Ruud J. Bosscher

Improving the Multidisciplinary Treatment of Chronic Pain by Stimulating Body Awareness: A Cluster-randomized Trial.

Background:Because of methodological flaws and a lack of theoretical foundation of body awareness (BA) in previous effect studies of interventions directed to stimulate BA, it is impossible to attribute treatment effects to this specific component of a multidisciplinary treatment. Therefore, this study evaluated short-term and long-term effects of a multidisciplinary pain rehabilitation program with and without psychomotor therapy (PMT), which focused on BA (measured by the scale of body connection) as a primary target of intervention. Methods:Ninety-four patients clustered in 20 treatment groups were cluster randomized, using a biased-coin design, to multidisciplinary treatment as usual with or without PMT. Outcome variables were health-related quality of life, disability, and depression. BA, catastrophizing, and self-efficacy were measured as potential process variables. Assessments were performed at baseline, directly after treatment, and at 3, 6, and 12 month follow-ups. The data were analyzed by linear mixed-model analysis according to the intention-to-treat principle. Results:Data of all 94 patients were used for analyses. After treatment, significant differences favoring PMT were found between conditions on depression (regression coefficient [RC]=−5.01; 95% confidence interval [CI], −8.81 to −1.21), BA (RC=0.23; 95% CI, 0.04 to 0.42) and catastrophizing (RC=−4.76; 95% CI, −8.03 to −1.48). These differences were no longer significant for depression at the 3-month follow-up and for catastrophizing at the 6-month follow-up. Conclusions:No clinical meaningful differences were found between treatment conditions in the primary outcome measures health-related quality of life and disability. However, this is the first long-term RCT that has shown that PMT improves BA in patients with chronic pain and shows good effect size and a significant decrease for catastrophizing.

Body image in patients with mental disorders : Characteristics, associations with diagnosis and treatment outcome

OBJECTIVE Despite the increasing recognition in clinical practice of body image problems in other than appearance related mental disorders, the question remains how aspects of body image are affected in different disorders. The aim of this study was to measure body image in patients with a variety of mental disorders and to compare scores with those in the general population in order to obtain more insight in the relative disturbance of body image in the patients group compared to healthy controls. In a further exploration associations with self-reported mental health, quality of life and empowerment were established as well as the changes in body image in patients over time. METHODS 176 women and 91 men in regular psychiatric treatment completed the Dresden Body Image Questionnaire, the Outcome Questionnaire, the Manchester Short Assessment of Quality of Life and the Mental Health Confidence Scale. Measurements were repeated after four months. RESULTS Patients with mental disorders, especially those with post-traumatic stress disorder (PTSD), scored significantly lower on body image, with large effect sizes, in comparison with the healthy controls. Scores of patients from different diagnostic groups varied across domains of body image, with body acceptance lowest in the group with eating disorders, and sexual fulfillment extremely low in PTSD. Vitality did not differ significantly between the various disorders. Gender differences were large for body acceptance and sexual fulfillment and small for vitality. Associations of body image with self-reported mental health, quality of life and empowerment were moderate to strong. After four months of treatment positive changes in body image were observed. CONCLUSIONS Negative body image is a common problem occurring in most patients with mental disorders. Diagnosis-specific profiles emerge, with PTSD being the most affected disorder. Body acceptance and sexual fulfillment were the most differentiating aspects of body image between diagnoses. Changes in body image occur over the course of treatment.

Negative body experience in women with early childhood trauma: associations with trauma severity and dissociation

ABSTRACT Background: A crucial but often overlooked impact of early life exposure to trauma is its far-reaching effect on a person’s relationship with their body. Several domains of body experience may be negatively influenced or damaged as a result of early childhood trauma. Objective: The aim of this study was to investigate disturbances in three domains of body experience: body attitude, body satisfaction, and body awareness. Furthermore, associations between domains of body experience and severity of trauma symptoms as well as frequency of dissociation were evaluated. Method: Body attitude was measured with the Dresden Body Image Questionnaire, body satisfaction with the Body Cathexis Scale, and body awareness with the Somatic Awareness Questionnaire in 50 female patients with complex trauma and compared with scores in a non-clinical female sample (n = 216). Patients in the clinical sample also filled out the Davidson Trauma Scale and the Dissociation Experience Scale. Results: In all measured domains, body experience was severely affected in patients with early childhood trauma. Compared with scores in the non-clinical group, effect sizes in Cohen’s d were 2.7 for body attitude, 1.7 for body satisfaction, and 0.8 for body awareness. Associations between domains of body experience and severity of trauma symptoms were low, as were the associations with frequency of dissociative symptoms. Conclusions: Early childhood trauma in women is associated with impairments in self-reported body experience that warrant careful assessment in the treatment of women with psychiatric disorders.

Sports Participation and Psychosocial Health in Elementary School Children

Objective: We examined the associations between sports participation and 3 aspects of psychosocial health in children, ie, internalizing problems, externalizing problems, and prosocial behavior. Methods: Cross-sectional data from 2062 Dutch fourth and fifth graders were obtained using a sports participation questionnaire and the Strengths and Difficulties Questionnaire (SDQ). Results: Fewer internalizing problems, fewer externalizing problems, and better prosocial behavior were found for sports club members. We also found fewer internalizing problems as frequency of sports participation increased. All associations were more prominent for boys. Conclusions: Given the positive associations between psychosocial health and sports participation, school administrators and policymakers should develop programs that encourage children to participate in organized sports activities.

Body awareness as an important target in multidisciplinary chronic pain treatment : Mediation and subgroup analyses

Background:The results of a recently performed randomized clinical trial showed that the effect of a multidisciplinary treatment of chronic pain patients on body awareness (BA), catastrophizing, and depression was improved by adding psychomotor therapy (PMT), an intervention targeting BA. No significant effects were found on quality of life and disability. The present follow-up study aimed to explore the relationship between improvements in BA and multidisciplinary chronic pain rehabilitation treatment outcome across treatment conditions and the possible mediating effect of BA between treatment conditions. Furthermore, the hypothesis that patients with low BA benefit more from PMT was investigated. Methods:In total, 94 patients with chronic pain participated in a randomized clinical trial comparing multidisciplinary treatment as usual (TAU) with TAU plus PMT. Outcome variables were health-related quality of life, disability, and depression. Self-efficacy and catastrophizing were the process variables of treatment and the potential mediating factors in the relationship between BA and the outcome variables. The data were analyzed by linear mixed-model analysis. Results:Improvements in BA were related to improvements in all outcome variables across treatment conditions. The relationships were partly mediated by self-efficacy, catastrophizing, or both. In the regression model with depression as the outcome variable, the regression coefficient of treatment (ie, PMT vs. TAU) decreased by 34% and became nonsignificant when BA was added as a potential mediator. Patients with low BA seemed to benefit more from PMT than patients with high BA, especially on depression, BA, and catastrophizing. Conclusions:BA might be an important target of treatment to improve the multidisciplinary treatment outcome in chronic pain patients. Furthermore, PMT is an intervention that seems to provide its benefits through improving BA and may be especially beneficial for patients with low BA.

Body attitude, body satisfaction and body awareness in a clinical group of depressed patients: An observational study on the associations with depression severity and the influence of treatment

BACKGROUND Apart from changes in mood and cognition, depressive disorders are also characterized by changes in body experience, changes that largely influence daily functioning and aggravate distress. In order to gain more insight into this important issue, three domains of body experience - body attitude, body satisfaction and body awareness - and their associations with symptom severity of depression were studied pre- and post-treatment in a clinical sample of depressed patients in a multidisciplinary setting. METHODS Body attitude (Dresden Body Image Questionnaire), body satisfaction (Body Cathexis Scale), body awareness (Somatic Awareness Questionnaire) and severity of depressive symptoms (Inventory of Depressive Symptomatology) were measured. Differences between pre-treatment and post-treatment scores were studied with paired t-tests. Associations between body experience and depression were analysed with Pearson correlations and partial correlations. RESULTS At the start of treatment, patients scored significantly lower than a healthy comparison sample on body attitude and body satisfaction, but not on body awareness. After treatment, depression scores decreased with large effect sizes, scores for body attitude and body satisfaction increased with medium effect sizes and body awareness scores increased slightly. Medium pre-treatment and strong post-treatment associations were found between depression severity and body attitude and between depression severity and body satisfaction. LIMITATIONS The design does not allow to draw causal conclusions. Because of the multidisciplinary treatment no information is available on the specific contribution of interventions targeting body experience. CONCLUSIONS The study provides evidence for medium to strong associations in clinically depressed patients between body attitude, body satisfaction and depression.

Characteristics of sports participation and psychosocial health in children: Results of a cross-sectional study

Abstract Several studies suggest that sports participation is beneficial for psychosocial health. There is, however, only a limited number of studies about the relationship of specific characteristics of sports participation with psychosocial health. The present study investigated associations between characteristics of sports participation and three aspects of psychosocial health, i.e. internalising problems, externalising problems and prosocial behaviour. The examined characteristics of sports participation pertained to individual versus team sports, indoor versus outdoor sports, involvement in competition or not, and contact sports versus non-contact sports. Cross-sectional data were collected from 1768 Dutch children aged 10–12 years who were member of a sports club. These children completed the Movement and Sports Monitor Questionnaire Youth aged 8–12 years (MSMQ) and the Strength and Difficulties Questionnaire (SDQ). Linear multilevel analyses and logistic generalised estimating equation were conducted. Children participating in team sports, outdoor sports, or competition showed fewer internalising problems than children engaged in individual sports, indoor sports, or only training. The associations with internalising problems were stronger for boys than for girls. Children participating in non-contact sports showed fewer externalising problems than children performing non-contact sports as well as contact sports. Children practising indoor sports or non-contact sports showed better prosocial behaviour than children doing outdoor or contact sports. In conclusion, the form of sports participation seemed to matter highly with respect to internalising problems, especially for boys, and, to a lesser extent, with respect to externalising problems and prosocial behaviour. This offers starting points for developing tailor-made sports programmes for children.

Body image in patients with somatoform disorder

BackgroundAlthough body-related problems are common in patients with somatoform disorder, research focusing on how patients with somatoform disorder perceive and evaluate their body is scarce. The present study compared differences in body image between patients with somatoform disorder and respondents from a general population sample. It also examined differences within the somatoform disorder group between men and women and between the diagnostic subgroups conversion disorder, pain disorder and undifferentiated somatoform disorder.MethodsData were obtained from 657 patients (67.5% female) with somatoform disorder (DSM-IV-TR 300.7, 300.11, 300.81, 300.82) and 761 participants (58.6% female) from the general population. The Dresden Body Image Questionnaire (DBIQ) was used to assess body image in five domains: body acceptance, vitality, physical contact, sexual fulfilment, and self-aggrandizement. Confirmatory factor analysis and analyses of variance were performed. Since differences in age and sex were found between the somatoform disorder sample and the comparison sample, analyses were done with two samples of 560 patients with somatoform disorder and 351 individuals from the comparison sample matched on proportion of men and women and age.ResultsPatients scored significantly lower than the comparison sample on all DBIQ domains. Men scored higher than women. Patients with conversion disorder scored significantly higher on vitality and body acceptance than patients with undifferentiated somatoform disorder and pain disorder.ConclusionsThe mostly large differences in body image between patients with somatoform disorder and the comparison sample as well as differences between diagnostic subgroups underline that body image is an important feature in patients with somatoform disorder. The results indicate the usefulness of assessing body image and treating negative body image in patients with somatoform or somatic symptom disorder.

1010 THE ADDITIONAL EFFECT OF PSYCHOMOTOR THERAPY IN TREATING CHRONIC MUSCULOSKELETAL PAIN: PRELIMINARY RESULTS

Background: Post-traumatic stress reactions with anxiety and avoidance behaviour have been reported in patients several years after traffic accidents. Relationships between pain and posttraumatic stress have been shown, and it has been proposed that in patients with chronic pain after accidents that these symptoms may co-exist and interact with each other (Bryant 2001, McCauley et al 2001). Aim: To investigate, in patients with injury-related chronic pain, pain intensity, level of post-traumatic stress, anxiety and depression before and after multidisciplinary rehabilitation. Methods: 28 patients, age 21–53 years, with injury-related chronic pain answered a set of questionnaires to assess post-traumatic stress on Impact of Event Scale (IES; Horowotz et al, 1979), pain intensity (VAS; Scott et al, 1977), depression and anxiety on Hospital Anxiety and Depression Scale (HAD; Zigmond and Snaith 1983) before and after participating in a multidisciplinary program Results: Total score of IES and pain intensity (VAS) were significantly decreased after the program (IES: p < 0.001; VAS: p =0.009). Patients <40 years reported significantly higher IES-scores than patients >40 years, before (p = 0.023) and after rehabilitation (p =0.029). The IES-scores were significantly correlated to the HAD-scores anxiety before (r = 0.570, p = 0.002) and after (r = 0.450, p = 0.016) rehabilitation. Conclusion: The multidisciplinary rehabilitation program was effective in reducing both pain intensity and posttraumatic stress. The experience of higher levels of posttraumatic stress in younger persons has to be taken into account when managing patients with injury-related chronic pain.