Improving quality of life using mind-body therapies : The evaluation of a course intervention for personal self-awareness and development
Abstract: The general aim of this research project was to conduct a research project in complementary alternative medicine (CAM), and to evaluate an unusual course method. Since 1985 a special training centre, founded by Bengt Stern at Vikbolandet outside Norrköping, has been holding courses in personal development, Meet Yourself stage 1 . The course includes body-psychotherapy and meditation, and exercises focusing on the importance of emotions for personal health. The old Indian chakra energy centre system for body awareness is used. As a survey of therapeutic methods, Jones classification primary modes of therapeutic action (PMTA) is useful, consisting of six groups: 1 chemical, e.g. herbal medicine; 2 physical, e.g. massage; 3 mind-body medicine (MBM), e.g. meditation; 4 energy flow, e.g. acupuncture; 5 psychology, e.g. psychotherapy; and 6 spiritual, e.g. healing. The method (course) studied here is focused on the three categories of PMTA: 3 MBM, 4 energy flow and 5 psychology. Aims and methods Study I is descriptive, a cross-sectional survey of self-assessed health-related quality of life (HRQOL) in participants, compared with the Swedish population. This initial study group consisted of 107 participants (age 20 70). On arrival, before the course, the participants completed three questionnaires. The first was SWEDQUAL, with 61 items for self-rating of HRQOL classified in 13 areas, e.g. cognition, physical functions, sleep, pain, relations and emotions. The second was Antonovsky s Sense of Coherence with 13 items divided into three areas: comprehensibility, meaningfulness and manageability. The third was about work, education, experience of CAM, sick listing and medication. Comparisons were made with population data from Statistics Sweden, the National Insurance Office and the National Board of Health and Welfare. Study II is a before-and-after, case-control intervention study, and the starting values above for HRQOL and SOC were compared with exactly the same questionnaire mailed six months later. Each of the participants (n=83) was compared with him/herself and the group. A control group was added consisting of earlier participants (1998 99, n=69), matched for sex and age, who had made parallel self-assessments. A third aim was to capture unexpected patterns in this unexplored field, by collecting responses to the open question Has anything happened in your life, which you feel is important, during the last six months? Results In study I, six of the 13 subscales for HRQOL showed pronounced and significantly low starting values (p<0.001) in the initial study group (n=107), namely: emotional health, cognitive, family and partner functioning. This is unusual in a group with such high education level. Long-term sick listing (>6 months) was three times as common as in the population. The outcome measures in Study II was changes in HRQOL and SOC-13 in the followed-up study group (n=83) and in the control group (n=69). Eight subscales of HRQOL showed clinically significant improvements in the study group (>9%, p<0.01), namely: general health (9%), emotional well-being (negative 45% and positive 26%), cognitive functioning (24%), sleep (15%), pain (10%), role limitations due to emotional health (22%) and family functioning (16%). Physical, partner and sexual functioning were normal in both groups. Self-rated SOC was improved in the study group after the course (5,1%, p<0.01), challenging previous conclusions that the SOC value is stable for the same person irrespective of events. Use of psychoactive drugs decreased in young participants after the course. The comments on important life events are grouped according to six different themes. The three most important themes were relations, work development and the awakening process, which then leads to creative decisions to change one s life. Two concern personal health and the health of family members. The last reflects psychological resistance. Conclusions This study group consisting of well-educated women and men rated their initial emotional health unexpectedly low. After the course there was a significant improvement in HRQOL and SOC, up towards normal population values. The studies also found that: a) It is possible to perform a scientific evaluation even of soft, self-assessment data describing subjective experiences after a course intervention based on a theoretical background of alternative medicine. b) The selected questionnaire methods gave a reasonable spectrum of clear, clinically significant changes mixed with stable values. The method seems particularly effective for discovering the state of emotional well-being. c) Allowing spontaneous comments in data collection can be well worth the effort in a previously unexplored area, enabling the capture of completely new phenomena. d) The course duration of seven days means that people with fraught memories have time to get past the initial shock phase of the crisis process and can better start emotionally dealing with it in a constructive way. e) The course intervention was able to improve the participants HRQOL and SOC. f) The course improves cognitive and emotional function, which in turn increases motivation. It thus has the potential to be used as a starting point in rehabilitation for working life, for people who are forced for health reasons to cope with a readjustment crisis and establish a foundation for a new orientation.
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