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CLINICAL OUTCOMES FOLLOWING MIND-BODY

CONNECTION GROUP-BASED FAMILY INTERVENTION

Jazzmin Grose
Dhariwal Research Team
HAVE YOU EVER EXPERIENCED:

Flushed Cheeks when embarrassed? A headache when you encounter stress? An upset stomach when youre nervous?

IF THIS IS THE CASE, YOU HAVE EXPERIENCED SOMATIZATION!


WWW.SANOVADERMATOLOGY.COM 2
INTRODUCTION TO SOMATIZATION: WHAT IS IT?
Experience of emotions/stress in the body
Disorder occurs when:
Physical symptoms occur in absence/excess of what would be expected for an illness/injury AND
Significant distress and impairment in response to symptoms

Involuntary expression of distress through physical symptoms


Two primary categories in DSM-V:
Somatic Symptom Disorder: aches or pains (common)
Conversion disorder: loss of sensor or motor function (rare)

~15-25% of all adolescents report recurrent or continuous


physical complaints (dizziness, headaches, fatigue)1

LUNDQVIST ET AL., 2006; PERQUIN ET AL., 20001 . 3


INTRODUCTION TO SOMATIZATION: CAUSES
Cause (etiology) of Somatic Symptoms and Related Disorders (SSRDs) is unknown
Complex interplay between biological vulnerability and the environment
Biological Vulnerability:
Somatization is most likely to occur when there is existing medical history
fMRI research found neural circuit for physical and mental pain

Environmental Factors:
Link between somatization and family context
Childrens physiological needs may better be responded through illness rather than by communication

Important to also intervene within the parent-child relationship system

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WHAT IS THE PROBLEM?
The somatizing patient population
creates a significant burden on
health care, with an increase in:

Overall, the medical system is the wrong place for these patients
SLIDEMODEL.COM 5
MIND-BODY CONNECTION GROUP FAMILY-BASED INTERVENTION
Validate families medical experiences 1
Self-awareness for inner experiences/emotions 2
Parental awareness of the other 3
Create realistic picture of journey 4

Support participation in everyday activities


Improve emotional awareness, expression, management

Group Normalize Somatization


process Increase attachment and p-c relationships
Families to accept emotions expressed in the body

8 to10 Medical System


families
Ultimate goal
Weekly
Runs for Mental Health
2-hour 6 weeks
sessions System

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WHY A PSYCHOLOGICAL INTERVENTION?
1. How can psychological interventions reduce physical
symptoms associated with somatization?
2. How can psychological interventions improve emotional
functioning in youth with somatization?
3. How can psychological interventions improve parent-child
relationships in youth with somatization?

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HYPOTHESES FOR A PSYCHOLOGICAL INTERVENTION
1. The more a child participates in the psychological intervention, the
higher the reduction of physical symptoms associated with
somatization.
2. The more a parent participates in the psychological intervention, the
higher the emotional functioning in youth with somatization.
3. Post-group parent-child scores will be significantly higher than pre-
group parent-child scores.

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SUPPORTING EVIDENCE: REDUCING PHYSICAL SYMPTOMS
Group program was associated with significant post treatment improvements in medical
symptom frequency, health-promoting behaviours, and psychologic symptoms1
Group CBT treatment better than individual CBT for improving emotional/mental health
dimensions2
Individual therapy better for improving symptoms, physical, mental and social
functioning, and role performance2
Enriching CBT with strategies focusing on emotion processing and regulation helps to
address physical symptoms and comorbid mental disorders effectively3

VRACENEAU ET AL., 20141; GILL ET AL., 20142; KLEINSTUBER ET AL., 20163. 9


SUPPORTING EVIDENCE: HIGHER EMOTIONAL FUNCTIONING

Ecological health approach focuses on environmental influences


It is important to make the effects of toxic stress less severe on the health and development of
people
Toxic stress is the absence of safe responsive caregiving and considered to be an important risk
factor for disease
Important for pediatric health care providers to find ways to integrate parental functioning into
clinical work
Found that parents are most likely to respond sensitively when they can understand the meaning and
intention of their childs signals and see their child as separate from themselves
Health care provides can play a critical role in fostering healthy relationships including a focus to
include families and childrens social and emotional health.

(ORDWAY, WEBB, SADLER, & SLADE, 2015) 10


SUPPORTING EVIDENCE: IMPROVING PARENT-CHILD RELATIONSHIPS

Child anxiety levels influence parental behaviours, decline in over-


involvement, no change in negativity1
Pain catastrophizing correlated with pain intensity, protective parental
responses to pain and functional disability2
Decreases in parent protectiveness were related to lower levels of disability
through pain catastrophizing3

CUNNINGHAM ET AL., 20141; GUITE ET AL., 20112; WELKOM, HWANG, & GUITE, 20133. 11
METHODS COMPLETED: PARTICIPANTS AND PROCEDURES
PARTICIPANTS
52 participating families (5 cohorts)
75 somatizing children/adolescents (age 11-17 years) and their parents
Referred from specialty medical clinics or by the community

PROCEDURES
To monitor changes over time, data was collected by a set of questionnaires at 3 time points:
Baseline: at admission of the intervention
Post-Intervention: immediately after the intervention
Follow-up: Six months after the intervention

Intervention is conducted 3 times a year

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METHODS COMPLETED: MEASURES
Domain of Functioning Measure What it Asses Type
Childrens Somatization Inventory Level of somatic symptoms Questionnaire
Functional Disability Inventory Activity levels Questionnaire
Healthcare Utilization Frequency of healthcare usage Interview
Medical Trauma Questionnaire Whether medical events perceived were traumatic Questionnaire
Physical Symptoms
and Health Level of understanding about the definitions/implications of
Somatization Knowledge Inventory Questionnaire
somatization and mind-body connection
Response to Stress Questionnaire Ability to cope about the stress of having a physical condition Questionnaire

Affect Regulation Checklist Taps affective reflection, control and suppression Questionnaire
Obtains expression of psychiatric symptomatology (depression,
Achenbach Scales Questionnaire
anxiety, oppositional behaviour)
Emotional Well-being
Patients readiness to adopt personal control over their physical
Pain Stages of Change Questionnaire Questionnaire
condition
Network of Relationships Inventory: How frequently different relationships are used to fill the functions
Questionnaire
Behavioural Systems Version of attachment, caregiving and affiliation
Parent Emotional Reaction Parents emotional preoccupation with their childs medical events
Questionnaire
Questionnaire including fear, sadness and anger
Interpersonal Relationships Coping with Childrens Negative
Parents responses to their childrens negative emotions Questionnaire
Emotions Scale
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METHODS: CURRENT
Youth Self Report (YSR) and Child Behavioural Checklist (CBCL) scoring
Once scoring is complete, enter the data into REDcap

Extract data to find missing data


Extract data from REDcap into SPSS in order to find out how much data we are missing

Data Analyses
Start analyzing data in order to support or refute hypotheses

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CONCLUSION:
Somatizing population creates a significant burden on the medical system
The MBC (psychological intervention) aims to normalize somatization and
standardize their approach
Research for treating somatization in the adult population with the implementation of
cognitive behavioural therapy, emotion focused therapy, and client-centered therapy
have been successful
Supporting evidence for:
Group intervention reducing physical symptoms (but individual could be better)
Similar therapeutic strategies (to MBC) that reduce physical symptoms
Parent participation improving youths emotional functioning
Pain catastrophizing correlated with influencing parent-child relationships and pain intensity
Child anxiety levels influences parent-child relationship

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QUESTIONS?
If you have any questions, please send an email to: jgrose@mail.uoguelph.ca

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ACKNOWLEDGMENTS:
Dhariwal Research Team
Dr. Amrit Dhariwal
Dr. Theresa Newlove
Dr. Andrea Chapman
Dr. Janine Slavec
Hope Walker
Katie Coopersmith
Jennifer Pooni
Reghan Strutt

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