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Background: Functional somatic symptoms (FFS) 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 significant numbers due to a mismatch between their and professionals’ understanding of the nature of the symptoms. New service models are urgently needed to address patients’ needs and to align with advances in aetiological evidence and diagnostic classification 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 multidisciplinary expert group, and the conclusions are summarised as recommendations for best practice. Results: The mapping exercise and multidisciplinary expert consultation revealed five themes for service improvement and pathway development: time/access, communication, barrier-free care, choice and governance. Service users identified four meta-themes for best practice recommendations: focus on healthcare professional communication and listening skills as well as professional attributes and knowledge base to help patients being both believed and understood in order to accept their condition; systemic and care pathway issues such as stronger emphasis on primary care as the first point of contact for patients, resources to reduce the length of the patient journey from initial assessment to diagnosis and treatment. 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 flexible access points to the care pathway. [ABSTRACT FROM AUTHOR]

Working therapeutically with and through embodiment is a topical issue in the psychoanalytic literature. Vice versa, body psychotherapy is deeply rooted in psychoanalytic theory and practice. This paper will explore corresponding themes, historic developments, and recent literature with reference to their actual and potential mutual influences, aiming to demonstrate: (1) that contemporary body psychotherapy practice continues to be informed and influenced by psychoanalytic theory, in particular the relational emphasis in psychoanalysis; and (2) that psychoanalytic psychotherapy, in turn, can be enriched and furthered while utilizing the theoretical paradigm of embodiment and body-oriented, experiential intervention strategies developed in body psychotherapy. [ABSTRACT FROM AUTHOR]

Background: Severe mental illness (SMI) is associated with care delivery problems because of the high levels of clinical resources needed to address patient's psychosocial impairment and to support inclusion in society. Current routine appointment systems do not adequately foster recovery care and are not systematically capturing information suggestive of urgent care needs. This study aimed to assess the feasibility, acceptability, and potential clinical benefits of a mobile technology health management tool to enhance community care for people with severe mental illness. Methods: This randomised-controlled feasibility pilot study utilised mixed quantitative (measure on subjective quality of life as primary outcome; questionnaires on self-management skills, medication adherence scale as secondary outcomes) and qualitative (thematic analysis) methodologies. The intervention was a simple interactive technology (Short Message Service - SMS) communication system called 'Florence', and had three components: medication and appointment reminders, daily individually defined wellbeing scores and optionally coded request for additional support. Eligible participants (diagnosed with schizophrenia, schizoaffective disorder or bipolar disorder ≥1 year) were randomised (1:1) to either treatment as usual (TAU, N = 29) or TAU and the technology-assisted intervention (N = 36). Results: Preliminary results suggest that the health technology tool appeared to offer a practicable and acceptable intervention for patients with SMI in managing their condition. Recruitment and retention data indicated feasibility, the qualitative analysis identified suggestions for further improvement of the intervention. Patients engaged well and benefited from SMS reminders and from monitoring their individual wellbeing scores; recommendations were made to further personalise the intervention. The care coordinators did not utilise aspects of the intervention per protocol due to a variety of organisational barriers. Quantitative analysis of outcomes (including a patient-reported outcome measure on subjective quality of life, self-efficacy/competence and medication adherence measures) did not identify significant changes between groups over time in favour of the Florence intervention, given high baseline scores. The wellbeing scores, however, were positively correlated with all outcome measures. Conclusion: It is feasible to conduct an adequately powered full trial to evaluate this intervention. Inclusion criteria should be revised to include patients with a higher level of need and clinicians should receive more in-depth assistance in managing the tools effectively. The preliminary data suggests that this intervention can aid recovery care and individually defined wellbeing scores are highly predictive of a range of recovery outcomes; they could, therefore, guide the allocation of routine care resources. Trial registration: ISRCTN34124141; retrospectively registered, date of registration 05/11/2019. [ABSTRACT FROM AUTHOR]

Schizophrenia patients frequently display an array of abnormal bodily phenomena (ABPs). There is literature to suggest that the presence of ABPs may be representative of a fundamental disruption of the embodied and prereflexive state of selfhood and hence be relevant for the development of schizophrenia spectrum disorders. ABPs have been considered as trait features of vulnerability to psychosis and may have value as potential markers for early detection, target symptoms for prevention and predictors of clinical outcomes. This longitudinal cohort study aimed to explore: (1) the prevalence of ABPs in first episode psychosis, (2) their longitudinal stability, (3) how ABPs compare with data from patients with enduring psychosis, and (4) how aspects of disorders of self-experience (DSEs) and ABPs and the corresponding instruments relate to each other. Sixteen patients were recruited from an early intervention in psychosis service. They were assessed with a series of structured and semi-structured interviews at point of entry, after 6 months and 12 months of follow-up. A variety of ABPs and DSEs were displayed in all study subjects, associated with high levels of core psychotic symptoms and reduced with treatment over time. Compared with findings of both acute and chronic schizophrenia patients, the prevalence of ABPs seems to be representative of severity and acuteness of the illness. Two factors were identified with stable trait characteristics and might be of predictive value for the course of the illness. Further studies with bigger samples are needed to further test the value of ABPs as early markers of detection and predictors of clinical course. The association between DSEs and ABPs warrants further investigation. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Highlights • The role of an embodied therapeutic relationship and the therapist's felt sense is explored in the change process. • Regulating emotional responses to adversity through expressive and symbolic enactments were central in addressing the trauma. • The playfulness in BOPT enabled the patient to experience a tangible connection with his creativity and resilience. Abstract This case study describes an innovative experiential Body Oriented Psychological Therapy (BOPT) for a patient with mixed dissociative conversion disorder (ICD-10, F44.7) and co-morbid depression resulting in severe somatoform complaints and emotional distress. The therapy process is informed by the main theoretical hypotheses of BOPT and utilises non-verbal expressive behaviour, body awareness and movement interventions to facilitate a change process through linking the expression of a wider range of emotions to implicit memories on a somatic level. Hereby the patient is enabled to access and bring into consciousness determinants of psychological states including repressed anger and conflicting feelings and ideas. The playfulness in BOPT fosters creative capabilities and embodied symbolic enactments of responses to trauma help to explore alternative coping mechanisms. Over the course of fifty sessions of BOPT important positive changes in the patient's presentation were noted. By the end of therapy the patient was much more able to cope with his disability and he felt empowered to move forward in his life. The positive outcome suggests that this BOPT approach offers a useful alternative intervention when working with patients with conversion disorders. [ABSTRACT FROM AUTHOR]

Current phenomenological approaches consider schizophrenia as a fundamental disturbance of the embodied self, or a disembodiment. This includes (I ) 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 relat.onship 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 :he 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 tc foster self-management and enable patients to re-establish a more stable and coherent sense of self. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Abstract: Background: Chronic major depressive disorder and dysthymia are associated with a high burden and substantial care costs. New and more effective treatments are required. This is the first randomized controlled trial designed to evaluate the effectiveness of Body Psychotherapy (BPT) in patients with chronic depression. Methods: Patients with chronic depressive syndromes (more than 2 years symptomatic) and a total score of ≥20 on the Hamilton Rating Scale for Depression (HAMD) were randomly allocated to either immediate BPT or a waiting group which received BPT 12 weeks later. BPT was manualized, delivered in small groups in 20 sessions over a 10 weeks period, and provided in addition to treatment as usual. In an intention to treat analysis, primary outcome were depressive symptoms at the end of treatment adjusted for baseline symptom levels. Secondary outcomes were self-esteem and subjective quality of life. Results: Thirty-one patients were included and twenty-one received the intervention. At the end of treatment patients in the immediate BPT group had significantly lower depressive symptom scores than the waiting group (mean difference 8.7, 95% confidence interval 1.0–16.7). Secondary outcomes did not show statistically significant differences. When the scores of the waiting group before and after BPT (as offered after the waiting period) were also considered in the analysis, the differences with the initial waiting group remained significant. Conclusions: The results suggest that BPT may be an effective treatment option for patients with chronic depression. Difficulty recruiting and subsequent attrition was one of the limitations, but the findings merit further trials with larger samples and process studies to identify the precise therapeutic mechanisms. [Copyright &y& Elsevier]

Abstract: Persistent negative symptoms are an ongoing challenge in the treatment of chronic schizophrenia. Evidence from randomised controlled trials suggests that arts/non-verbal therapies may be effective in treating negative symptoms of schizophrenia. These treatments have not yet been evaluated in open clinical settings. The present uncontrolled clinical trial examines the therapeutic processes and clinical outcomes of group body psychotherapy (BPT) on marked negative symptoms in patients with chronic schizophrenia. Changes in symptom scores, subjective quality of life, social functioning and emotional processing between baseline and post-treatment were assessed. The ratings from clinical assessments of independent researchers were compared with the post-therapy summary assessment of the therapists. A total of 39 eligible patients were referred, out of which 18 patients agreed to participate and received BPT in addition to treatment as usual within three therapy groups run by different therapists. Patients had high symptom levels and low psychosocial functioning at baseline. Negative symptoms and general psychopathology significantly reduced during treatment. Positive symptoms and other outcomes did not change. Researcher ratings of psychopathology were in line with the assessment of clinical outcome by therapists and qualitative observations on changes in movement behaviour during therapy. The results of this study are consistent with findings from a RCT (), indicating that BPT is associated with reduced negative symptoms even when administered in routine clinical settings. Therapists’ qualitative judgements may be considered as a valid source for assessing treatment outcomes. Future studies should explore effects of longer term treatments on other outcomes. [Copyright &y& Elsevier]

Objectives: Irritable bowel syndrome (IBS) is a frequently disabling and almost invariably distressing disease with a high overall prevalence. Numerous trials identified the importance of psychogenic and emotional etiological factors, and this is obvious in clinical practice. Although relaxation techniques are frequently recommended, there is still a lack of evidence for their efficacy in the management of IBS. This study therefore aims to determine the efficacy of functional relaxation (FR) in IBS. Subjects: The subjects were 80 patients with IBS. Interventions: Participants were randomly allocated either to FR or to enhanced medical care (EMC: treatment as usual plus two counseling interviews) as control intervention with 2 weekly sessions over the 5-week trial each. Thirty-nine (39) patients completed FR and 39 received EMC. Outcome measures: An impairment-severity score (IS) was employed as the primary outcome parameter with assessment at baseline, after treatment, and again after 3-month follow-up. Results: FR was significantly superior to EMC with a standardized effect size of 0.85. The achieved effects through FR remained stable in terms of psychic and bodily impairment after 3-month follow-up. Conclusions: The results of our trial suggest a positive effect of FR training on subjective functional impairment in the IS, if provided in addition to treatment as usual (TAU). There appears to be a clinically relevant long-term benefit of FR as a nonpharmacological and complementary therapy approach in IBS. [ABSTRACT FROM AUTHOR]

Studies have highlighted the impact of ego-consciousness, religiosity and spirituality on psychotic symptoms, although so far no study has investigated if and how these factors may be interrelated. In this exploratory cross-sectional study, involving 42 patients with a diagnosis of acute paranoid schizophrenia (DSM-IV), we assessed religiosity (Religious Orientation Test) spirituality (Spiritual Transcendence Scale) and ego-pathology (Ego Pathology Inventory) and analysed any relationship with these and psychopathological symptoms (Positive and Negative Symptom Scale). The subjects were divided into four ethnic groups (Caucasian, Afro-Caribbean, African, and Asian) and a structured, qualitative interview on religious needs and self-concepts was also conducted. Using a multivariate analysis, we found statistically significant negative associations between the scores on ego and common pathology and religiosity and spirituality as covariates. This was seen across all ethnic groups. The findings are discussed in respect of the potential clinical importance of ethnic, religious and spiritual factors for assessment and management of patients with schizophrenia. [ABSTRACT FROM AUTHOR]

Objective: To identify and characterize a subgroup of schizophrenia patients with marked and dominating bodily sensations (cenesthesias and body image aberration). Method: We assessed cenesthesias and different aspects of body image aberration systematically along with common (general, positive and negative symptoms) and ego-psychopathology in 60 patients with acute paranoid schizophrenia. Cluster analysis was applied to identify subgroups. Psychopathology scores of the clusters were compared at admission and after 2 weeks of hospital treatment. Results: One of the three clusters comprised of 14 patients (23.3%) with marked disturbances of body experience (underestimation of lower extremities, desomatization, boundary loss and diminution). The subgroup was further characterized by significantly higher ego-psychopathology scores at admission. Some of the differences held true over a 2-week period. Conclusion: The findings from the present study suggest that cenesthesias and body image aberration might represent an additional dimension of psychopathology that might be used for defining a nosological subtype of schizophrenia. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Highlights • Depression and bodily dissatisfaction are associated with personal construing. • This study explores this association and the effects of body psychotherapy. • During body psychotherapy the bodily self became more salient to participants. • There was evidence of impact of the intervention on self-construing. Abstract The frequent association of depression with somatic symptoms suggests that body psychotherapy may be an appropriate therapeutic intervention for people with chronic depression. Using a subset of twenty-three participants from a randomized controlled trial that had demonstrated the effectiveness of such an intervention in reducing depressive symptoms, the present study investigated whether it may also impact aspects of construing which have been associated with depression. Patients presenting with chronic depression were randomly allocated to a treatment group or a waiting list group, which received body psychotherapy after a period on a waiting list. Correlations between repertory grid, questionnaire, and visual analogue measures indicated that depression and bodily dissatisfaction were associated with features of the content and structure of construing. There were no significant changes while patients were on the waiting list, but during treatment reduction in depression and bodily dissatisfaction, together with increase in self-esteem and quality of life, were accompanied by an increase in the salience of construing of the bodily self. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]