Affect-focused body psychotherapy for patients with generalised anxiety disorder

Introduction and aims: This thesis investigates Affect-focused Body Psychotherapy (ABP) for patients with Generalised Anxiety Disorder (GAD). ABP has demonstrated good results in patients with chronic pain, but its effect has not been empirically tested in psychiatric disorders. The aim of the present thesis was to evaluate ABP for GAD from several angles. Study I was an outcome trial comparing ABP to Psychiatric treatment as usual (TAU). Study II investigated whether ABP influenced affect consciousness (AC), and how AC was related to psychiatric symptoms. Study III explored the relationship of treatment preferences and experiences to outcome. Study IV investigated how patients with GAD experienced ABP.

Methods: A group of 61 consecutive referrals with GAD, 21-55 years old, were randomised to ABP (n=33) or TAU (n= 28). Patients were assessed before treatment and followed-up one and two years after inclusion. ABP patients received treatment once a week for one year. Five self-report questionnaires were administered to both groups: SCL-90, Beck Anxiety Inventory, WHO (Ten) Well-Being Index, SCID screen, and Treatment Preferences and Experiences Questionnaire (TPEX). Patients in ABP were interviewed at the end of treatment and one year afterwards concerning their treatment experiences. ABP patients were also assessed with the Affect Consciousness Interview prior to and at termination of treatment.

Results: Both groups showed significant clinical improvement. At termination ABP had improved significantly more on the SCL-90 Global Symptom Index than TAU, whereas differences were non-significant on the BAI and WWBI. Affect consciousness increased after ABP, and patients with high levels of anxiety at treatment start as measured with the BAI increased their affect-consciousness most. However, it was not possible to conclude that affect consciousness had an effect on outcome, directly or as a mediator. ABP patients reported being helped by supportive and reflective treatment interventions to a greater extent than controls, but it was found that differences in outcome were considerably more marked for patients who had mainly positive treatment experiences compared to those who had mainly negative ones independent of treatment form. Treatment expectations appeared to be based on patients perception of their bodies. A key aspect concerning shame and control emerged in the interview material. Patients who approached the body with curiosity and interest tended to reformulate anxiety, and could see such reactions as conveying meaningful information about their life situation.

Conclusions: The integration of body-based techniques and a focus on affects into a body psychotherapy framework, such as ABP, may constitute an effective treatment for GAD, especially among patients who are interested in exploring the questions of mindbody unity. However, the results indicate that interpersonal aspects of therapy need to be more fully explored. Paying closer attention to treatment preferences and body attitudes may increase the potential of ABP and improve outcome.

List of scientific papers

I. Levy Berg A, Sandell R, Sandahl C (2009). Affect-focused body psychotherapy in patients with generalized anxiety disorder: evaluation of an integrative method. Journal of Psychotherapy Integration. 19: 67-85

II. Levy Berg A, Sandell R, Sandahl C (2009). Is there a relationship between affect-consciousness and distress in patients with generalised anxiety disorder before and after treatment with affect-focused body psychotherapy? [Submitted]

III. Levy Berg A, Sandahl C, Clinton D (2008). The relationship of treatment preferences and experiences to outcome in generalized anxiety disorder (GAD). Psychol Psychother. 81(Pt 3): 247-59. Epub 2008 Apr 23
https://pubmed.ncbi.nlm.nih.gov/18435869

IV. Levy Berg A, Sandahl C, Bullington J (2009). Patients perspective of change processes in affect-focused body psychotherapy. [Manuscript]