“After all the traumas my body has been through, I feel good that it is still working.” – Basic Body Awareness Therapy for traumatised refugees
Keywords:Refugees, PTSD, physiotherapy, traumatised, basic body awareness therapy, treatment satisfaction, mprovements in symptoms, Body Awareness Rating Scale-Movement Harmony
Basic Body Awareness Therapy (BBAT) is a form of physiotherapy that is often used for psychiatric patients in Scandinavian countries. To our knowledge, there have not been any studies investigating BBAT as a treatment for traumatised refugees until now.
Objective: To explore the compliance, acceptability and treatment satisfaction using group BBAT in traumatised refugees. To study changes in psychiatric and somatic symptoms as well as the quality of life, level of functioning and quality of movement during treatment with BBAT.
Method: All Arabic speaking patients that previously had received treatment at the Competence Centre for Transcultural Psychiatry in Copenhagen from April 2008 to June 2009 were invited to participate (N=29). Nine persons were included in a male (N=4) and female (N=5) group. All participants were traumatised refugees. The BBAT treatment consisted of 14 sessions over a period of 14 weeks. Before and after treatment the participants were interviewed using a semi-structured interview guide. The interviews were transcribed and analyzed with a thematic approach. The participants also filled out self-administrated questionnaires and two physiotherapists tested the participants’ movement harmony using the Body Awareness Rating Scale-Movement Harmony (BARS-MH) test. At the end of the study, the participants filled out anonymous questionnaires about treatment satisfaction.
Results: The results showed that the participants had a high compliance, acceptability and treatment satisfaction with BBAT. The majority of participants showed improvements in symptoms from baseline to post-intervention on the self-administrated questionnaires and in the BARS-MH test.
Conclusions: Further research is needed to expand the scientific knowledge regarding the use of BBAT in traumatised refugees. If future research can confirm our positive findings it will have a considerable impact on future treatment designs and for the individual patient.
2. Bhugra D. Migration and mental health. Acta Psychiatr Scand. 2004 Apr;109(4):243–58.
3. Carlsson J, Sonne C, Silove D. From pioneers to scientists: challenges in establishing evidence-gathering models in torture and trauma mental health services for refugees. J Nerv Ment Dis. 2014 Sep;202(9):630–7.
4. Chung RC, Kagawa-Singer M. Predictors of psychological distress among Southeast Asian refugees. Soc Sci Med. 1993 Mar;36(5):631–9.
5. Sabin M, Lopes Cardozo B, Nackerud L, Kaiser R, Varese L. Factors associated with poor mental health among Guatemalan refugees living in Mexico 20 years after civil conflict. JAMA. 2003 Aug 6;290(5):635–42.
6. Shrestha N, Sharma B, Van Ommeren M, et al. Impact of torture on refugees displaced within the developing world: symptomatology among Bhutanese refugees in Nepal. JAMA. 1998 Aug 5;280(5):443–8.
7. Carlson EB, Rosser-Hogan R. Cross-cultural response to trauma: a study of traumatic experiences and posttraumatic symptoms in Cambodian refugees. J Trauma Stress. 1994 Jan;7(1):43– 58.
8. Olsen DR, Montgomery E, Bøjholm S, Foldspang A. Prevalence of pain in the head, back and feet in refugees previously exposed to torture: A ten-year follow-up study. Disabil Rehabil. 2007 Jan 30;29(2):163–71.
9. Buhmann C, Andersen I, Ekstrøm M. Cognitive-Behavioral Psychotherapeutic treatment at a psychiatric trauma clinic for Refugees: description and evaluation. Torture. 2015;25(1): pp
10. Morris P, Silove D. Cultural influences in psychotherapy with refugee survivors of torture and trauma. Hosp Community Psychiatry. 1992 Aug;43(8):820–4.
11. Scarpinati Rosso M , Bäärnhielm S. Use of the Cultural Formulation in Stockholm: A qualitative study of mental illness experience among migrants. Transcult Psychiatry. 2012 Apr;49(2):283–301.
12. Prip K, Persson AL, Sjölund BH. Self-reported activity in tortured refugees with long-term sequelae including pain and the impact of foot pain from falanga – a cross-sectional study. Disabil Rehabil. 2011 Apr;33(7):569–78.
13. Danneskiold-Samsøe B, Bartels EM, Genefke I. Treatment of torture victims--a longitudinal clinical study. Torture. 2007;17(1):11–7.
14. Williams AC, Peña CR, Rice AS. Persistent pain in survivors of torture: a cohort study. J Pain Symptom Manage. 2010 Nov;40(5):715–22.
15. Olsen DR, Montgomery E, Carlsson J, Foldspang A. Prevalent pain and pain level among torture survivors: a follow-up study. Dan Med Bull. 2006 May;53(2):210–4.
16. Andersen LL, Kjaer M, Søgaard K, Hansen L, Kryger AI, Sjøgaard G. Effect of two contrasting types of physical exercise on chronic neck muscle pain. Arthritis Rheum. 2008 Jan 15;59(1):84–91.
17. Diaz AB, Motta R. The effects of an aerobic exercise program on posttraumatic stress disorder symptom severity in adolescents. Int J Emerg Ment Health. 2008;10(1):49–59.
18. Lawrence S, De Silva M, Henley R. Sports and games for post-traumatic stress disorder (PTSD). Cochrane Database Syst Rev. 2010 Jan 20;(1).
19. Johnston J. The impact of yoga on military personnel with post-traumatic stress disorder. Northeastern University. Boston; 2011. Available from: http://iris.lib.neu.edu/couns_psych_diss/29/
20. Grodin MA, Piwowarczyk L, Fulker D, Bazazi AR, Saper RB. Treating survivors of torture and refugee trauma: a preliminary case series using qigong and t’ai chi. J Altern Complement Med. 2008 Sep;14(7):801–6.
21. Harris DA. Dance/movement therapy approaches to fostering resilience and recovery among African adolescent torture survivors. Torture. 2007;17(2):134–55.
22. Bentley JA, Thoburn JW, Stewart DG, Boynton LD. The indirect effect of somatic complaints on report of posttraumatic psychological symptomatology among Somali refugees. J Trauma Stress. 2011 Aug;24(4):479–82.
23. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders [Internet]. American Psychiatric Association; 2013. Available from: http://dsm.psychiatryonline.org/ doi/book/10.1176/appi.books.9780890425596.
24. Lund M, Sørensen JH, Christensen JB, Ølholm A. MTV om behandling og rehabilitering af PTSD - herunder traumatiserede flygtninge. Region Syddanmark. Vejle; 2008. Available from: http://www.traumeogtorturoverlevere.dk/default. asp?id=409751.
25. Roxendal G. Body awareness therapy and the body awareness scale : treatment and evaluation in psychiatric physiotherapy. University of Gothenburg. Sweden; 1985. Available from: https:// gupea.ub.gu.se/handle/2077/13853.
26. Skjaerven LH, Kristoffersen K, Gard G. How can movement quality be promoted in clinical practice? A phenomenological study of physical therapist experts. Phys Ther. 2010 Oct;90(10):1479–92.
27. Gyllensten AL, Hansson L, Ekdahl C. Outcome of Basic Body Awareness Therapy. A Randomized Controlled Study of Patients in Psychiatric Outpatient Care. Adv Physiother. 2003 Dec;5(4):179–90.
28. Hedlund L, Gyllensten AL. The experiences of basic body awareness therapy in patients with schizophrenia. J Bodyw Mov Ther. 2010 Jul;14(3):245–54.
29. Catalan-Matamoros D, Helvik-Skjaerven L, Labajos-Manzanares MT, Martínez-de-SalazarArboleas A, Sánchez-Guerrero E. A pilot study on the effect of Basic Body Awareness Therapy in patients with eating disorders: a randomized controlled trial. Clin Rehabil. 2011 Jul;25(7):617–26.
30. Gyllensten AL, Ekdahl C, Hansson L. Long-term effectiveness of Basic Body Awareness Therapy in psychiatric outpatient care. A randomized controlled study. Adv Physiother. 2009 Jan;11(1):2–12.
31. Hedlund L, Gyllensten AL. The physiotherapists’ experience of Basic Body Awareness Therapy in patients with schizophrenia and schizophrenia spectrum disorders. J Bodyw Mov Ther. 2013 Apr;17(2):169–76.
32. Wallin U, Kronovall P, Majewski M-L. Body awareness therapy in teenage anorexia nervosa: outcome after 2 years. Eur Eat Disord Rev. 2000;8(1):19–30.
33. Friis S, Skatteboe UB, Hope M.K, Vaglum P. Body awareness group therapy for patients with personality disorders. 2. Evaluation of the Body Awareness Rating Scale. Psychother Psychosom. 1989;51(1):18-24.
34. Malmgren-Olsson EB, Armelius BA, Armelius K. A comparative outcome study of body awareness therapy, feldenkrais, and conventional physiotherapy for patients with nonspecific musculoskeletal disorders: changes in psychological symptoms, pain, and self-image. Physiother Theory Pract. 2001 Jan;17(2):77–95.
35. Gard G. Body awareness therapy for patients with fibromyalgia and chronic pain. Disabil Rehabil. 2005 Jun 17;27(12):725–8.
36. Kira IA, Ahmed A, Wasim F, Mahmoud V, Colrain J, Rai D. Group therapy for refugees and torture survivors: treatment model innovations. Int J Group Psychother. 2012 Jan;62(1):69–88.
37. Kinzie JD, Leung P, Bui A, Ben R, Keopraseuth KO, Riley C, et al. Group therapy with Southeast Asian refugees. Community Ment Health J. 1988;24(2):157–66.
38. Droždek B, Kamperman AM, Bolwerk N, Tol WA, Kleber RJ. Group therapy with male asylum seekers and refugees with posttraumatic stress disorder: a controlled comparison cohort study of three day-treatment programs. J Nerv Ment Dis. 2012 Sep;200(9):758-65.
39. Kira IA, Ahmed A, Mahmoud V, Wasim F. Group therapy model for refugee and torture survivors. Torture. 2010;20(2):108–13.
40. Buhmann C, Mortensen EL, Nordentoft M, Rydberg J, Ekstrøm M. Follow-up study of the treatment outcomes at a psychiatric trauma clinic for refugees. Torture. 2015;25(1):pp
41. Mollica RF, Caspi-Yavin Y, Bollini P, Truong T, Tor S, Lavelle J. The Harvard Trauma Questionnaire. Validating a cross-cultural instrument for measuring torture, trauma, and posttraumatic stress disorder in Indochinese refugees. J Nerv Ment Dis. 1992 Feb;180(2):111–6.
42. WHO. Info package; mastering depression in primary care Frederiksborg, Denmark: World Health Organisation, Regional Office for Europe, Psychiatric Research Unit; 1998 [updated 1998]. Available from: http://www.who-5.org.
43. Mollica RF, Wyshak G, de Marneffe D, Khuon F, Lavelle J. Indochinese versions of the Hopkins Symptom Checklist-25: a screening instrument for the psychiatric care of refugees. Am J Psychiatry. 1987 Apr;144(4):497–500.
44. Derogatis LR, Rickels K, Rock AF. The SCL90 and the MMPI: a step in the validation of a new self-report scale. Br J Psychiatry. 1976 Mar 1;128(3):280–9.
45. Arbuckle R, Frye MA, Brecher M, Paulsson B, Rajagopalan K, Palmer S, et al. The psychometric validation of the Sheehan Disability Scale (SDS) in patients with bipolar disorder. Psychiatry Res. 2009 Jan 30;165(1):163–74.
46. Boonstra AM, Schiphorst Preuper HR, Reneman MF, Posthumus JB, Stewart RE. Reliability and validity of the visual analogue scale for disability in patients with chronic musculoskeletal pain. J Rehabil Res. 2008 Jun;31(2):165–9.
47. Mattsson L, Karlsson EL, Währborg L, Währborg P, Svantesson U. Validitetstest av Body Awareness Scale vid bedömning av pasienter med långvarig smärta. Nord Fysioter. 2005;9(4):170–80.
48. Gyllensten AL, Ovesson MN, Lindström I, Hansson L, Ekdahl C. Reliability of the Body Awareness Scale-Health. Scand J Caring Sci. 2004 Jun;18(2):213–9.
49. Elert J. Aspects of Criterion Validity and Sensitivity of the BAS-Health Scale in Chronic Pain Patients - A Pilot Study of Patients at a Multidisciplinary Pain Centre. Adv Physiother. 1999 Jan;1(2):83–97.
50. Gyllensten AL, Ekdahl C, Hansson L. Validity of the Body Awareness Scale-Health (BAS-H). Scand J Caring Sci. 1999;13(4):217–26.
51. Harper D, Thompson AR. Qualitative research methods in mental health and psychotherapy : a guide for students and practitioners. Chichester, West Sussex: John Wiley & Sons; 2012.
52. Liedl A, Müller J, Morina N, Karl A, Denke C, Knaevelsrud C. Physical activity within a CBT intervention improves coping with pain in traumatized refugees: results of a randomized controlled design. Pain Med. 2011;12(2):234–45.
53. Kivling-Bodén G, Sundbom E. The relationship between post-traumatic symptoms and life in exile in a clinical group of refugees from the former Yugoslavia. Acta Psychiatr Scand. 2002 Jun;105(6):461–8.
54. Klingberg-Olson K, Lundgren M, Lindström I. Våga välja vad jag vill - Basal Kroppskännedom og samtal i grupp - ett samarbetsprojekt mellan sjukgymnasterog psykolog för patienter med smärt-spänningssyndrom. Nord Fysioter. 2000;4:133–42.
55. Guerin PB, Diiriye RO, Corrigan C, Guerin B. Physical activity programs for refugee Somali women: working out in a new country. Women Health. 2003;38(1):83–99.
56. Wieland ML, Weis JA, Palmer T, Goodson M, Loth S, Omer F, et al. Physical activity and nutrition among immigrant and refugee women: a community-based participatory research approach. Women's Health Issues. 2012 Mar;22(2):225–32.
57. Kvale S, Brinkmann S. Den sociale konstruktion af validitet. Interview: introduktion til et håndværk. 2nd ed. Hans Reitzel Forlag; 2009. p. 267–74.
58. Carlsson JM, Olsen DR, Kastrup M, Mortensen EL. Late mental health changes in tortured refugees in multidisciplinary treatment. J Nerv Ment Dis. 2010 Nov;198(11):824–8.
59. The Effect of BAT Versus Mixed Physical Activity as add-on Treatment for Traumatised Refugees. - Full Text View - ClinicalTrials.gov [Internet]. ClinicalTrials.gov. [cited 2013 Oct 27]. Available from: https://clinicaltrial.gov/ct2/show/ NCT01955538?term=the%20effect%20of%20 basic%20body%20awareness%20therapy.
How to Cite
We accept that some authors (e.g. government employees in some countries) are unable to transfer copyright. The Creative Commons Licence Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0) covers both the Torture Journal and the IRCT web site. The publisher will not put any limitation on the personal freedom of the author to use material contained in the paper in other works which may be published, provided that acknowledgement is made to the original place of publication.