Abstract
BackgroundThere is continuing uncertainty in back pain research as to which treatment is best suited to patients with non-specific chronic low back pain (CLBP). In this study, Gestalt therapy and the shock trauma method Somatic Experiencing® (SE) were used as interventions in parallel with the usual cross-disciplinary approach. The aim was to investigate how these treatments influence a patient’s capacity to cope with CLBP when it is coupled with depression.MethodsIn this qualitative explorative study, a phenomenological–hermeneutic framework was adopted. Patients were recruited on the basis of following criteria: A moderate depression score of 23–30 according to the Beck Depression Inventory Scale and a pain score of 7–10 (Box scale from 0–10) and attendance at five- six psychotherapeutic sessions. Six patients participated in the study. The data was comprised of written field notes from each session, which were subsequently analysed and interpreted at three levels: naive reading, structural analysis and critical interpretation and discussion.ResultsThree areas of focus emerged: the significance of previous experiences, restrictions in everyday life and restoration of inner resources during the therapy period. The study revealed a diversity of psychological stressors that related to loss and sorrow, being let down, violations, traumatic events and reduced functioning, which led to displays of distress, powerlessness, reduced self-worth, anxiety and discomfort.Overall, the sum of the stressors together with pain and depression were shown to trigger stress symptoms. Stress was down-played in the psychotherapeutic treatment and inner resources were re-established, which manifested as increased relaxation, presence, self-worth, sense of responsibility and happiness. This, in turn, assisted the patients to better manage their CLBP.ConclusionsCLBP is a stress factor in itself but when coupled with depression, they can be regarded as two symptom complexes that mutually affect each other in negative ways. When pain, stress and depression become overwhelming and there are few internal resources available, stress seems to become prominent. In this study, Gestalt therapy and the SE-method may have helped to lower the six patients’ level of stress and restore their own internal resources, thereby increasing their capacity to cope with their CLBP.
Highlights
There is continuing uncertainty in back pain research as to which treatment is best suited to patients with non-specific chronic low back pain (CLBP)
This article reports on the way in which two psychotherapeutic treatments can influence a patients capacity to cope with non-specific chronic low back pain when it is complicated by depression
We found patterns related to pain, distress, insomnia, anger and irritation at not being as able as before
Summary
There is continuing uncertainty in back pain research as to which treatment is best suited to patients with non-specific chronic low back pain (CLBP). This article reports on the way in which two psychotherapeutic treatments can influence a patients capacity to cope with non-specific chronic low back pain when it is complicated by depression. Interest in this area stems from the first authors experience as a nurse, Gestalt therapist and Somatic ExperiencingW Practitioner, working with patients who have low back pain. With longer-term or chronic low back pain (CLBP), psychological factors often play a role, but in cross-disciplinary treatment, individual psychological intervention is rarely included. Different theories [3] have been developed to explain the connection between CLBP and depression, but none is comprehensive
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