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