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Movement Therapy in S chizophrenia T reatment

Movement Therapy in S chizophrenia T reatment. Běla Hátlová, Alena Špůrková, Milena Adamková Charles University in Prague Faculty of Physical Education and Sport, Czech Republic. M ovement T herapies. Psychomotor therapy (PMT) Body awarenes therapy (BAT,BBAT) Dance therapy

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Movement Therapy in S chizophrenia T reatment

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  1. Movement Therapy in Schizophrenia Treatment Běla Hátlová, Alena Špůrková, Milena Adamková Charles University in Prague Faculty of Physical Education and Sport, Czech Republic

  2. Movement Therapies • Psychomotor therapy (PMT) • Body awarenes therapy (BAT,BBAT) • Dance therapy • Adventure therapy • Kinesiotherapy • Psychomotor fitness training • other movement therapies

  3. The Term Kinesiotherapy • Therapy of actively performed intentional movement. • Supportive method of treatment that works as a parallel to pharmacotherapy. • Basic method of prevention

  4. Theoretical Rationale • Psychological change will be reflected in function of central nervous system • Corporeal scheme is the basic co-existence with the world • Motoric functionsclosely refer to the ability to perceive, to evaluate and to use the space relations

  5. The incidence of mental disorders • 10.5% in men • 8.7% in women. • Psychoses are represented by • 0,5% in men • 0,6% in women.

  6. Schizophrenia • Changes in personal relation to the reality • Deformation of experiencing, behavior, personal characteristics • Disturbances of thinking, perception and affectivity • Lose of sense for individuality, unity, autonomy • Changes in working and social relationships mostly chronic nature (30%) • Disturbation of verbal communication (dezorganization, low enunciation value, rarely verbal communication impossible)

  7. body response disturbancies: • Disturbancies of body perception ( 74% of cases ): • feelings of miniature, enlarge, missing, abundance body parts, basic body feelings, discontinuance in running of any physically function • Psychomotor disturbances: discoordination of the movements, stupor states • Lose of automatical body locomotion • Problems with incoherent perception of the personality and body design structure

  8. Somatic State and Kinetic Skills in Schizophrenia • Low physic activity and physic form • Completely muscle inertia, wrong body posture • Disturbation of the cardiopulmonary system function, diminished fatiquebility • Weight excess • During long hospitalization: decrease of psychomo- toric skills (stability, accuracy of movements and coordination)

  9. Therapy of Schizophrenia Farmacotherapy – controll of „positive” symptoms – bad controll of „negative” symptoms New approach in psychiatria – bio-psycho-social unity of the person – looking for factors for strenghten the stability of the personality and increasing stamina against stress alternative procedure – movement therapy

  10. Kinesiotherapy… …is asupportive method of treatment that works parallel to pharmacotherapy, biological, physical, psychosocial and surgical therapies; Using goal-directed causing to psychethrough the movementof the diseased person, his/hermental processes, functions, states, personality and respectively relations. … allows to acquire approach through personal experience of the diseased persons and gives the possibility to influencing on his/her psyche in intentions of self-consciousness of psychosomatic self and its boundaries

  11. Ground of the Kinesiotherapy • Kinesiotherapy is based on neurofysiology, which shows relations between somatic and mental processes • Kinesiotherapy rise on premisse: that through the movement we should cause on mental processes and mental state of the person

  12. Why „Movement Therapy“ ? • Fixation of „Self“ (consciousness body perception) • Easier communication on non-verbal level with diseased person • Enhance of self esteem, self image, negative identity • Mental and somatic integration • Development of communication and social skills

  13. … • Enhance self confidance (participation in „common“ activities) • Positive influence on awareness function • Lower interruption of obsesive disturbation and anxious thoughts • Natural active participation on programme • Enhance of physical form also control functions of CNS

  14. Research Questions 1. Is there any causal relations among regulary applied kinesiotherapeutics programs and mental stateof diseased persons (in progressive positive sense) ? • Which symptoms will positive (or negative) influence placing in kinesiotherapeutics programmes? • How strong is a correlation between total change of mental state of diseased persons and their integration in therapy?

  15. Research Group Selections-Basic Characteristic • …special created for each program by diseased persons: • Long term hospitalization (not less then 1 year) • Four different places (departments of successive • care) • Men and women separated programme • Each department 1 experimental and 1 control • group

  16. Research Methods Brief Psychiatric Rating Scale – BPRS (Overall, J.E.; Gorham, D.R - Filip; Sikora; Marsalek aj.1997): • Used to pursuingmental state of schizophrenia disease adults in the therapy process • 18 items evaluated on scale 0-6 points according to intensity non verbal displayor verbal behavior • Transformed values: - total score -factor´s score (average item scoresin realated factor)

  17. Factors of BPRS: Factor I.: Anxiosity -depressive syndrom (ANDP) Factor II.: Apatic-abulic syndrom (ANER) Factor III.: Paranoid-halucinatory syndrom (THOT) Factor IV.: Productive katatonnic syndrom (ACTV) Factor V.: Hostility - suspicious (HOST)

  18. Aplication in Treatment Regime • 3x in week in forenoon hours • continually past 14 week (totally 41) • excercise lesson duration: integrative programme: 15 – 35 minutes communicative programme: 20-45 minutes

  19. Integrative Programme Suitable for: diseased persons with low level of personality integration Target of the therapy: consiousness of self body structure schema contens of the excercise: basic and singularic gymnastic excercise and positions, breathers

  20. Communicative Programme • Suitable for : diseased persons in stabilised psychosomatic state • Target of the therapy : enhancement of communication and social skills • contens of the excercise : • Simple elements of health gymnastics with dynamic elements with stretching • Basic hand manipulation skills with instruments (scarves, balls)

  21. The categories of patients according to their placement into kinesioerapeutic programmes before beginning of the experiment Participated Total Men Women 89 43 46 Program Exp. control Exp. control Exp. Control Communication programme 24 21 11101311 Integrative programme 24 20 12 10 12 10

  22. The categories of patients according to their placement into kinesioerapeutic programmes at the end the experiment Participated Total Men Women 78 38 40 Program Exp. control Exp. control Exp. Control Communication programme 18 19 9 9 9 10 Integrative programme 21 20 10 10 11 10

  23. Lowering problems in syndromes BPRS in average % after application of kinesiotherapeutic programmes Syndromes BPRS ANDPANERTHOTACTVHOST experiment Integrative Men 37,2 17,5 17,5 30,8 30,2 programme Women 39,8 23,1 15,9 35,1 25,2 Control Integrative Men 7,5 4,6 5,7 4,5 -2,5 programme Women -0,6 -5,0 6,1 4,6 2,2

  24. Lowering problems in syndromes BPRS in average % after application of kinesiotherapeutic programmes Syndromes BPRS ANDPANERTHOTACTVHOST experiment Communication Men 37,1 16,3 19,6 33,8 29,6 Programme Women 33,6 15,7 23,0 26,4 32,2 control Communication Men 4,8 -2,4 7,6 7,8 1,0 Programme Women 2,6 -0,4 10,6 3,6 -1,5

  25. Results • Participation of patients in each programme showed significant improvement of their psychic state: decrease of global problems (global score: p 0,001), decrease of problems in anxiety-depression syndrome (ANDP: p 0,001) and in hostility-suspiciousness syndrome (HOST: p 0,001). Changes in (Anergia, ANER; Activation, ACTV; Thought Disturbance, THOT), are not significant. Integrative programme showed decrease problems in syndromes: ACTV: p < 0,001, THOT: p < 0,01 and ANER: p < 0,01.Communication programme showed lowering problems in: ACTV: p < 0,01) and ANER: p < 0,01. Changes in THOT are not significant. There is reasonably high attendance, activity and acceptation of programmes by majority of patients.

  26. Publication: • Špůrková Alena. (2003). Kinesiotherapeutical programmesintreatment of long-term hospitalised patients with schisophrenia. Disertation , Charles University in Prague,Faculty of Physical Education and Sports, Department of Education, Psychology and Didactics, Czech RepublicHátlova, Běla. Kinesiotherapy, Movement Therapy In Psychiatric Treatment: Praha, Karolinum 2003. • Hátlova, Běla et al. Kinesiotherapy, Movement Therapy In Psychiatric Treatment: Praha, Archeus 2007 (CD) .

  27. Thank you for your attention.www.sportpsy.czbelahatlova@centrum.cz

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