Article

Bioenergetic exercises in inpatient treatment of Turkish immigrants with chronic somatoform disorders: A randomized, controlled study

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Abstract

The aim of this study was to examine whether bioenergetic exercises (BE) significantly influence the inpatient psychotherapeutic treatment results for Turkish immigrants with chronic somatoform disorders. In a 6-week randomized, prospective, controlled trial, we treated a sample of 128 Turkish patients: 64 were randomly assigned to BE and 64 participated in gymnastic exercises in lieu of BE. The Symptom Checklist (SCL-90-R) and State-Trait Anger Expression Inventory (STAXI) were employed. According to the intent-to-treat principle, the bioenergetic analysis group achieved significantly better treatment results on most of the SCL-90-R and STAXI scales. BE appears to improve symptoms of somatization, social insecurity, depressiveness, anxiety, and hostility in the inpatient therapy of subjects with chronic somatoform disorders. Reduction of the anger level and reduction in directing anger inwards, with a simultaneous increase of spontaneous outward emotional expression, could be expected.

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... Sixteen studies were included in the meta-analysis (online Fig. DS1). 4,[6][7][8][9][10]12,[39][40][41][42][43][44][45][46][47] The main characteristics are summarised in online Table DS1. Fourteen studies focused exclusively on somatoform disorder; two studies included patients with a range of mental disorders but were eligible because statistics for the somatoform disorder subgroup were reported separately. ...
... 39,40 All studies but one were published after 2000. 41 Ten studies were conducted in Germany, 4,6,7,9,12,39,40,[45][46][47] two in the USA, 8,10 two in The Netherlands, 43,44 one in Turkey, 42 and one in China. 41 ...
... The median duration of psychotherapy was 9.2 weeks (range 2-25) for all but one study which provided more than 250 sessions over on average 178 weeks. 46 In the TAU groups, patients received treatment for a median of 9 weeks (range 5.5-12). Other relevant information regarding the study characteristics and therapeutic interventions is reported in online Tables DS1 and DS2. ...
Article
Patients with severe somatoform disorder (in secondary and tertiary care) typically experience functional impairment associated with physical symptoms and mental distress. Although psychotherapy is the preferred treatment, its effectiveness remains to be demonstrated. To examine the effectiveness of psychotherapy for severe somatoform disorder in secondary and tertiary care compared with treatment as usual (TAU) but not waiting-list conditions. Main inclusion criteria were presence of a somatoform disorder according to established diagnostic criteria and receiving psychotherapy for somatoform disorder in secondary and tertiary care. Both randomised and non-randomised trials were included. The evaluated outcome domains were physical symptoms, psychological symptoms (depression, anxiety, anger, general symptoms) and functional impairment (health, life satisfaction, interpersonal problems, maladaptive cognitions and behaviour). Ten randomised and six non-randomised trials were included, comprising 890 patients receiving psychotherapy and 548 patients receiving TAU. Psychotherapy was more effective than TAU for physical symptoms (d = 0.80 v. d = 0.31, P<0.05) and functional impairment (d = 0.45 v. d = 0.15, P<0.01), but not for psychological symptoms (d = 0.75 v. d = 0.51, P = 0.21). These effects were maintained at follow-up. Overall findings suggest that psychotherapy is effective in severe somatoform disorder. Future randomised controlled studies should examine specific interventions and mechanisms of change.
... Twenty-nine records used self-report questionnaires; of these, 22 specified in which language the questionnaires were administered and whether the scales were adapted to the language of the participants (see Table 1). Thirteen articles (Mak and Zane, 2004;Nickel et al., 2006;Cwikel et al., 2008;Sachs et al., 2008;Shiroma and Alarcon, 2011;David et al., 2012;Heredia Montesinos et al., 2012;Mölsä et al., 2014Mölsä et al., , 2017Rask et al., 2015Rask et al., , 2016Spiller et al., 2016;Choi et al., 2017) used the Symptom Checklist-90-R (SCL-90-R) Somatization subscale (Derogatis, 1977). The SCL-90-R consists of nine subscales aimed at measuring psychopathology, including somatization. ...
... Frontiers in Psychology | www.frontiersin.org 1987; Lipowski, 1988;Escobar et al., 1989;Mumford et al., 1991;American Psychiatric Association, 1994Castillo et al., 1995;Escobar, 1995;Gureje et al., 1997;Kirmayer and Young, 1998;Silove et al., 1998;Simon et al., 1999;Mak and Zane, 2004;Aragona et al., 2005Aragona et al., , 2008Aragona et al., , 2010Aragona et al., , 2011Aragona et al., , 2012Aragona et al., , 2013Nickel et al., 2006;Kirmayer and Sartorius, 2007;Cwikel et al., 2008;Jackson and Kroenke, 2008;Sachs et al., 2008;Liberati et al., 2009;Bermejo et al., 2010;Beirens and Fontaine, 2011;Perruchoud and Redpath-Cross, 2011;Schweitzer et al., 2011;Shiroma and Alarcon, 2011;David et al., 2012;Deisenhammer et al., 2012;Heredia Montesinos et al., 2012;Stewart et al., 2012;Van Wyk et al., 2012;Bragazzi et al., 2014;Mölsä et al., 2014Mölsä et al., , 2017Rohlof et al., 2014;Haller et al., 2015;Rask et al., 2015Rask et al., , 2016Spiller et al., 2016;Choi et al., 2017;Dreher et al., 2017;Mendoza et al., 2017;Morawa et al., 2017;Radl-Karimi et al., 2018) were each used in three records. (Small et al., 2003), the Modified Somatic Perception Questionnaire (MSPQ) (Bragazzi et al., 2014), and the Brief Symptom Inventory (BSI) somatization subscale (Ritsner et al., 2000) were used in one article each. ...
... Finally, only two studies sought to evaluate the effects of treatment interventions on somatization in immigrants. In a 6-week randomized prospective controlled trial aimed at examining whether bioenergetic exercises significantly influenced the inpatient psychotherapeutic treatment results for 128 Turkish immigrants with chronic somatoform disorders, this activity appeared to improve symptoms of somatization (Nickel et al., 2006). A longitudinal nonrandomized study (Van Wyk et al., 2012) examined the impact of therapeutic interventions of mental health conducted with the aim of facilitating adjustment and acculturation for adult Burmese refugees within a naturalistic setting in Australia. ...
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Background: Somatic and psychopathological conditions (e.g., anxiety, depression, post-traumatic stress disorder, and somatization) are frequent among immigrants belonging to various ethnic groups. Worldwide findings on the epidemiology regarding specific mental conditions still vary with respect to different migration samples and migration contexts. This inconsistency also holds true in the incidence of somatization among migrants. We carried out a systematic review analyzing the relationship between migration and somatization by providing a qualitative data synthesis of original research articles on the topic. Methods: According to PRISMA guidelines, we conducted a systematic search of the literature on PubMed, Scopus, ISI Web of Science, PsycINFO, Google Scholar, and ScienceDirect. The articles were selected using multiple combinations of relevant search terms (e.g., defined somatization and related disorders, and migration status). Each database was searched systematically from January 2000 to December 2017. Results: The initial search identified 338 records, of which 42 research reports met the predefined inclusion criteria and were analyzed. Most studies (n = 38; 90%) were cross-sectional. The main findings of this study are that migrants with somatization exhibited more psychological distress, had an increased perceived need for healthcare service utilization, and reported more post-migration living difficulties and/or post-traumatic stress disorder than those without somatization. It was also found that specific individual features mediate the association between somatization and migration. The prevalence and correlates of somatization were found to vary across the immigrant groups, depending on cultural variation in reasons for migration, stress exposure, explanatory models of illness, coping, and other individual variables. Conclusion: Somatization is a challenge for health professionals due to its vague nature. In this regard, clinical management of immigrant patients should include further efforts to address emotional distress, with special attention to social, cultural, and linguistic differences.
... Grounding expresses the nature of the psycho-physical presence in the "here and now" in relation to the degree of physical and emotional support by the ground (the ability to be "down to earth," "feet on the ground") (Hilton, 2000;Meekums, 2002;Lowen, 2004;Guest et al., 2019). Enhancing grounding by structured movement interventions in conditions of depression (Pylvänäinen et al., 2015), post-trauma (Ko, 2017), and for somatoform disorders (Nickel et al., 2006) are in widespread clinical use among body psychotherapists and dance movement therapists. The assumption is that movement interventions for grounding improvement help to improve the individual's functioning, emotion regulation and emotional awareness (Guest et al., 2019). ...
... The analytical working method that Lowen developed is called bioenergetic analysis and involves assessment and intervention in the emotional realm through experiences in the body and movement (Lowen, 2004). The assumption underlying this method is that important life experiences are preserved not only in the mind but also in body posture, movement and breathing, and that physical, mental and emotional processes are intertwined (Nickel et al., 2006). Unlike gymnastic exercises, bioenergetic analysis is directed towards a person's emotional needs and their expression in the body (Nickel et al., 2006). ...
... The assumption underlying this method is that important life experiences are preserved not only in the mind but also in body posture, movement and breathing, and that physical, mental and emotional processes are intertwined (Nickel et al., 2006). Unlike gymnastic exercises, bioenergetic analysis is directed towards a person's emotional needs and their expression in the body (Nickel et al., 2006). Accordingly, improving grounding is a fundamental goal in this therapeutic approach (Miller, 2010). ...
Article
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The concept of grounding is accepted and common among dance movement therapists and body psychotherapists. It expresses a stable physical and emotional presence – “supported by the ground.” The assumption is that embodied emotional knowledge is expressed through the manner of physical holding and in the emotional experience in the world. However, along with the clinical use of the term, an empirical tool for examining grounding is lacking. The goal of the study was to examine the reliability and validity of an observation tool for assessing the quality of grounding, the Grounding Assessment Tool (GAT), which was created for the present study on the basis of theory, research, and clinical knowledge in the field. Forty three adult participants (age, M = 28.2 years, SD = 8.54) were recruited for an experimental and controlled session, the session included guided movement for approximately 10 min. The movement was recorded on video. The quality of the movement was rated by two raters and was scored using the GAT. The study findings indicated that the GAT is a reliable and valid tool – with good internal consistency (α = 0.850) and high interrater and intrarater reliability (Kendall’s ’range from 0.789 to 0.973 and intraclass correlation coefficient range from 0.967 to 1.00, respectively). The exploratory factor analysis showed that four factors are involved in the assessment of grounding quality: fluid and rhythmic movement, emotional expression in movement, pattern of foot placement, and lack of stability and weightiness. The results of this study expand the theoretical understanding of the concept of grounding. They contribute to the understanding of the benefits of body focus, dance and movement in psychotherapy and to validating body psychotherapy and dance movement therapy (DMT). The existence of a reliable and valid tool is essential for assessment and diagnostic processes, for formulating therapeutic goals focused on the body, and for examining their effectiveness.
... Various components of body-relatedness have been emphasized in clinical literature . Treatment programs for somatoform disorders for instance commonly emphasize body-relatedness components like awareness, acceptance, expression of the self, pain management, and adaptation to impairment [13,14,15,16,17,18]. Perceived body sensations, attention quality, attitude, and mind-body integration are seen as being of key importance for an appropriate questionnaire [3]. ...
... If patients learn and dare to distinguish themselves from others instead of trying to meet expectations, they may perhaps change to a higher level of emotional awareness, appreciating the complex experience of self and other [4]. These self-awareness components that are mentioned in the literature as expression of the self [15], attitude [3], self care [19], and emotional awareness [4], emphasize the importance of a positive feeling about the unique self to overcome the difficulties of somatoform disorder. ...
Article
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How a patient is connected with one's body is core to rehabilitation of somatoform disorder but a common model to describe body-relatedness is missing. The aim of our study was to investigate the components and hierarchical structure of body-relatedness as perceived by patients with severe somatoform disorder and their therapists. Interviews with patients and therapists yielded statements about components of body-relatedness. Patients and therapists individually sorted these statements according to similarity. Hierarchical cluster analysis was applied to these sortings. Analysis of variance was used to compare the perceived importance of the statements between patients and therapists. The hierarchical structure included 71 characteristics of body-relatedness. It consisted of three levels with eight clusters at the lowest level: 1) understanding, 2) acceptance, 3) adjustment, 4) respect for the body, 5) regulation, 6) confidence, 7) self-esteem, and 8) autonomy. The cluster 'understanding' was considered most important by patients and therapists. Patients valued 'regulating the body' more than therapists. According to patients with somatoform disorders and their therapists, body-relatedness includes awareness of the body and self by understanding, accepting and adjusting to bodily signals, by respecting and regulating the body, by confiding and esteeming oneself and by being autonomous. This definition and structure of body-relatedness may help professionals to improve interdisciplinary communication, assessment, and treatment, and it may help patients to better understand their symptoms and treatment. (German language abstract, Abstract S1; Spanish language abstract, Abstract S2).
... , Bleichhardt et al. 2004 im Vergleich zur Wartelistenkontrollgruppe. Fast alle Studien zeigten bessere Ergebnisse der Intervention als der Kontrollbedingung bezüglich Besserung der Zielsymptomatik und / oder medizinischer Inanspruchnahme. Nur Nickel et al. (2006) konnten keinen zusätzlichen Benefit bioenergetischer Übungen gegenüber Gymnastik zeigen, allerdings fand ihre Studie im stationären Setting einer multidisziplinären integrativen Therapie statt. Die positiven Ergebnisse lassen jedoch nicht generell auf einen positiven Effekt für die über 60-jährigen Teilnehmer schließen. ...
... Alle Studien untersuchten Gruppeninterventionen, acht von elf untersuchten ambulante Psychotherapie, davon fünf verhaltenstherapeutische Interventionen (Hellmann et al. 1990;Allen et al. 2006;Escobar et al. 2007;Martin et al. 2007). Drei Studien untersuchten stationäre interdisziplinäre Psychotherapie, davon zwei verhaltensthera- Nickel et al. 2006 Bioenergetische Übungen vs. Gymnastik zusätzlich zu stationärer interdisziplinärer PT in psychosomatischer Klinik, 12 Sitzungen in 6 Wochen ...
Article
Medically unexplained and somatoform complaints and disorders in the elderly: A systematic review of the literature Objective: To provide a systematic overview of the research concerning the frequency of medi-cally unexplained, somatoform complaints and disorders in the elderly, their risk factors, co-morbidity, course, management in primary and secondary care, and psychotherapy. Method: We evaluated 248 clinical and randomized trials, reviews, meta-analyses and practice guidelines for adult samples identified from "PubMed" and "PsycInfo" using the search terms "somatoform" OR "medically unexplained" OR "somatization" OR "somatisation" in com-bination with other terms for their relevance for the elderly. Other relevant trials were identi-fied from the references from these publications. Results: Medically unexplained, somatoform complaints and disorders occur in older persons and are more frequent in elderly women than in elderly men. Although many studies found no increased frequency of somatoform complaints in the elderly, based on present research we cannot draw final conclusions concerning the frequency of somatoform disorders and com-plaints in the elderly, and we cannot give evidence based recommendations for their treatment in primary and secondary care and psychotherapy. Discussion: This situation results from the special problems encountered in the diagnosis of somatoform complaints and disorders in the elderly, from problems in conceptualisation also found in younger adults, and from the lack of research concerning treatment focussed solely on the old and very old.
... (many with hyperlinks to the originals) on the EABP website (www.eabp.org) in the 'Research' section, which forms: 'The Research Base for Body Psychotherapy'. [31] Given these considerations, there have only been a few RCT studies in Body Psychotherapy (Lowe et al., 2001;Nickel et al., 2006;Röhricht & Priebe, 2006;Lahman et al., 2009;Lahman et al., 2010;Röhricht, Papadopoulos & Priebe, 2013). These are listed on the EABP website under the tab: ...
... There have also only been a few meta-studies about Body Psychotherapy research. John May published a 2005 review in the USABP Journal; [33] there was another research article published (in 2006) in German; [34] Given all these different considerations, there have only been a few (scientific) RCT studies in Body Psychotherapy ( Lowe et al., 2001;Nickel et al., 2006;Röhricht & Priebe, 2006;Lahman et al., 2009;Lahman et al., 2010;Röhricht, Papadopoulos & Priebe, 2013). These are listed on the EABP website under the tab: 'The evidence-base for Body Psychotherapy'. ...
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This three-part article looks at: Part 1: The 'history' of the EABP Science and Research Committee initiatives; Part 2: Different types of appropriate research for Body Psychotherapy; Part 3: Possibilities for future developments towards a better research culture in Body Psychotherapy. Research into the efficacy and effectiveness of the many and various different 'modalities' of psychotherapy is absolutely essential that if that branch (or 'mainstream') of psychotherapy is to have any 'standing' at all within the general psychotherapy community, or with universities, or with governments and ministries of health, and with the general public. Up until fairly recently, the field of Body Psychotherapy has been quite 'strong' on theory; it has also been 'good enough' (until recently) in the clinical practice of its many different modalities and methods; but has been decidedly 'poor' with respect to any proper research. In this article, different aspects of Body Psychotherapy research are explored. Research in the field of Body Psychotherapy is seen as an essential part of developing a professional culture, which has to be fostered both in training and in practice. We also need (much better => good) connections with research departments in universities. Therefore, apart from being sufficiently trained in and now (hopefully) being able to demonstrate the 'professional competencies' [2] of a Body Psychotherapist, as a 'clinician', there is an additional role (or set of competencies)-as a potential 'researcher-practitioner'-that now have to be developed and fostered, especially as there are often negative perceptions of research-or lip-service paid towards the need for research-to be found within the psychotherapy community in general, and especially within the humanistic and body-oriented (somatic) psychotherapies. Some of this wider background and some of the more recent developments with respect to research into Body Psychotherapy are mentioned, but this article is focussed more on the development of a solid 'research-practitioner' culture in Body Psychotherapy, now and especially for the future. Body Psychotherapy (or Somatic Psychology as it is also known in the USA, Australia, etc.) is a well-established and unique set of psychotherapeutic approaches and body-related procedures, which have developed separately over the last 100 years or so, have come together into one integrative branch (or mainstream) of psychotherapy. The foundations of Body Psychotherapy are: a holistic concept of human nature; a bio-psycho-social model of disease ; somatically-oriented considerations of aspects of developmental psychology, attachment theory, cognition theory (an 'embodied mind') and various neuro-psychological scientific theories; and a general theory and various types of praxis in psychotherapy, which, in addition to conscious and unconscious cognitive and emotional processes, consistently encompasses processes of body experience, body expression and body communication; and methodically includes the client's body in aspects of their 'treatment' in a variety of ways. Body
... Accordingly, new and innovative treatment approaches are required to address the specific predicament of this patient group. In previous studies specific psychosomatic disorders such as tension headache, IBS, Asthma and also in one study somatoform disorders in a group of inpatients were successfully treated with a symptom-focused approach of body-oriented psychological therapy (BOPT) [13][14][15][16][17]. The rational for this approach is based upon efforts to enrich, widen and complete patient's explanatory beliefs by steering them towards the direction of a more inclusive bio-psycho-social model whilst exploring new ways of relating to the somatic symptoms in order to alleviate distress. ...
... The role of the therapist here is to help the patients to develop an alternative conceptualization of the body, shifting from a judgemental perspective (body being perceived as a mere hostile object, causing trouble and controlling the self) to a more holistic perspective of self-respect and acceptance. The final phase (session [14][15][16][17][18][19][20] of therapy is characterised by narrative re-configuration. Patients are trained/guided to reduce the catastrophic effects of somatic sensations and to increase the acceptance of psychosocial causal attributions. ...
Article
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Background Clinical outcomes for patients with heterogeneous somatoform disorder (bodily distress disorder, including medically unexplained symptoms) are suboptimal, new treatments are required to improve acceptance. Body-oriented psychological therapy approaches have been identified as potentially beneficial additions to the portfolio of treatments. This study was aiming to assess the acceptability, the potential benefits, and associated change processes of manualised group body psychotherapy (BPT) for outpatients with Somatoform Disorder. Methods A randomized controlled feasibility trial was carried out with follow-up at 6 months after baseline assessments using the Primary Health Questionnaire (PHQ), Somatic Symptom Screening Scale (SOMS-7), quality of life ratings (Short-Form Health Survey-36; SF-36) and body image measures (Dresden Body Image Questionnaire). Acceptance was assessed with the Helping Alliance Scale (HAS). Results A total of 24 patients were recruited to participate. Sixteen patients were randomly assigned to receive either manualised BPT or TAU, eight patients were directly assigned to BPT. Drop-out rates were acceptable, patients reported to be highly satisfied with the group intervention. Somatic symptom levels reduced significantly in the BPT group. Additionally, a significant effect on self-acceptance and the mental component of quality of life was observed. Conclusion Group body psychotherapy is a feasible and acceptable treatment for patients with somatoform disorder and a larger trial studying the effectiveness of BPT in these patients should be conducted. Trial registration Retrospectively registered SRCTN12277345; Trial Registraton Date: 27/03/2019.
... (many with hyperlinks to the originals) on the EABP website (www.eabp.org) in the 'Research' section, which forms: 'The Research Base for Body Psychotherapy'. [31] Given these considerations, there have only been a few RCT studies in Body Psychotherapy (Lowe et al., 2001;Nickel et al., 2006;Röhricht & Priebe, 2006;Lahman et al., 2009;Lahman et al., 2010;Röhricht, Papadopoulos & Priebe, 2013). These are listed on the EABP website under the tab: ...
... There have also only been a few meta-studies about Body Psychotherapy research. John May published a 2005 review in the USABP Journal; [33] there was another research article published (in 2006) in German; [34] Given all these different considerations, there have only been a few (scientific) RCT studies in Body Psychotherapy ( Lowe et al., 2001;Nickel et al., 2006;Röhricht & Priebe, 2006;Lahman et al., 2009;Lahman et al., 2010;Röhricht, Papadopoulos & Priebe, 2013). These are listed on the EABP website under the tab: 'The evidence-base for Body Psychotherapy'. ...
Article
Full-text available
This three-part article looks at: Part 1: The 'history' of the EABP Science and Research Committee initiatives; Part 2: Different types of appropriate research for Body Psychotherapy; Part 3: Possibilities for future developments towards a better research culture in Body Psychotherapy. Research into the efficacy and effectiveness of the many and various different 'modalities' of psychotherapy is absolutely essential that if that branch (or 'mainstream') of psychotherapy is to have any 'standing' at all within the general psychotherapy community, or with universities, or with governments and ministries of health, and with the general public. Up until fairly recently, the field of Body Psychotherapy has been quite 'strong' on theory; it has also been 'good enough' (until recently) in the clinical practice of its many different modalities and methods; but has been decidedly 'poor' with respect to any proper research. In this article, different aspects of Body Psychotherapy research are explored. Research in the field of Body Psychotherapy is seen as an essential part of developing a professional culture, which has to be fostered both in training and in practice. We also need (much better => good) connections with research departments in universities. Therefore, apart from being sufficiently trained in and now (hopefully) being able to demonstrate the 'professional competencies' [2] of a Body Psychotherapist, as a 'clinician', there is an additional role (or set of competencies)-as a potential 'researcher-practitioner'-that now have to be developed and fostered, especially as there are often negative perceptions of research-or lip-service paid towards the need for research-to be found within the psychotherapy community in general, and especially within the humanistic and body-oriented (somatic) psychotherapies. Some of this wider background and some of the more recent developments with respect to research into Body Psychotherapy are mentioned, but this article is focussed more on the development of a solid 'research-practitioner' culture in Body Psychotherapy, now and especially for the future. Body Psychotherapy (or Somatic Psychology as it is also known in the USA, Australia, etc.) is a well-established and unique set of psychotherapeutic approaches and body-related procedures, which have developed separately over the last 100 years or so, have come together into one integrative branch (or mainstream) of psychotherapy. The foundations of Body Psychotherapy are: a holistic concept of human nature; a bio-psycho-social model of disease ; somatically-oriented considerations of aspects of developmental psychology, attachment theory, cognition theory (an 'embodied mind') and various neuro-psychological scientific theories; and a general theory and various types of praxis in psychotherapy, which, in addition to conscious and unconscious cognitive and emotional processes, consistently encompasses processes of body experience, body expression and body communication; and methodically includes the client's body in aspects of their 'treatment' in a variety of ways. Body
... Previous studies showed that even relatively short periods of exercise (10 days, (Dimeo et al., 2001)) can be beneficial. There is less research in the effects of exercise in somatoform spectrum disorders, and the few published studies point toward symptom reduction (Kornreich, 2006;Nickel et al., 2006). More widely, 'functional somatic syndromes', medical conditions associated with somatoform disorders such as chronic pain, fibromyalgia and chronic fatigue syndrome have been targeted for exercise interventions. ...
... So far, results also point towards symptom reduction connected to exercise: logistic regression analyses by Strohle et al. (2007) demonstrate associations between regular exercise and lower incidence of somatoform disorders in the general population, similar results are reported by Asztalos et al. (2010). Nickel et al. (2006) demonstrate a significant decrease of somatization after 6 weeks of a program combining exercise and other therapeutic elements ("bioenergetic exercise") in persons with somatoform disorders. However, Allen et al. (2002) emphasize that the observed effects of psychosocial treatments (including exercise interventions) are often small and not clinically relevant. ...
Article
Exercise leads to symptom reduction in affective disorders and functional somatic syndromes. Biological hypotheses of underlying mechanisms include serotonergic and immunological pathways. We aimed to investigate biological features in persons with major depression and somatoform syndromes, and to analyze effects of short-term graded exercise on these parameters. Baseline values for depressive and somatoform symptoms, tryptophan, kynurenine, 5-hydroxyindoleacetic acid, neopterin and interleukin-6 were compared with those after one week of increased and one week of reduced physical activity. Thirty-eight persons with major depression, 27 persons with a minimum of 6-8 somatoform symptoms, and 48 healthy controls participated in the study. Depressive and somatoform symptoms were reduced after the active week, and an interaction pointed towards group-specific reduction of psychopathology. Participants with major depression had lower levels of kynurenine compared to controls, with intermediate concentrations in somatoform patients. There were no systematic associations of symptom improvement with biological changes. A possible limitation of the design is that a control condition with low physical activity, but no placebo condition was included. People with multiple somatoform symptoms and major depression benefit from a short and low-graded exercise intervention. These effects do not seem to be mediated by changes in serotonergic and inflammatory parameters.
... Particularly, a number of authors draw on a long tradition of research 294 H. Payne (Shaw, 2003) and theory (Mathew, 1998;Soth, 2002;Staunton, 2002) on the body in psychotherapy to discuss the transferential and counter-transferential issues in the therapeutic relationship. In the only randomised controlled study (Nickel et al., 2006) found bioenergetics (one technique in body psychotherapy) reduced the somatisation of symptoms experienced by Turkish immigrant men. ...
... European Journal of Psychotherapy and Counselling 295 Keel, Bodoky, Gerhard, & Muller, 1998;Majumdar et al., 2002;Mueller-Braunschweig, 1998;Nickel et al., 2006;Taggart et al., 2003;Thulin, 1997) can relieve MUS in many cases. One approach should not be favoured over another, however. ...
Article
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This paper presents a literature review of research into interventions with people with medically unexplained symptoms (MUS). The review forms the basis for the research questions, provides a rationale for an innovative approach (The BodyMind Approach/BMA) to intervention for patients with anxiety/depression with MUS and justification for the most suitable methodology for the pilot study. An overview of the problem is provided as backdrop to the rationale. Patients with MUS make up a substantial percentage of all primary care (PC) consultations, are notoriously difficult to treat and make huge demands on resources. A pilot study took place in the National Health Service (NHS) in the UK between 2004 and 2007 receiving full NHS ethical approval for delivery in PC. Following on from the systematic search of the literature the argument for, and description of, the BMA (based on the discipline Authentic Movement from within the field of Dance Movement Psychotherapy) to group psychotherapy is presented. The intervention emphasises learning in a verbal and non-verbal-integrated approach, encouraging an awareness of the inter-relationship between body, self and mind. It uses meditative, mindful movement deriving from natural body gestures and posture, relaxation, massage promoting movement metaphor to change beliefs and to understand the meaning of the symptoms within a self-managing framework. The symptom is seen as a metaphor for connections between body, self and mind. It is founded on the principle that bodily experience can be an avenue for meaning-making in personal development leading to increased well-being; better coping strategies; changes in perception of the body-felt sense and improved lifestyle choices and behaviours. The research sought to answer a number of questions concerning the intervention such as benefits, process and outcomes from the perspective of participants and the facilitator. The methodology selected was mixed, using both qualitative (analysis of pre, post and follow-up interviews with participants and facilitator's process recordings); and quantitative whereby standardised outcome measures were completed by patients pre/during/post intervention and at follow-up. Medication, secondary referral and GP visits were also quantified pre/post-intervention and at follow-up. Findings supported the hypothesis, and went beyond it, revealing a reduction in, and disappearance of, symptoms to a significant effect.
... We certainly attempted to pay attention to the specific cultural factors of the patient population, mostly from rural Turkey, and adjusted the intervention accordingly. Still, one must consider if more intensive therapy might have yielded better results, although the limited evidence available regarding in-patient treatment of migrant patients suffering from chronic pain, even with a much higher intensity of treatment than ours, has not shown impressive results [63][64][65][66]. ...
Article
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The incidence of chronic pain is higher among immigrants in Europe than among the native European population. Therapeutic interventions in this population are far less effective than in patients for whom these programmes were originally developed. In a randomised trial, we investigated whether a cognitive behavioural treatment (CBT) programme supplemented with culturally sensitive aspects (CsCBT) improves pain intensity, pain disability and quality of life among immigrant patients, compared with a treatment of culturally sensitive exercise therapy (CsET) alone. Furthermore, we investigated whether healthcare costs would decrease. First-generation Turkish immigrants residing in Switzerland (20-65 years of age) who suffered from chronic pain were enrolled in the trial. Patients were randomised to attend either CsCBT or CsET. The CsCBT intervention was based upon a manualised cognitive-behavioural group treatment programme for chronic pain patients and adapted to the needs of a Turkish immigrant population. The CsET intervention was based on principles of exercise therapy for treatment of nonspecific low back pain. A total of 116 outpatients were recruited between October 2004 and November 2006. The intervention was completed by 89 patients (77%). A total of 78 subjects (67%) completed follow-up, 12 months after the completion of the intervention programme. The intervention showed no effects in reducing pain, pain disability or quality of life. The analysis of healthcare utilisation yielded no intervention effect. Cognitive behavioural intervention is feasible with immigrants with chronic disabling pain, but the evidence-based CBT programme, as well as exercise therapy supplemented with culturally sensitive aspects, showed no improvement.
... Twelve articles with paediatric subjects were identified ( Table 2). Seven articles were excluded on the basis that it was unclear if subjects had functional or organic motor symptoms [8][9][10][11][12][13][14]. These, together with the remaining excluded articles that were reviewed in full are detailed in supplemental online material. ...
... [63][64][65] Physical approaches are also being used as an adjunct to psychotherapy, again with a view to brain retraining. [66][67][68][69] From a lifestyle perspective, there is a need for further research, as discussed previously, to investigate which aspects can be used most effectively to retrain a sensitized nervous system and restore normal brain processing. ...
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This article reviews both traditional and emerging aspects of pain medicine within the context of a "whole-person," lifestyle-based approach. This is consistent with contemporary systems theory formulations of chronic disease in general. A traditional approach sees ongoing pain as a fixed biological disorder and much of its management as the task of medically palliating or learning to cope. Within this framework, chronic pain has been conceptualized by some authors as a disease in its own right based on underlying alterations in nervous system processing. This explains the stronger correlation of chronic pain with neural sensitization than with structural change in bodily tissues. However, recent research findings are expanding current views of causation and management, and there is now a growing recognition that pain-related nervous system changes are potentially reversible. The so-called paradox of plasticity proposes that the same property of changeability in the nervous system that allows chronic pain to develop can also lead to its resolution. Nutrition and personal story are key aspects of an emerging whole-person approach and can be combined with traditional biomedical and cognitive behavioral interventions to enhance therapeutic gains. An interesting hypothesis deriving from recent research is that multiple unhelpful aspects of lifestyle contribute to systemic metaflammation, which in turn spills over to sensitize the nervous system and facilitate pain-related transmission. Therefore, addressing lifestyle factors therapeutically has the potential to desensitize the nervous system and reduce pain.
... Conclusie: Er is dringend onderzoek nodig naar de effecten van reguliere, GGZ-gerelateerde behandeling van somatoforme stoornissen bij allochtonen alsmede naar de effecten van cultuurgevoelige, op good practices gebaseerde GGZ-behandeling van somatoforme stoornissen bij deze groepen. Bij dit laatste verdient het aanbeveling aan te sluiten bij de bevindingen van Kocken et al. (2008) en Nickel et al. (2006), en ook aandacht te besteden aan de langere-termijneffecten. ...
... Another recent RCT applied robust methodology in order to investigate the specific effects of another form of BOP named 'Bioenergetic exercises from Bioenergetic Analysis' in a group of Turkish inpatients with chronic somatoform disorder. They compared BOP with a control condition of gymnastic exercises (Nickel et al., 2006). The SCL-90-R measures and records of the intensity of anger and expression of anger showed significantly greater improvements in the group receiving the experimental BOP condition. ...
Article
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The heterogeneous field of body oriented psychotherapy (BOP) provides a range of unique contributions for the treatment of mental disorders. Practice based clinical evidence and a few empirical studies point towards good efficacy of these non-verbal intervention strategies. This is particularly relevant for those disorders with body image aberration and other body-related psychopathology, but also for mental disorders with limited treatment response to traditional talking therapies, e.g. somatoform disorders/medically unexplained syndromes, PTSD, anorexia nervosa or chronic schizophrenia. However, the evidence base is not yet sufficiently developed in order to get BOP recognised as suitable mainstream treatment by national health services and their commissioning bodies. Strong academic links are urgently required in order to support practitioners in their efforts to evaluate the clinical work in systematic research. The field would greatly benefit from the development of international higher education training in integrated clinical body psychotherapy, enabling practitioners to obtain a master's degree. From a scientific perspective, projects on the interface between neuroscience and psychotherapy research should be conducted in order to understand more fully the therapeutic processes in BOP, particularly with regard to emotional processing, movement behaviour and body/self perception. Qualitative research is needed to further investigate the specific interactive therapeutic relationship, the dynamics of touch in psychotherapy and the additional self-helping potential of creative/arts therapy components. Provided that these requirements will be fulfilled, BOP could be established as one of the main psychotherapeutic modalities in clinical care, alongside other mainstream schools such as psychodynamic, cognitive-behavioural and systemic.
... The use of antipsychotic drugs and their connection with weight gain and metabolic abnormalities may lead to negative body image and low self-esteem (De Hert et al., 2006;Loh et al., 2008). Therefore, alternative treatments other than medication and cognitive behavior therapy such as body orientation processes in psychotherapy, regular exercise or aerobic dance therapy may result to positive psychological outcomes concerning body image and offer an alternative or complementary treatment option for patients with psychiatric disorders (Burgess et al., 2006;Nickel et al., 2006). ...
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The aim of this study was to examine the effect of an exercise program on improving self-image and self-esteem of thirty (30) patients with schizophrenia. The sample was separated randomly in three groups of 10 individuals, that is, a control group, an exercise observation with tokens group (experiment group A) and an actual exercise with tokens group (experiment group B). Data from patients with schizophrenia collected using the Body-Cathexis Scale and the Rosenberg Self-Esteem Scale which were selected and administered to participants prior and after the application of the exercise program. The 8 weeks duration of the exercise program was conducted combining physical activity with behavioristic treatment so as to promote exercise behavior and minimize drop out risk. The results reported that the physical activity program had positive effects in experiment group B participants compared to those of the experiment group A and control group as felling more vigorous and with higher self-esteem, leading to an improved personal care and less social limitations.
... The use of antipsychotic drugs and their connection with weight gain and metabolic abnormalities may lead to negative body image and low self-esteem (De Hert et al., 2006;Loh et al., 2008). Therefore, alternative treatments other than medication and cognitive behavior therapy such as body orientation processes in psychotherapy, regular exercise or aerobic dance therapy may result to positive psychological outcomes concerning body image and offer an alternative or complementary treatment option for patients with psychiatric disorders (Burgess et al., 2006;Nickel et al., 2006). ...
Article
Full-text available
The aim of this study was to examine the effect of an exercise program on improving self-image and self-esteem of thirty (30) patients with schizophrenia. The sample was separated randomly in three groups of 10 individuals, that is, a control group, an exercise observation with tokens group (experiment group A) and an actual exercise with tokens group (experiment group B). Data from patients with schizophrenia collected using the Body-Cathexis Scale and the Rosenberg Self-Esteem Scale which were selected and administered to participants prior and after the application of the exercise program. The 8 weeks duration of the exercise program was conducted combining physical activity with behavioristic treatment so as to promote exercise behavior and minimize drop out risk. The results reported that the physical activity program had positive effects in experiment group B participants compared to those of the experiment group A and control group as felling more vigorous and with higher self-esteem, leading to an improved personal care and less social limitations.
... The use of antipsychotic drugs and their connection with weight gain and metabolic abnormalities may lead to negative body image and low self-esteem (De Hert et al., 2006;Loh et al., 2008). Therefore, alternative treatments other than medication and cognitive behavior therapy such as body orientation processes in psychotherapy, regular exercise or aerobic dance therapy may result to positive psychological outcomes concerning body image and offer an alternative or complementary treatment option for patients with psychiatric disorders (Burgess et al., 2006;Nickel et al., 2006). ...
Article
Full-text available
The aim of this study was to examine the effect of an exercise program on improving self-image and self-esteem of thirty (30) patients with schizophrenia. The sample was separated randomly in three groups of 10 individuals, that is, a control group, an exercise observation with tokens group (experiment group A) and an actual exercise with tokens group (experiment group B). Data from patients with schizophrenia collected using the Body-Cathexis Scale and the Rosenberg Self-Esteem Scale which were selected and administered to participants prior and after the application of the exercise program. The 8 weeks duration of the exercise program was conducted combining physical activity with behavioristic treatment so as to promote exercise behavior and minimize drop out risk. The results reported that the physical activity program had positive effects in experiment group B participants compared to those of the experiment group A and control group as felling more vigorous and with higher self-esteem, leading to an improved personal care and less social limitations.
... Regarding cellular immunity, there is some evidence that regular exercise may increase the number of lymphocytes and monocytes in healthy individuals, although inconsistent findings have been reported with respect to exercise-induced changes in specific lymphocyte subtype counts (Cosgrove et al., 2012;Koizumi et al., 2003;LaPerriere et al., 1994;Shimizu et al., 2011Shimizu et al., , 2008Yeh et al., 2006). Both somatization syndromes and major depression may be accompanied by reduced physical activity, and interventions which include physical activity have been shown to reduce the severity of depressive and somatoform symptoms (Nickel et al., 2006;Penedo and Dahn, 2005). ...
... The results from the small sample of this pilot are in line with previous studies, 14,16,[29][30][31] indicating that BOPT is a promising intervention for patients with MUS, particularly those with undifferentiated somatoform pain disorder, who frequently attend primary care. There was an early reduction in the reporting of somatic symptom severity and also a significant reduction in service use for the year after therapy. ...
Article
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Aims and method Service utilisation and clinical outcomes of a newly developed specialist primary-secondary care liaison clinic for patients with medically unexplained symptoms (MUS) were evaluated in a cross-sectional and feasibility pilot study. The impact of body-oriented psychological therapy (BOPT) was explored in a small cohort of patients with an identified somatoform disorder. Results Of 147 consecutive referrals, 113 patients engaged with the assessment process. Of patients with MUS, 42% (n = 45) had a primary diagnosis of somatoform disorder, 36% (n = 38) depressive disorder, and depressive symptoms (even subsyndromal) mediated the effect of somatic symptoms. A marked variation of presenting complaints and service utilisation across ethnic groups was noted. A significant reduction in somatic symptom levels and service utilisation was achieved for patients undergoing BOPT. Clinical implications A high proportion of patients with MUS have undiagnosed and therefore untreated mental disorders. New and locally derived collaborative care models of active engagement in primary care settings are required. Patients with somatoform disorder may benefit from BOPT; this requires further evaluation in adequately powered clinical trials.
... ), and the number needed to treat was 6.4 (95% CI: 0.89–11.890). Tertiary care Bleichhardt et al. 2004 (82) Germany 191 Somatization syndrome DSM-IV somatoform symptoms Individual therapy and problem-focused group therapy, assertiveness training and, for other therapy modules focusing on comorbid disorders 34 waiting list controls Long-term improvements in number of somatoform symptoms, subjective health status, life satisfaction, visits, anxiety, and depression Nickel et al. 2006 (83) Germany 128 Turkish immigrants with chronic somatoform disorders Bioenergetics exercises (BE) ...
Data
anti-depressants" with Boolean operators AND and OR on the entire text. Searches were confined to literature in English. Results: Studies were carried out in primary, secondary, and tertiary care settings. The therapists ranged from medical specialists, psychiatrists, and psychologists to primary care physicians. Three types of interventions (antidepressant medication, cognitive behavioral therapy (CBT), and other nonspecific interventions) were supported by evidence on the efficacy of treatment for patients with medically unexplained symptoms. There is more level I evidence for CBT compared with the amount for other approaches. There was only one study reported from the developing world. Conclusions: CBT is efficacious for either symptom syndromes or for the broader category of medically unexplained symptoms, reducing physical symptoms, psychological distress, and disability. A relatively small number of studies were carried out in primary care, but the trend has been changing over the last decade. No studies have compared pharmacological and psychological treatments. Most trials assessed only short-term outcomes. Use of divergent selection procedures, interventions, outcome measures, and instruments, and other methodological differences observed in these studies hamper the ability to compare treatment effects across studies.
... Patients who are treated with BPT appear to benefit in terms of improved general well-being, reduced motor tension and enhanced activity levels. There is substantial evidence for the efficacy of Functional Relaxation on psychosomatic disorders (asthma, tension headache, irritable bowel syndrome) and evidence from one randomised controlled trial (RCT), that Bioenergetic Analysis may be specifically effective for somatoform disorder patients (Nickel et al., 2006). At least three RCTs have demonstrated that chronic schizophrenia patients with predominant negative symptoms respond to manualised BPT (or body-oriented psychological intervention strategies such as movement therapy), improving patients' psychomotor behaviour and social as well as emotional interaction; a multicentre trial across the UK will be completed in 2014 (Nitsun, Stapleton, & Bender, 1974;Priebe et al., 2013;Röhricht & Priebe, 2006). ...
Article
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The evidence base for the effectiveness of body psychotherapy (BPT) in the treatment of severe mental disorders has improved much over the last decade; both methodologically robust randomised controlled trials and also qualitative studies demonstrated how BPT can contribute substantially to the treatment portfolio and help address chronic conditions and disorder-specific psychopathology. This paper summarises how BPT is utilised for the treating a range of severe mental disorders including mania and schizophreniform psychosis, personality disorder and severe anxiety as well as depressive disorders. The intervention strategies are related to specific body-oriented phenomena, i.e. disturbances of body experience and body-mind regulation disorders; the approaches are described in the context of a new theoretical paradigm of BPT as embodied and embedded relational psychotherapy, aiming to facilitate improved self/affect regulation. For each specific illness, a short sketch of the cardinal symptoms and body image phenomenology is followed by a summary of disorder-specific intervention strategies of BPT for severe mental illness.
... Lowen described a physiologically and physically stable person as the one who "has his feet on the ground" and "who is in touch with reality" [18]. Interventions targeted at increasing the level of groundedness using movement techniques are in everyday clinical use by psychotherapists and dance movement therapists who treat a variety of patients with emotional impairments manifesting in physical impairments and symptoms, such as depression, post-traumatic stress disorder, and somatoform disorders [19][20][21]. Movement interventions for enhancing grounding are based on the rationale that the body and mind are connected. Thus, therapeutic interventions should combine the muscular and nervous systems with the cognition and emotions of an individual [22]. ...
... Bioenergetic exercises in inpatient treatment of Turkish immigrants with chronic somatoform disorders: A randomized, controlled study, Marius Nickel e outros (Nickel et al., 2006). Avalia os efeitos de uma atividade corporal grupal de exercícios de bioenergética no tratamento psicoterapêutico de pacientes imigrantes turcos. ...
Article
Com o objetivo de explicitar e discutir as publicacoes existentes acerca do Grupo de Movimento, uma tecnica de trabalho grupal oriunda da psicoterapia corporal e vinculada, de alguma forma, ao pensamento de Wilhelm Reich (1897-1957), realizou-se o levantamento dos estudos publicados sobre o assunto a partir de buscas em bases de dados em sites cientificos, institutos de formacao reichiana e neorreichiana, e revistas de abordagem corporal. Foram encontrados 26 trabalhos: sete dissertacoes de mestrado, quatro monografias, tres artigos e doze resumos. Desse acervo, analisou-se aspectos como: forma de publicacao, tipo de participante, papel do coordenador do grupo, enfoque metodologico e resultados obtidos. Dado o estado da arte encontrado, as producoes indicaram a presenca de contribuicoes positivas desencadeadas pelo Grupo de Movimento, bem como uma estrategia de trabalho ainda em construcao, carente de material investigativo e com pouco rigor cientifico. Nesse sentido, algumas orientacoes de pesquisa foram discutidas e sugeridas.
... Sowohl in Einzel-wie in Gruppentherapie sind Körperwahrnehmung und Körperpsychotherapie (KPT) ein wichtiger und besonders geeigneter Bestandteil, sodass auch eine Manual-gestützte KPT-Gruppentherapie entwickelt wurde (Röhricht, 2011a). Bisherige Ergebnisse zeigen, dass eine körperpsychotherapeutische Behandlung bei SSD erfolgversprechend ist (Nickel et al., 2006;Röhricht et al., 2019). ...
Article
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Mit der Klage über ausschliesslich körperliche Beschwerden und einer strikten Ablehnung psychosomatischer Erklärungen begegnen uns die als schwierig geltenden PatientInnen mit somatoformen Störungen (SSD). Das Schmerzerleben wird zum Beispiel nur körperlich wahrgenommen und sie finden dafür keinen seelisch-gefühlsmässigen Beziehungskontext (Alexithymie). Ätiologische Überlegungen helfen uns bei einem tieferen Verständnis ihres spezifisch leidvoll-schmerzhaften Körpererlebens und ihrer Beziehungsformen. SSD-PatientInnen haben meist keine liebevolle, körperlich-emotionale und seelische Resonanz bei frühen Bezugspersonen erlebt und dabei gelernt, ihren Körper als (dysfunktionales) Objekt zu betrachten. Körperpsychotherapie kann diesen Symptomfokus gut aufgreifen. Es werden Prinzipien und Möglichkeiten einer differenzierten Förderung der Körperwahrnehmung als Basis für hilfreiche Veränderungen bei SSD beschrieben – und soweit vorhanden, entwicklungspsychologische und neurobiologische Zusammenhänge ausgeführt. Die neue Selbstwahrnehmung sowie erklärenden Informationen verhelfen Betroffenen zu einem selbstbestimmteren/wirksameren Umgang mit ihren Störungen und zu neuen Möglichkeiten, Gefühle für die Gestaltung von Beziehungen und ihres Lebens zu nutzen. Vorhandene Studien sprechen dafür, dass ein Vorgehen mit den hier beschriebenen Grundprinzipien hilfreich sein kann.
... Det å identifisere adferd som øker smerter og stress og finne frem til adferd som bedrer helsen, blir vektlagt (Winterowd et al., 2003). I tillegg til kognitiv terapi består KSI av kroppslige øvelser som i tidligere studier har vist positiv effekt på smerter, depresjon og angst (Haugstad et al., 2008;Nickel et al., 2006). Det ble også brukt progressiv muskelavspenning i intervensjonen (Conrad & Roth, 2007). ...
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ABSTRACT Cognitive and Somatic Intervention - a non randomized clinical trial Introduction: The purpose of this study was to investigate changes in work participation and health related quality of life after an outpatient cognitive and somatic «return to work» intervention. Materials/Methods: 47 patients with musculoskeletal pain and psychological symptoms were included in the study Results: 17 % of the participants worked full time at inclusion. At one year follow up this percentage increased to 40 %, at 2,5–5,5 years to 39 %. However, the percentage of participants receiving social security benefits increased significantly at follow up. Quality of life improved significantly after intervention. Conclusion: Cognitive and somatic intervention could be a factor to increase work participation and quality of life for patients with musculoskeletal pain and psychological symptoms. We need randomized controlled studies to conclude about the effectiveness of this intervention. Keywords: cognitive behavioral therapy, multidisciplinary intervention, return to work GRUPPEBASERT KOGNITIV OG SOMATISK INTERVENSJON – En klinisk forløpsstudie KARINE BOKERØD HANSEN fysioterapeut MSc, Poliklinikken «Raskere tilbake», Sunnaas sykehus, GRO KILLI HAUGSTAD fysioterapeut, Ph.d, førsteamanuensis, Institutt for fysioterapi, Høgskolen i Oslo og Akershus, SOLVEIG GRENNESS psykolog, Lilleaker psykologpraksis, BIRGITTA ERIXON HALCK klinisk sosionom, Poliklinikken «Raskere tilbake», Sunnaas sykehus, ARVE OPHEIM fysioterapeut, Ph.d, Forskningsavdelingen Sunnaas sykehus / Rehabiliteringsmedisin Shalgrenska Akademin, Gøteborgs Universitet, TOR S. HAUGSTAD dr. med., spesialist i nevrologi, Avdelingsoverlege, Sunnaas sykehus. KONTAKT KarineBokerod.Hansen@sunnaas.no
... The findings are in line with previous studies that explored health benefits of BOPT for MUS, 24 somatoform disorders, 16,25 and specific 'psychosomatic' disorders. [26][27][28] Evidence-based approaches at primary and secondary care level are few for patients with MUS. ...
Article
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Background Existing care models for patients with persistent medically unexplained symptoms (MUS) do not adequately address the needs of these patients. New and innovative intervention strategies are necessary to achieve better health and corresponding economic outcomes. Aim To explore the feasibility of implementing a pragmatic care package that provides primary care treatment for patients with persistent MUS and to evaluate recruitment, retention, and acceptability as well as the potential impact on clinical outcomes and service utilisation. Design & setting Prospective cohort intervention study involving a cluster of seven GP surgeries in Newham, East London, providing a 'One-Stop-Shop' primary care treatment service. Method The care package included: identification, assessment, engagement, psychoeducation, and a choice of group interventions (mindfulness-based stress reduction [MBSR] and body-oriented psychological therapy [BOPT]). Baseline and follow-up data on somatic symptom levels (PHQ-15), health-related quality of life (SF-36, EQ-5D) and service utilisation was analysed. Results In total, 145 patients were referred and assessed for eligibility, and 93 were included in the study. Participants engaged well with different components of the care package and gained significant improvements in somatic symptom levels with corresponding increases of quality-of-life ratings and a reduction in healthcare utilisation (GP contacts and referrals to specialist services) as well as associated healthcare costs. Conclusion The primary care treatment package can be successfully implemented in primary care at a relatively low cost and easily adopted into routine care. The body-oriented approach is well accepted by clinicians and patients. Controlled trials should be conducted to test the efficacy of the treatment package.
... The inter-rater reliability as assessed with the Cohen's kappa was k = 0.84 (95% CI 0.81 to 0.87). Of these, 16 studies were RCTs (Andersen, Hostmark, & Anderssen, 2012;Kandula et al., 2015;Khare, Cursio, Locklin, Bates, & Loo, 2014;Lee, Chae, Cho, Kim, & Yoo, 2017;Liedl et al., 2011;Lofvander, Engstrom, Theander, & Furhoff, 1997;Nickel et al., 2006 The mean study sample size of RCTs and CCTs was 168 participants. The mean sample size of pre-post intervention studies was 22 participants. ...
Article
Objectives The role of physical activity (PA) in the promotion of mental wellbeing and prevention of psychological disorders in population groups at increased risk for mental health conditions, such as migrant populations, has never been systematically investigated. Methods We conducted a systematic review and meta-analysis according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement. We searched the Cochrane Central Register of Controlled Trials (CENTRAL), Pubmed, Web of Science, SportDiscus. We included randomized (RCTs), controlled clinical trials (CCT), and pre-post intervention studies, that assessed the efficacy of PA interventions in migrants, compared with any types of controls. Results We included 27 studies (4166 participants) (16 RCTs; 2 CCTs; 9 pre-post design) between 1997 and 2020. Meta-analysis showed a significant beneficial effect of PA over control conditions for general functioning (SMD -0.35, 95% CI -0.83 to -0.16; 400 participants), outcome expectancies (SMD -0.78, 95% CI -1.17 to -0.40; 118 participants), self-efficacy/coping (SMD -0.28, 95% CI -0.52 to -0.03; 269 participants), and psychological symptoms (SMD -0.48, 95% CI -0.88 to -0.08; 6 RCTs; 597 participants). Similar findings were produced by pre-post intervention studies (SMD -0.35, 95% CI -0.60 to -0.10; 7 studies; 302 participants). Conclusions Migrant populations may benefit from PA interventions to improve psychological outcomes. Uncertainty remains about the best approach to promote PA in this population, and future research should consider the complex factors that characterize the migration experience.
... liegen Ergeb nisse einiger randomisiertkontrollierter Stu dien vor, die sich auf PatientInnen mit Span nungskopfschmerz, Reizdarmsyndrom, Asthma Bronchiale und Tinnitus beziehen (siehe Über sicht bei Loew et al. 2006; Röhricht 2009). Eine Studie wurde zur Methode Bioenergetische Analyse(Nickel et al. 2006) durchgeführt und zeigte, dass die in der KPT behandelten Patien ten mit somatoformer Störung im Vergleich zu einer randomisierten Kontrollgruppe zum The rapieende signifikant reduzierte Symptome aufwiesen.Koemeda et al. (2006) führten eine prospektive, therapiebegleitende Multicenter studie bei N = 342 PatientInnen in ambulanter ...
Chapter
This chapter will consider first the unmet need for care among patients with bodily distress syndromes. As discussed in Chapter 2, the term ‘bodily distress syndromes’ encompasses patients referred to as having medically unexplained symptoms, somatoform disorders or functional somatic syndromes. The chapter then describes current models of care, including those in use in three European countries and specific clinical services for this group of patients. The last section provides a framework for recommending improved services.
Article
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Background: This article reports quantitative results from a pilot study in primary care (PC) undertaken from 2004–2007. The intervention programme, derived from movement psychotherapy, was termed ‘Learning groups: the BodyMind approach (BMA),’ and emphasised a verbal and non-verbal integrated model, awareness of the inter-relationship between body and mind and a self-managing framework. Aim: To evaluate systematically the outcomes of a 12-week group BMA intervention programme with patients suffering from anxiety/depression with at least one chronic (over two years) medically unexplained symptom (MUS), another term for a psychosomatic condition or somatoform disorder. Method: A mixed method was applied to a single-case design. Outcome measures completed at baseline, mid-, post- intervention and three-month follow-up were the Measure Yourself Medical Outcome Profile (MYMOP) and the Counselling Outcome Routine Evaluation (CORE). Results: Increased activity levels and well-being; more effective coping/functioning strategies; reduction in anxiety/depression, GP-consultation and medication usage, and symptom distress. All changes were maintained at three-month follow-up.
Article
Gravity is one of the four basic forces in nature. Life forms must adapt to gravity pull. This paper addresses two questions: 1. In life forms, how does gravity work and how is it basically handled? 2. What are the advantages of gravity integration, the organismic response we have inherited from nature? Historical contributions from A. Lowen, P.M. Helfaer, S. Keleman and Ida Rolf along with new knowledge are shortly reviewed. The principle of biotensegrity is presented as a feasible mechanism for organismic anti-gravity regulation. Implications for the field of bioenergetics at both the cell level and for the human organism as a whole are presented. What are the advantages of gravity integration, in the form of biotensegrity? Tensegrity structures in the body have the valuable property of self correction in response to gravity. By serving as a soft yielding response, tensegrity manages to integrate gravity as a resource for vitality and energetic economy. Also it promotes organismic unity and is involved in the healing function of bioenergetic flow and pulsation. This examination shows above all one crucial fact: Since human beings stand erect on two feet, variation in postural balance becomes a variable that makes a great difference. Balancing capacity is a resource that makes a difference from the individual cell to the person as a whole. We may suspect that even at the level of Social Self balancing capacity is a source of integration and healing.
Article
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Despite the growing relevance and applicability of elements based on and derived from the embodied mind paradigm, body psychotherapy (BPT) appears not to be a well-established treatment option. This might be due to a lack of proof for its efficacy. We searched electronic databases (Pubmed MEDLINE, PsycInfo, and PSYNDEX) for randomized controlled trials (RCTs) examining predefined BPT interventions. A total of 2,180 references were screened, of which 113 studies were scrutinized in detail and 18 RCTs finally included. The observed effect size (ES) demonstrated medium effects of BPT on primary outcomes psychopathology and psychological distress. In case of significant statistical heterogeneity, exploratory subgroup analyses revealed diagnosis and the degree of control group activity as noteworthy moderators. For secondary outcomes, evidence was scarce, and an improvement could be demonstrated only for coping abilities. The identified evidence indicates that BPT is beneficial for a wide spectrum of psychic suffering. There is a strong need for high-quality studies with bigger samples and for well-defined diagnostic entities to underpin its effectiveness.
Article
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Grounding is an accepted concept in the field of dance movement therapy and expresses an aware and regulated physical and emotional experience. Previous studies have shown that movement interventions to improve the physical sensation of grounding contribute to an increase in emotional awareness and regulation. The aim of the current study is to explore the convergent validity of the Grounding Assessment Tool (GAT) with emotional awareness and regulation. A convenience sample of 43 participants (age, M = 28.5, SD = 8.6) were assessed in an observation of walking and free movement for 10 min, recorded on video, and filled out the Toronto Alexithymia Scale-26 [TAS-26] and the Emotion Regulation Questionnaire [ERQ]. Emotional awareness was measured by the TAS- 26 refer to the ability to recognize emotions that arise in himself and others. The results indicated a significant negative correlation between the GAT score and the level of alexithymia (r = −.36, p = .02), and between the GAT factor which examines fluid and rhythmic movement and suppression strategy in the ERQ (r = −.336, p < .05). No relationship was found between the GAT score and the reappraisal strategy as reported in the ERQ. The fact that no associations were found between the grounding score and the reappraisal regulation strategy can be explained by the difference between emotion regulation strategies. These strategies are: avoiding the expression of emotion versus expressing emotions in the body. The findings contribute to the theoretical understanding of the physical expression of processes related to emotional awareness, and emotion regulation.
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Patienten mit einer somatoformen Störung werden oft als schwierig behandelbar empfunden. Dieses Bild spiegelt sich auch in der verhältnismäßig geringen Anzahl qualitativ hochwertiger Psychotherapiestudien bei dieser Patientengruppe wider. Die meisten Wirksamkeitsnachweise liegen für die kognitive Verhaltenstherapie vor; für psychodynamische Verfahren kamen erste randomisierte klinische Studien hinzu. Der vorliegende Beitrag bietet Informationen zum wirksamen Umgang mit diesen Patienten. Des Weiteren führt er therapieschulenübergreifende Therapieziele ein und erläutert explizit einzelne Schritte der Therapie in drei Phasen: Aufbau einer therapeutischen Beziehung, Vermittlung eines Störungsmodells und Vermittlung von Bewältigungsstrategien. Abschließend werden exemplarisch eine kognitiv-verhaltenstherapeutische Studie, eine psychodynamische Studie, ein Gruppenprogramm und ein neuer Ansatz, welcher kognitive Verhaltenstherapie und Emotionsregulationstraining integriert, vorgestellt.
Article
OF BACKGROUND DATA: The incidence of chronic pain is higher among immigrants in Europe than among the native European population. Therapeutic interventions in this population are far less effective than in patients for whom these programmes were originally developed. OBJECTIVES: In a randomised trial, we investigated whether a cognitive behavioural treatment (CBT) programme supplemented with culturally sensitive aspects (CsCBT) improves pain intensity, pain disability and quality of life among immigrant patients, compared with a treatment of culturally sensitive exercise therapy (CsET) alone. Furthermore, we investigated whether healthcare costs would decrease. METHODS: First-generation Turkish immigrants residing in Switzerland (20–65 years of age) who suffered from chronic pain were enrolled in the trial. Patients were ran-domised to attend either CsCBT or CsET. The CsCBT intervention was based upon a manualised cognitive-behavi-oural group treatment programme for chronic pain patients and adapted to the needs of a Turkish immigrant population. The CsET intervention was based on principles of exercise therapy for treatment of nonspecific low back pain. RESULTS: A total of 116 outpatients were recruited between October 2004 and November 2006. The intervention was completed by 89 patients (77%). A total of 78 subjects (67%) completed follow-up, 12 months after the completion of the intervention programme. The intervention showed no effects in reducing pain, pain disability or quality of life. The analysis of healthcare utilisation yielded no intervention effect. CONCLUSIONS: Cognitive behavioural intervention is feasible with immigrants with chronic disabling pain, but the evidence-based CBT programme, as well as exercise therapy supplemented with culturally sensitive aspects, showed no improvement.
Article
Introduction: Quality assurance in psychosomatic medicine in Austria is currently based on a voluntary continuing medical education programme in psychosocial, psychosomatic and psychotherapeutic medicine. It is questionable whether psychosomatic care can be sufficiently provided in this manner. In addition, a broadly based proposal to create a subspecialty in psychosomatic medicine in order to facilitate quality assurance, is investigated. Methods: The necessity to reorganize psychosomatic care was explored through semi-structured qualitative interviews with experts. Data-based analyses probed the labour market of the proposed subspecialty, and the literature was reviewed to look into the cost-benefit ratio of psychosomatic treatment. Results: All experts expressed a need to restructure psychosomatic care in Austria. Examples exist for psychosomatic treatment with an efficient cost-benefit relation in diverse medical settings. Conclusion: Establishing a subspecialty in Psychosomatic Medicine seems feasible and could contribute to increased quality assurance and the nationwide provision of psychosomatic care.
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This doctoral study explores social workers’ shared understandings of spirituality as lived experience in their personal lives and professional practice. It examines Canadian social workers’ shared conceptualizations of spirituality as lived experience, what it entails, its role and purpose (why), and how it informs professional practice. Data collection involved three steps: a national publicity led to 24 completed self-screening questionnaires (SSQ); 14 in-depth interviews conducted through constructivist grounded theory’s theoretical sampling and; the preliminary findings were validated by the 24 SSQ participants. This study generated two key findings. The central concepts category of the conceptual schema of spirituality as lived experience emerged as Transcendent Life Energy (TLE) as Unconditional Love (UL) in Transformative Relationships (TR) With Self (WS) in Support of Wellbeing (SW)- i.e. TLE-UL-TR-WS-SW. Second, the conceptual schema analyzed through Self as body-mind-emotions-spirit-social (B-M-E-S-S) being—the social work practitioners— illuminated that spirituality as lived experience is about inherent, interconnected, transformative relationships that involve individuation as a life-long process that support healing, development of personal values, growth, and wellbeing in participants’ lives, their clients’ and social life. These findings unveiled interrelated discoveries of significance in social work practice. The wellbeing of Self is inherently interconnected with practitioners’ professional practice, their clients’ and others’ wellbeing. This confirmation is consistent with the concerns about the use of Self in countertransference and religion/culture. However, the personal values that participants developed through the conceptual schema were consistent with human rights and social work values; they included: respect for inherent dignity and worth of persons, self-determination, personal and professional integrity, do no harm, and social justice. Participants’ process of developing personal values exposed a distinction between beliefs and values acquired through socialization and those developed through the conceptual schema. These findings illuminate the function of social work as catalyst for transformative relationships and clarify the role of individuation as directly related to wellbeing, in the midst of cultural and embodied hegemony. Furthermore, the findings illuminate how, why, and what spirituality as lived experience entails and; highlight the multidisciplinary nature of social work practice and theory as inherently interconnected, encompassing human, natural, and social sciences.
Article
The recent review by Koelen and colleagues[1][1] of psychotherapy for severe somatoform disorder is welcome in highlighting the need for better evidence in this area. It has unfortunately omitted a number of relevant studies, especially relating to conversion disorder. One major reason for this is
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Multiple unerklärte Körperbeschwerden stellen in der therapeutischen Praxis häufig eine Herausforderung dar. Die Patienten stehen in der Regel unter einem hohen Leidensdruck und tragen das deutliche Risiko der Chronifizierung und Entwicklung komorbider psychischer Störungen. Beides muss ggf. als negativer Einflussfaktor auf den Krankheitsverlauf und die therapeutische Ansprechbarkeit berücksichtigt werden.
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To determine effects of physical activity on depressive symptoms (primary objective), symptoms of schizophrenia, anthropometric measures, aerobic capacity, and quality of life (secondary objectives) in people with mental illness and explore between-study heterogeneity. MEDLINE, Cochrane Controlled Trials Register, PsycINFO, CINAHL, Embase, and the Physiotherapy Evidence Database (PEDro) were searched from earliest record to 2013. Randomized controlled trials of adults with a DSM-IV-TR, ICD-10, or clinician-confirmed diagnosis of a mental illness other than dysthymia or eating disorders were selected. Interventions included exercise programs, exercise counseling, lifestyle interventions, tai chi, or physical yoga. Study methodological quality and intervention compliance with American College of Sports Medicine (ACSM) guidelines were also assessed. Two investigators extracted data. Data were pooled using random-effects meta-analysis. Meta-regression was used to examine sources of between-study heterogeneity. Thirty-nine eligible trials were identified. The primary meta-analysis found a large effect of physical activity on depressive symptoms (n = 20; standardized mean difference (SMD) = 0.80). The effect size in trial interventions that met ACSM guidelines for aerobic exercise did not differ significantly from those that did not meet these guidelines. The effect for trials with higher methodological quality was smaller than that observed for trials with lower methodological quality (SMD = 0.39 vs 1.35); however, the difference was not statistically significant. A large effect was found for schizophrenia symptoms (SMD = 1.0), a small effect was found for anthropometry (SMD = 0.24), and moderate effects were found for aerobic capacity (SMD = 0.63) and quality of life (SMD = 0.64). Physical activity reduced depressive symptoms in people with mental illness. Larger effects were seen in studies of poorer methodological quality. Physical activity reduced symptoms of schizophrenia and improved anthropometric measures, aerobic capacity, and quality of life among people with mental illness. PROSPERO registration #CRD42012002012.
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Karasu, M. ve Karlıdağ, S. (2017). Barış psikolojisinin panoraması. Onto Online Psikoloji Dergisi, 13, 7-14.
Article
Group work is a key modality in social work practice. In this study, we sought to explore how the growing trend toward body-oriented psychotherapy is being integrated into group work, and to identify the potential significance of this trend for social work practice with groups. We conducted in-depth interviews with 20 practitioners engaged in developing this emerging form of practice across the United States, and used thematic analysis to identify how integrating body-oriented psychotherapy may impact the nature and practice of group work from their perspectives. The overarching theme identified was that using body-oriented psychotherapy serves to Deepen the Group Process and Enhance the Therapeutic Potential of Group. This overarching theme was supported by four subthemes that describe how participants used body-oriented psychotherapy to enrich their group work. These subthemes include Coming into the Present Moment, Accessing the Body’s Unconscious Knowing, Regulating Affect and Facilitating Working Through, and Enhancing Interpersonal Connection. We discuss how these findings fit with existing research on group work and body-oriented psychotherapy, and describe how they reflect recent neurobiological models of therapeutic change. We also identify potential benefits and limitations to using body-oriented psychotherapy in group work, and outline key considerations for responding to this emerging trend in the profession at large.
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Psychotherapy practice and research are supposed to complement each other; however, links between them are usually only weakly developed. This study was designed and conducted with the aim of collecting information about body psychotherapy (BP) practice, and about research resources among body psychotherapists (BPs). A total of 404 body psychotherapists from 36 countries participated in an online survey. The findings revealed a great diversity of BP modalities currently practiced within and across different countries, especially diversity in respect to body psychotherapists' socio-demographic characteristics: 66.4% of participants were over 50 years old, suggesting a shortage of young people involved in both BP practice and research. Most therapists provide BP for adults in the format of individual sessions in private practice. Only a few BP practitioners work in mainstream healthcare settings. The results also suggest significant research knowledge, experience, and interest in research among BP practitioners; however, a lack of application of these research resources in body psychotherapy is noticeable. Results are discussed with an emphasis on the practical implications: i.e., the possible role for BP training schools to strengthen the research culture among practitioners, the importance of sharing BP experiences and research among different countries (and languages), and the need to develop collaborations between practitioners and academic groups in order to strengthen research capacities and accumulate knowledge about the intriguing construct of applied embodiment in BP.
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introduces practitioners to the strategies and techniques of One Person Family Therapy (OPFT) / aimed at family therapists and counselors who want to make immediate, practical use of structural and strategic family therapy techniques but who either prefer or need to work with only one person rather than a whole family in most therapy sessions time limitation / diagnosis / restructuring when to have whole family sessions choosing the One Person (PsycINFO Database Record (c) 2012 APA, all rights reserved)
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This paper presents a theoretical framework for understanding the impact of culture on the processes of symptom recognition, labeling, and help-seeking and consequently on large-scale epidemiological studies involving different ethnic groups. We begin with the assumption that the subjective experience of illness is culture-bound and that the cognitive and linguistic categories of illness characteristic of any culture constrain the interpretative and behavioral options available to individuals in response to symptoms. We hypothesize the existence of learned cognitive structures, through which bodily experiences are filtered, that influence the interpretation of deviations from culturally-defined physical and mental health norms. Certain contradictory findings concerning the self-reported health of Mexican Americans are discussed in order to illustrate the impact of culture on perceived health status.
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The aim of this investigation was to determine whether irritability, defined as the propensity to experience and express anger following actual or perceived provocation, is a component of the liability to alcohol and drug abuse. Sons of substance abusing fathers (n = 40) and normal fathers (n = 56) were studied when they were 10-12 years of age and followed-up 2 years later. Hierarchical regression analysis revealed that resting salivary cortisol concentration, impulsivity and family discord measured when the subjects were 10-12 years of age explained 35% of the variance on a scale measuring irritability 2 years later. At follow-up, when the boys were 12-14 years of age, it was observed that irritability scale scores and family discord were the only variables that accounted for significance variance on a scale measuring coping via alcohol and drug use. Latency and amplitude of the N1 and P3 event-related potentials of an auditory oddball task, measured at age 10-12, were not associated with drug use at age 12-14. These results indicate that family dysfunction, stress state of the child, and low behavioral self-control additively account for a significant proportion of variance on irritability scale scores 2 years later, and that this trait, in conjunction with family discord, is associated with substance use as a coping response by early adolescence.
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The cross-cultural prevalence of somatization and the limitations of current nosology and psychiatric theory for interpreting cultural variations in somatization are reviewed. Selective review was conducted of recent research literature and research findings from an epidemiological survey and ethnographic study of help-seeking and health care utilization of a random sample of 2246 residents in a Canadian urban multicultural milieu. Somatization is common in all ethnocultural groups and societies studied to date. However, significant differences in somatization across ethnocultural groups persist even where there is relatively equitable access to health care services. Analysis of illness narratives collected from diverse ethnocultural groups suggests that somatic symptoms are located in multiple systems of meaning that serve diverse psychological and social functions. Depending on circumstances, these symptoms can be seen as an index of disease or disorder, an indication of psychopathology, a symbolic condensation of intrapsychic conflict, a culturally coded expression of distress, a medium for expressing social discontent, and a mechanism through which patients attempt to reposition themselves within their local worlds. Major sources of differences in somatization among ethnocultural groups include styles of expressing distress ("idioms of distress"), the ethnomedical belief systems in which these styles are rooted, and each group's relative familiarity with the health care system and pathways to care. Psychological theories of somatization focused on individual characteristics must be expanded to recognize the fundamental social meanings of bodily distress.
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Previous reports on the incidence of schizophrenia in immigrant groups to The Netherlands were based on hospital data. To compare the incidence of psychotic disorders in the immigrant groups to that in natives. Two-year first-contact incidence study in The Hague. The risks of schizophrenia, schizophreniform or schizoaffective disorder (DSM-IV criteria) were increased for subjects born in Morocco (gender and age-adjusted relative risk=4.5; 95% Cl 1.4-8.5), Surinam (relative risk=3.2; 1.8-5.7), The Netherlands Antilles (relative risk=2.9; 0.9-9.5) and other non-Western countries (relative risk=2.4; 1.3-4.7). This risk was also increased for Moroccans (relative risk=8.0; 2.6-24.5) and Surinamese (relative risk=5.5; 2.5-11.9) of the second generation. The risks for Turkish immigrants, first or second generation, and for immigrants from Western countries were not significantly increased. This study indicates that the incidence of schizophrenia is increased in several, but not all, immigrant groups to The Netherlands. It is possible that factors associated with a process of rapid westernisation precipitate schizophrenia in people who are genetically at risk.
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It is often thought, that men have more difficulties in body oriented psychotherapy than women because of the gender specific differences in the attitude towards the body. Using a sample of 62 in-patients, the present study considers the question, whether in clinical psychotherapy influences of sex and age (as control variables) on course and outcome of treatment with Concentrative Movement Therapy (KBT) are found. Course of treatment is recorded by the Group Experience Questionnaire for KBT. Global results of treatment are recorded multidimensionally. KBT related results are determined by ratings of the group therapist. Both global scores are computed. Main result is, that sex and age have no predictive meaning for treatment results and do not clearly differentiate the treatment course. Some effects of sex and age are found concerning the connection of group experience and treatment results. The results lead to hypotheses about differential therapeutic mechanism of KBT depending on age and sex. They need further empirical confirmation.
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This paper reports results from the evaluation of a cultural consultation service (CCS) for mental health practitioners and primary care clinicians. The service was designed to improve the delivery of mental health services in mainstream settings for a culturally diverse urban population including immigrants, refugees, and ethnocultural minority groups. Cultural consultations were based on an expanded version of the DSM-IV cultural formulation and made use of cultural consultants and culture brokers. We documented the service development process through participant observation. We systematically evaluated the first 100 cases referred to the service to establish the reasons for consultation, the types of cultural formulations and recommendations, and the consultation outcome in terms of the referring clinician's satisfaction and recommendation concordance. Cases seen by the CCS clearly demonstrated the impact of cultural misunderstandings: incomplete assessments, incorrect diagnoses, inadequate or inappropriate treatment, and failed treatment alliances. Clinicians referring patients to the service reported high rates of satisfaction with the consultations, but many indicated a need for long-term follow-up. The cultural consultation model effectively supplements existing services to improve diagnostic assessment and treatment for a culturally diverse urban population. Clinicians need training in working with interpreters and culture brokers.
Article
Objectives This paper reports results from the evaluation of a cultural consultation service (CCS) for mental health practitioners and primary care clinicians. The service was designed to improve the delivery of mental health services in mainstream settings for a culturally diverse urban population including immigrants, refugees, and ethnocultural minority groups. Cultural consultations were based on an expanded version of the DSM-IV cultural formulation and made use of cultural consultants and culture brokers. Methods We documented the service development process through participant observation. We systematically evaluated the first 100 cases referred to the service to establish the reasons for consultation, the types of cultural formulations and recommendations, and the consultation outcome in terms of the referring clinician's satisfaction and recommendation concordance. Results Cases seen by the CCS clearly demonstrated the impact of cultural misunderstandings: incomplete assessments, incorrect diagnoses, inadequate or inappropriate treatment, and failed treatment alliances. Clinicians referring patients to the service reported high rates of satisfaction with the consultations, but many indicated a need for long-term follow-up. Conclusion The cultural consultation model effectively supplements existing services to improve diagnostic assessment and treatment for a culturally diverse urban population. Clinicians need training in working with interpreters and culture brokers.
Article
This report is a retrospective investigation of the efficacy of bioenergetic therapies given to adults in a private practice setting and furthermore a study of the stability of the therapeutic results achieved. In the spring of 1997 a total of 16 bioenergetic therapists (6 of them medical doctors and 10 psychologists), all members of the Swiss Society of Bioenergetic Therapists (SGBAT), provided upon request a number of data on 319 patients who had terminated their therapies after a minimum of 20 sessions 6 months to 6 years earlier. A self-evaluating questionnaire was then constructed, to be answered anonymously, and was sent to these 319 patients in late summer 1997; 290 of them could be reached and 142 (49%) returned it. The questionnaire contained questions related to the psychic and physical condition, to interpersonal and psychosomatic problems, and to the effect of body work on physical consciousness, cognitive insights and changes of the quality of life. Regarding the efficacy of bioenergetic therapies, the statistical analysis of the returned questionnaires showed significant positive changes in all areas questioned. Bioenergetic body work was judged to be important and indispensable by about half of the patients. Regarding the stability of the therapeutic result, 107 patients indicated a stable or even improved condition. Of the 35 patients who since termination of the bioenergetic therapy had chosen to undergo further therapy, 16 opted again for a body-oriented psychotherapy.
Article
Definition: Evidence-based medicine relies on conscientious, precise and judicious use of the best available scientific evidence in individual patient management. Methods: In practice, use of evidence-based medicine requires assessment of the evidence by critical reading according to wellestablished rules. This can be done individually or by adopting the conclusions of expert groups. The data provided by evidencebased medicine should be used to improve one's individual medical practice and then to assess its impact on patient management. Results: Various surveys have pointed to the growing influence of evidence-based medicine in today's medical profession.
Article
Structural family therapy, psychodynamic child therapy, and a recreational control condition were compared for 69 six-to-twelve-year-old Hispanic boys who presented with behavioral and emotional problems. The results suggest that the control condition was significantly less effective in retaining cases than the two treatment conditions, which were apparently equivalent in reducing behavioral and emotional problems as well as in improving psychodynamic ratings of child functioning. Structural family therapy was more effective than psychodynamic child therapy in protecting the integrity of the family at 1-year follow-up. Finally, the results did not support basic assumptions of structural family systems therapy regarding the mechanisms mediating symptom reduction.
Article
This is a review of the book "Psychotherapy and Culture Conflict" by Georgene Seward (see record 1957-01152-000). The author speaks of this volume as a collaboration: he supplied the textual material and Dr. Judd Marmor supplied the four case studies from his own practice. The purpose of the book "is to delineate various cultural aspects of psychotherapy that have hitherto been slighted.... The major portion of the book is devoted to an exposition of the psychodynamics peculiar to members of a variety of subcultures in the United States today." Whether or not the reader is inclined towards psychoanalytic interpretations, he will find in this book valuable suggestions for better insight into problems of personality with special reference to the influence of cultures and the conflicts between cultures. Examples given indicate how completely psychotherapy can fail when the facts of cultural conflicts are not known and understood. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Article
This report is a retrospective investigation of the efficacy of bioenergetic therapies given to adults in a private practice setting and furthermore a study of the stability of the therapeutic results achieved. In the spring of 1997 a total of 16 bioenergetic therapists (6 of them medical doctors and 10 psychologists), all members of the Swiss Society of Bioenergetic Therapists (SGBAT), provided upon request a number of data on 319 patients who had terminated their therapies after a minimum of 20 sessions 6 months to 6 years earlier. A self-evaluating questionnaire was then constructed, to be answered anonymously, and was sent to these 319 patients in late summer 1997; 290 of them could be reached and 142 (49%) returned it. The questionnaire contained questions related to the psychic and physical condition, to interpersonal and psychosomatic problems, and to the effect of body work on physical consciousness, cognitive insights and changes of the quality of life. Regarding the efficacy of bioenergetic therapies, the statistical analysis of the returned questionnaires showed significant positive changes in all areas questioned. Bioenergetic body work was judged to be important and indispensable by about half of the patients. Regarding the stability of the therapeutic result, 107 patients indicated a stable or even improved condition. Of the 35 patients who since termination of the bioenergetic therapy had chosen to undergo further therapy, 16 opted again for a body-oriented psychotherapy.
Article
Der überwiegende Teil der in die psychosomatische Rehabilitation gelangenden türkischen Mitbürgerinnen und Mitbürger sind Migranten der 1. Generation, für die nur wenige Behandlungsplätze mit entsprechender sprach- und kulturspezifischer Kompetenz bereitgehalten werden. Geringe Bildungsvoraussetzungen, eine ländliche Sozialisation gekoppelt an ein orthodoxes religöses Weltbild ist bei dieser Klientel verbunden mit einer externalen Kausal- und externalen bis external-fatalistischen Kontrollattribution. Die stationäre Behandlung sollte deswegen vermehrt psychoedukative Elemente beinhalten und Techniken anbieten, die die Selbstwirksamkeitserwartung der Patienten steigern. Aufgrund eines ausgeprägten kollektiven Selbstbilds kann es in der problemorientierten Gruppentherapie zu verstärkten Scham- und Schuldaffekten kommen, was durch indirekte Methoden der Konfliktbearbeitung wie z.B. der themenzentrierten interaktionellen Gruppentherapie gemildert werden kann. Für die in der Rehabilitation vorherrschenden kurzgruppenpsychotherapeutischen Konzepte bietet sich die Bildung monokultureller Behandlungseinheiten mit türkischen Patienten an, sofern eine ausreichend große Klientel mit vergleichbaren soziokulturellen Eingangsvoraussetzungen zur Behandlung gelangen.
Changes in cortisol dynamics are important correlates of various psychophysiological states in children. The two most important measures of the cortisol dynamics are changes in plasma cortisol concentrations at predetermined times and the dexamethasone suppression test (DST). Unfortunately, much restandardization of adult norms is required before these tests can be applied to infants. Measurements of salivary cortisol appear to be a reliable, accurate and nontraumatic sampling technique for assaying cortisol dynamics. Salivary cortisol values should provide a noninvasive method in the application of the DST to the investigation of psychophysiological states in infants and children.
Article
A group comprising lower-class Greek immigrant patients with chronic psychiatric illness has been conducted for over three years. The barriers of language, culture and class have been overcome. An analysis of these barriers, as demonstrated in the group, is provided. Contentions about the effects of culture on psychopathology and treatment are discussed.
Article
Contrary to Singer's contention that the features of depressive disorders do not exhibit significant cross-cultural differences, the author uses material from field research in Taiwan and data from recent anthropological and clinical investigations to support the opposite view that such differences exist and are a function of the cultural shaping of normative and deviant behavior. Somatization amongst Chinese depressives is used as an illustration. This discrepancy reflects substantial changes in the nature of more recent cross-cultural studies by anthropologists and psychiatrists, changes which are giving rise to a new cross-cultural approach to psychiatric issues. Some features and implications of that approach are described.
Article
Referring to a previous clinical and sociopsychiatric investigation on 130 foreign workers, the transcultural psychiatric factors determining forms and contents were studied. It is stressed that remains of magic thinking and rigid tribe-centered sociocultural structures are the main factors, in addition to the beginning of the loosening of these structures accompanied by initial assimiltion of occidental ways of life in the homeland, and integrational crises through collision of Old and New after immigration. Atypical psychosis, outweighting affective and somatic factors, obliteration of the limits between classic etiological units, and the possibility of confounding magic contents with psychosis are illustrated by case histories. New criteria for diagnosis and therapy of foreign workers are suggested.
Article
Cortisol 3-(o-carboxymethyl)oxime (C3-CMO) and a commercially available biotin-hydrazide derivative were used to synthesize a C3-CMO-biotin conjugate. C3-CMO was converted into a N-hydroxysuccinimide ester derivative which in a second reaction step was allowed to interact with the hydrazide derivative of biotin. This simple-to-perform synthesis yielded a conjugate suitable for use as a tracer in immunoassays for cortisol measurement. Employing biotin as the primary probe in a competitive solid phase immunoassay allows for variable end point determination by means of commercially available labeled avidin or streptavidin derivatives. Streptavidin-Europium was used in conjunction with the DELFIA-system for time-resolved fluorometric end point measurement (TR-FIA) throughout the study. In addition, colorimetric end point determination (ELISA) using streptavidin-alkaline phosphatase as a secondary probe was established and evaluated. Both forms of this non-isotopic assay showed excellent correlation with a commercially available radioimmunoassay adapted for salivary cortisol measurement. The lower detection limit was 0.43 nM for a 50 microliters salivary sample. The intra-assay coefficient of variation was 6.7, 4.7 and 4.0% at cortisol concentrations of 2.2, 5.5 and 13.2 nM, respectively (n = 37), and the corresponding inter-assay coefficients of variation were 9.0, 8.6 and 7.1% (n = 50). The competitive immunoassay requires 1.5 h incubation time and shows robust and reproducible performance. The C3-CMO-biotin conjugate allows for sensitive and flexible end point determination of salivary cortisol levels in immunoassays.
Article
The relation of symptoms of conduct disorder (CD) and anxiety to salivary cortisol was explored in 67 clinic-referred boys aged 8 to 13 years. Children with anxiety disorder had higher levels of cortisol, but this main effect was qualified by a significant CD x anxiety disorder interaction. Consistent with Gray's biological model of the behavioral inhibition system (BIS), children with both CD and anxiety disorder had higher levels of salivary cortisol than children with CD without comorbid anxiety disorder. In the absence of CD, however, anxiety disorder was not clearly associated with higher cortisol. This result suggests that cortisol may be a useful biological marker of arousal associated with BIS activity in children with CD.
Article
The transcultural view is evident throughout all of Positive Family-Therapy. It helps us to understand the individual conflicts and can also be important in dealing with such social issues as the treatment of illegal aliens and refugees, foreign aid for the Third World countries, problems in dealing with members of other cultural systems, interracial and transcultural marriages, prejudices, alternative life-styles societies and political problems. 4 ways of dealing with conflict and the 5-stage Positive Family-Therapy are therapeutic strategies in which therapy and self-help are intertwined.
This is a follow-up study of a group of patients of Foreign origin for which an indication for analytic psychotherapy was found. The importance of mutual therapist-patient recognition is emphasized. It seems necessary that the patient masters the cultural and socio-economic environment in which he lives, in order to open himself up to an intra-psychic reality. Finally, we formulate the hypothesis that symptoms shown by the patient reveal indirectly adjustment disorders to the cultural environment.
Article
Culture influences the experience and expression of distress from its inception. While Western psychiatry has identified several universal patterns of distress, there are significant geographical variations in the prevalence, symptomatology, course and outcome of psychiatric illness. Indirect evidence suggests that cultural differences in the recognition, labelling and interpretation of deviant behaviour affect the outcome of major psychiatric disorders as well as milder forms of distress. Emotion theory and the cultural concept of the person provide links between social and cognitive processes that contribute to the natural history of emotional distress. However, many current studies of ethnopsychology confound psychology (mechanisms of behaviour) and meta-psychology (theories of the self). Further advances in understanding the impact of culture on distress depend on the development of psychological and social theory that is neither ethnocentric nor naive about the wellsprings of action. Three arenas for further study are identified: (1) the handling of the gap between experience and expression; (2) the labelling of deviant behaviour and distress as voluntary or accidental; and, (3) the interpretation of symptoms as symbols or as meaningless events. Attention to these themes can guide re-thinking the assumptions of Western psychological and social theory.
Article
Heritability of the variation of the plasma concentrations of total and unbound cortisol, cortisol binding globulin (CBG), and dehydroepiandrosterone sulfate (DHEA-S) was investigated in 20 monozygotic (MZ) and 20 dizygotic (DZ) male twin pairs. Three plasma samples collected between 8 AM and 9:30 AM were pooled for the assays. Heritability was calculated from the intraclass correlation [2(rMZ - rDZ)]. The mean age, total and unbound cortisol, CBG, and DHEA-S were not significantly different between the MZ and DZ groups of twins. The heritability index for variability of the plasma content of steroids was 45.4% (p less than .05) for total cortisol, 50.6% (P less than .05) for unbound plasma cortisol, 57.8% (P less than .05) for DHEA-S, and 32.4% (P greater than .05) for CBG. The data were analyzed by factor analysis, and heritability estimates were corrected for factors including age, smoking, drinking, exercise, and degree of obesity. These factors did not account for the variation in hormone values in twin pairs. Factor analysis of the three quantitative measurements, cortisol, percent free cortisol, and DHEA-S, provides no evidence for shared factors. The correlation coefficients between age and CBG and total and unbound plasma cortisol concentrations were insignificant. The correlation coefficient between total plasma cortisol levels and CBG was 0.57, which indicates that CBG accounts for 32% of the variation of plasma cortisol concentrations. The results suggest that genetic factors have a decided influence on the variation of the concentration of cortisol of DHEA-S in normal adult men.
Article
This article is based on intensive interviews made with 75 Turkish migrant women living in Denmark. The interviews were conducted in the women's own homes, in their own language, and special care was taken to establish an atmosphere of confidence. The methodological problems involved in this kind of research are discussed. The purpose of the study was to obtain information on the women's own evaluation of their physical, psychological and social conditions in the host country. Only 8% of the informants reported that they were in good health. The remaining had complaints of somatic character and considered themselves as being ill. There were no cases of severe psychopathology. The background of the women's illnesses is analysed at three levels: the physical, the psychosocial and the cultural levels respectively, in an attempt to elucidate their multifactorial etiology as well as to give a more comprehensive picture of the meaning of illness in a societal context.
Article
The explanatory model perspective of medical anthropology emphasizes the cultural shaping of individuals' efforts to make sense of their symptoms and suffering. Causal attribution is a pivotal cognitive process in this personal and social construction of meaning. Cultural variations in symptom attribution affect the pathogenesis, course, clinical presentation and outcome of psychiatric disorders. Research suggests that styles of attribution for common somatic symptoms may influence patients' tendency to somatize or psychologize psychiatric disorders in primary care. At the same time, symptom attributions are used to negotiate the sociomoral implications of illness. Recent work in social psychology and medical anthropology emphasizes the roots of attributional processes in bodily and social processes that are highly context-dependent, and hence, must be understood as part of the construction of a local world of meaning. Symptom attributions then may be understood as forms of positioning with both cognitive and social consequences relevant to psychiatric assessment and intervention.
Article
Conduct disorder (CD) symptom counts in preadolescent boys, and antisocial personality disorder (ASP) and childhood conduct disorder symptom counts in their parents, were used as dimensional measures of behavioral deviation. A significant correlation was found for CD and ASP symptom counts between the two parents and between CD symptom counts of the children and parental CD and ASP symptom counts. Although socioeconomic level correlated negatively with parental symptom counts, no association was observed between parental socioeconomic status and children's CD symptom counts. Saliva cortisol level in the children was negatively associated with their CD symptom count and with their fathers' ASP count. Cortisol level was also lower among sons whose fathers had CD as children and subsequently developed ASP compared with the cortisol level in sons whose fathers either did not have any Axis I psychiatric disorder or did not develop ASP.
Article
Investigations of adults with a psychoactive substance use disorder (PSUD) or antisocial behavior have reported diminished secretion of the adrenal "stress" hormone, cortisol. Consequently, we determined whether prepubertal sons of PSUD fathers, at high risk for later PSUD, differed from controls on salivary cortisol concentrations before, and after, an anticipated stressor. The roles of problematic behavioral disposition and state anxiety in the cortisol responses were also examined. A significant risk-group x time interaction for salivary cortisol concentrations was found, with high-risk boys secreting less salivary cortisol than controls when anticipating the task. High-risk boys also had significantly higher scores for aggressive delinquency and impulsivity that wholly accounted for the risk-group x time effect on salivary cortisol. Thus, cortisol hyporesponsivity was associated with the dysregulated behaviors prevalent among high-risk boys. The results suggest that cortisol hyporesponsivity could be a "marker" for later antisociality and PSUD.
Article
The results of several studies suggest an inverse relationship between cortisol secretion and aggressive behavior. This study examined basal plasma cortisol levels in aggressive and nonaggressive boys with attention-deficit hyperactivity disorder (ADHD). The subjects were 23 aggressive and 27 nonaggressive boys with ADHD, aged 7 to 11 years. After 3 days of a low monoamine diet and an overnight fast, an indwelling catheter was inserted into a forearm vein. Samples for plasma cortisol levels were obtained 105 and 115 minutes after insertion of the catheter. A one-way analysis of covariance (ANCOVA) controlling for body mass revealed no significant difference in plasma cortisol between the aggressive and nonaggressive boys. Furthermore, when the children were alternatively divided on the basis of the presence or absence of a DSM-III-R diagnosis of conduct disorder, a one-way ANCOVA again revealed no significant difference in cortisol levels. The hypothesized inverse relationship between cortisol secretion and aggressive behavior in boys with ADHD was not found. These findings are consistent with a large body of literature indicating that the biological substrate of aggression is complex and that the identification of biological laboratory markers of aggressive behavior is not a clinically useful strategy at this time.
Article
After describing the difference between body therapies and body-centered psychotherapies, the methods of body-centered psychotherapy IKP are treated in this article. In order to explain the reduction of panic by motor activity, neurophysiological hypothesis are also discussed. Assuming that symptoms of panic are no "psycho"-pathological symptoms but multidimensional pathological phenomenon, the therapeutic approach has to be holistic and multirelational. Activating resources of the six different life dimensions also belongs to the holistic IKP approach. This way of holistic-multirelational thinking is demonstrated along two case studies.
Article
This paper reviews the historical aspects of expatriate mental health, and comments on the paucity of literature in the medical and psychiatric journals. Data obtained from 397 expatriate probands examined during overseas service are described. It was noted that there was a high incidence of affective and adjustment disorders. The results showed six areas significantly related to those with affective disorders at interview, namely a history of consultation for psychological problems in out-patient departments or with the patient's own doctor, a history of depressed mood, and a family history of suicide, psychosis or personality disorder. Subjects with adjustment disorders at interview showed a significant positive correlation with four stressors (occupational anxiety, home country anxieties, acculturation and physical ill-health), but showed a negative association with a past personal history of consultation for psychological problems at out-patient departments or with their own doctors. These findings are discussed and practical applications suggested for improving expatriate mental health.
Article
The purpose of this investigation was three-fold. First, we extended our original observation of decreased cortisol reactivity to an anticipated stressor in sons of fathers with a substance use disorder (SUD). Second, we examined the hypothesis that salivary cortisol underresponsivity in these high-risk prepubertal boys is an adaptation to the stress associated with having a father with a current, rather than remitted, SUD. Third, we tested the hypothesis that prepubertal cortisol underreactivity might be associated with subsequent drug use behavior during adolescence. Preadolescent salivary cortisol responses were examined in the context of risk-group status, paternal substance abuse offsets, and subsequent adolescent drug use behavior. The results confirmed a decreased salivary cortisol response to an anticipated stressor among sons of SUD fathers in our expanded sample. In addition, sons of fathers with a current SUD and boys whose fathers had a SUD offset from their 3rd to 6th birthdays had lower anticipatory stress cortisol levels compared with sons of control fathers. Finally, lower preadolescent anticipatory cortisol responses were associated with regular monthly cigarette smoking and regular monthly marijuana use during adolescence. Hyporeactivity as an adaptation to chronic stress may be salient to the intergenerational transmission of substance abuse liability.
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This paper critically reviews the process and outcome of an effort to enhance the cultural validity of DSM-IV and outlines recommendations to improve future diagnostic systems. An ordered presentation of the antecedents and the main phases of this developmental effort is followed by a content analysis of what was proposed and what was actually incorporated, and a conceptual analysis of underlying biases and their implications. The cultural effort for DSM-IV, spearheaded by a scholarly independent NIMH workgroup, resulted in significant innovations including an introductory cultural statement, cultural considerations for the use of diagnostic categories and criteria, a glossary of culture-bound syndromes and idioms of distress, and an outline for a cultural formulation. However, proposals that challenged universalistic nosological assumptions and argued for the contextualization of illness, diagnosis, and care were minimally incorporated and marginally placed. Although a step forward has been taken to introduce cultural elements in DSM-IV much remains to be done. Further culturally informed research is needed to ensure that future diagnostic systems incorporate a genuinely comprehensive framework, responsive to the complexity of health problems in increasingly multicultural societies.
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To examine factors associated with bullying and victimization from age 8 to 16. An 8-year longitudinal study included questions about bullying and victimization at age 8 and 16. Children were evaluated with Rutter scales by parents and teachers and with the Child Depression Inventory filled in by the children at age 8. When the children were at the age of 16 parents filled in the CBCL and adolescents the YSR. About 15% of boys and 7% of girls were bullied and 12% of girls and 13% of boys were victimized at age 16. Both bullying and victimization at age 16 were associated with a wide range of psychological problems at age 8 and 16, and with referral to child mental health services. Bullying at age 8 was associated with bullying at age 16, while victimization at age 8 was associated with victimization 8 years later. Bullying and victimization are often persistent and associated with severe emotional and behavior problems. Preventive efforts should be focused, and targeted at those children who are characterized by both psychological disturbance and bullying.
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Little research has addressed the impact of dating violence and forced-sex victimization and perpetration on adolescent well-being. In this cross-sectional study, we provide (1) estimates of severe dating violence (SDV) by victimization and perpetration status, (2) estimates of lifetime forced-sex victimization and perpetration, (3) demographic and health behaviors correlated with SDV, and (4) associations between SDV and forced sex and well-being as assessed by (1) health-related quality of life (H-R QOL) and (2) life satisfaction measures. We used a stratified cluster sample of 5414 public high school students, grades 9 through 12, who responded to the 1997 self-administered South Carolina Youth Risk Behavior Survey. Nearly 12% of adolescents self-reported SDV as a victim (7.6%) or a perpetrator (7.7%), and SDV rates (victimization/perpetration combined) are higher in girls (14.4%) than boys (9.1%). Race, aggressive behaviors, substance use, and sexual risk-taking are correlates of SDV. Among young women, SDV victimization, not perpetration, was associated with recent poor H-R QOL and suicide ideation or attempts, but not lower life-satisfaction scores. Among young men, SDV perpetration, not victimization, was strongly associated with poor H-R QOL and suicide attempts, and lower scores for all domains of life satisfaction. This research provides evidence that SDV and forced sex are associated with poor H-R QOL, low life-satisfaction scores, and adverse health behaviors in adolescent female victims and male perpetrators. Screening for dating violence is needed to identify and intervene early to reduce the impact of dating violence.
Article
This paper presents the results from a qualitative study conducted with the aim of exploring structures of illness meaning among somatizing Turkish-born migrant women (age 31-48) living in a poor and low status suburb of Stockholm in contact with local health care services. Two to three interviews regarding experiences and understanding of illness were conducted as well as one year, validating follow-up interviews. Interviews were analysed with a grounded theory approach. Results are presented as the participants' agenda of understanding. Distress was communicated by concrete expressions about the body, emotions, social and life situation. Pain was prominent and often lateralised to one side of the body. The use of traditional expressions of distress ranged from open use to avoidance. Attribution was characterised by verbalising links of coherence between health and aspects of life. Psychiatric attribution was rarely accepted or valued as a tool for recovery, or as helpful in linking bodily symptoms to emotional distress. Three main sources for healing were used: medical care in Sweden and in Turkey and traditional treatment. Own capacity to influence recovery was mostly regarded as low. Relations to family and the clinician were regarded as important to recovery. The encounter with local health care had brought the participants in contact with a psychological agenda of understanding their illness and new ways of dealing with illness and healing. Some expressed a feeling of being misunderstood whereas some related positive experiences of re-evaluation. They were all actively trying, but experiencing varying degrees of difficulty, to grasp the meaning of the caregiver. The results of the study point to the mutual need of exploring meaning in the clinical encounter to help patients make sense out of different perspectives of illness and healing. The need for enhanced knowledge about this process in a migration context will be discussed.