Body-oriented therapy in recovery from child sexual abuse: an efficacy study.

For women in therapeutic recovery from childhood sexual abuse, recovery is intimately related to integration of the self — involving on the one hand reassociation with the self, and on the other hand, reduction of dissociation.1 ,2 Integration of the self is addressed in experiential psychology, which holds the premise that healthy functioning results when as many parts of the self as possible are integrated in awareness.3 The dissociative strategies that are protective in dealing with childhood abuse involve fragmentation of self and separation from sensory and emotional experience and can inhibit healing from trauma.1,4 Dissociation involves psychological and physical distress and is associated with post-traumatic stress disorder (PTSD),5 affect dysregulation and somatization,6 and problems with gastrointestinal health.7 Sexual symptoms and dysfunction, also frequent consequences of sexual abuse,8, 9 are closely related to dissociation from the body.10, 11 Women with a history of childhood sexual abuse have higher levels of psychological and physical distress than non-abused women,12 which likely contribute to the common lack of emotional and sensory awareness—or body connection—seen clinically in this population.13, 14 Problems with affect regulation and physiological regulation are also common among female survivors of childhood trauma,6, 15 which indicates the importance of self-regulation as a primary goal in therapeutic recovery with this population. In recent years, there has been increased attention to the clinical importance of addressing the body to facilitate integration of sensory and emotional awareness in sexual abuse recovery.2,16-19 Body psychotherapy approaches for trauma recovery include teaching patients and facilitating their ability to incrementally access and sustain inner body awareness, which increases the capacity for body connection and thus facilitates dissociation reduction and reassociation or integration with the self.19 -21 Body psychotherapy is psychotherapy focused on the interactions between the patient’s mental representations and their bodily phenomena.22To date, there has been little clinical research in body psychotherapy approaches in sexual abuse recovery. This is a study of body-oriented psychotherapy, an approach well-suited to the process of integration. Body-oriented therapy falls under the auspices of body psychotherapy and involves the combination of bodywork an—umbrella term for touch therapy modalities (eg, massage, polarity, accupressure) and the emotional processing of psychotherapy. The therapeutic goal of body-oriented therapy is to promote integration of psyche and soma, a shared and stated purpose within body psychotherapy.22Body psychotherapy approaches often use proprioceptive sensing to enhance somatic awareness.23-25 Examples of proprioceptive sensing include the internal awareness of physiological release in tight muscle tissue during a massage and the internal awareness of the underlying emotion associated with stomach “knots.” Touch therapy, when combined with proprioceptive sensing, provides a focal point for inner awareness, serving to facilitate access and sustained presence in bodily attention.26,27 Engaging in proprioceptive sensing is not a passive process; as in biofeedback, there is a reciprocal “feedback loop” that increases self-regulation.28 There is both anecdotal and experimental evidence that body-oriented therapy is beneficial for therapeutic recovery from sexual abuse.2,29 A pilot-test comparison of body-oriented therapy found a decrease in psychological symptoms, physical symptoms, and PTSD for the body-oriented therapy group compared to a wait-list control among women in psychotherapeutic recovery from childhood sexual abuse.29The body-oriented therapy approach used in this study was designed to teach proprioceptive sensing to access inner-body sensory awareness and to facilitate integration of psyche and soma using a combination of verbal and touch therapies. This study, which follows up on the pilot, compares the body-oriented therapy process to a standardized massage. Whereas many studies have examined the benefits of massage,30 a search of such literature databases as the Cumulative Index to Nursing and Allied Health Literature (CINAHL), PubMed, PsycINFO revealed little research focused on the potential benefits of body-oriented therapy. Consequently, we know little about the relative efficacy of body-oriented therapy interventions or the mechanisms by which they are purported to work. As a relatively new area of study within mind-body research, there are many elements that need to be systematically developed and examined to build a strong basis of research in body-oriented therapy. These include comparing body-oriented therapy to other bodywork approaches to address the lack of touch-based comparison groups in bodywork research; testing the feasibility of developing and implementing a body-oriented therapy protocol; developing measures that are specific to the bodywork process; and addressing ethical issues as they pertain to human subjects concerns and high-risk populations. This study tested the efficacy of body-oriented therapy as an adjunct to psychotherapy and the hypothesis that body-oriented therapy compared to massage would result in increased psychological well-being (decreased PTSD, dissociation, and psychological distress); increased physical well-being (decreased physical symptoms); and increased body connection (increased body awareness, body association, and body investment) among women in psychotherapeutic recovery from childhood sexual abuse. In addition, this study examined the experience and impact of the interventions through qualitative analysis of open-ended questions on written questionnaires.