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ASSESSING THE
EFFICACY OF SOMATIC
   EXPERIENCING
   FOR REDUCING
SYMPTOMS OF ANXIETY
 AND DEPRESSSION
Somatic Experiencing Restoring
Innate Resilience




      “Nature has instilled in all animals,
  including humans, a nervous system capable of
  restoring equilibrium. When self-regulating
  function is blocked or disturbed… symptoms
  develop.”
  (Foundation for Human Enrichment, 2007. p. B1.4).
This slide show will address
four questions…
•   Why this study?

•   Why this study now?

•   How this study was conducted?

•   What this study found?
Why this study?


                            QuickTimeª and a
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                    are needed to see this picture.




 Increasing resilience could help homeless
 adults to find: work, obtain housing and
 develop a support system.
Resilience

 Resilience is the ability to bounce back after
  life stressors (Luthar, 2003).

 Resiliency models include: risk factors,
  protective factors and growth due to positive
  coping (Luthar, 2003).

 Somatic Experiencing is a resiliency based
  treatment model.
Why This Study?
 Homelessness is a highly stressful life event that can shake
   people’s confidence in themselves and life.

 Homeless adults are exposed to significant amounts of
   trauma and increased life stress due to being homeless.

 Mental health difficulties could decrease the ability of
   homeless adults to effectively engage with services.

 A short-term psychological first aid model aimed at
   stabalization could decrease the mental health sequilae of
   homelessness in a cost effective resource efficient
   manner.
QuickTimeª and a
TIFF (Uncompressed) decompressor
   are needed to see this picture.
Why Now? Somatic Experiencing Studies


 55 survivers of the South Asian Tsunami were given
  between one and two individual sessions and affect
  regulation skills training (Leitch, 2007).

 At two to three days following the first session
  individuals showed 90% improvements.

 At two to three days following the second session
  84% of individuals reported complete or partial
  remission of symptoms.
Somatic Experiencing Studies
 Leitch (2009) TRM (trauma resiliency model) was
  used with care providers in the aftermath of
  hurricanes Katrina and Rita.

 Case workers and social workers (n = 142) were
  given between one and three sessions and skills
  training in affect regulation.

 All participants showed increased symptoms. The SE
  group show significantly less increase in symptoms
  then the wait list control group.
Why this study now?
 Somatic Experiencing Psychological first-aid
  models have shown some efficacy in the
  aftermath of extreme events.

 No studies to date directly measure Somatic
  Experiencing’s effects on symptoms depression.

 No studies currently assesses the Somatic
  Experiencing model for reducing mental health
  symptoms for people who are homeless.
Why measure depression and
anxiety?
 Increased life stress can lead to increased depression
  and anxiety.

 The Somatic Experiencing model conceptualizes
  depression and anxiety as symptoms of a dysregulated
  autonomic nervous system.

 Bosnian refugees at 7 mo people with symptoms of
  depression were 9.5 times more likely to also display
  symptoms of trauma.

 Cortisol dysregulation is found in many mental health
  disorders.
Methods Overview

  A matched between groups pre-test post-test
   matched control group design.

  Sample: A convenience sample of adults
   who are currently living at COTS shelter.
   (N = 18 in each group)

  Matching Criteria: Years homeless, age,
   gender.
Results: What this study found.
 Symptoms of depression were not
  significantly different at measurement three.

 Symptoms of trait anxiety were not
  significantly different at measurement three.

 Symptoms of state anxiety were significantly
  different between groups at measurement
  three.
State Anxiety
State Anxiety Significance
 Multivariate statistical analysis
    Parallelism: F(2, 48) = 4.938, p = .011
    Flatness p = .007;
    Levels were not found to be significant.
    Between groups contrasts was significant p = .009 for the
     liner function and approached significance with p = .054 for
     the quadratic function


 Multivariate discriminant analysis
    Wilks Lambda: p = .031
    72.5% assignment of cases to the proper group
    50% would be expected with random assignment.
Results: Independent Sample t-tests
 A sub-sample (control n = 7, experimental n = 12)
  were measured on five occasions.

 No significant difference between any level of
  measurement was found at the initial measurement or
  at the fourth measurement.

 At measurement five: cognitive and somatic
  symptoms of depression were found to be significant
  (p = .046, p = .023).

 Total score on the BDI-II approached sig. (p = .058)
Results: Covariate Analysis
 When the number of individual sessions is entered as
  a covariate somatic and cognitive symptoms of
  depression both became significant.

    Cognitive - Parallelism: p = .007, Flatness: p = .
     006, Levels: not sig., Liner contrasts p = .035.

    Somatic - Parallelism p = .003, Flatness: p = .002
     Levels: not sig., Liner contrasts: p = .001.

 Total score on the BDI-II approached significance.
Conclusions
 There are implications that increased numbers of
  individual sessions and a longer period of data
  collection could yield more positive results.

 The shelter that houses the SE clinic is therapy rich.
  (Control - 12 therapeutic activities weekly,
  Experimental - 9 activities weekly).

 Significant reduction in state symptoms of anxiety
  could be a beneficial outcome for individuals who are
  homeless.
Limitations
 Small sample size lacked statistical power

 Lack of random sampling procedures, Lack of
  random assignment to groups, Lack of blinding
  procedures, Lack of placebo control.
 A small number of interventions (m = 1.33 sessions
  and m = 2.64 workshop series)
 Lack of measurement of physical pain, lack of
  measurement of life stressors.
 Variance between measurement instances was high:
  (m = 10) range of 7 to 35 days (m = 7) and a range of
  7 to 35.
Implications
 Positive trends in the data imply that this treatment could
   possibly be a cost effective resource efficient treatment protocol
   the study outlined below could assess this further.

 What’s next:

     As study that includes: Random assignment, blinding
       procedures, placebo and CBT control groups.

     10 session protocol (see outline).

     Measuring: PTSD symptoms, symptoms of pain, current life
       stress, resilience, autonomic indicators, addictive behavior
       and successful transition to more permanent housing.
25

20
                     Depression Total
15                   Symptoms Control
                     Group
10                   Depression Total
                     Symptoms
 5                   Experimental Group

 0
     1   2   3   4
12

10

 8                   Depression Cognitive
                     Symptoms Control
 6                   Group
                     Depression Cognitive
 4
                     Symptoms
 2                   Experimental Group

 0
     1   2   3   4
12

10

 8                   Depression Somatic
                     Symptoms Control
 6                   Group
                     Depression Somatic
 4
                     Symptoms
 2                   Experimental Group

 0
     1   2   3   4
60

50

40
                     State Anxiety Control
30                   Group

20                   Sate Anxiety
                     Experimental Group
10

 0
     1   2   3   4
60

50

40
                     Trait Anxiety
30                   Control Group

20                   Trait Anxiety
                     Experimental
10                   Group
 0
     1   2   3   4
Methods
 Data were collected for each participant on three
  occasions. A sub-sample of participants were
  measured five times.

 Participants were given a $5 gift card at the first
  assessment and a $10 gift card at each follow up.

 Initial data collection included: Demographic survey,
  BDI-II, STAI, and therapy participation form

 At follow up measurements individuals completed:
  BDI-II, STAI, and therapy participation form.
Methods: Data analysis.

 Repeated Measures Multivariate Profile Analysis will
   be used to asses all hypothesis.

 Discriminant Analysis will be used to assess all
   hypothesis.
              QuickTimeª and a
   TIFF (Uncompressed) ª and a
              QuickTimedecompressor
 Independent to see this picture.
      are needed samples t-tests
   TIFF (Uncompressed) decompressor
       are needed to see this picture.
Affect Regulation
 Implicit Affect Regulation: Automatic regulatory
  processes (Schore, 2008).

 Explicit Affect Regulation: Regulation that requires
  conscious choice and use of a skill (Schore, 2008).

 Co-regulation: Regulation of affect through
  relationship or inter-subjective relatedness (Schore, 2008).
Affect Dysregulation
Over Activated Parasympathetic…

   Physical: Low energy, exaughstion,
    numbness, low muscle tone, poor
    digestion, low heart rate, blood pressure,
    poor immune function
   (Foundation for Human Enrichment, 2007)


   Mental/Emotional: Depression,
    dissociation, apathy, disconnection in
    relationship, under responsive
    (Foundation for Human Enrichment, 2007)



                      (Foundation for Human Enrichment, 2007)
Affect Dysregulation
Over Activated Sympathetic…

   Physical: Increase heart rate, difficulty breathing,
    cold sweats, tingling, muscular tension,
    exaggerated startle response, difficulty with
    sleeping.
    (Foundation for Human Enrichment, 2007)


   Mental/Emotional: Anxiety attacks, rage
    outbursts, hyper vigilance, racing thoughts, worry
     (Foundation for Human Enrichment, 2007)




                           (Foundation for Human Enrichment, 2007)
Stress Based Model of Resilience
 Homeostasis: The self regulatory processes inherent
  in a system.

 Allostasis: Achieving stability in a system through
  behavioral adaptations.

 Allostatic Load: The costs to the body and mind of
  long-term or extreme autonomic stress.

 Health and Mental Health Risks of Allostatic
  Load: Increased weight gain/loss, diabetes,
  depression, PTSD, anxiety, poor immune functioning,
  loss of efficiency in mental processes.
Why this study?
 Paradigm Shift: Resilience, affect regulation,
  deterministic chaos,. and the Bodymind. (Schore, 2003;
  Schore, 2008; Foundation for Human Enrichment, 2007)


 Over the last ten years there has been a growing body
  of literature on resilience (Luthar, 2003).

 Much of this literature matches the assumptions
  underling Somatic Experiencing theory.

 Preliminary studies show indications of SE being a
  short term effective treatment (Leitch, Vanslyke, & Marisa, 2009,
  Leitch, 2007).
Multivariate Profile Analysis
 Repeated measures multivariate profile analysis
  includes three types of statistics.

 Parallelism assesses how likely is it that the lines
  representing the control group and the experimental
  group are parallel.

 Flatness assesses if there are changes in the dependent
  variable regardless of group assignment.

 The levels statistical analysis measures the distance
  between the data points across both groups.
Multivariate Profile Analysis


 Often in repeated measures multivariate analysis there
  is a conflict between aspects of the profile.


 The method this study used to resolve differences
  between findings in the statistical analysis is called
  simple contrast analysis.
References
Foundation for Human Enrichment. (2007). Somatic
  experiencing: Healing trauma training manual. Boulder,
  CO: Foundation for Human Enrichment.
Luthar, S. (Ed.). (2003). Resilience and vulnerability:
  Adaptation in the context of childhood adversities.
  Cambridge: Cambridge University Press.
Leitch, L. Vanslyke, J., & Marisa, A. (2009). Somatic
  Experiencing Treatment with Social Service Workers
  Following Hurricanes Katrina and Rita. Social Work,
  54(1), 9-18(10).
Leitch, L. (2007). Somatic experiencing treatment with
  tsunami survivors in Thailand: Broadening the scope of
  early intervention. Journal of Traumatology, 13(4)
  11-20.
References
Levine, P. & Frederick, A. (1997). Waking the Tiger:
  Healing Trauma The Innate Capacity to Transform
  Overwhelming Experiences. Berkeley, CA: North
  Atlantic Books.
McEwen, B. & Lasley, L. (2002). The end of stress as we
  know it. Washington, DC: National Academies Press.
McEwen, B. (2003). Mood disorders and allostatic load.
  Biological Psychiatry, 54(3), 200-7.
National Center for Family Homelessness (2008).
  Homeless children: America’s new outcasts. Retrieved
  from www.familyhomelessness.org.
References
Schore, A. N. (2003). Affect regulation and
 repair of the self. New York, NY: W. W.
 Norton & Company.
Schore, A. N. (2008). Quarterly study group on
 attachment theory. Berkeley, CA: Alta Bates
 Hospital.

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ASSESSING THE EFFICACY OF SOMATIC EXPERIENCING FOR REDUCING SYMPTOMS OF ANXIETY AND DEPRESSSION

  • 1. ASSESSING THE EFFICACY OF SOMATIC EXPERIENCING FOR REDUCING SYMPTOMS OF ANXIETY AND DEPRESSSION
  • 2. Somatic Experiencing Restoring Innate Resilience “Nature has instilled in all animals, including humans, a nervous system capable of restoring equilibrium. When self-regulating function is blocked or disturbed… symptoms develop.” (Foundation for Human Enrichment, 2007. p. B1.4).
  • 3. This slide show will address four questions… • Why this study? • Why this study now? • How this study was conducted? • What this study found?
  • 4. Why this study? QuickTimeª and a TIFF (Uncompressed) decompressor are needed to see this picture. Increasing resilience could help homeless adults to find: work, obtain housing and develop a support system.
  • 5. Resilience  Resilience is the ability to bounce back after life stressors (Luthar, 2003).  Resiliency models include: risk factors, protective factors and growth due to positive coping (Luthar, 2003).  Somatic Experiencing is a resiliency based treatment model.
  • 6. Why This Study?  Homelessness is a highly stressful life event that can shake people’s confidence in themselves and life.  Homeless adults are exposed to significant amounts of trauma and increased life stress due to being homeless.  Mental health difficulties could decrease the ability of homeless adults to effectively engage with services.  A short-term psychological first aid model aimed at stabalization could decrease the mental health sequilae of homelessness in a cost effective resource efficient manner.
  • 7. QuickTimeª and a TIFF (Uncompressed) decompressor are needed to see this picture.
  • 8. Why Now? Somatic Experiencing Studies  55 survivers of the South Asian Tsunami were given between one and two individual sessions and affect regulation skills training (Leitch, 2007).  At two to three days following the first session individuals showed 90% improvements.  At two to three days following the second session 84% of individuals reported complete or partial remission of symptoms.
  • 9. Somatic Experiencing Studies  Leitch (2009) TRM (trauma resiliency model) was used with care providers in the aftermath of hurricanes Katrina and Rita.  Case workers and social workers (n = 142) were given between one and three sessions and skills training in affect regulation.  All participants showed increased symptoms. The SE group show significantly less increase in symptoms then the wait list control group.
  • 10. Why this study now?  Somatic Experiencing Psychological first-aid models have shown some efficacy in the aftermath of extreme events.  No studies to date directly measure Somatic Experiencing’s effects on symptoms depression.  No studies currently assesses the Somatic Experiencing model for reducing mental health symptoms for people who are homeless.
  • 11. Why measure depression and anxiety?  Increased life stress can lead to increased depression and anxiety.  The Somatic Experiencing model conceptualizes depression and anxiety as symptoms of a dysregulated autonomic nervous system.  Bosnian refugees at 7 mo people with symptoms of depression were 9.5 times more likely to also display symptoms of trauma.  Cortisol dysregulation is found in many mental health disorders.
  • 12. Methods Overview  A matched between groups pre-test post-test matched control group design.  Sample: A convenience sample of adults who are currently living at COTS shelter. (N = 18 in each group)  Matching Criteria: Years homeless, age, gender.
  • 13. Results: What this study found.  Symptoms of depression were not significantly different at measurement three.  Symptoms of trait anxiety were not significantly different at measurement three.  Symptoms of state anxiety were significantly different between groups at measurement three.
  • 15. State Anxiety Significance  Multivariate statistical analysis  Parallelism: F(2, 48) = 4.938, p = .011  Flatness p = .007;  Levels were not found to be significant.  Between groups contrasts was significant p = .009 for the liner function and approached significance with p = .054 for the quadratic function  Multivariate discriminant analysis  Wilks Lambda: p = .031  72.5% assignment of cases to the proper group  50% would be expected with random assignment.
  • 16. Results: Independent Sample t-tests  A sub-sample (control n = 7, experimental n = 12) were measured on five occasions.  No significant difference between any level of measurement was found at the initial measurement or at the fourth measurement.  At measurement five: cognitive and somatic symptoms of depression were found to be significant (p = .046, p = .023).  Total score on the BDI-II approached sig. (p = .058)
  • 17. Results: Covariate Analysis  When the number of individual sessions is entered as a covariate somatic and cognitive symptoms of depression both became significant.  Cognitive - Parallelism: p = .007, Flatness: p = . 006, Levels: not sig., Liner contrasts p = .035.  Somatic - Parallelism p = .003, Flatness: p = .002 Levels: not sig., Liner contrasts: p = .001.  Total score on the BDI-II approached significance.
  • 18. Conclusions  There are implications that increased numbers of individual sessions and a longer period of data collection could yield more positive results.  The shelter that houses the SE clinic is therapy rich. (Control - 12 therapeutic activities weekly, Experimental - 9 activities weekly).  Significant reduction in state symptoms of anxiety could be a beneficial outcome for individuals who are homeless.
  • 19. Limitations  Small sample size lacked statistical power  Lack of random sampling procedures, Lack of random assignment to groups, Lack of blinding procedures, Lack of placebo control.  A small number of interventions (m = 1.33 sessions and m = 2.64 workshop series)  Lack of measurement of physical pain, lack of measurement of life stressors.  Variance between measurement instances was high: (m = 10) range of 7 to 35 days (m = 7) and a range of 7 to 35.
  • 20. Implications  Positive trends in the data imply that this treatment could possibly be a cost effective resource efficient treatment protocol the study outlined below could assess this further.  What’s next:  As study that includes: Random assignment, blinding procedures, placebo and CBT control groups.  10 session protocol (see outline).  Measuring: PTSD symptoms, symptoms of pain, current life stress, resilience, autonomic indicators, addictive behavior and successful transition to more permanent housing.
  • 21.
  • 22. 25 20 Depression Total 15 Symptoms Control Group 10 Depression Total Symptoms 5 Experimental Group 0 1 2 3 4
  • 23. 12 10 8 Depression Cognitive Symptoms Control 6 Group Depression Cognitive 4 Symptoms 2 Experimental Group 0 1 2 3 4
  • 24. 12 10 8 Depression Somatic Symptoms Control 6 Group Depression Somatic 4 Symptoms 2 Experimental Group 0 1 2 3 4
  • 25. 60 50 40 State Anxiety Control 30 Group 20 Sate Anxiety Experimental Group 10 0 1 2 3 4
  • 26. 60 50 40 Trait Anxiety 30 Control Group 20 Trait Anxiety Experimental 10 Group 0 1 2 3 4
  • 27. Methods  Data were collected for each participant on three occasions. A sub-sample of participants were measured five times.  Participants were given a $5 gift card at the first assessment and a $10 gift card at each follow up.  Initial data collection included: Demographic survey, BDI-II, STAI, and therapy participation form  At follow up measurements individuals completed: BDI-II, STAI, and therapy participation form.
  • 28. Methods: Data analysis.  Repeated Measures Multivariate Profile Analysis will be used to asses all hypothesis.  Discriminant Analysis will be used to assess all hypothesis. QuickTimeª and a TIFF (Uncompressed) ª and a QuickTimedecompressor  Independent to see this picture. are needed samples t-tests TIFF (Uncompressed) decompressor are needed to see this picture.
  • 29. Affect Regulation  Implicit Affect Regulation: Automatic regulatory processes (Schore, 2008).  Explicit Affect Regulation: Regulation that requires conscious choice and use of a skill (Schore, 2008).  Co-regulation: Regulation of affect through relationship or inter-subjective relatedness (Schore, 2008).
  • 30. Affect Dysregulation Over Activated Parasympathetic…  Physical: Low energy, exaughstion, numbness, low muscle tone, poor digestion, low heart rate, blood pressure, poor immune function (Foundation for Human Enrichment, 2007)  Mental/Emotional: Depression, dissociation, apathy, disconnection in relationship, under responsive (Foundation for Human Enrichment, 2007) (Foundation for Human Enrichment, 2007)
  • 31. Affect Dysregulation Over Activated Sympathetic…  Physical: Increase heart rate, difficulty breathing, cold sweats, tingling, muscular tension, exaggerated startle response, difficulty with sleeping. (Foundation for Human Enrichment, 2007)  Mental/Emotional: Anxiety attacks, rage outbursts, hyper vigilance, racing thoughts, worry (Foundation for Human Enrichment, 2007) (Foundation for Human Enrichment, 2007)
  • 32. Stress Based Model of Resilience  Homeostasis: The self regulatory processes inherent in a system.  Allostasis: Achieving stability in a system through behavioral adaptations.  Allostatic Load: The costs to the body and mind of long-term or extreme autonomic stress.  Health and Mental Health Risks of Allostatic Load: Increased weight gain/loss, diabetes, depression, PTSD, anxiety, poor immune functioning, loss of efficiency in mental processes.
  • 33. Why this study?  Paradigm Shift: Resilience, affect regulation, deterministic chaos,. and the Bodymind. (Schore, 2003; Schore, 2008; Foundation for Human Enrichment, 2007)  Over the last ten years there has been a growing body of literature on resilience (Luthar, 2003).  Much of this literature matches the assumptions underling Somatic Experiencing theory.  Preliminary studies show indications of SE being a short term effective treatment (Leitch, Vanslyke, & Marisa, 2009, Leitch, 2007).
  • 34. Multivariate Profile Analysis  Repeated measures multivariate profile analysis includes three types of statistics.  Parallelism assesses how likely is it that the lines representing the control group and the experimental group are parallel.  Flatness assesses if there are changes in the dependent variable regardless of group assignment.  The levels statistical analysis measures the distance between the data points across both groups.
  • 35. Multivariate Profile Analysis  Often in repeated measures multivariate analysis there is a conflict between aspects of the profile.  The method this study used to resolve differences between findings in the statistical analysis is called simple contrast analysis.
  • 36. References Foundation for Human Enrichment. (2007). Somatic experiencing: Healing trauma training manual. Boulder, CO: Foundation for Human Enrichment. Luthar, S. (Ed.). (2003). Resilience and vulnerability: Adaptation in the context of childhood adversities. Cambridge: Cambridge University Press. Leitch, L. Vanslyke, J., & Marisa, A. (2009). Somatic Experiencing Treatment with Social Service Workers Following Hurricanes Katrina and Rita. Social Work, 54(1), 9-18(10). Leitch, L. (2007). Somatic experiencing treatment with tsunami survivors in Thailand: Broadening the scope of early intervention. Journal of Traumatology, 13(4) 11-20.
  • 37. References Levine, P. & Frederick, A. (1997). Waking the Tiger: Healing Trauma The Innate Capacity to Transform Overwhelming Experiences. Berkeley, CA: North Atlantic Books. McEwen, B. & Lasley, L. (2002). The end of stress as we know it. Washington, DC: National Academies Press. McEwen, B. (2003). Mood disorders and allostatic load. Biological Psychiatry, 54(3), 200-7. National Center for Family Homelessness (2008). Homeless children: America’s new outcasts. Retrieved from www.familyhomelessness.org.
  • 38. References Schore, A. N. (2003). Affect regulation and repair of the self. New York, NY: W. W. Norton & Company. Schore, A. N. (2008). Quarterly study group on attachment theory. Berkeley, CA: Alta Bates Hospital.

Editor's Notes

  1. (e.g. depressed individuals have no diurnal pattern, individuals with PTSD have dysregulation but no diurnal pattern.)