The common ground of mind-body therapies

Body Awareness: a phenomenological inquiry into the common ground of mind-body therapies | Philosophy, Ethics, and Humanities in Medicine | Full Text

Enhancing body awareness has been described as a key element or a mechanism of action for therapeutic approaches often categorized as mind-body approaches… with reported benefits for a variety of health conditions.

To better understand the conceptualization of body awareness in mind-body therapies, leading practitioners and teaching faculty of these approaches were invited as well as their patients to participate in focus groups.

The qualitative analysis of these focus groups with representative practitioners of body awareness practices, and the perspectives of their patients, elucidated the common ground of their understanding of body awareness. 

For them body awareness is an inseparable aspect of embodied self awareness realized in action and interaction with the environment and world. It is the awareness of embodiment as an innate tendency of our organism for emergent self-organization and wholeness.

The process that patients undergo in these therapies was seen as a progression towards greater unity between body and self, very similar to the conceptualization of embodiment as dialectic of body and self described by some philosophers as being experienced in distinct developmental levels.

Introduction

A variety of therapeutic approaches often categorized as mind-body approaches claim to enhance body awareness including

  • yoga,
  • TaiChi,
  • Body-Oriented Psychotherapy,
  • mindfulness based therapies/meditation,
  • Feldenkrais,
  • Alexander Method,
  • Breath Therapy, and
  • even massage and
  • mental training for athletic exercise and sport performance.

They have been studied to a preliminary degree for their effects in patients with a variety of medical conditions including

  • chronic low back pain,
  • pelvic pain,
  • fibromyalgia,
  • musculoskeletal pain,
  • chronic pain in general,
  • disordered eating and obesity,
  • irritable bowel syndrome,
  • sexual abuse trauma,
  • coronary artery disease,
  • congestive heart failure,
  • chronic renal failure,
  • falls in the elderly,
  • anxiety and
  • depression.

Body awareness involves an attentional focus on and awareness of internal body sensations.

Body awareness, as we define it here, is the subjective, phenomenological aspect of proprioception and interoception that enters conscious awareness, and is modifiable by mental processes including attention, interpretation, appraisal, beliefs, memories, conditioning, attitudes and affect.

We are primarily concerned with those aspects of inner body awareness that, although interacting with thoughts and exteroceptive stimuli, are distinguishable from these and are potentially of key relevance for a deeper understanding of the interaction of mind and body.

Therefore, we have restricted our definition of body awareness to the core-awareness of sensations from inside the body and exclude exteroceptive channels. 

The aim of this paper is to articulate the place and function of body awareness in each of the approaches and how these lead to desired outcomes as narrated by practitioners and patients and, thereby, to gain insights into the concept of body awareness as it is understood theoretically, as it is conveyed in practice, and as it is experienced.

Practitioners

Patients

1) Theoretical Stance

1) Reasons for Therapy

A) Integrity of Self

A) specific, individual reason based on symptoms, illness, or sense of dis-ease

B) Human Capacity for Embodiment

B) motivational drive to seek new resources for active coping

C) Central Role Of Embodiment And Integrity Of Self To The Practice

2) The Practice

2) Engagement in the practice and what happens from the patients’ point of view

A) Breath and Breathing

A) Process

B) Repetition and Training

B) Shift in Awareness

a) Negative Emotion

b) Body Sensation

C) Noticing/Discriminating/Discerning

C) Engagement in

a) Self Regulation

b) Self Care

D) Goal of Practice: Integration of Mind, Body and Life Context

D) Integration of Mind, Body and Life Context

a)Context

b) Mind-Body Integration

Overview of Themes and Sub-Themes Presented by Practitioners and Patients

Practitioners’ Views of Body Awareness

Prior to the first meeting, all participants were in agreement that body awareness is a core feature of their approaches and welcomed the invitation.

The group interview focused first on questions relating to the role of body awareness in the participating practitioners’ various practices.

Interestingly, the practitioners initially responded by clarifying basic theoretical tenets about embodiment, making it clear that they all held to the notion that the mind and body are not distinct entities, but integrated and interactive. To begin, we present this theoretical stance, and then proceed to elements common to their practices.

Theoretical Stance

With respect to their theoretical stance, the practitioners’ accounts spoke to the following commonalities:

(1) integrity of self (mind and body not viewed as separate entities),

(2) innate human capacity for embodiment and challenges to achieving embodiment.

Integrity of Self

The practitioners voiced a concern that the term body awareness may not reflect their view of the person as an embodied being

Embodiment includes an integration of mind and body and a bodily capacity for knowing. They expressed a preference for the term “self awareness” rather than body awareness. Or conversely, when they used the term body awareness, they emphasized that it is meant to include “every level… the physical, the breath, the mind, the personality and the emotions”, that the ‘body’ of body awareness is inseparable from its functions and all other aspects of self awareness. They could talk about body awareness if it was understood as a core aspect of embodied self-awareness.

Only once these theoretical understandings were made clear did the practitioners turn to the concept of body awareness itself and how it manifested in their practice.

The Practice

Although the practitioners represented multiple healing modalities, there were basic similarities in their approaches. These included

(1) the use or role of breathing,

(2) training and repetition,

(3) noticing body sensations, discerning and differentiating changes in the body, thoughts and/or emotions, and

(4) body-mind integration as the therapeutic goal

Breath and Breathing

The role of breath and breathing was thematic among the practitioners. For the Breath Therapist, breath was central to embodiment and to the healing process.

Repetition and Training

All of the healing approaches have in common that they are practices, and, for the practice to be effective therapeutically, it has to be learned by the patient. This learning requires training and repetition.

Noticing/Discriminating/Discerning

A central skill that patients learn through training and repetition is the ability to notice sensations, thoughts and feelings as they occur in their actual immediacy. What is noticed might be verbalized or not. The point is that the process of noticing and the learning of differentiated noticing were viewed by the practitioners as a path to integration.

“…the instinct in terms of differentiation and embodiment, though, shouldn’t be confused with the process, which is: the process is the careful attunement to the moment-to-moment awareness of process…. So even though embodiment is the key, not-embodiment is the way.”

This sounds like Zen Buddhism.

Goal Of The Practice: Integration of Mind, Body and Life Context

There was strong agreement among the practitioners that their practices held the ultimate goal of integration mind and body in the context of daily life. They saw their practice as a process that moved through four dimensions of body awareness, perceived body sensation, attention, attitude, and integration, and is actualized in daily life.

Patients’ Views of Body Awareness

We begin with the patients’ reason for seeking therapy and then present how the patients describe their experience resulting from their engagement in the practice.

Patients’ Reason for Therapy

The common theme for everyone was that something was not working well for them and they had reached a point where they felt they had to do something. Many had tried multiple other avenues before they took up the practice they describe in the interview.

The patients did not come to therapy because of their theoretical understanding of or commitment to embodiment and the integrity of the self that the practitioners held. Their reasons for seeking therapy were individual and personal.

Engagement in the Practice and What Happens From the Patients’ Point of View

The patients described four aspects of what engagement in the practice entailed and what happened to them in the course of participating in the practice. First, like the practitioners, they saw the practice as a process. Second, they described experiencing a shift in their awareness. Third, they articulated how they learned to engage in self regulation and self care. And, fourth, they described their lived experience of an integration of mind and body in the context of their ongoing lives.

Process

Like the practitioners, the patients understood the therapy as a process. And also like the practitioners, the patients recognize the process as ongoing, unfolding and never static.

Shift In Awareness

Patients described a shift in awareness as a result of the process of engaging in the practice. Although this could be generally described as “body awareness,” the patients discriminated between two aspects of this awareness. First, they recounted a shift in awareness of their experience of and response to negative emotion. Second, they described a shift in awareness of bodily sensations.

Negative Emotion

The topic of negative emotion, and awareness of a change in the experience, or awareness of emotion came up frequently among the participants. They discussed negative emotional reactions they had prior to engagement in body awareness practices. These previous emotional reactions could be in the form of catastrophizing over pain; alternatively, they could be a more general reaction to a stressful situation.

Here, catastrophizing rears its ugly head again (more posts on catastrophizing).

While the practitioners were articulate in talking theoretically about mind-body issues, the patients were articulate in speaking of their lived experience. They described how a mind-body practice altered an emotional reaction or changed the way they responded to emotion.

In sum, the patients described both a pre-existing relationship between body sensations and emotions and the ways in which that relationship and awareness had changed with their mind-body practice. The practice gave them more possibilities beyond their previous automatic responses to sensation.

Body Sensation

Patients described a shift in awareness of body sensations as part of the process of engaging in the practice. The shift in awareness of body sensations then could lead to a change in how the patients responded and related to the sensations.

Engagement In Self Regulation And Self Care

Learning to notice, differentiate, and discern as described above appears to lead to and to facilitate development of the skills of self regulation and self care.

Self Regulation

Self regulation is a skill the patients learned in their practice, which they then applied while doing the practice or when dealing with bodily sensations such as pain. They learned how to accept the limitations of their body and adapt their movements and behavior.

Self-Regulation extended to emotion regulation by letting go of judgment and appraisal of life situations.

And, as some of the patients expressed, this learning process may not involve conscious and purposive mental activities or engage the personal will.

Self Care is another related skill. It is directed to taking care of the self in life situations that could be challenging. It can involve a change in personal orientation such that self care is a worthy practice rather than something to avoid in subordination to goal accomplishment.

Integration of Mind, Body and Life Context

The practitioners described the integration of mind and body in a life context as a goal of their therapies. The patients provided examples of the lived experience of integration within their life contexts.

Context

Context is a dimension that the practitioners touched on a number of times and indicated its importance. They indicated that context needed to be included in the construct of body awareness because it is an important part of what is attended to in their practices. The patients elaborated on the issue of context in terms of lived experience in relating to the world and others. Participants described how their relationships with other people also changed as a result of their therapy.

Mind-Body Integration

The practitioners held integration of mind-body as the ultimate goal of their therapies: what they hoped their patients would attain. The patients provide an extension of this aim by describing the ways in which they experienced this integration in the course of their ongoing lives.

Discussion

The qualitative analyses of focus groups with representative practitioners of a variety of body awareness practices, and the perspectives of their patients, elucidated the common ground of their joint understanding of body awareness.

For them body awareness is an inseparable aspect of embodied self awareness realized in action and interaction with the environment and world. It is the awareness of embodiment as an innate tendency of our organism for emergent self-organization and wholeness. This innate tendency toward embodiment drives the motivation for patients to engage in these practices.

The process that patients undergo in these therapies was seen as a progression towards greater unity between body and self, very similar to the conceptualization of embodiment as a dialectic of body and self described by some philosophers as being experienced in four levels.

1) in a level labeled “the lived body” the body is taken for granted, and patients are unself-consciously aware or unaware of it, the body often described as “absent”. This state was well-described by the patients when they began their practices.

2) in a level labeled “the objective body state” the body is experienced as opposed to the self. Body and self are in tension with each other or in disunity, the body becomes “symptomatic” and the patient describes physical constraints including pain and some degree of loss of function. That state seemed to be the situation that brought the patients into the therapy.

3) A third stage labeled as “cultivated immediacy” was described by practitioners and patients as well: it is experienced as a new relationship to the body characterized by acceptance, immediacy and the body experienced without objectification.

4) In the fourth state labeled “the subjective body” the body is experienced as a source of learning and meaning, by practitioners described as endowed with “intelligence” and an “innate tendency towards embodiment”.
In this state the body a) is no longer just the means by which the self carries out its projects or b) the source of constraints and limits to the self’s goals, but rather an integral and equal part of the self and the locus of consciousness and subjectivity with its own perspective
.

This dialectic of body and self formulated by phenomenological philosophers has been expanded to a body-self-environment “trialectic” by the practitioner and patient focus groups incorporating the person as embedded and active in a cultural environment and society[55]. Our participants clearly confirmed this view.

In summary, this qualitative study examined the common ground of body awareness-enhancing mind-body therapies and adds additional evidence to the referenced qualitative studies of individual approaches. In addition, these findings suggest that we need to broaden the biomedical paradigm to consider and include a developmental model of embodiment in order to better understand how body awareness-enhancing therapies work

This paradigmatic model has been proposed for several decades in philosophical and nursing literature

It overcomes the mind-body split, as it still persists in the biomedical model and integrates the phenomenology of complex mind-body interactions, as they are experienced by practitioners and patients in body awareness-enhancing therapies.

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