talk therapies and the body in working with the elderly somatosensory methods and balance training...
TRANSCRIPT
Talk therapies and the body in working
with the elderly somatosensory methods and balance training
as adjuvants in treating elderly with anxiety and depressions
Münsterlingen11.5.2006Pirjo Juhela
Why balance training?
Are these specifically problemswith geropsychiatric patients?
Why the interest in the body?
Not really,our main problems are of course:
different psychiatric symptoms and problems
Depression
Anxiety
Paranoid symptoms
Personality disorders etc.
- often the problem is social isolation and avoidant behavior.
But.......
- often our patients have somatic complaints
(with or without somatic conditions)
Regardless of the diagnosis.
Patients complain:
”Oh, I would love to do all kinds of things if I werehealthy again. But since I am not feeling wellI can't. ”
”I can’t do anything you understand, when I feel so misarable, shaky and dizzy. If I just could get the right medication I would be ableto go shopping and visit friends.”
”Yes I feel lonely, and it would be nice to have someone visit me. But my daughter is so tired of hearing me complain. And I don’t care forstrangers, I don’t want to participate in any groups or activities.”
Our physiotherapist and I searched for a physical training methodin addition to psychotherapeutic approach and relaxation methods
which would be:
- Easy to apply
- Could be done in a group
- ”normal” and acceptable by our clients (over the age of 65)
And which would help break the vicious circle of social isolation and avoidant behavior
This same type of patients are also foundin general practice:
- complaining of somatic symptoms- extensive testing, imaging is done- usually results are minimal- patient is left unsatisfied
or- patient has been diagnosed with a
somatic condition, but is unable to cope with the situation
Hypochondriasis
Somatization syndrome
Somatoform disordersPanic attacks
Anxiety
Depression
”Health phobias”
”Somatic distress syndrome”
””Health distress””
Typical problems with ’health distress” patients are:
• Worry / preoccupation = distress (fear?) over bodily sensations / somatic symptoms
• heightened vigilance for bodily sensations • Catastrophizing
• Frequent but unsatisfactory visits to health services
And the cardinal symptom often is social isolation and avoidant behavior
What is the common denominator?
Is it fear ?
reactions of the autonomic nervuos
system
emotionally orientedbehaviour
stress hormones
amygdalathalamus
cortex
memory centers(hippocampus,rhinal cortex)
Juhela 2002
Development of THREAT
VigilanceArousal -
action tendency
sympathetic reaction:
fight orflight
Juhela/Siivola 2002
parasympatheticreaction (dorsalvagal):
freeze
or
What is experienced in hyperarousal?
- focusing on the threat, selective perception
- bodily reactions (hyperventilation, choking, racing and pounding heart, throbbing, pulsating sensation in the ears, sweating, dizzyness etc)
- need to act out - run, seek help
- feeling of fear, terror
- cognitions of catastrophe
Balance training
1. instability training which challenges balance
2. stability training which corrects balance
Movements that are common everyday movements. And failures in balance which are common in falls.
Balance training - daring to do something
Psychotherapeutic approach - verbalization and conceptualization, reflection
Body awareness, relaxation – getting to know your body
*Learning to trust one’s body
Our treatment repertoire
The goals of our treatment in general are:
Autonomy – maximizing and maintaining
Loneliness – minimizing negative ideation about alternative social contacts
Subjective well-being – increasing possibilities
Does balance training add important elements into our repertoire??
Improves physical mobility, improves physical fitness
Increases ’discretely’ social contacts: - it is activity in a group, but performance individually- it is fun and playful
Enhances daring, encourages to try more and diminishes avoidant behaviour
Strong sensorimotor experience combined with emotion of succeeding
Repetive, can become a custom, pattern, organize the day
*Improves mood
With special thanks to
Pirkko Makkonen
and
Kirsti Udd