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Purpose: Infibulation is the most pervasive form of female genital cutting. Infibulated women face difficulties such as obstruction of urine and menstrual blood flow, sexual problems, and birth complications, and may therefore need medical defibulation. This study explores the lived experiences of young migrant women from Somalia and their views on undergoing medical defibulation in Sweden. Methods: A qualitative study was conducted using phenomenological lifeworld research. Data were collected through in-depth interviews with nine young women originating from Somalia, now resident in Sweden. The interviews were analysed to reveal the meaning of the phenomenon of infibulation. Results: The essential meaning of the phenomenon is characterized by a limbo regarding both infibulation and defibulation. There is a strong desire both to handle the Swedish perspective on infibulation and to stay with the Somalian cultural values. These women are being exposed to a tacit tradition that makes it hard to relate to the possibility of medical defibulation. As a result, the women perceive the possibility to undergo medical defibulation as limited or non-existent. Conclusions: Healthcare professionals can be a support to encourage women in need of medical defibulation to reflect on traditional ideals concerning infibulation and defibulation. [ABSTRACT FROM AUTHOR]

Objective: To evaluate feasibility and potential effectiveness of work-directed rehabilitation in people with common mental disorders. Design: Pilot randomized controlled trial. Setting: Primary healthcare, Sweden. Subjects: Working adults (n = 42) of mean age 46.2 ± 11.1 years with depression or anxiety disorder. Interventions: Eight weeks of work-directed rehabilitation (n = 21) or physical activity (n = 21). Work-directed rehabilitation included sessions with a physiotherapist and/or an occupational therapist, to develop strategies to cope better at work. Physical activity included a planning session and access to a local gym. Main measures: Feasibility: attendance, discontinuation and adverse events. Measurements were the Work Ability Index, the Global Assessment of Functioning, the Montgomery–Asberg Depression Rating Scale, the Beck Anxiety Inventory and the World Health Organization—Five Well-Being Index. Results: Attendance to rehabilitation sessions was 88% (n = 147/167) and discontinuation rate was 14% (n = 3/21). No serious adverse events were reported. Within both groups, there was a significant improvement in Work Ability Index score (mean change: 3.6 (95% confidence interval (CI): 0.45, 6.7) in work-directed rehabilitation and 3.9 (95% CI: 0.9, 7.0) in physical activity) with no significant difference between groups. For the other outcomes, significant improvements were found within but not between groups. Per-protocol analysis showed a trend toward the antidepressant effect of work-directed rehabilitation compared to physical activity (mean difference in depression score −3.1 (95% CI: −6.8, 0.4), P = 0.075). Conclusion: Work-directed rehabilitation was feasible to persons with common mental disorders and improved their work ability and mental health. Comparable improvements were seen in the physical activity group. Suggested modifications for a larger trial include adding a treatment-as-usual control. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Background. Although the effectiveness of physical exercise for depression has been studied for many years, few studies have described patients' experiences of what exercise means to them, beyond the biological focus. Moreover, exercise as a treatment for depression is rarely explored in a physical therapy context. Objectives. The purpose of this study was to explore a physical therapy exercise intervention, as experienced by people with major depression. Design. This study had an inductive approach and used qualitative content analysis. Methods. Semistructured interviews were conducted with 13 people who participated in physical therapist-guided aerobic exercise in a randomized controlled trial. All participants were diagnosed with major depression according to the Diagnostic and Statistical Manual of Mental Disorders. Data were collected and analyzed in an inductive manner using qualitative content analysis according to Graneheim and Lundman. Results. Pour categories emerged: (1) struggling toward a healthy self, (2) challenging the resistance, (3) feeling alive but not euphoric, and (4) needing someone to be there for you. The participants experienced that although the exercise intervention was hard work, it enhanced the feeling of being alive and made them feel that they were doing something good for themselves. These feelings were a welcome contrast to the numbness and stagnation they experienced during depression. Limitations. The study was conducted in Swedish primary care. Transferability of results must be viewed in relation to context. Conclusions. Exercise in a physical therapy context can improve the patients' perception of their physical ability and create a sense of liveliness, improving their depressed state. The therapeutic relationship is essential for supporting the patient's vulnerability and ambiguity in an empathic and perceptive way. [ABSTRACT FROM AUTHOR]

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 patient's struggle, acknowledging both destructive and recharging elements of the withdrawing, and the perceived conflict in-between. [ABSTRACT FROM AUTHOR]

The generalized anxiety is characterized by long-term psychological and physiological discomfort. Pharmacological and psychotherapeutic interventions have been extensively examined, whereas knowledge is scant regarding other professional perspectives. This article focuses on the physiotherapeutic perspective on anxiety, exploring physiotherapists' perceptions of their treatment for patients with generalized anxiety. Semi-structured interviews were conducted with 10 physiotherapists working in psychiatry or primary health care. Data were analysed using qualitative content analysis, resulting in one main category and five subcategories. The main category 'To sense and make sense of one's anxiety' reflects the idea that physiotherapy works through immediate, tangible bodily experiences to help a person understand and handle his or her anxiety better. Five subcategories reflected different aspects of this main category: (1) the body is the arena of anxiety, (2) to get in touch with oneself, (3) to get down-to-earth with oneself, (4) to make sense of bodily sensations, and (5) to gain trust in one's capability to handle anxiety. In conclusion, the gradual bodily awareness of sensations, to sense and make sense of anxiety in physiotherapy treatment, becomes an opportunity to find ways to withstand and to manage symptoms of anxiety, encouraging an embodied self-trust. The emphasis on the immediately lived body involves the potential to learn how to endure anxiety instead of running away from it, to discern and to understand different sensations, leading to an integration of anxiety as being part of oneself rather than overflowing oneself. [ABSTRACT FROM AUTHOR]

Most people with common mental disorders are working despite symptoms. This study explores individuals' experiences of a work-directed rehabilitation, provided by occupational therapists and physiotherapists, aiming to promote work capacity in persons with common mental disorders. A qualitative content analysis was used, and 11 women and 8 men with depression or anxiety disorder were interviewed. They were 25–66 years old, had different occupations and were working full or part-time. The participants experienced a process interpreted as Increasing belief in one's capacity through supported reflection and practice. This theme reflects the shifting between "reflecting" and "doing" through rehabilitation and the growing hope for change. The increasing belief in one's capacity was developed through three stages, comprised of the categories To be supported by a professional, To realise things about oneself and To try new strategies for change. Strategies suggested by occupational therapists and physiotherapists have the potential to promote work capacity in people who are working while depressed and anxious. The results may deepen the understanding among rehabilitation professionals about the importance of a person-centred approach to people with common mental disorders, and to combine reflection and practical exercises to support the development of work-related strategies. Work-directed rehabilitation provided by occupational therapists and/or physiotherapists is beneficial to people with common mental disorders. Rehabilitation professionals should focus on facilitating self-efficacy among people with common mental disorders. An individualised person-centred approach seems important in order to initiate change. [ABSTRACT FROM AUTHOR]

Background: There is a need for high-quality research regarding exercise interventions for persons with anxiety disorders. We investigate whether a 12-week exercise intervention, with different intensities, could reduce anxiety symptoms in patients with anxiety disorders.Methods: 286 patients were recruited from primary care in Sweden. Severity of symptoms was self-assessed using the Beck Anxiety Inventory (BAI) and the Montgomery Åsberg Depression Rating Scale (MADRS-S). Participants were randomly assigned to one of two group exercise programs with cardiorespiratory and resistance training and one control/standard treatment non-exercise group, with 1:1:1 allocation.Results: Patients in both exercise groups showed larger improvements in both anxiety and depressive symptoms compared to the control group. No differences in effect sizes were found between the two groups. To study a clinically relevant improvement, BAI and MADRS-S were dichotomized with the mean change in the control group as reference. In adjusted models the odds ratio for improved symptoms of anxiety after low-intensity training was 3.62 (CI 1.34-9.76) and after moderate/high intensity 4.88 (CI 1.66-14.39), for depressive symptoms 4.96 (CI 1.81-13.6) and 4.36 (CI 1.57-12.08) respectively. There was a significant intensity trend for improvement in anxiety symptoms.Limitations: The use of self-rating measures which bears the risk of an under- or overestimation of symptoms.Conclusions: A 12-week group exercise program proved effective for patients with anxiety syndromes in primary care. These findings strengthen the view of physical exercise as an effective treatment and could be more frequently made available in clinical practice for persons with anxiety issues. [ABSTRACT FROM AUTHOR]