. (2020). Enactivism, causality, and therapy. Philosophy,
Psychiatry, & Psychology,27(1), 27–28. https://doi.org/10.1353/
ppp.2020.0002
Gallagher, S., & Francesconi, D. (2012). Teaching phenomenology to
qualitative researchers, cognitive scientists, and phenomenologists.
Indo-Pacific Journal of Phenomenology,12(suppl 3), 1–10. https://
doi.org/10.2989/IPJP.2012.12.3.4.1112
Gallagher, S., & Lindgren, R. (2015). Enactive metaphors: Learning
through full-body engagement. Educational Psychology Review,
27(3), 391–404. https://doi.org/10.1007/s10648-015-9327-1
Gallagher, S., & Zahavi, D. (2012). The phenomenological mind.
Routledge. https://doi.org/10.4324/9780203086599
Gibson, J. J. (1977). Theory of affordances. In R. Shaw & J. Bransford
(Eds.), Perceiving, acting, and knowing (pp. 67–82). Erlbaum.
Hay, S. I., Abajobir, A. A., Abate, K. H., Abbafati, C., Abbas, K. M.,
Abd-Allah, F., Abdulkader, R. S., Abdulle, A. M., Abebo, T. A.,
Abera, S. F., Aboyans, V., Abu-Raddad, L. J., Ackerman, I. N., Ade-
deji, I. A., Adetokunboh, O., Afshin, A., Aggarwal, R., Agrawal, S.,
Agrawal, A., & ...Murray, C. J. L. (2017). Global, regional, and
national disability-adjusted life-years (DALYs) for 333 diseases and
injuries and healthy life expectancy (HALE) for 195 countries
and territories, 1990–2016: A systematic analysis for the Global Bur-
den of Disease Study 2016. The Lancet,390(10100), 1260–1344.
https://doi.org/10.1016/S0140-6736(17)32130-X
Heidegger, M. (1927/1996). Being and time: A translation of Sein und
Zeit. State University of New York Press. https://doi.org/10.1353/
mln.1998.0037
Høffding, S., & Martiny, K. (2016). Framing a phenomenological
interview: What, why and how. Phenomenology and the Cognitive
Sciences,15(4), 539–564. https://doi.org/10.1007/s11097-015-
9433-z
Holloway, I., Sofaer-Bennett, B., & Walker, J. (2007). The stigmati-
sation of people with chronic back pain. Disability and Rehabilita-
tion,29(18), 1456–1464. https://doi.org/10.1080/0963
8280601107260
Huber, M., van Vliet, M., Giezenberg, M., Winkens, B., Heerkens, Y.,
Dagnelie, P. C., & Knottnerus, J. A. (2016). Towards a “patient-
centred” operationalisation of the new dynamic concept of health:
A mixed methods study. BMJ Open,6(1), e010091. https://doi.org/
10.1136/bmjopen-2015-010091
Hutto, D. D., & Abrahamson, D. (n.d.). Embodied, enactive education
conservative versus radical approaches. In S. L. Macrine & J.
Fugate (Eds.), Movement matters: How embodied cognition
informs teaching and learning. MIT Press.
Hutto, D. D., & Myin, E. (2013). Radicalizing enactivism: Basic
minds without content. MIT Press.
Hutto, D. D., & Myin, E. (2017). Evolving enactivism: Basic minds
meet content. MIT Press.
Jelic, A., Tieri, G., De Matteis, F., Babiloni, F., & Vecchiato, G.
(2016). The enactive approach to architectural experience: A neu-
rophysiological perspective on embodiment, motivation, and affor-
dances. Frontiers in Psychology,7(MAR), 1–20. https://doi.org/
10.3389/fpsyg.2016.00481
Kyselo, M. (2016). The enactive approachand disorders of the self—The
case of schizophrenia. Phenomenology and the Cognitive Sciences,
15(4), 591–616. https://doi.org/10.1007/s11097-015-9441-z
Laverty, S. M. (2003). Hermeneutic phenomenology and phenomen-
ology: A comparison of historical and methodological considera-
tions. International Journal of Qualitative Methods,2(3), 21–35.
https://doi.org/10.1177/160940690300200303
Lobo, L. (2019). Current alternatives on perceptual learning: Intro-
duction to special issue on post-cognitivist approaches to per-
ceptual learning. Adaptive Behavior,27(6), 355–362. https://
doi.org/10.1177/1059712319875147
Malterud, K., Siersma, V. D., & Guassora, A. D. (2016). Sample size
in qualitative interview studies. Qualitative Health Research,
26(13), 1753–1760. https://doi.org/10.1177/1049732315617444
Mart´ınez-Pern´ıa,D.,Huepe,D.,Huepe-Artigas,D.,Correia,R.,
Garc´ıa, S., & Beitia, M. (2016). Enactive approach and
dual-tasks for the treatment of severe behavioral and cognitive
impairment in a person with acquired brain injury: A case study.
14 International Journal of Qualitative Methods

Frontiers in Psychology,7(November), 1–8. https://doi.org/10.33
89/fpsyg.2016.01712
Martiny, K. (2016). Embodying investigations of cerebral palsy:
A case of open cognitive science (Issue June 2015) [Københavns
Universitet]. https://doi.org/10.13140/RG.2.1.1193.7529
Maturana, H. R., & Varela, F. J. (1992). The tree of knowledge:
The biological roots of human understanding (Rev. ed.). Shamb-
hala Publications Inc.
Merleau-Ponty, M. (1962). Phenomenology of perception. Routledge
& Kegan Paul.
Newen, A., Gallagher, S., & De Bruin, L. (2018). 4E cognition. In A.
Newen, L. De Bruin, & S. Gallagher (Eds.), Oxford handbook of
4E cognition (Vol. 1, Issue October). Oxford University Press.
https://doi.org/10.1093/oxfordhb/9780198735410.013.1
Nowell, L. S., Norris, J. M., White, D. E., & Moules, N. J. (2017).
Thematic analysis: Striving to meet the trustworthiness criteria.
International Journal of Qualitative Methods,16(1). https://doi.
org/10.1177/1609406917733847
Øberg, G. K., Normann, B., & Gallagher, S. (2015). Embodied-
enactive clinical reasoning in physical therapy. Physiotherapy The-
ory and Practice,31(4), 244–252. https://doi.org/10.3109/09593
985.2014.1002873
Ongaro, G., & Ward, D. (2017). An enactive account of placebo
effects. Biology & Philosophy,32(4), 507–533. https://doi.org/
10.1007/s10539-017-9572-4
Palinkas, L. A., Horwitz, S. M., Green, C. A., Wisdom, J. P., Duan, N.,
& Hoagwood, K. (2015). Purposeful sampling for qualitative data
collection and analysis in mixed method implementation research.
Administration and Policy in Mental Health and Mental Health
Services Research,42(5), 533–544. https://doi.org/10.1007/
s10488-013-0528-y
Peeters, A., & Segundo-Ortin, M. (2019). Misplacing memories?
An enactive approach to the virtual memory palace. Consciousness
and Cognition,76, 102834. https://doi.org/10.1016/j.concog.2019.
102834
Reid, D. A. (1996, January). Enactivism as a methodology. Proceed-
ings of the Twentieth Annual Conference of the International
Group for the Psychology of Mathematics Education (Vol. 4.,
pp. 203–210). Valencia, Spain.
Sandelowski, M. (2002). Reembodying qualitative inquiry. Qualita-
tive Health Research,12(1), 104–115. https://doi.org/10.1177/
1049732303255997
Slade, S. C., Molloy, E., & Keating, J. L. (2009). Stigma experienced
by people with nonspecific chronic low back pain: A qualitative
study. Pain Medicine,10(1), 143–154. https://doi.org/10.1111/j.
1526-4637.2008.00540.x
Smith, J. A. (2018). “Yes It Is Phenomenological”: A Reply to Max
Van Manen’s critique of interpretative phenomenological analysis.
Qualitative Health Research,28(12), 1955–1958. https://doi.org/
10.1177/1049732318799577
Stewart, J., Gapenne, O., & Di Paolo, E. A. (2010). Enaction.MITPress.
Stilwell, P. (2020). Exploring pain and clinical communication [PhD
Dissertation, Dalhousie University]. https://dalspace.library.dal.ca/
handle/10222/78346
Stilwell, P., & Harman, K. (2019). An enactive approach to pain:
Beyond the biopsychosocial model. Phenomenology and the
Cognitive Sciences,18(4), 637–665. https://doi.org/10.1007/
s11097-019-09624-7
Stilwell, P., Stilwell, C., Sabo, B., & Harman, K. (2020). Painful
metaphors: Enactivism and art in qualitative research. Medical
Humanities, medhum-2020-011874. https://doi.org/10.1136/med
hum-2020-011874
Thompson, E. (2005). Sensorimotor subjectivity and the enactive
approach to experience. Phenomenology and the Cognitive Sciences,
4(4), 407–427. https://doi.org/10.1007/s11097-005-9003-x
Thompson, E. (2007). Mind in life: Biology, phenomenology, and the
sciences of mind. The Belknap Press of Harvard University Press.
Thompson, E. (2017). Enaction without hagiography. Constructivist
Foundations,13(1), 65–108. https://doi.org/10.1080/15265160903
013829
Thompson, E., & Stapleton, M. (2009). Making sense of sense-
making: Reflections on enactive and extended mind theories.
Topoi,28(1), 23–30. https://doi.org/10.1007/s11245-008-9043-2
Thorne, S. (2016). Interpretive description: Qualitative research for
applied practice (2nd ed.). Routledge.
Thorne, S. (2020). Beyond theming: Making qualitative studies matter.
Nursing Inquiry,27(1), e12343. https://doi.org/10.1111/nin.12343
Tong, A., Sainsbury, P., & Craig, J. (2007). Consolidated criteria for
reporting qualitative research (COREQ): A 32-item checklist for
interviews and focus group. International Journal of Quality in
Health Care,19(6), 349–357.
van Manen, M. (1990). Researching lived experience: Human science
foranactionsensitivepedagogy. State Universityof New York Press.
van Manen, M. (2017). But is it phenomenology? Qualitative Health
Research,27(6), 775–779. https://doi.org/10.1177/10497323
17699570
Varela, F. J., & Shear, J. (1999). First-person methodologies: What,
why, how? Journal of Consciousness Studies,2–3, 1–14.
Varela, F., Thompson, E., & Rosch, E. (1991). The embodied mind:
Cognitive science and human experience. MIT Press. https://doi.
org/10.1111/j.1468-0149.1965.tb01386.x
Ward, D., Silverman, D., & Villalobos, M. (2017). Introduction:
The varieties of enactivism. Topoi,36(3), 365–375. https://doi.
org/10.1007/s11245-017-9484-6
Wideman, T. H., Edwards, R. R., Walton, D. M., Martel, M. O.,
Hudon, A., & Seminowicz, D. A. (2019). The multimodal assess-
ment model of pain. The Clinical Journal of Pain,35(3), 212–221.
https://doi.org/10.1097/AJP.0000000000000670
Zahavi, D. (2019a). Applied phenomenology: Why it is safe to ignore
the Epoch´e. Continental Philosophy Review. https://doi.org/10.
1007/s11007-019-09463-y
Zahavi, D. (2019b). Getting it quite wrong: Van Manen and Smith on
phenomenology. Qualitative Health Research,29(6), 900–907.
https://doi.org/10.1177/1049732318817547
Zahavi, D. (2019c). The practice of phenomenology: The case of Max
van Manen. Nursing Philosophy,July, 1–9. https://doi.org/10.
1111/nup.12276
Zahavi, D., & Martiny, K. M. M. (2019). Phenomenology in
nursing studies: New perspectives. International Journal of
Nursing Studies,93, 155–162. https://doi.org/10.1016/j.ijnurstu.
2019.01.014
Stilwell and Harman 15