(e.g. depressed individuals have no diurnal pattern, individuals with PTSD have dysregulation but no diurnal pattern.)
ASSESSING THE EFFICACY OF SOMATIC EXPERIENCING FOR REDUCING SYMPTOMS OF ANXIETY AND DEPRESSSION
ASSESSING THEEFFICACY OF SOMATIC EXPERIENCING FOR REDUCINGSYMPTOMS OF ANXIETY AND DEPRESSSION
Somatic Experiencing RestoringInnate Resilience “Nature has instilled in all animals, including humans, a nervous system capable of restoring equilibrium. When self-regulating function is blocked or disturbed… symptoms develop.” (Foundation for Human Enrichment, 2007. p. B1.4).
This slide show will addressfour questions…• Why this study?• Why this study now?• How this study was conducted?• What this study found?
Why this study? QuickTimeª and a TIFF (Uncompressed) decompressor are needed to see this picture. Increasing resilience could help homeless adults to find: work, obtain housing and develop a support system.
Resilience Resilience is the ability to bounce back after life stressors (Luthar, 2003). Resiliency models include: risk factors, protective factors and growth due to positive coping (Luthar, 2003). Somatic Experiencing is a resiliency based treatment model.
Why This Study? Homelessness is a highly stressful life event that can shake people’s confidence in themselves and life. Homeless adults are exposed to significant amounts of trauma and increased life stress due to being homeless. Mental health difficulties could decrease the ability of homeless adults to effectively engage with services. A short-term psychological first aid model aimed at stabalization could decrease the mental health sequilae of homelessness in a cost effective resource efficient manner.
QuickTimeª and aTIFF (Uncompressed) decompressor are needed to see this picture.
Why Now? Somatic Experiencing Studies 55 survivers of the South Asian Tsunami were given between one and two individual sessions and affect regulation skills training (Leitch, 2007). At two to three days following the first session individuals showed 90% improvements. At two to three days following the second session 84% of individuals reported complete or partial remission of symptoms.
Somatic Experiencing Studies Leitch (2009) TRM (trauma resiliency model) was used with care providers in the aftermath of hurricanes Katrina and Rita. Case workers and social workers (n = 142) were given between one and three sessions and skills training in affect regulation. All participants showed increased symptoms. The SE group show significantly less increase in symptoms then the wait list control group.
Why this study now? Somatic Experiencing Psychological first-aid models have shown some efficacy in the aftermath of extreme events. No studies to date directly measure Somatic Experiencing’s effects on symptoms depression. No studies currently assesses the Somatic Experiencing model for reducing mental health symptoms for people who are homeless.
Why measure depression andanxiety? Increased life stress can lead to increased depression and anxiety. The Somatic Experiencing model conceptualizes depression and anxiety as symptoms of a dysregulated autonomic nervous system. Bosnian refugees at 7 mo people with symptoms of depression were 9.5 times more likely to also display symptoms of trauma. Cortisol dysregulation is found in many mental health disorders.
Methods Overview A matched between groups pre-test post-test matched control group design. Sample: A convenience sample of adults who are currently living at COTS shelter. (N = 18 in each group) Matching Criteria: Years homeless, age, gender.
Results: What this study found. Symptoms of depression were not significantly different at measurement three. Symptoms of trait anxiety were not significantly different at measurement three. Symptoms of state anxiety were significantly different between groups at measurement three.
State Anxiety Significance Multivariate statistical analysis Parallelism: F(2, 48) = 4.938, p = .011 Flatness p = .007; Levels were not found to be significant. Between groups contrasts was significant p = .009 for the liner function and approached significance with p = .054 for the quadratic function Multivariate discriminant analysis Wilks Lambda: p = .031 72.5% assignment of cases to the proper group 50% would be expected with random assignment.
Results: Independent Sample t-tests A sub-sample (control n = 7, experimental n = 12) were measured on five occasions. No significant difference between any level of measurement was found at the initial measurement or at the fourth measurement. At measurement five: cognitive and somatic symptoms of depression were found to be significant (p = .046, p = .023). Total score on the BDI-II approached sig. (p = .058)
Results: Covariate Analysis When the number of individual sessions is entered as a covariate somatic and cognitive symptoms of depression both became significant. Cognitive - Parallelism: p = .007, Flatness: p = . 006, Levels: not sig., Liner contrasts p = .035. Somatic - Parallelism p = .003, Flatness: p = .002 Levels: not sig., Liner contrasts: p = .001. Total score on the BDI-II approached significance.
Conclusions There are implications that increased numbers of individual sessions and a longer period of data collection could yield more positive results. The shelter that houses the SE clinic is therapy rich. (Control - 12 therapeutic activities weekly, Experimental - 9 activities weekly). Significant reduction in state symptoms of anxiety could be a beneficial outcome for individuals who are homeless.
Limitations Small sample size lacked statistical power Lack of random sampling procedures, Lack of random assignment to groups, Lack of blinding procedures, Lack of placebo control. A small number of interventions (m = 1.33 sessions and m = 2.64 workshop series) Lack of measurement of physical pain, lack of measurement of life stressors. Variance between measurement instances was high: (m = 10) range of 7 to 35 days (m = 7) and a range of 7 to 35.
Implications Positive trends in the data imply that this treatment could possibly be a cost effective resource efficient treatment protocol the study outlined below could assess this further. What’s next: As study that includes: Random assignment, blinding procedures, placebo and CBT control groups. 10 session protocol (see outline). Measuring: PTSD symptoms, symptoms of pain, current life stress, resilience, autonomic indicators, addictive behavior and successful transition to more permanent housing.
2520 Depression Total15 Symptoms Control Group10 Depression Total Symptoms 5 Experimental Group 0 1 2 3 4
1210 8 Depression Cognitive Symptoms Control 6 Group Depression Cognitive 4 Symptoms 2 Experimental Group 0 1 2 3 4
1210 8 Depression Somatic Symptoms Control 6 Group Depression Somatic 4 Symptoms 2 Experimental Group 0 1 2 3 4
605040 Trait Anxiety30 Control Group20 Trait Anxiety Experimental10 Group 0 1 2 3 4
Methods Data were collected for each participant on three occasions. A sub-sample of participants were measured five times. Participants were given a $5 gift card at the first assessment and a $10 gift card at each follow up. Initial data collection included: Demographic survey, BDI-II, STAI, and therapy participation form At follow up measurements individuals completed: BDI-II, STAI, and therapy participation form.
Methods: Data analysis. Repeated Measures Multivariate Profile Analysis will be used to asses all hypothesis. Discriminant Analysis will be used to assess all hypothesis. QuickTimeª and a TIFF (Uncompressed) ª and a QuickTimedecompressor Independent to see this picture. are needed samples t-tests TIFF (Uncompressed) decompressor are needed to see this picture.
Affect Regulation Implicit Affect Regulation: Automatic regulatory processes (Schore, 2008). Explicit Affect Regulation: Regulation that requires conscious choice and use of a skill (Schore, 2008). Co-regulation: Regulation of affect through relationship or inter-subjective relatedness (Schore, 2008).
Affect DysregulationOver Activated Parasympathetic… Physical: Low energy, exaughstion, numbness, low muscle tone, poor digestion, low heart rate, blood pressure, poor immune function (Foundation for Human Enrichment, 2007) Mental/Emotional: Depression, dissociation, apathy, disconnection in relationship, under responsive (Foundation for Human Enrichment, 2007) (Foundation for Human Enrichment, 2007)
Affect DysregulationOver Activated Sympathetic… Physical: Increase heart rate, difficulty breathing, cold sweats, tingling, muscular tension, exaggerated startle response, difficulty with sleeping. (Foundation for Human Enrichment, 2007) Mental/Emotional: Anxiety attacks, rage outbursts, hyper vigilance, racing thoughts, worry (Foundation for Human Enrichment, 2007) (Foundation for Human Enrichment, 2007)
Stress Based Model of Resilience Homeostasis: The self regulatory processes inherent in a system. Allostasis: Achieving stability in a system through behavioral adaptations. Allostatic Load: The costs to the body and mind of long-term or extreme autonomic stress. Health and Mental Health Risks of Allostatic Load: Increased weight gain/loss, diabetes, depression, PTSD, anxiety, poor immune functioning, loss of efficiency in mental processes.
Why this study? Paradigm Shift: Resilience, affect regulation, deterministic chaos,. and the Bodymind. (Schore, 2003; Schore, 2008; Foundation for Human Enrichment, 2007) Over the last ten years there has been a growing body of literature on resilience (Luthar, 2003). Much of this literature matches the assumptions underling Somatic Experiencing theory. Preliminary studies show indications of SE being a short term effective treatment (Leitch, Vanslyke, & Marisa, 2009, Leitch, 2007).
Multivariate Profile Analysis Repeated measures multivariate profile analysis includes three types of statistics. Parallelism assesses how likely is it that the lines representing the control group and the experimental group are parallel. Flatness assesses if there are changes in the dependent variable regardless of group assignment. The levels statistical analysis measures the distance between the data points across both groups.
Multivariate Profile Analysis Often in repeated measures multivariate analysis there is a conflict between aspects of the profile. The method this study used to resolve differences between findings in the statistical analysis is called simple contrast analysis.
ReferencesFoundation for Human Enrichment. (2007). Somatic experiencing: Healing trauma training manual. Boulder, CO: Foundation for Human Enrichment.Luthar, S. (Ed.). (2003). Resilience and vulnerability: Adaptation in the context of childhood adversities. Cambridge: Cambridge University Press.Leitch, L. Vanslyke, J., & Marisa, A. (2009). Somatic Experiencing Treatment with Social Service Workers Following Hurricanes Katrina and Rita. Social Work, 54(1), 9-18(10).Leitch, L. (2007). Somatic experiencing treatment with tsunami survivors in Thailand: Broadening the scope of early intervention. Journal of Traumatology, 13(4) 11-20.
ReferencesLevine, P. & Frederick, A. (1997). Waking the Tiger: Healing Trauma The Innate Capacity to Transform Overwhelming Experiences. Berkeley, CA: North Atlantic Books.McEwen, B. & Lasley, L. (2002). The end of stress as we know it. Washington, DC: National Academies Press.McEwen, B. (2003). Mood disorders and allostatic load. Biological Psychiatry, 54(3), 200-7.National Center for Family Homelessness (2008). Homeless children: America’s new outcasts. Retrieved from www.familyhomelessness.org.
ReferencesSchore, A. N. (2003). Affect regulation and repair of the self. New York, NY: W. W. Norton & Company.Schore, A. N. (2008). Quarterly study group on attachment theory. Berkeley, CA: Alta Bates Hospital.