Background: Functional somatic symptoms and bodily distress disorders are highly prevalent across... more Background: Functional somatic symptoms and bodily distress disorders are highly prevalent across all medical settings. Services for these patients are dispersed across the health care system with minimal conceptual and operational integration and patients do not currently access therapeutic offers in signi cant numbers due to a mismatch between their and professionals' understanding of the nature of the symptoms. New service models are urgently required to address patients' needs and to align with advances in aetiological evidence and diagnostic classi cation systems to overcome the body-mind dichotomy. Method: A panel of clinical experts from different clinical services involved in providing aspects of health care for patients with functional symptoms reviewed the current care provision. This review and the results from a focus group exploration of patients with lived experience of functional symptoms were explored by the expert advisory group and conclusions summarised as recommendations for best practice. Conclusion: We propose a novel, integrated care pathway for patients with 'functional somatic disorder', which delivers care according to and working with patients' explanatory beliefs. The therapeutic model should operate based upon an understanding of the embodied nature of patient's complaints and provide exible access points to the care pathway.
Fallstudien werden in der psychotherapeutischen Ausbildung essentiell zur Illustration theoretisc... more Fallstudien werden in der psychotherapeutischen Ausbildung essentiell zur Illustration theoretischer Lehrinhalte genutzt. In der Psychotherapie-Forschung sind Fallstudien erneut zentral berucksichtigt, seitdem im Rahmen der Effektivitatsstudien zunehmend Fragen bezuglich der psychotherapeutischen Veranderungsprozesse, Therapeutenvariablen und der therapeutischen Beziehung in den Fokus geruckt sind. Fur die Korperpsychotherapie sind Fallstudien als besonders wichtig zu erachten, um uber eine detaillierte Beschreibung der („verkorperten“) Therapieprozesse grundlegenden Hypothesen zu hinterfragen und zu einem besseres und empirisch fundierten Verstandnis der spezifischen korperbezogenen Wirkmechanismen zu gelangen.
In diesem Artikel wird der aktuelle Diskurs zur Frage der Relevanz und der geeigneten Methodik ei... more In diesem Artikel wird der aktuelle Diskurs zur Frage der Relevanz und der geeigneten Methodik einer Psychotherapieforschung fur den Bereich der Korperorientierten Psychotherapie (KOPT) dargestellt. Unter Bezugnahme auf zwei zentrale Leitthemen – Embodiment und Enaktivismus – wird argumentiert, dass die Anwendungs- und Interventionsforschung der KOPT sinnvollerweise als „Mixed-Method-Design“ konzipiert wird. Dabei werden die spezifischen verkorperten therapeutischen Prozesse und die diese bestimmenden therapeutischen Beziehungen mittelbar auf die therapeutischen Effekte und die zu beobachtenden sonstigen Veranderungen („Outcomes“) bezogen. Dieses Vorgehen wird anhand eines konkreten Beispiels klinischer Forschung bei chronischer Depression illustriert.
Current phenomenological approaches consider schizophrenia as a fundamental disturbance of the em... more Current phenomenological approaches consider schizophrenia as a fundamental disturbance of the embodied self, or a disembodiment. This includes (1) a weakening of the basic sense of self, (2) a disruption of implicit bodily functioning, and (3) a disconnection from the intercorporeality with others. As a result of this disembodiment, the pre-reflective, practical immersion of the self in the shared world is lost. Instead, the relationship of self and world is in constant need of being reconstructed by deliberate efforts, leading to the growing perplexity and hyperreflexive ruminations that are found in schizophrenia patients. The paper distinguishes different levels of self-experience and relates them to the psychopathology of schizophrenia, taking particularly into account disturbances of self-awareness, perception, action, and intersubjectivity. On this basis, psychotherapeutic approaches based on body awareness and movement techniques are outlined that are suited to foster self-management and enable patients to re-establish a more stable and coherent sense of self.
We report on the case of a man, whose psychopathological symptoms markedly varied during differen... more We report on the case of a man, whose psychopathological symptoms markedly varied during different phases of his illness, causing difficulties in applying common diagnostic criteria for schizophrenia. Depending upon each of the predominant symptoms, this resulted in different diagnoses and therapeutic strategies. We also discuss the importance of obsessions and compulsions in differential diagnosis in this case.
Introduction: In primary care, difficulty to distinguish somatic syndromes from depression with s... more Introduction: In primary care, difficulty to distinguish somatic syndromes from depression with somatic symptoms is recognised. In somatoform disorders co-morbid depression and anxiety have an additive detrimental effect on level of functioning. Aim: To investigate role of depressive symptoms in somatic presentations and elucidate its impact on level of functioning. Method: Cohort is 106 consecutive patients referred to a specialist somatoform disorder clinic as part of a naturalistic followup study. Tools used included Hamilton rating scale for depression (HAMD), Patient Health Questioner (PHQ-15), Global Assessment of Functioning (GAF). Results: 26% of cohort had only depressive disorder (ICD-10 F32-34, 38), 44% had a somatic syndrome (F 44-45, 48), 10% with anxiety or psychotic disorders and 20% had no mental disorders. 34% of somatic syndrome had co-morbidities, mainly depressive disorder. No significant difference in HAMD, PHQ-15 and GAF, seen between diagnostic groups. In the somatic syndrome group, HAMD and PHQ-15 scores negatively correlated with GAF (functioning) (t=-4.5, df=1, p=0.0001 and t=-2.3, df=1, p=0.04). When HAMD along with PHQ-15, age, gender, co-morbidity and medication-use entered in a multiple regression model, HAMD score was the only significant parameter (F=17, t-4.2, df=1, p=0.001). Conclusions: A considerable number of patients with severe somatic symptoms and functional impairment have depressive disorder. In patients with somatic syndrome, depressive symptoms (even sub-syndromal) appear to influence the level of functioning and mediate the effect of somatic symptoms on level of functioning. This finding may have implication in treatment and needs establishing.
evidence is needed. Since the publication of NICE guidelines one large trial of conventional art ... more evidence is needed. Since the publication of NICE guidelines one large trial of conventional art therapy has been completed (MATISSE) that found no significant treatment effect on negative symptoms. 8 Following MATISSE, the aim of the present study was to evaluate the effectiveness of a different type of arts therapy, namely body psychotherapy, as a treatment for negative symptoms of schizophrenia. Body psychotherapy is a form of therapy that involves an explicit theory of body-mind functioning designed to improve emotional, cognitive, physical and social integration. In an earlier trial where this therapy was evaluated, 9 a significant reduction in negative symptoms was detected in the body psychotherapy group in comparison with a supportive counselling control group. The effect size was large, and was maintained months later. However, this study was relatively small (45 participants), did Declaration of interest None.
In the light of the heterogeneous literature on disturbances of body image in schizophrenic patie... more In the light of the heterogeneous literature on disturbances of body image in schizophrenic patients, we examined body schema, body concept and body cathexis, their changes during hospital treatment and their correlations with psychopathology in 38 patients with acute paranoid schizophrenia. The image-marking method according to Askevold, the Body Distortion Questionnaire, a visual-analogue scale on body cathexis and psychopathometric scales were applied. Body schema was also investigated in 27 healthy controls. On average, patients underestimated the size of their lower extremities, indicating a centralized body schema. They accurately assessed proximal fixed points. Underestimation was significantly correlated with anxiety, overestimation with grandiosity. Body schema and body concept were relatively independent from each other and from body hallucinations. Disturbances of body perception were reduced significantly, but not completely, during the time from admission to discharge. The results confirm and clarify some findings in the literature on a distorted perception of body size and support theories on body perception in schizophrenia.
Background: Body oriented psychological therapy (BOPT) for patients with MUS is a new and innovat... more Background: Body oriented psychological therapy (BOPT) for patients with MUS is a new and innovative intervention offering patients an alternative way to engage with and manage their MUS symptoms as well as their emotional responses. Methods: This paper is a qualitative report on a pilot study which took place in a primary care setting. Patients were offered 10 weekly sessions of BOPT in small groups.Results: The qualitative findings suggest that (i) patients responded well to this treatment approach, (ii) they experienced their bodily realities in a more positive way and not just as a source of negativity or pain, (iii) they learnt to manage their symptoms more effectively and (iv) they began to understand the relationship between their bodily symptoms and their emotional state as well as the impact of the one on the other including very poignant themes such as loss and dislocation.Conclusion: BOPT is a useful therapeutic approach in the person-centered care of MUS.
The role of the embodied therapeutic relationship and the therapist's felt sense was explored as ... more The role of the embodied therapeutic relationship and the therapist's felt sense was explored as a central mechanism for the change process. Regulating emotional responses to adversity through expressive and symbolic enactments were identified as an effective strategy to bring into consciousness determinants of psychological states related to implicit memories of traumatic events. The playfulness in BOPT enabled the patient to experience a tangible connection with creative capabilities to strengthen resilience and empowerment.
Background: Negative symptoms of schizophrenia are frequently associated with poor long term outc... more Background: Negative symptoms of schizophrenia are frequently associated with poor long term outcomes. Established interventions have little, if any, positive effects on negative symptoms. Arts Therapies such as Body Psychotherapy (BPT) have been suggested to reduce negative symptoms, but the existing evidence is limited. In a small exploratory trial a manualised form of group BPT led to significantly lower negative symptom levels both at the end of treatment and at 4 months follow-up as compared to supportive counseling. We designed a large multi-site trial to assess the effectiveness of a manualised BPT intervention in reducing negative symptoms, compared to an active control. Methods/Design: In a randomised controlled trial, 256 schizophrenic outpatients with negative symptoms will be randomly allocated either to BPT or Pilates groups. In both conditions, patients will be offered two 90 minutes sessions per week in groups of about 8 patients over a period of 10 weeks. Outcomes are assessed at the end of treatment and at six months follow-up. The primary outcome is severity of negative symptoms, as measured by the Positive and Negative Symptom Scale (PANSS), whilst a range of secondary outcome measures include general psychopathology, social contacts, and quality of life. We will also assess the cost-effectiveness of the intervention. Discussion: The study aims to evaluate the effectiveness of a promising form of group therapy which may help alleviate negative symptoms that are associated with unfavourable long-term outcomes and have so far been difficult to treat. If the trial is successful, it will add a new and effective option in the treatment of negative symptoms. Group BPT is manualised, might be attractive to many patients because of its unusual approach, and could potentially be rolled out to services at relatively little additional cost.
Background: Functional somatic symptoms and bodily distress disorders are highly prevalent across... more Background: Functional somatic symptoms and bodily distress disorders are highly prevalent across all medical settings. Services for these patients are dispersed across the health care system with minimal conceptual and operational integration and patients do not currently access therapeutic offers in signi cant numbers due to a mismatch between their and professionals' understanding of the nature of the symptoms. New service models are urgently required to address patients' needs and to align with advances in aetiological evidence and diagnostic classi cation systems to overcome the body-mind dichotomy. Method: A panel of clinical experts from different clinical services involved in providing aspects of health care for patients with functional symptoms reviewed the current care provision. This review and the results from a focus group exploration of patients with lived experience of functional symptoms were explored by the expert advisory group and conclusions summarised as recommendations for best practice. Conclusion: We propose a novel, integrated care pathway for patients with 'functional somatic disorder', which delivers care according to and working with patients' explanatory beliefs. The therapeutic model should operate based upon an understanding of the embodied nature of patient's complaints and provide exible access points to the care pathway.
Fallstudien werden in der psychotherapeutischen Ausbildung essentiell zur Illustration theoretisc... more Fallstudien werden in der psychotherapeutischen Ausbildung essentiell zur Illustration theoretischer Lehrinhalte genutzt. In der Psychotherapie-Forschung sind Fallstudien erneut zentral berucksichtigt, seitdem im Rahmen der Effektivitatsstudien zunehmend Fragen bezuglich der psychotherapeutischen Veranderungsprozesse, Therapeutenvariablen und der therapeutischen Beziehung in den Fokus geruckt sind. Fur die Korperpsychotherapie sind Fallstudien als besonders wichtig zu erachten, um uber eine detaillierte Beschreibung der („verkorperten“) Therapieprozesse grundlegenden Hypothesen zu hinterfragen und zu einem besseres und empirisch fundierten Verstandnis der spezifischen korperbezogenen Wirkmechanismen zu gelangen.
In diesem Artikel wird der aktuelle Diskurs zur Frage der Relevanz und der geeigneten Methodik ei... more In diesem Artikel wird der aktuelle Diskurs zur Frage der Relevanz und der geeigneten Methodik einer Psychotherapieforschung fur den Bereich der Korperorientierten Psychotherapie (KOPT) dargestellt. Unter Bezugnahme auf zwei zentrale Leitthemen – Embodiment und Enaktivismus – wird argumentiert, dass die Anwendungs- und Interventionsforschung der KOPT sinnvollerweise als „Mixed-Method-Design“ konzipiert wird. Dabei werden die spezifischen verkorperten therapeutischen Prozesse und die diese bestimmenden therapeutischen Beziehungen mittelbar auf die therapeutischen Effekte und die zu beobachtenden sonstigen Veranderungen („Outcomes“) bezogen. Dieses Vorgehen wird anhand eines konkreten Beispiels klinischer Forschung bei chronischer Depression illustriert.
Current phenomenological approaches consider schizophrenia as a fundamental disturbance of the em... more Current phenomenological approaches consider schizophrenia as a fundamental disturbance of the embodied self, or a disembodiment. This includes (1) a weakening of the basic sense of self, (2) a disruption of implicit bodily functioning, and (3) a disconnection from the intercorporeality with others. As a result of this disembodiment, the pre-reflective, practical immersion of the self in the shared world is lost. Instead, the relationship of self and world is in constant need of being reconstructed by deliberate efforts, leading to the growing perplexity and hyperreflexive ruminations that are found in schizophrenia patients. The paper distinguishes different levels of self-experience and relates them to the psychopathology of schizophrenia, taking particularly into account disturbances of self-awareness, perception, action, and intersubjectivity. On this basis, psychotherapeutic approaches based on body awareness and movement techniques are outlined that are suited to foster self-management and enable patients to re-establish a more stable and coherent sense of self.
We report on the case of a man, whose psychopathological symptoms markedly varied during differen... more We report on the case of a man, whose psychopathological symptoms markedly varied during different phases of his illness, causing difficulties in applying common diagnostic criteria for schizophrenia. Depending upon each of the predominant symptoms, this resulted in different diagnoses and therapeutic strategies. We also discuss the importance of obsessions and compulsions in differential diagnosis in this case.
Introduction: In primary care, difficulty to distinguish somatic syndromes from depression with s... more Introduction: In primary care, difficulty to distinguish somatic syndromes from depression with somatic symptoms is recognised. In somatoform disorders co-morbid depression and anxiety have an additive detrimental effect on level of functioning. Aim: To investigate role of depressive symptoms in somatic presentations and elucidate its impact on level of functioning. Method: Cohort is 106 consecutive patients referred to a specialist somatoform disorder clinic as part of a naturalistic followup study. Tools used included Hamilton rating scale for depression (HAMD), Patient Health Questioner (PHQ-15), Global Assessment of Functioning (GAF). Results: 26% of cohort had only depressive disorder (ICD-10 F32-34, 38), 44% had a somatic syndrome (F 44-45, 48), 10% with anxiety or psychotic disorders and 20% had no mental disorders. 34% of somatic syndrome had co-morbidities, mainly depressive disorder. No significant difference in HAMD, PHQ-15 and GAF, seen between diagnostic groups. In the somatic syndrome group, HAMD and PHQ-15 scores negatively correlated with GAF (functioning) (t=-4.5, df=1, p=0.0001 and t=-2.3, df=1, p=0.04). When HAMD along with PHQ-15, age, gender, co-morbidity and medication-use entered in a multiple regression model, HAMD score was the only significant parameter (F=17, t-4.2, df=1, p=0.001). Conclusions: A considerable number of patients with severe somatic symptoms and functional impairment have depressive disorder. In patients with somatic syndrome, depressive symptoms (even sub-syndromal) appear to influence the level of functioning and mediate the effect of somatic symptoms on level of functioning. This finding may have implication in treatment and needs establishing.
evidence is needed. Since the publication of NICE guidelines one large trial of conventional art ... more evidence is needed. Since the publication of NICE guidelines one large trial of conventional art therapy has been completed (MATISSE) that found no significant treatment effect on negative symptoms. 8 Following MATISSE, the aim of the present study was to evaluate the effectiveness of a different type of arts therapy, namely body psychotherapy, as a treatment for negative symptoms of schizophrenia. Body psychotherapy is a form of therapy that involves an explicit theory of body-mind functioning designed to improve emotional, cognitive, physical and social integration. In an earlier trial where this therapy was evaluated, 9 a significant reduction in negative symptoms was detected in the body psychotherapy group in comparison with a supportive counselling control group. The effect size was large, and was maintained months later. However, this study was relatively small (45 participants), did Declaration of interest None.
In the light of the heterogeneous literature on disturbances of body image in schizophrenic patie... more In the light of the heterogeneous literature on disturbances of body image in schizophrenic patients, we examined body schema, body concept and body cathexis, their changes during hospital treatment and their correlations with psychopathology in 38 patients with acute paranoid schizophrenia. The image-marking method according to Askevold, the Body Distortion Questionnaire, a visual-analogue scale on body cathexis and psychopathometric scales were applied. Body schema was also investigated in 27 healthy controls. On average, patients underestimated the size of their lower extremities, indicating a centralized body schema. They accurately assessed proximal fixed points. Underestimation was significantly correlated with anxiety, overestimation with grandiosity. Body schema and body concept were relatively independent from each other and from body hallucinations. Disturbances of body perception were reduced significantly, but not completely, during the time from admission to discharge. The results confirm and clarify some findings in the literature on a distorted perception of body size and support theories on body perception in schizophrenia.
Background: Body oriented psychological therapy (BOPT) for patients with MUS is a new and innovat... more Background: Body oriented psychological therapy (BOPT) for patients with MUS is a new and innovative intervention offering patients an alternative way to engage with and manage their MUS symptoms as well as their emotional responses. Methods: This paper is a qualitative report on a pilot study which took place in a primary care setting. Patients were offered 10 weekly sessions of BOPT in small groups.Results: The qualitative findings suggest that (i) patients responded well to this treatment approach, (ii) they experienced their bodily realities in a more positive way and not just as a source of negativity or pain, (iii) they learnt to manage their symptoms more effectively and (iv) they began to understand the relationship between their bodily symptoms and their emotional state as well as the impact of the one on the other including very poignant themes such as loss and dislocation.Conclusion: BOPT is a useful therapeutic approach in the person-centered care of MUS.
The role of the embodied therapeutic relationship and the therapist's felt sense was explored as ... more The role of the embodied therapeutic relationship and the therapist's felt sense was explored as a central mechanism for the change process. Regulating emotional responses to adversity through expressive and symbolic enactments were identified as an effective strategy to bring into consciousness determinants of psychological states related to implicit memories of traumatic events. The playfulness in BOPT enabled the patient to experience a tangible connection with creative capabilities to strengthen resilience and empowerment.
Background: Negative symptoms of schizophrenia are frequently associated with poor long term outc... more Background: Negative symptoms of schizophrenia are frequently associated with poor long term outcomes. Established interventions have little, if any, positive effects on negative symptoms. Arts Therapies such as Body Psychotherapy (BPT) have been suggested to reduce negative symptoms, but the existing evidence is limited. In a small exploratory trial a manualised form of group BPT led to significantly lower negative symptom levels both at the end of treatment and at 4 months follow-up as compared to supportive counseling. We designed a large multi-site trial to assess the effectiveness of a manualised BPT intervention in reducing negative symptoms, compared to an active control. Methods/Design: In a randomised controlled trial, 256 schizophrenic outpatients with negative symptoms will be randomly allocated either to BPT or Pilates groups. In both conditions, patients will be offered two 90 minutes sessions per week in groups of about 8 patients over a period of 10 weeks. Outcomes are assessed at the end of treatment and at six months follow-up. The primary outcome is severity of negative symptoms, as measured by the Positive and Negative Symptom Scale (PANSS), whilst a range of secondary outcome measures include general psychopathology, social contacts, and quality of life. We will also assess the cost-effectiveness of the intervention. Discussion: The study aims to evaluate the effectiveness of a promising form of group therapy which may help alleviate negative symptoms that are associated with unfavourable long-term outcomes and have so far been difficult to treat. If the trial is successful, it will add a new and effective option in the treatment of negative symptoms. Group BPT is manualised, might be attractive to many patients because of its unusual approach, and could potentially be rolled out to services at relatively little additional cost.
Sensoria: A Journal of Mind, Brain and Culture, 2014
New approaches in the philosophy of mind defend the idea that basic forms of cognition and human ... more New approaches in the philosophy of mind defend the idea that basic forms of cognition and human intersubjectivity are deeply and inextricably embodied and embedded. In its more extreme forms this approach to mind and cognition opposes the idea that cognition is always or primarily a matter of forming mental representations of that environment (Gallagher & Hutto, 2008; Hutto & Myin, 2013). Taking these ideas seriously in the context of therapy directs us to the way therapy can be enhanced by modifying environmental and social affordances and the way clients interact with them as opposed to how they represent them. These conceptual and methodological paradigms encourage a rethinking of existing applications, inspired by reformulating the theoretical foundation that underpins practice in body psychotherapy (BPT; e.g. Geuter, in press). Given the emerging evidence base for BPT in the treatment of severe mental health problems (e.g. Röhricht, 2009) it is timely to question whether its intervention strategies can be better understood as a kind of applied embodied cognition. In this paper we only explore BPT practice from a framework of its more radical variants. We explore new ways that effective therapeutic embodied engagements might be realised, while casting fresh light on how therapists can successfully venture into the everyday life of their patients and their interactions with significant others. This includes discussing a revised version of encounter groups and “marathon” workshops as well as experimental solutions such as “Virtual Reality” clinics.
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Papers by Frank Rohricht