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Justice C, Sullivan MB, Van Demark CB, Davis CM, Erb M. Guiding Principles for the Practice of Integrative Physical Therapy. Phys Ther 2023; 103:pzad138. [PMID: 37815938 PMCID: PMC10757068 DOI: 10.1093/ptj/pzad138] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 07/03/2023] [Accepted: 09/12/2023] [Indexed: 10/12/2023]
Abstract
Integrative health is an emerging specialty inside multiple disciplines within the medical community, yet the practice of integrative physical therapy remains undefined. This perspective paper suggests a set of guiding principles to support the role of physical therapy in integrative health. These guiding principles, including therapeutic partnership, whole person health, living systems, movement as an integrative experience, and salutogenesis, are described and explored in-depth as they relate to all aspects of patient care and clinician experience. These guiding principles are articulated within the context of social determinants of health and the interrelated roles that environment, trauma, stress, and lifestyle all play within an integrative physical therapy plan of care. Examples of current integrative physical therapy practices that embody these principles are described. The 5 guiding principles are designed to elicit interprofessional inquiry into how integrative health models can be applied to the art and science of physical therapy practice. The expansion of integrative health into the field of physical therapy has the potential to improve individual and population health, as integrative physical therapy can be used to address prevention, health promotion, primary care, and wellness while acknowledging the complex, dynamic, and interconnected nature of the human condition. IMPACT This perspective article presents 5 guiding principles to establish a framework to define and shape the growing application of an integrative health model to physical therapy practice. These integrative physical therapy guiding principles aim to improve the quality of whole-person, patient-centered care.
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Affiliation(s)
- Catherine Justice
- Integrative Health and Wellness Division of the Department of Medicine, Hennepin Healthcare Systems, Minneapolis, Minnesota, USA
| | - Marlysa B Sullivan
- Empower Veterans Program, Atlanta Veterans Administration Health Care System, Atlanta, Georgia, USA
| | - Cheryl B Van Demark
- Physical Rehabilitation Services, Dignity Health Yavapai Regional Medical Center, Prescott, Arizona, USA
| | - Carol M Davis
- Department of Physical Therapy, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Matt Erb
- The Center for Mind-Body Medicine, Washington District of Columbia, USA
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Morrison K, Dwarika V. Trauma Survivors' Experiences of Kundalini Yoga in Fostering Posttraumatic Growth. JOURNAL OF CHILD & ADOLESCENT TRAUMA 2022; 15:821-831. [PMID: 35126802 PMCID: PMC8799407 DOI: 10.1007/s40653-022-00441-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/17/2022] [Indexed: 06/14/2023]
Abstract
The prevalence of traumatic events in South Africa is considerably high due to a history of political violence and the ongoing cycle of interpersonal, community-based, and socioeconomic violence. While conventional therapeutic techniques have been found to support trauma survivors in the local context, alternative approaches that focus on the mind-body connection have become increasingly popular. However, studies reporting on the use of these approaches remain scarce. This study aimed to add to the body of knowledge on yoga as a non-conventional therapy to support trauma survivors and foster posttraumatic growth. Semi-structured interviews were conducted with a sample of seven Kundalini yoga practitioners who had been exposed to trauma. A thematic analysis confirmed that Kundalini yoga was beneficial in fostering posttraumatic growth. Overall, the study findings, evidence a pocket of success in relation to value of such an intervention within a low socio economic black South African context.
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Affiliation(s)
- Karlita Morrison
- Department of Educational Psychology, Faculty of Education, University of Johannesburg, Johannesburg, South Africa
| | - Veronica Dwarika
- Department of Educational Psychology, Faculty of Education, University of Johannesburg, Johannesburg, South Africa
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Poli A, Gemignani A, Soldani F, Miccoli M. A Systematic Review of a Polyvagal Perspective on Embodied Contemplative Practices as Promoters of Cardiorespiratory Coupling and Traumatic Stress Recovery for PTSD and OCD: Research Methodologies and State of the Art. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:11778. [PMID: 34831534 PMCID: PMC8619958 DOI: 10.3390/ijerph182211778] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 11/03/2021] [Accepted: 11/05/2021] [Indexed: 12/12/2022]
Abstract
Baseline respiratory sinus arrhythmia (RSA) has been proposed as a transdiagnostic biomarker of stress vulnerability across psychopathologies, and a reliable association between PTSD, OCD and lower resting RSA was found. Contemplative practices have been linked to the activation of the vagus as well as to an increased RSA that, according to the polyvagal theory, reflects the activation of the ventral vagal complex (VVC) and may promote PTSD and OCD recovery. PubMed and Scopus databases were selected to conduct a search following the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) 2020 guidelines, and A MeaSurement Tool to Assess systematic Reviews-2 (AMSTAR-2) was used to appraise the methodological quality for this systematic review. Six articles met the inclusion criteria (one cross-sectional study, one study with pre-post measurements, two cohort studies and two RCT studies). Mindfulness-related interventions promoted parasympathetic activity, an increased vagal tone and improvements in PTSD and OCD symptoms. According to the polyvagal theory, mindfulness-related and compassion-related meditations would be conceptualized as neural exercises expanding the capacity of the ventral vagal complex to regulate the present state and to promote resilience. Clinical and methodological issues are discussed.
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Affiliation(s)
- Andrea Poli
- Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy;
| | - Angelo Gemignani
- Department of Surgical, Medical and Molecular Pathology and of Critical Care Medicine, University of Pisa, 56126 Pisa, Italy;
| | | | - Mario Miccoli
- Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy;
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Bhattacharyya KK, Andel R, Small BJ. Effects of yoga-related mind-body therapies on cognitive function in older adults: A systematic review with meta-analysis. Arch Gerontol Geriatr 2020; 93:104319. [PMID: 33338831 DOI: 10.1016/j.archger.2020.104319] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 11/24/2020] [Accepted: 12/06/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVES Considering dementia has no definite curative intervention available through modern medical management, alternative therapeutic symptomatic interventions are needed urgently. This systematic review with meta-analysis evaluated whether yoga-related practices, as a preventive mind-body therapy, is effective for the management of cognitive decline in older adults. METHODS Seven electronic databases (Abstracts in Social Gerontology, Age Line, CINAHL, PsycINFO, PubMed, Scopus, and Web of Science) were searched using specified inclusion criteria to identify original studies that investigated the effects of yoga-related mind-body therapies on cognitive function, in the context of aging. A meta-analysis was also carried out calculating the overall effect sizes, expressed as standardized mean differences (i.e., d). RESULTS Twelve studies, including 912 participants (73.9% female; 239 with and 673 without cognitive impairment) were selected for this review; eleven were randomized controlled trials. One study had a high risk of bias and was excluded from the meta-analysis. Studies involved a wide variety of yoga practices with a common focus on meditative postural exercises. Results revealed significant beneficial effects on memory (Cohen's d = 0.38), executive function (Cohen's d = 0.40), and attention and processing speed (Cohen's d = 0.33). No adverse effects were reported. DISCUSSION Yoga-related mind-body interventions for older adults appear to be safe, feasible, and effective alternative practice for maintenance of cognitive functions both in age- and disease-related cognitive decline. Practicing yoga can be a useful part of daily routine to maintain cognitive function in older adulthood. Suggestions for further research were discussed.
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Affiliation(s)
| | - Ross Andel
- School of Aging Studies, University of South Florida, 4202 E Fowler Avenue, Tampa, FL 33620, USA
| | - Brent J Small
- School of Aging Studies, University of South Florida, 4202 E Fowler Avenue, Tampa, FL 33620, USA
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Galit ZS, Dita F, Rachel LW. The Traumatic Story as Expressed Through Body Narration. JOURNAL OF LOSS & TRAUMA 2019. [DOI: 10.1080/15325024.2018.1507470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Zana-Sterenfeld Galit
- The School of Creative Art Therapies & the Emili Sagol CAT Research Center, University of Haifa, Haifa, Israel
| | - Federman Dita
- Emili Sagol CAT Research Center, University of Haifa, Haifa, Israel
| | - Lev-Wiesel Rachel
- Graduate School for Creative Arts Therapies, The University of Haifa, Haifa, Israel
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Koch SC, Wirtz G, Harter C, Weisbrod M, Winkler F, Pröger A, Herpertz SC. Embodied Self in Trauma and Self-Harm: A Pilot Study of Effects of Flamenco Therapy on Traumatized Inpatients. JOURNAL OF LOSS & TRAUMA 2019. [DOI: 10.1080/15325024.2018.1507472] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Sabine C. Koch
- Department of Creative Arts Therapies and Therapy Sciences, Alanus University Alfter, Alfter, Germany
- Faculty for Therapy Sciences, SRH University Heidelberg, Heidelberg, Germany
| | - Gustav Wirtz
- Department of Psychiatry, SRH Hospitals Karlsbad-Langensteinbach, Karlsbad-Langensteinbach, Germany
| | - Christian Harter
- Department of Psychiatry, SRH Hospitals Karlsbad-Langensteinbach, Karlsbad-Langensteinbach, Germany
| | - Matthias Weisbrod
- Department of Psychiatry, SRH Hospitals Karlsbad-Langensteinbach, Karlsbad-Langensteinbach, Germany
| | - Franziska Winkler
- Department of Psychiatry, Psychosocial Center, University of Heidelberg, Heidelberg, Germany
| | - Annett Pröger
- Department of Psychiatry, Psychosocial Center, University of Heidelberg, Heidelberg, Germany
| | - Sabine C. Herpertz
- Department of Psychiatry, Psychosocial Center, University of Heidelberg, Heidelberg, Germany
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Holt R, McLean L. Australian Psychotherapy for Trauma Incorporating Neuroscience: Evidence- and Ethics-Informed Practice. NEUROETHICS-NETH 2019. [DOI: 10.1007/s12152-019-09398-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Dance as a Catalyst for Stress Busting. CENTRAL EUROPEAN JOURNAL OF SPORT SCIENCES AND MEDICINE 2019. [DOI: 10.18276/cej.2019.2-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Sullivan MB, Erb M, Schmalzl L, Moonaz S, Noggle Taylor J, Porges SW. Yoga Therapy and Polyvagal Theory: The Convergence of Traditional Wisdom and Contemporary Neuroscience for Self-Regulation and Resilience. Front Hum Neurosci 2018; 12:67. [PMID: 29535617 PMCID: PMC5835127 DOI: 10.3389/fnhum.2018.00067] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Accepted: 02/06/2018] [Indexed: 12/21/2022] Open
Abstract
Yoga therapy is a newly emerging, self-regulating complementary and integrative healthcare (CIH) practice. It is growing in its professionalization, recognition and utilization with a demonstrated commitment to setting practice standards, educational and accreditation standards, and promoting research to support its efficacy for various populations and conditions. However, heterogeneity of practice, poor reporting standards, and lack of a broadly accepted understanding of the neurophysiological mechanisms involved in yoga therapy limits the structuring of testable hypotheses and clinical applications. Current proposed frameworks of yoga-based practices focus on the integration of bottom-up neurophysiological and top-down neurocognitive mechanisms. In addition, it has been proposed that phenomenology and first person ethical inquiry can provide a lens through which yoga therapy is viewed as a process that contributes towards eudaimonic well-being in the experience of pain, illness or disability. In this article we build on these frameworks, and propose a model of yoga therapy that converges with Polyvagal Theory (PVT). PVT links the evolution of the autonomic nervous system to the emergence of prosocial behaviors and posits that the neural platforms supporting social behavior are involved in maintaining health, growth and restoration. This explanatory model which connects neurophysiological patterns of autonomic regulation and expression of emotional and social behavior, is increasingly utilized as a framework for understanding human behavior, stress and illness. Specifically, we describe how PVT can be conceptualized as a neurophysiological counterpart to the yogic concept of the gunas, or qualities of nature. Similar to the neural platforms described in PVT, the gunas provide the foundation from which behavioral, emotional and physical attributes emerge. We describe how these two different yet analogous frameworks-one based in neurophysiology and the other in an ancient wisdom tradition-highlight yoga therapy's promotion of physical, mental and social wellbeing for self-regulation and resilience. This parallel between the neural platforms of PVT and the gunas of yoga is instrumental in creating a translational framework for yoga therapy to align with its philosophical foundations. Consequently, yoga therapy can operate as a distinct practice rather than fitting into an outside model for its utilization in research and clinical contexts.
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Affiliation(s)
- Marlysa B. Sullivan
- Integrative Health Sciences, Maryland University of Integrative Health, Laurel, MD, United States
| | - Matt Erb
- The Center for Mind-Body Medicine, Washington, DC, United States
| | - Laura Schmalzl
- College of Science and Integrative Health, Southern California University of Health Sciences, Whittier, CA, United States
| | - Steffany Moonaz
- Director of Clinical and Academic Research, Maryland University of Integrative Health, Laurel, MD, United States
| | | | - Stephen W. Porges
- Kinsey Institute, Indiana University, Bloomington, IN, United States
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
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Kabir RS, Haramaki Y, Ki H, Ohno H. Self-Active Relaxation Therapy (SART) and Self-Regulation: A Comprehensive Review and Comparison of the Japanese Body Movement Approach. Front Hum Neurosci 2018; 12:21. [PMID: 29472851 PMCID: PMC5809433 DOI: 10.3389/fnhum.2018.00021] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Accepted: 01/15/2018] [Indexed: 11/13/2022] Open
Abstract
Relaxation programs are known for their versatility, cost-effectiveness, and ability to help people obtain skills to regulate their mental states and promote and maintain health. Self-Active Relaxation Therapy (SART) is a body-oriented approach to psychological rehabilitation that grew out of the suite of movement tasks developed in the Japanese psychotherapy known as Dohsa-hou, or the body movement method. The program for SART is designed to stretch, twist, and release areas of the upper, lower, and whole body through a set of movements which are guided by the practitioner and performed "self-actively" by the client to empower them to learn to recognize points of tension in the body and act on their own to achieve a relaxed state. Numerous studies have showed that SART is associated with reduced negative mood states and enhanced body awareness. A short version of SART has been investigated as a psychological support salon activity for the elderly, mothers raising children, special needs students, and children adapting to school. The full program has also been applied in clinical settings to address or supplement treatments for psychological and developmental conditions, and longitudinally employed in community contexts to assist residents facing long-term disaster recovery circumstances in Japan. This paper reviews the research and applications of SART as a bodymind approach by critically examining evidence and research gaps for future studies, comparing it with techniques established in the literature, and positing a self-regulatory framework for SART as a tool to become aware of bodily states, regulate mood, and manage stress through the deliberate practice of relaxation.
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Affiliation(s)
- Russell S Kabir
- Graduate School of Education, Hiroshima University, Higashihiroshima, Japan
| | - Yutaka Haramaki
- Department of Clinical Psychology, Hiroshima University, Higashihiroshima, Japan
| | - Hyeyoung Ki
- Department of Psychology, Fukuoka Jo Gakuin University, Fukuoka, Japan
| | - Hiroyuki Ohno
- Department of Clinical Psychology, Fukuoka Jo Gakuin University, Fukuoka, Japan
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Martin L, Oepen R, Bauer K, Nottensteiner A, Mergheim K, Gruber H, Koch SC. Creative Arts Interventions for Stress Management and Prevention-A Systematic Review. Behav Sci (Basel) 2018; 8:bs8020028. [PMID: 29470435 PMCID: PMC5836011 DOI: 10.3390/bs8020028] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Revised: 02/11/2018] [Accepted: 02/13/2018] [Indexed: 01/15/2023] Open
Abstract
Stress is one of the world's largest health problems, leading to exhaustion, burnout, anxiety, a weak immune system, or even organ damage. In Germany, stress-induced work absenteeism costs about 20 billion Euros per year. Therefore, it is not surprising that the Central Federal Association of the public Health Insurance Funds in Germany ascribes particular importance to stress prevention and stress management as well as health enhancing measures. Building on current integrative and embodied stress theories, Creative Arts Therapies (CATs) or arts interventions are an innovative way to prevent stress and improve stress management. CATs encompass art, music, dance/movement, and drama therapy as their four major modalities. In order to obtain an overview of CATs and arts interventions' efficacy in the context of stress reduction and management, we conducted a systematic review with a search in the following data bases: Academic Search Complete, ERIC, Medline, Psyndex, PsycINFO and SocINDEX. Studies were included employing the PICOS principle and rated according to their evidence level. We included 37 studies, 73% of which were randomized controlled trials. 81.1% of the included studies reported a significant reduction of stress in the participants due to interventions of one of the four arts modalities.
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Affiliation(s)
- Lily Martin
- Research Institute for Creative Arts Therapies (RIArT), Alanus University of Arts and Social Sciences, Alfter/Bonn, Villestr. 3, 53347 Alfter, Germany.
| | - Renate Oepen
- Research Institute for Creative Arts Therapies (RIArT), Alanus University of Arts and Social Sciences, Alfter/Bonn, Villestr. 3, 53347 Alfter, Germany.
| | - Katharina Bauer
- Department for Therapy Sciences, SRH University Heidelberg, Maria-Probst-Str. 3, 69123 Heidelberg, Germany.
| | | | - Katja Mergheim
- Schoen-Klinik, Hofgarten 10, 34454 Bad Arolsen, Germany.
| | - Harald Gruber
- Research Institute for Creative Arts Therapies (RIArT), Alanus University of Arts and Social Sciences, Alfter/Bonn, Villestr. 3, 53347 Alfter, Germany.
| | - Sabine C Koch
- Research Institute for Creative Arts Therapies (RIArT), Alanus University of Arts and Social Sciences, Alfter/Bonn, Villestr. 3, 53347 Alfter, Germany.
- Department for Therapy Sciences, SRH University Heidelberg, Maria-Probst-Str. 3, 69123 Heidelberg, Germany.
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Calsius J, De Bie J, Hertogen R, Meesen R. Touching the Lived Body in Patients with Medically Unexplained Symptoms. How an Integration of Hands-on Bodywork and Body Awareness in Psychotherapy may Help People with Alexithymia. Front Psychol 2016; 7:253. [PMID: 26973560 PMCID: PMC4770185 DOI: 10.3389/fpsyg.2016.00253] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Accepted: 02/09/2016] [Indexed: 12/15/2022] Open
Abstract
Medically unexplained symptoms (MUS) are a considerable presenting problem in general practice. Alexithymia and difficulties with mental elaboration of bodily arousal are hypothesized as a key mechanism in MUS. In turn, this inability influences the embodied being and participating of these patients in the world, which is coined as 'the lived body' and underlies what is mostly referred to as body awareness (BA). The present article explores a more innovative hypothesis how hands-on bodywork can influence BA and serve as a rationale for a body integrated psychotherapeutic approach of MUS. Research not only shows that BA is a bottom-up 'bodily' affair but is anchored in a interoceptive-insular pathway (IIP) which in turn is deeply connected with autonomic and emotional brain areas as well as verbal and non-verbal memory. Moreover, it is emphasized how skin and myofascial tissues should be seen as an interoceptive generator, if approached in the proper manual way. This article offers supportive evidence explaining why a 'haptic' touch activates this IIP, restores the myofascial armored body, helps patients rebalancing their window of tolerance and facilitates BA by contacting their bodily inner-world. From a trans-disciplinary angle this article reflects on how the integration of bodywork with non-directive verbal guidance can be deeply healing and resourcing for the lived body experience in MUS. In particular for alexithymic patients this approach can be of significance regarding their representational failure of bodily arousal.
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Affiliation(s)
- Joeri Calsius
- Rehabilitation Research Center - Biomedical Research Center, Faculty of Medicine and Life Sciences, University of Hasselt Hasselt, Belgium
| | - Jozef De Bie
- Department of Psychiatry, Ziekenhuis Oost-Limburg Genk, Belgium
| | | | - Raf Meesen
- Rehabilitation Research Center - Biomedical Research Center, Faculty of Medicine and Life Sciences, University of Hasselt Hasselt, Belgium
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