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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 Münsterlingen 11.5.2006 Pirjo Juhela
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Why balance training? Are these specifically problems with 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 were healthy again. But since I am not feeling well I 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 able to 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 for strangers, I don’t want to participate in any groups or activities.”
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Our physiotherapist and I searched for a physical training method in 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 found in 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 disorders Panic 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 oriented behaviour stress hormones amygdala thalamus cortex memory centers (hippocampus, rhinal cortex) Juhela 2002
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Development of THREAT Vigilance Arousal - action tendency sympathetic reaction: fight or flight Juhela/Siivola 2002 parasympathetic reaction (dorsal vagal): 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
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