Change in the moving bodymind: Quantitative results from a pilot study on the use of the BodyMind approach (BMA) to psychotherapeutic group work with patients with medically unexplained symptoms (MUSs)

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.     

Personal Constructs of Mind-Body Identity in People Who Experience Medically Unexplained Symptoms

“Medically unexplained symptoms” (MUS) refers to chronic physical symptoms without a clear medical cause, which produce significant levels of distress and functional impairment. This project modified the repertory grid technique to explore how twenty participants experiencing MUS construed self and others in bodily and psychological ways. Findings suggested that symptoms are well integrated within participants' wider mind–body construct systems. Increased distance between how self in general is construed compared to self when symptoms are worst was associated with reduced anxiety. Measuring intrapersonal and interpersonal implicative dilemmas suggested that moral and relational construing of identity is affected by MUS.     

The development of the Body Morph Assessment version 2.0 (BMA 2.0): Tests of reliability and validity

This study tested the psychometric characteristics of the Body Morph Assessment version 2.0 (BMA 2.0). A sample of 563 adults composed of four groups classified by gender and ethnicity (Caucasian men and women and African-American men and women) were studied. Support for the internal consistency and test–retest reliability of the BMA 2.0 was found for both men and women. A study of convergent validity was conducted. The BMA 2.0 was found to have adequate reliability and validity. Norms were established for the BMA 2.0 estimates of current body size (CBS), ideal body size (IBS), and acceptable body size (ABS) for Caucasian and African-American men and women. In summary, the BMA 2.0 is a reliable and valid computerized measure of CBS, IBS, ABS, the CBS–IBS discrepancy (body dissatisfaction), and provides an estimate of over/underestimation of body size as compared to individuals of the same sex and body mass index.     

Supporting Japanese Mothers of Children with ADHD: Cultural Adaptation of the New Forest Parent Training Programme

International practice guidelines recommend medication and behavioral intervention as evidenced‐based treatments for attention deficit hyperactivity disorder (ADHD). Currently in Japan, the availability of non‐pharmacological interventions for ADHD is limited. We report the results of a pilot and a proof‐of‐concept study for a new behavioral intervention for Japanese mothers of children with ADHD. The pilot study delivered a standard six‐session behavioral intervention and two parent‐support sessions. Participants approved the group format and requested additional support to change parenting practices and behavioral strategies targeting ADHD symptoms. For the proof‐of‐concept study, the intervention was revised to include five sessions of pre‐intervention support followed by six sessions of the New Forest Parent Training Programme (NFPP), an evidence‐based intervention for ADHD. The revised intervention, NFPP‐Japan, was associated with reductions in the mothers’ reports of children's ADHD symptoms and aggression, more effective parenting practices, and reduced parenting stress. The pilot and proof‐of‐concept studies indicate that it is possible to successfully modify Western behavioral interventions for Japanese mothers and to justify a randomized controlled trial evaluation of the NFPP‐Japan, which is currently underway.     

Dispositional aspects of body focus and idiopathic environmental intolerance attributed to electromagnetic fields (IEI‐EMF)

Body focus is often considered an undesirable characteristic from medical point of view as it amplifies symptoms and leads to higher levels of health anxiety. However, it is connected to mindfulness, well‐being and the sense of self in psychotherapy. The current study aimed to investigate the contribution of various body focus related constructs to acute and chronic generation and maintenance of medically unexplained symptoms (MUS). Thirty‐six individuals with idiopathic environmental intolerance to electromagnetic fields (IEI‐EMF) and 36 controls were asked to complete questionnaires assessing negative affect, worries about harmful effects of EMFs, health anxiety (HA), body awareness, and somatosensory amplification (SSA), and to report experienced symptoms evoked by a sham magnetic field. Body awareness, HA, SSA, and EMF‐related worries showed good discriminative power between individuals with IEI‐EMF and controls. Considering all variables together, SSA was the best predictor of IEI‐EMF. In the believed presence of a MF, people with IEI‐EMF showed higher levels of anxiety and reported more symptoms than controls. In the IEI‐EMF group, actual symptom reports were predicted by HA and state anxiety, while a reverse relationship between symptom reports and HA was found in the control group. Our findings show that SSA is a particularly important contributor to IEI‐EMF, probably because it is the most comprehensive factor in its aetiology. IEI‐EMF is associated with both a fear‐related monitoring of bodily symptoms and a non‐evaluative body focus. The identification of dispositional body focus may be relevant for the management of MUS.     

A Mindfulness-Based Meditation Pilot Study: Lessons Learned on Acceptability and Feasibility in Adolescents with Cancer

A growing body of research has documented the psychological impact of cancer on adolescents (such as symptoms of depression, anxiety and withdrawal). Findings from the adult literature suggest that mindfulness-based interventions (MBIs) are a promising treatment option for helping individuals manage cancer and alleviate the associated psychological symptoms. The aim of the present pilot study was to assess the feasibility and acceptability of a MBI for adolescents with cancer and examine its potential positive impact on sleep, mood, and quality of life. Over 9 months of recruitment, 481 youth were screened for participation in this project. Of these, 418 (86.9 %) were excluded because they lived further than 1 h from the intervention site, had no history of cancer, had died or were not reachable by telephone. Of the 63 who were contacted, only 7 (1.4 %) agreed to participate, gave their consent, and provided a complete dataset. A prospective quasi-experimental pretest–posttest design with two groups (experimental; n = 7 and no treatment; n = 7) was used to assess the MBI. Only participants from the experimental group completed follow-up measures at 6 months. Repeated-measure ANOVAs were conducted to assess the impact of the intervention. No significant differences between or within groups were found pre to post assessment and at follow-up. A narrow pool of eligible participants, a high refusal rate, school scheduling conflicts and absenteeism had a significant impact on the final sample size. Suggestions to conduct future trials are presented. Larger randomized-controlled trials are necessary to assess whether MBIs have significant beneficial effects in teenagers with cancer.     

Body language and metaphors revealed through applications of Movement Psychotherapy in a hospice: A clinical case of refractory pruritis

Movement psychotherapy (MP), and dance/movement therapy (DMT), are body-orientated psychotherapy approaches that use movement for the integration of emotional, cognitive, physical, social and spiritual aspects of self (European Association Dance Movement Therapy, 2010). It is distinctively a combination of moving and sensing the body with verbal self-reflection (Bloom, 2006). Several papers have presented DMT as a treatment in general medical care and cancer care, but there is still a paucity of evidence-based studies. The authors describe a clinical case illustrative of many of the situations in which facing death was particularly tormenting. The emotional pressure can produce a barrier of communication with the risk of rupturing the therapeutic relationship. The movement therapist’s function is to clarify the elements of body language and this has important implications for clinical practice because the end-of-life decisions are difficult, like palliative sedation therapy (PST). Even if procedural guidelines for PST help physicians and care teams through the decision-making process and make them more comfortable when responding to physical suffering, physicians more frequently report an emotional pressure when their patients experience psychological symptoms, with the risk that PST could become a potential “counterphobic defence to treat”.     

Quality of Life of Persons With Medical Illnesses: Counseling's Holistic Contribution

This article presents a rationale for the addition of psychological counseling in the treatment of persons with medical illnesses. Empirical data on the mind‐body connection are presented, and I. Pollin's (1995) Medical Crisis Counseling model is outlined as an example of an effective intervention. The authors discuss the issues and counseling techniques related to the model within the frameworks of individual, group, and family counseling; use case studies to illustrate intervention strategies; and suggest implications for future research and training.     

The synergy of memory, affects and metaphor

Recently, the concept of metaphor has been revitalized as a result of the convergence of interest in this subject from a variety of disciplines including neurobiology, linguistics and cognitive science. Metaphor is now viewed as an emergent property of mind. Metaphor is rooted in the body in two senses: metaphor is used to organize bodily sensation cognitively, especially affects, and secondly, metaphor is rooted in the body as it rests on the border between mind and brain. Metaphor is therefore viewed as a developmentally early, primitive mental function related to synesthesia. There is a significant distinction between frozen or foreclosed metaphors and open and generative metaphors. The foreclosed metaphor will dominate the perception of others in cases of trauma and can be understood as an explanation of transference repetition. Clinical examples of foreclosed metaphors are illustrated by vignettes of patients who have suffered traumas. Examples taken from two artists are used to illustrate instances in which the artist's own unassimilated experiences appear as generative metaphors.     

Children and Adolescents with Medically Unexplained Symptoms: A Systematic Review of the Literature

Abstract

Medically unexplained symptoms (MUS) in children and adolescents are confounding and concerning for patients, parents, and health care practitioners. Our goal was to review and summarize the literature for family therapists working with a diverse, challenging patient population coping with MUS. A search of multiple databases from 1994 to 2018 was conducted using MUS and related terms. The literature was then organized into subcategories based on its relevance to family therapists, particularly medical family therapists collaborating with primary care physicians. We conclude with a discussion about gaps in the literature and suggestions for clinical management.     

The patient experience of medically unexplained symptoms: an existentialist analysis

This article explores the patient experience of medically unexplained symptoms (MUS) from an existentialist standpoint. Drawing on the work of Jean-Paul Sartre and Simone de Beauvoir, I explore their concepts of existential situation, existential project, authenticity, and praxis. I then analyze the situation of MUS patients in the current cultural and institutional context, elucidating that a lack of explanation for their symptoms puts MUS patients in an existential bind. I illustrate the effects of the experience of MUS on patients’ existential projects. Last, I develop an ethical response in the existentialist tradition from the perspective of patients, providers, and society at large. I argue that there is a collective responsibility to foster conditions more conducive to authentic patient well-being and to improve the experience of patients with medically unexplained symptoms.

     

The spread and impact of Cartesian philosophy in China: historical and comparative perspectives

Cartesian philosophy has had a profound influence on modern Chinese intellectuals since the mid 19^th century. After the May Fourth Movement, there have been many Chinese scholars who worked immensely on Cartesian philosophy and conducted fruitful research including translations, biographies, monographs, and a large number of papers. The examination of mind/body has been one of the most important philosophic issues and also a fundamental truth-searching of the various great thinkers, from Confucius and Socrates to many later Eastern and Western philosophers. There are certain similarities and distinctions between Confucian ‘mind/body’ and Cartesian ‘mind/body’. As a super country with the highest population in the world, the studies of Cartesian philosophy in China have been very inadequate; it should be more prosperous and successful.     

MIND UPLOADING AND EMBODIED COGNITION: A THEOLOGICAL RESPONSE

One of the more radical transhumanist proposals for future human being envisions the uploading of our minds to a digital substrate, trading our dependence on frail, degenerating “meat” bodies for the immortality of software existence. Yet metaphor studies indicate that our use of metaphor operates in our bodily inhabiting of the world, and a phenomenological approach emphasizes a “hybridity” to human being that resists traditional mind/body dichotomies. Future scenarios envisioning mind uploading and disembodied artificial intelligence (AI) share an apocalyptic category with more traditional religious eschatologies, though they differ markedly in content; therefore, the insights of embodied cognition and their uptake in technological innovation are considered as they apply to theological concerns. Theology often functions in debates over the technological future to critique or to caution. However, theologians may learn from their technological dialogue partners when it comes to the future of embodiment and its implications for the construction and practice of theology.     

Effects of an indicated cognitive-behavioral depression prevention program are similar for Asian American, Latino, and European American adolescents

The authors tested whether a brief indicated cognitive-behavioral depression prevention program produced similar effects for Asian American, Latino, and European American adolescents (M age = 17.3, SD = 1.6) with elevated depressive symptoms using data from two randomized trials. The first trial involved 37 Asian-American/Pacific Islanders, 32 Latinos, and 98 European Americans and the second trial involved 61 Latinos and 72 European Americans. Reductions in depressive symptoms from pre- to post-intervention and from pre to 6-month follow-up for intervention participants versus assessment-only controls did not differ significantly for the various ethnic groups in either trial, despite sufficient power to detect clinically meaningful differences. These findings suggest that this indicated depression prevention intervention is similarly efficacious for Asian American, Latino and European American adolescents.     

A Controlled Comparison of Eye Movement Desensitization & Reprocessing and Progressive Counting

Ten therapists who were already trained and experienced in eye movement desensitization and reprocessing (EMDR) received training in progressive counting (PC), a newer trauma resolution method. Nineteen volunteers with single-incident trauma or loss were assigned to a therapist and then randomized to treatment condition; 15 completed treatment to termination criteria or until the 4th session. Participants in both conditions experienced significant reductions in post-traumatic stress disorder (PTSD) symptoms, memory-related distress, and presenting problems at one week posttreatment, and maintained at 12-week follow-up, with no significant differences in outcomes, treatment efficiency, or dropout rate. The preliminary findings of this pilot study suggest that PC is an efficient, well-tolerated, and effective trauma treatment that is relatively easy for therapists to master.     

Nicotine withdrawal in smokers with current depressive disorders undergoing intensive smoking cessation treatment.

The authors investigated withdrawal in smokers with current threshold and subthreshold depressive disorders (N = 21) who were participating in a pilot study of intensive counseling interventions for smoking cessation. The majority of participants (67%) were taking antidepressants when they entered the trial. Withdrawal symptoms were compared in prolonged abstainers versus nonabstainers across a 12-week treatment period and at the 3-month follow-up assessment visit. Prolonged abstinence was associated with an increase in positive affect and a decrease in depressive symptoms and craving over time. Nonabstinence was associated with little overall change in these variables from treatment onset to the 3-month follow-up. At the 3-month follow-up, 44% of prolonged abstainers were in complete remission of their baseline depressive disorders, compared with 0% remission among nonabstainers. Findings suggest that within the context of an intensive smoking cessation intervention, some smokers with current depressive disorders may experience significant improvement in affective and craving symptoms. Findings also suggest that abstinence may be associated with improvement in affect.     

Virtual Reality and Cognitive-Behavioral Therapy for Driving Anxiety and Aggression in Veterans: A Pilot Study

Within the U.S. military, motor vehicle accidents (MVAs) are the leading cause of preventable morbidity and mortality. Prior combat exposure and anxiety symptoms are associated with risky and aggressive driving, which is responsible for over half of MVA fatalities. Therefore, interventions are needed to reduce driving anxiety and aggression in veterans in order to mitigate the public health impact of MVAs. Virtual reality exposure therapy (VRET) offers safe, controlled exposure to distressing stimuli. The current study piloted a novel virtual reality and cognitive behavioral intervention (VRET + CBT) for veterans that integrated both anxiety and anger management components. Virtual reality driving scenarios were delivered in a driving simulator and tailored for the military population. Six previously deployed veterans completed eight intervention sessions, as well as pre/post, one month follow-up and six to nine month follow-up assessments. Repeated measures ANOVAs demonstrated significant decline and large effect sizes for PTSD symptoms, driving phobia, hyperarousal in driving situations, anxiety/anger-related thoughts and behaviors, and risky driving. Hyperarousal in driving situations declined by 69%, aggressive driving declined by 29%, and risky driving declined by 21%. Treatment gains were maintained at follow-up. Recruitment, retention, immersion, simulator sickness scores, and qualitative feedback demonstrated feasibility of the intervention. Implications for future research and adaptation are discussed.     

Positive living: A pilot study of group positive psychotherapy for people with schizophrenia

Positive psychology interventions target positive emotions in order to increase happiness, engagement in life, and well being while also ameliorating the impact of symptoms on a person's life. We examined an adapted version of group positive psychotherapy for people with schizophrenia (Positive Living (PL)) in a pilot study. Sixteen participants were recruited to participate in two separate PL groups and were assessed at baseline, post-intervention and at 3-month follow-up. We examined feasibility of this intervention in addition to a preliminary exploration of well-being outcomes including psychological well-being, hope, savoring, and self-esteem as well as clinically related outcomes including symptoms, psychological recovery, and social functioning. Findings indicate that the PL group was feasible and associated with possible improvements in psychological well-being, hope, savoring, psychological recovery, self-esteem, and psychiatric symptoms.     

At the borders of medical reasoning: aetiological and ontological challenges of medically unexplained symptoms

Medically unexplained symptoms (MUS) remain recalcitrant to the medical profession, proving less suitable for homogenic treatment with respect to their aetiology, taxonomy and diagnosis. While the majority of existing medical research methods are designed for large scale population data and sufficiently homogenous groups, MUS are characterised by their heterogenic and complex nature. As a result, MUS seem to resist medical scrutiny in a way that other conditions do not. This paper approaches the problem of MUS from a philosophical point of view. The aim is to first consider the epistemological problem of MUS in a wider ontological and phenomenological context, particularly in relation to causation. Second, the paper links current medical practice to certain ontological assumptions. Finally, the outlines of an alternative ontology of causation are offered which place characteristic features of MUS, such as genuine complexity, context-sensitivity, holism and medical uniqueness at the centre of any causal set-up, and not only for MUS. This alternative ontology provides a framework in which to better understand complex medical conditions in relation to both their nature and their associated research activity.