talk therapies and the body in working with the elderly somatosensory methods and balance training...
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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
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Why balance training?
Are these specifically problemswith geropsychiatric patients?
Why the interest in the body?
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Not really,our main problems are of course:
different psychiatric symptoms and problems
Depression
Anxiety
Paranoid symptoms
Personality disorders etc.
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- 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.
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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.”
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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
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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
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Hypochondriasis
Somatization syndrome
Somatoform disordersPanic attacks
Anxiety
Depression
”Health phobias”
”Somatic distress syndrome”
””Health distress””
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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
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What is the common denominator?
Is it fear ?
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reactions of the autonomic nervuos
system
emotionally orientedbehaviour
stress hormones
amygdalathalamus
cortex
memory centers(hippocampus,rhinal cortex)
Juhela 2002
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Development of THREAT
VigilanceArousal -
action tendency
sympathetic reaction:
fight orflight
Juhela/Siivola 2002
parasympatheticreaction (dorsalvagal):
freeze
or
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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
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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.
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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
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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
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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
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With special thanks to
Pirkko Makkonen
and
Kirsti Udd