Susanne Rosberg

Opening toward life: experiences of basic body awareness therapy in persons with major depression.

Although there is a vast amount of research on different strategies to alleviate depression, knowledge of movement-based treatments focusing on body awareness is sparse. This study explores the experiences of basic body awareness therapy (BBAT) in 15 persons diagnosed with major depression who participated in the treatment in a randomized clinical trial. Hermeneutic phenomenological methodology inspired the approach to interviews and data analysis. The participants’ experiences were essentially grasped as a process of enhanced existential openness, opening toward life, exceeding the tangible corporeal dimension to also involve emotional, temporal, and relational aspects of life. Five constituents of this meaning were described: vitality springing forth, grounding oneself, recognizing patterns in ones body, being acknowledged and allowed to be oneself, and grasping the vagueness. The process of enhanced perceptual openness challenges the numbness experienced in depression, which can provide hope for change, but it is connected to hard work and can be emotionally difficult to bear. Inspired by a phenomenological framework, the results of this study illuminate novel clinical and theoretical insight into the meaning of BBAT as an adjunctive approach in the treatment of depression.

Depression embodied: an ambiguous striving against fading.

Although depression is associated to physical discomfort, meanings of the body in depression are rarely addressed in clinical research. Drawing on the concept of the lived body, this study explores depression as an embodied phenomenon. Using a hermeneutic phenomenological approach, the analysis of narrative-based interviews with 11 depressed adults discloses a thematic structure of an embodied process of an ambiguous striving against fading. Five subthemes elicit different dimensions of this process, interpreted as disabling or enabling: feeling estranged, feeling confined, feeling burdensome, sensing life and seeking belongingness. In relation to clinical practice, we suggest that the interdisciplinary team can focus on enhancing the enabling dimensions, for example through guided physical activities to support the patient to feel more alive, capable and connected. Moreover, we suggest that the treatment process benefits from an increased awareness of the ambiguity in the patients struggle, acknowledging both destructive and recharging elements of the withdrawing, and the perceived conflict in-between.

Quality of life in parents/caretakers of children with cerebral palsy in Kampong Cham, Cambodia.

The purpose of this study was to investigate QOL in parents/caretakers of children with cerebral palsy in the province of Kampong Cham, Cambodia. Forty parents/caretakers of children with cerebral palsy aged 1-13 years (F19/M21) participated in this study. The study was carried out using the Comprehensive Quality of life Scale A5 (ComQOL-A5) questionnaire. Results point out three major domains where quality of life is unsatisfactory: health, material well-being and emotional well-being. Of these areas, QOL in the health domain demonstrates the lowest scores. Results support a further commitment in providing comprehensive rehabilitation for parents and their children with CP in Kampong Cham. This study identifies the need for further research on QOL in parents/caretakers of children with CP in Cambodia and the need for development of valid and reliable QOL instruments targeting the developing world.

From idealistic helper to enterprising learner: Critical reflections on personal development through experiences from Afghanistan

There is little written about the cultural, social, and ethical challenges encountered by physiotherapists engaging in development work. This article takes a critical perspective on what it means to engage in development work as an expatriate physiotherapist, through a self-critical reflection on experiences from Afghanistan. The field notes from an ethnographic study of a development project conducted in Afghanistan were analysed to explore the transformative process of personal and professional development of the development worker. The critical reflective process entailed a change in meaning perspective, described as a shift from the position of an Idealistic Helper to an Enterprising Learner. Of importance in this process were “disorienting dilemmas” that challenged personal perceptions. Critical reflection over such dilemmas led to deeper understanding facilitating the process of change. The essential lesson learned is that the baseline for understanding others is an understanding of ones own meaning perspectives and manner of participation in relation to others and their context. The insights gained have implications for physiotherapists working in development contexts, for other development workers, and for physiotherapists working with patients in clinical practice in a nondevelopment context. Exploring how to collaborate in development contexts could be done using reflective groups with expatriate and local physiotherapists and/or patients. This could lead to greater understanding of oneself, each other, and the local context.

Cross-Cultural Adaptation, Validity and Reliability of the Arabic Version of the Falls Efficacy Scale-International (FES-I).

Objective: The aim of this study was to evaluate the validity and reliability of an Arabic language version (Ar) of the Falls Efficacy Scale-International (FES-I) with respect to its use with Arabic-speaking elderly subjects. Subjects and Methods: For cross-cultural adaptation, the translation of the original English version of the scale was conducted based on the protocol of the Prevention of Falls Network Europe (ProFaNE). The FES-I (Ar) was administered via face-to-face interviews to 108 community-dwelling elderly Palestinians (61 women and 47 men, aged 60-84 years). Statistical analyses were used to determine group differences with respect to age, gender and fall history. To assess validity, Spearmans rank correlation coefficient was used to examine the correlation between the total scores of FES-I (Ar) and the Timed Up and Go (TUG) test, gait speed and balance. Test-retest reliability between the two test occasions was assessed in accordance with Svenssons method. Results: The FES-I (Ar) total scores were positively correlated with TUG (rs = 0.641, p < 0.001) and negatively correlated with gait speed (rs = -0.670, p < 0.001) and balance (rs = -0.592, p < 0.001). All items of the FES-I (Ar) indicated a high percentage agreement (from 88 to 93%), and the relative position ranged from 0.01 to 0.06. Conclusion: In this study, the FES-I (Ar) was shown to be a comprehensible, valid and reliable measure of the concern about falling among community-dwelling elderly subjects. In clinical practice and future research, the FES-I (Ar) instrument could be used to effectively assess concern about falling in Arabic-speaking elderly persons.

A transformative perspective on learning and professional development of Afghan physiotherapists.

The aim of this article is to explore factors that impacted learning of Afghan physiotherapists in a development project to improve the physiotherapy services in a disability programme implemented by a Swedish nongovernmental organisation in Afghanistan. Participant observation, recorded as field notes, was used to document the process, to gain a better understanding of professional development of physiotherapists in Afghanistan. Field notes were analysed and factors affecting learning were interpreted from a perspective inspired by transformative learning. Various factors were identified: a pattern approach to treatment, linear thinking, and socially oriented decision making affected how new things learned were put into practice; concrete representations and an instrumental view of knowledge characterised learning approaches; language barriers, different interpretations of meaning, and cultural codes challenged communication; and a prescriptive, encouraging approach of the expatriate physiotherapy development worker affected teaching and learning. Working with professional development across cultural borders is challenging, and the identified factors impacting learning can help expatriate physiotherapists in adapting training to the Afghan context. Exploring meaning perspectives and communicative learning could enhance understanding of these factors for both expatriate and Afghan physiotherapists and should be a focus in future development activities.

Anxiety management: Participants’ experiences of a physiotherapeutic group treatment in Swedish psychiatric outpatient care

ABSTRACT Anxiety disorders are among the most persistent mental health syndromes. There is extensive research showing effectiveness of pharmacotherapy and psychotherapy interventions targeting anxiety, while knowledge is still sparse for other treatment options. The aim of this study was to explore how participants with anxiety disorders experience a physiotherapeutic group treatment in psychiatric outpatient care, and their perceived ability to manage anxiety within two months after participating in the treatment. Semi-structured interviews with participants were conducted to explore experiences of the treatment. Data were analyzed using qualitative content analysis, which resulted in one main theme: Reconnecting to the body in the supportive atmosphere of a group. Six categories reflect the main theme: (1) sharing with others supported by the group, (2) grounding oneself in the body, (3) getting to know the body and learning to manage its reactions, (4) learning to tolerate bodily sensations of anxiety, (5) gaining a more compassionate attitude toward oneself, and (6) challenging old patterns to become more active in life. The participants reported that their ability to reconnect to their bodies increased so that anxious sensations became more endurable and acceptable after treatment. The supportive group context was described as valuable, enabling the participants to feel safe enough to start exploring new ways to manage anxiety. In conclusion, this study suggests that a physiotherapeutic group treatment can be a useful add-on treatment to the standard treatment models of anxiety disorders, including psychotherapy and pharmacotherapy, since it targets the embodied, nonverbal domain of anxiety.

Nonverbal affect attunement in mentalization-based treatment for patients with borderline personality disorder

Abstract The aim of this study was to describe and analyse the nonverbal affect attunement in relation to the verbal dialogue in mentalization-based treatment (MBT) for patients with borderline personality disorder (BPD). The therapists’ nonverbal affect attunement documented in five video recorded individual sessions in MBT, with five women, diagnosed with BPD, was analysed with part process analysis, a qualitative method developed for video recorded material. Four categories of nonverbal affect attunement were identified in the results: (1) nonverbal affect attunement that supports the therapeutic process; (2) nonverbal misattunement that supports the therapeutic process; (3) nonverbal misattunement that does not support the therapeutic process; (4) no nonverbal affect attunement that does not support the therapeutic process. The study suggests that making therapists more aware of the significance of nonverbal affect attunement could be supportive in helping patients to develop their ability to regulate affects and develop and stabilize the mentalizing ability.