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.

Joeri Calsius,Jozef De Bie,Raf Hertogen,Raf Meesen

doi:10.3389/fpsyg.2016.00253

Joeri Calsius, Jozef De Bie + Show 2 more

Open Access

https://doi.org/10.3389/fpsyg.2016.00253

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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.

Highlights

Unexplained symptoms (MUS) are estimated to be the presenting problem for 35% up to 64% of new patients in general practice (Jackson and Passamonti, 2005; Steinbrecher et al, 2011) and for 37–66% of new outpatients at specialist medical clinics (Nimnuan et al, 2001)
In that way, working with the inability to mentalize bodily arousal, tension, and inner feelings together with its representational failure has a pivotal role in therapy with Medically unexplained symptoms (MUS)-patients
Given the often disappointing outcomes of verbal psychotherapies as well as somatic therapies, this article reflected on how hands-on bodywork influences body awareness (BA), helps patients to mentalize and express what they experience and legitimizes a more body integrated psychotherapeutic approach of MUS

Summary

INTRODUCTION

Unexplained symptoms (MUS) are estimated to be the presenting problem for 35% up to 64% of new patients in general practice (Jackson and Passamonti, 2005; Steinbrecher et al, 2011) and for 37–66% of new outpatients at specialist medical clinics (Nimnuan et al, 2001). After firstly situating how MUS and alexithymia are related to BA processing, this article will secondly elaborate in detail on the significance and specificity of interoceptive brain-pathways to BA This will lead to possible underpinnings for a more innovative hypothesis in which we explore how myofascial tissue dynamics, as related to hands-on bodywork, influence BA-processing and how this can serve as a plausible rationale for a body integrated therapeutic approach of MUS. In particular the role of the autonomic nervous system has led to several models of psychosomatic dysfunction or trauma related disorder such as the visceral brainbody transfer (Cameron, 2009), the polyvagal theory (Porges, 2009), the neurovisceral integration (Thayer and Brosschot, 2005; Cameron, 2009), the window of tolerance (Ogden et al, 2006) or more recently the preparatory set (Payne and Crane-Godreau, 2015) In essence all these models point at the significant influence of a deeply disturbed autonomic nervous system with severe consequences for all afferent and efferent processing. Especially interoception is essential and seems to be a key element in what leads to body- and self-awareness (Cameron, 2001, 2009; Craig, 2003, 2011), which in turn is the quintessence of EBW

PART II: BRAIN PATHWAYS OF BODY AWARENESS AND INTEROCEPTION

Findings

CONCLUSION